RESUMEN
BACKGROUND: Rectal cancer treatment advanced rapidly during last decades. The most important factors of this progress are new neoadjuvant therapy options, improvement in imaging (allowing for quality staging and restaging) and routine implementation of the total mesorectal excision technique. For the best outcomes, it is crucial to combine the treatment methods in the best way possible with ideal timing. It is necessary to keep in mind both advantages and complications of the individual kinds of approach. Therefore, interdisciplinary agreement is essential in the treatment of rectal cancer. Considering these new therapeutic possibilities, the debate about timing, indication and radicality of the surgical procedures is reopened. Surgical approaches are currently focused on mini-invasive methods and robotic surgery. New trend with promising potential seems to be clinical complete response achievement with watch and wait follow-up strategy. This approach, in the spirit of the organ sparing philosophy, however asks new questions about indication, timing and conception of this method. Proper answers are essential for sparing, yet radical oncotherapy of this disease.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Terapia Neoadyuvante/métodos , Neoplasias del Recto/terapia , Humanos , Terapia Neoadyuvante/tendencias , Tratamientos Conservadores del Órgano , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Procedimientos Quirúrgicos Robotizados , Factores de Tiempo , Resultado del TratamientoRESUMEN
Gastric antral vascular ectasia (GAVE) and solitary rectal ulcer syndrome (SRUS) are both mentioned in the literature as rare causes of iron deficiency anemia and gastrointestinal (GI) bleeding. GAVE accounts for up to 4 % of upper non-variceal GI bleeding; SRUS is a rare benign disorder that presents with rectal bleeding. We present the case of a 75-year-old patient who was admitted to our facility with anemia. In the same patient, we encountered chronic bleeding from GAVE and SRUS. Both diagnoses were treated endoscopically: GAVE by argon plasma coagulation and a subsequent treatment with proton pump inhibitors and SRUS by adrenaline injection and clipping, consecutively treated with mesalazine enemas. The patient was successfully cured, resulting in a stable level of hemoglobin and no recurrent GI bleeding. We report a unique case of chronic GI bleeding caused by two uncommon diagnoses. The co-occurrence of GAVE and SRUS has not been previously described or published.Key words: anemia - endoscopy - gastric antral vascular ectasia (GAVE) - gastrointestinal bleeding - solitary rectal ulcer syndrome (SRUS).
Asunto(s)
Anemia/etiología , Ectasia Vascular Antral Gástrica/complicaciones , Úlcera/complicaciones , Anciano , Anemia Ferropénica/etiología , Ectasia Vascular Antral Gástrica/diagnóstico , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Inhibidores de la Bomba de Protones/uso terapéutico , Úlcera/diagnósticoRESUMEN
Colorectal cancer (CRC) is one of the main causes of death of neoplasia. Demand for predictive and prognostic markers to reverse this trend is increasing. Long non-coding RNA HOTAIR (Homeobox Transcript Antisense Intergenic RNA) overexpression in tumors was previously associated with poor prognosis and higher mortality in different carcinomas. We analyzed HOTAIR expression levels in tumor and blood of incident sporadic CRC patients in relation to their overall survival with the aim to evaluate surrogate prognostic marker for CRC. Tissue donor group consisted of 73 CRC patients sampled for tumor and normal tissue. Blood donor group was represented by 84 CRC patients compared with 40 healthy controls. Patients were characterized for tumor-node-metastasis stage, tumor grade, microsatellite instability and tumor penetration by stromal cells. HOTAIR levels were assessed by real-time quantitative PCR. CRC patients had higher HOTAIR expression in blood than healthy controls (P = 0.0001), whereas there was no difference in HOTAIR levels between tumor and adjacent mucosa of CRC patients. HOTAIR levels positively correlated between blood and tumor (R = 0.43, P = 0.03). High HOTAIR levels in tumors were associated with higher mortality of patients [Cox's proportional hazard, hazard ratio = 4.4, 95% confidence interval: 1.0-19.2, P = 0.046]. The hazard ratio was even higher when blood HOTAIR levels were taken into account (hazard ratio = 5.9, 95% confidence interval: 1.3-26.1, P = 0.019). Upregulated HOTAIR relative expression in primary tumors and in blood of CRC patients is associated with unfavorable prognosis. Our data suggest that HOTAIR blood levels may serve as potential surrogate prognostic marker in sporadic CRC.