RESUMO
Hepatocellular carcinoma (HCC) is the fifth most frequent malignant tumour and the third leading cause of death due to cancer worldwide [1]. Surgical treatment is the only long-term curative therapy. But the resection rate remains low in cirrhotic patients due to contraindications imposed mainly by hepatic insufficiency and excessively advanced tumoral stages. In recent years, however, due to the extended use of screening programmes in high-risk patients, tumours are smaller at presentation, making treatments easier. In the current context of shortage of organs for transplantation, surgical resection remains the best available treatment option for most patients with HCC in cirrhotic livers. Despite the encouraging results reported by several groups in terms of overall survival, the high recurrence rate is still an unsolved problem. Recently, a large, randomised, placebo-controlled trial has shown that a multikinase inhibitor targeting Ras-kinase and VEGFR-2, sorafenib, improves survival of patients with advanced HCC. Sorafenib was approved by regulatory agencies during 2007 and is likely to become the new standard therapy for HCC patients with advanced disease.
Assuntos
Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/cirurgia , Cirrose Hepática/complicações , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica , Ensaios Clínicos como Assunto , Terapia Combinada/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Neoplasias Hepáticas/mortalidade , Transplante de FígadoRESUMO
Surgery represents the only chance of cure for patients with colorectal liver metastases. The results of expanded indications for surgical treatment revealed that even advanced disease can be cured in a significant percentage of cases. What is the explanation for this systemic impact of a local treatment such as surgery? What is different in those patients who can be cured by resection? In this review we analyse the available evidence of the complex relationship between the growing tumour and the immune system. Special attention is directed to the role of T regulatory cells (Tregs) recruited by the tumour to construct a tolerogenic microenvironment in which to grow. Based on the published data we developed the hypothesis that surgery breaks the tumour immune tolerance status because it not only removes the tumour, but also the protective shield of T regulatory cells.
Assuntos
Neoplasias Colorretais/imunologia , Neoplasias Colorretais/cirurgia , Tolerância Imunológica , Neoplasias Hepáticas/imunologia , Neoplasias Hepáticas/cirurgia , Neoplasias Colorretais/patologia , Humanos , Imunoterapia , Neoplasias Hepáticas/secundário , Linfócitos/imunologia , Linfócitos T Reguladores/imunologiaRESUMO
BACKGROUND: The elderly are under-represented in series of patients operated on for colorectal liver metastases (LM). OBJECTIVE: To analyse the influence of age on surgery of colorectal LM, and the identification of factors that could be used as exclusion criteria. PATIENTS AND METHODS: Six hundred and forty-eight patients underwent liver resection between 1990 and 2006. Demographic data, primary tumour related variables, stage of the disease, morbidity, mortality, survival and recurrence were prospectively recorded. RESULTS: One hundred and sixty of 648 patients (25%) were 70 years old or older. Postoperative mortality was significantly higher in elderly patients (8% vs. 3%, p=0.008). Morbidity was also higher (41% vs. 34%, p=0.008). Survival rate at 1, 3 and 5 years was 88%, 62% and 45% respectively in patients younger than 70 years, and 82%, 48% and 36% in the elderly (p=0.007). Excluding the postoperative mortality, the figures were 90%, 64% and 46%. 90%, 53% and 38% (p=0.061). Disease-free survival rates at 1, 3 and 5 years excluding postoperative mortality were 68%, 32% and 25% in younger patients, compared to 68%, 34% and 30% (p=0.71) in the elderly. Major liver resections increased mortality in the elderly. In the multivariate analyses only a tumour size equal to or more than 10 cm significantly increased the postoperative mortality risk in elderly patients. CONCLUSIONS: The elderly have a higher mortality. In recent years that difference has been markedly reduced. Excluding the postoperative mortality, the overall survival and disease-free survival are similar between both groups. The criteria to indicate surgery must be the same in both groups.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Idoso , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de SobrevidaRESUMO
Mediante la presentación de un caso de rhinosporidiosis se hace una detallada revision de esta rara enfermedad. Se discute su frecuencia en Colombia comparándola con la de otros paises, asi como sus manifestaciones clinicas, su diagnostico, su tratamiento y su pronostico
Assuntos
RinosporidioseRESUMO
La amigdalectomia es hoy en dia un procedimiento relativamente seguro gracias a las tecnicas quirurgicas y de anestesia. Sin embargo, pese a los estudios prequirurgicos, usualmente recomendados para su ejecución tales como hemograma, pruebas de coagulación etc. se pueden presentar complicaciones como la expuesta en este caso, en un paciente con sangrado masivo de etiologia desconcertante
Assuntos
Hemorragia , Complicações Pós-Operatórias , TonsilectomiaRESUMO
Conjuntamente con la descripción de un caso de miasis otica se revisan en forma breve las manifestaciones, el diagnostico y el tratamiento de la miasis en otorrinolaringologia