RESUMO
PURPOSE: The aims of this study are to characterize the frequency, density, and distribution of aberrant crypt foci (ACF) and its histological features and to determine the frequency of loss of expression of DNA mismatch repair (MMR) proteins of subjects with hereditary nonpolyposic colorectal cancer (HNPCC) and sporadic colon rectal cancer (CRC). METHODS: Patients with HNPCC, first-degree relatives of subjects with HNPCC, sporadic CRC, and average risk subjects of sporadic CRC were included prospectively. Total colonoscopy with chromoendoscopy using methylene blue 0.5% and magnification in the right colon (cecum and 20 cm of the ascending colon) and in the left colon (rectum) was performed; loss of expression of MLH1 and MSH2 was evaluated by immunohistochemistry in confirmed ACF. RESULTS: Fifty-two subjects were included. Thirty-eight of the 119 ACF detected by endoscopy were biopsied. In 14 of the 38 specimens (36.8%), ACF were confirmed by histology (Cohen's kappa, 0.44). In subjects with HNPCC, ACF were identified more frequently in the right segment of the colon than in the left (73.1% vs. 26%); in contrast, ACF predominated in the left segment of the colon (89.3% vs. 10.6%) in subjects with sporadic CRC. There was a loss of MLH1 expression in ACF in subjects with HNPCC. CONCLUSIONS: In HNPCC, we found a greater density of ACF in the right colon, and in sporadic CRC, greater density in the left. ACF present loss in the expression of DNA MMR protein and can be used as an early marker in patients with a risk of HNPCC in whom carcinogenesis appears to be accelerated.
Assuntos
Focos de Criptas Aberrantes/metabolismo , Proteínas Adaptadoras de Transdução de Sinal/biossíntese , Neoplasias Colorretais Hereditárias sem Polipose/metabolismo , Neoplasias Colorretais/metabolismo , Reparo de Erro de Pareamento de DNA , Proteína 2 Homóloga a MutS/biossíntese , Proteínas Nucleares/biossíntese , Focos de Criptas Aberrantes/genética , Focos de Criptas Aberrantes/patologia , Proteínas Adaptadoras de Transdução de Sinal/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Colonoscopia , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/patologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL , Proteína 2 Homóloga a MutS/análise , Proteínas Nucleares/análiseRESUMO
BACKGROUND: chronic radiation proctopathy (CRP) is associated with recurrent rectal bleeding and transfusional requirements. Argon plasma coagulation (APC) and hyperbaric oxygen therapy (HOT) have been shown to be effective in the control of CRP. No prospective comparisons have been reported between these treatments. AIM: the aim was to evaluate the effectiveness, safety and impact on tissue toxicity of APC compared to HOT in patients with CRP. MATERIAL AND METHODS: a prospective study for evaluating treatment response was conducted. Patients with cervical cancer and CRP with rectal bleeding were recruited. They had not received previous treatment. Collected data included: demographics, previous radiation dosage, duration and severity of rectal bleeding. Hemoglobin, transfusional requirements, and tissue toxicity (SOMA LENT questionnaire) at baseline and at 1, 2, and 3 months follow up were recorded. RESULTS: thirty-one patients were included, 14 in the APC group and 17 in the HOT group. No response was noted in 13 and 18% of patients in the APC and HOT group respectively (p = NS). At the 1 and 2 months follow-up, the APC group showed a significantly better response in terms of transfusional requirements (0.6 vs. 3.4 and 0.7 vs. 2.5) and tissue toxicity score (5.3 vs. 8.6 and 3.8 vs. 7.248). After 3 months, both groups showed further improvement in all parameters without significant differences between them. CONCLUSIONS: APC and HOT were effective, safe and decreased the tissue toxicity scores in patients with CRP. However, response rate was higher and faster in the APC group.
Assuntos
Coagulação com Plasma de Argônio , Hemorragia Gastrointestinal/terapia , Oxigenoterapia Hiperbárica , Lesões por Radiação/terapia , Doenças Retais/terapia , Doença Crônica , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/patologia , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Lesões por Radiação/patologia , Doenças Retais/etiologia , Doenças Retais/patologia , Resultado do Tratamento , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/radioterapiaRESUMO
The role of endoscopic ultrasound (EUS) is in a constant state of evolution. Newer and more sophisticated imaging methods contrast very favorably to EUS and questions arise as to the real utility and even the existence of this method. Recent work has aimed to establish the actual role of EUS in this context and to establish its rightful place in the endoscopist's armamentarium. Limited information about this method, the indications, contraindications, virtues and limitations is an obstacle against widespread adoption not only in our country. Furthermore, the cost of the equipment and the long learning curve conspire to slow the implementation of EUS. In this paper we review the most recent developments in equipment and procedures as well as analyze the established role of EUS in clinical practice from recent literature.