An unusual presentation of synchronous bladder metastases from an oesophageal adenocarcinoma

2021 ◽  
Vol 103 (7) ◽  
pp. e227-e230
Author(s):  
D Wignall ◽  
R Sawant ◽  
A Gkentzis ◽  
L Lee
Keyword(s):  
Multidisciplinary Approach ◽  
Clinical Evidence ◽  
Oesophageal Carcinoma ◽  
Oesophageal Adenocarcinoma ◽  
Gastrointestinal Malignancy ◽  
Direct Invasion ◽  
Bladder Abnormalities ◽  
Upper Gastrointestinal ◽  
Progressive Dysphagia

Adenocarcinoma of the bladder is a rare form of malignancy accounting for fewer than 2% of bladder tumours. It is most commonly a result of direct invasion from prostatic, rectal or gynaecological primaries and less commonly presents from distant haematological or lymphatic metastasis. We report a rare case of oesophageal carcinoma metastasising to the bladder. It involves a 71-year-old man with progressive dysphagia and diagnostic computerised tomography findings of thickening in the oesophagus, bladder and common bile duct. Subsequent endoscopic biopsies of the oesophageal and bladder abnormalities showed immunohistochemical features consistent with upper gastrointestinal malignancy. This report aims to add to current clinical evidence of this route of metastasis and also highlight some of the key markers used by pathologists in interpretation of specimens. It also emphasises the essential role of a multidisciplinary approach for the diagnosis of such rare conditions.

Gastrointestinal and hepatobiliary surgery

2016 ◽  
Keyword(s):  
General Surgery ◽  
Multidisciplinary Approach ◽  
Malignant Disease ◽  
Clinical Evidence ◽  
Disease Free Survival ◽  
Evidence Base ◽  
Hepatobiliary Surgery ◽  
Free Survival ◽  
Upper Gastrointestinal ◽  
Disease Free

Increasing specialization within general surgery has allowed the firm establishment of upper gastrointestinal, colorectal, and hepatobiliary surgery as distinct and separate disciplines. Each subspecialty has evolved and subsequently faced the challenge of improving its outcomes, in the fields of both benign and malignant disease. In cancer treatment, the multidisciplinary approach has developed to become standard, and the evidence base reflects this, now routinely incorporating neoadjuvant and adjuvant oncological treatments, resulting in significant advances in both survival and disease-free survival. This chapter examines the clinical evidence that underpins the main advances in treatment in these three major subspecialties.

The use of Palma's procedure in the salvage therapy for a leiomyosarcoma of the right pelvic sidewall: an intraoperative multidisciplinary approach

2005 ◽  
Vol 15 (1) ◽  
pp. 175-179 ◽  
Author(s):  
S. Ahuja ◽  
M. Gaunt ◽  
R. Crawford
Keyword(s):  
Multidisciplinary Approach ◽  
Clinical Evidence ◽  
Broad Ligament ◽  
Pelvic Mass ◽  
Iliac Vein ◽  
Vascular Surgeon ◽  
Primary Surgery ◽  
Stage Disease ◽  
The Right

Leiomyosarcomas of the ovary and broad ligament are relatively rare. Less than 50 cases of primary ovarian and broad ligament leiomyosarcomas have been reported. The prognosis is poor, with late-stage disease being a problem in the majority of cases. It is difficult to determine the exact role of surgery, chemotherapy, and radiotherapy in the management of these tumors. So far, no cases of ovarian or broad ligament leiomyosarcomas have been reported where primary surgery for the sarcoma had to be combined with a Palma's procedure. We report a case of a right pelvic sidewall leiomyosarcoma with involvement of 10 cm of the right external iliac vein. A review of the imaging preoperatively did not suggest involvement of the venous system. Resection of the pelvic mass was carried out and a Palma's procedure was performed by the vascular surgeon. Histology reported an incompletely excised high-grade leiomyosarcoma. Chemotherapy was given postoperatively. Imaging at 12 months after surgery showed a patent vascular graft and no evidence of recurrence. There was no clinical evidence of recurrence at 21 months postsurgery.

Role of cyclooxygenase-2 in the development and treatment of oesophageal adenocarcinoma

2003 ◽  
Vol 38 (0) ◽  
pp. 87-93 ◽  
Author(s):  
C. J. Buskens ◽  
Ristimäki A. ◽  
G. J. A. Offerhaus ◽  
D. J. Richel ◽  
J. J. B. van Lanschot
Keyword(s):  
Cyclooxygenase 2 ◽  
Oesophageal Adenocarcinoma

Non-pharmacological Strategies Against Systemic Inflammation: Molecular Basis and Clinical Evidence

2020 ◽  
Vol 26 (22) ◽  
pp. 2620-2629 ◽  
Author(s):  
Rita Del Pinto ◽  
Davide Pietropaoli ◽  
Annalisa Monaco ◽  
Giovambattista Desideri ◽  
Claudio Ferri ◽  
...  
Keyword(s):  
Human Genome ◽  
Systemic Inflammation ◽  
Clinical Evidence ◽  
Metabolic Diseases ◽  
Lifestyle Changes ◽  
Common Denominator ◽  
Active Lifestyle ◽  
Systemic Impact ◽  
Public Health Strategies

Systemic inflammation is a common denominator to a variety of cardiovascular (CV) and non-CV diseases and relative risk factors, including hypertension and its control, metabolic diseases, rheumatic disorders, and those affecting the gastrointestinal tract. Besides medications, a non-pharmacological approach encompassing lifestyle changes and other complementary measures is mentioned in several updated guidelines on the management of these conditions. We performed an updated narrative review on the mechanisms behind the systemic impact of inflammation and the role of non-pharmacological, complementary measures centered on lowering systemic phlogosis for preserving or restoring a good global health. The central role of genetics in shaping the immune response is discussed in conjunction with that of the microbiome, highlighting the interdependence and mutual influences between the human genome and microbial integrity, diversity, and functions. Several plausible strategies to modulate inflammation and restore balanced crosstalk between the human genome and the microbiome are then recapitulated, including dietary measures, active lifestyle, and other potential approaches to manipulate the resident microbial community. To date, evidence from high-quality human studies is sparse to allow the unconditioned inclusion of understudied, though plausible solutions against inflammation into public health strategies for global wellness. This gap claims further focused, well-designed research targeted at unravelling the mechanisms behind future personalized medicine.

PI3K/ Akt/ mTOR Pathway as a Therapeutic Target for Colorectal Cancer: A Review of Preclinical and Clinical Evidence

2019 ◽  
Vol 20 (12) ◽  
pp. 1217-1226 ◽  
Author(s):  
Arunaksharan Narayanankutty
Keyword(s):  
Colorectal Cancer ◽  
Drug Resistance ◽  
Therapeutic Target ◽  
Clinical Evidence ◽  
Mtor Pathway ◽  
Colorectal Cancers ◽  
Patent Literature ◽  
Mtor Signalling ◽  
Natural And Synthetic

Background: Phosphoinositide 3-kinase (PI3Ks) is a member of intracellular lipid kinases and involved in the regulation of cellular proliferation, differentiation and survival. Overexpression of the PI3K/Akt/mTOR signalling has been reported in various forms of cancers, especially in colorectal cancers (CRC). Due to their significant roles in the initiation and progression events of colorectal cancer, they are recognized as a striking therapeutic target. Objective: The present review is aimed to provide a detailed outline on the role of PI3K/Akt/mTOR pathway in the initiation and progression events of colorectal cancers as well as its function in drug resistance. Further, the role of PI3K/Akt/mTOR inhibitors alone and in combination with other chemotherapeutic drugs, in alleviating colorectal cancer is also discussed. The review contains preclinical and clinical evidence as well as patent literature of the pathway inhibitors which are natural and synthetic in origin. Methods: The data were obtained from PubMed/Medline databases, Scopus and Google patent literature. Results: PI3K/Akt/mTOR signalling is an important event in colorectal carcinogenesis. In addition, it plays significant roles in acquiring drug resistance as well as metastatic initiation events of CRCs. Several small molecules of natural and synthetic origin have been found to be potent inhibitors of CRCs by effectively downregulating the pathway. Data from various clinical studies also support these pathway inhibitors and several among them are patented. Conclusion: Inhibitors of the PI3K/mTOR pathway have been successful for the treatment of primary and metastatic colorectal cancers, rendering the pathway as a promising clinical cancer therapeutic target.

scholarly journals Focused ultrasound in neuro-oncology: the role of the Focused Ultrasound Foundation in driving adoption and innovation

2021 ◽  
Author(s):  
Emily C. Whipple ◽  
Camille A. Favero ◽  
Neal F. Kassell
Keyword(s):  
Drug Delivery ◽  
Brain Tumors ◽  
Focused Ultrasound ◽  
Clinical Evidence ◽  
Neurological Injury ◽  
High Concentration ◽  
Potential Applications ◽  
Tumor Agent

Abstract Introduction Intra-arterial (lA) delivery of therapeutic agents across the blood-brain barrier (BBB) is an evolving strategy which enables the distribution of high concentration therapeutics through a targeted vascular territory, while potentially limiting systemic toxicity. Studies have demonstrated lA methods to be safe and efficacious for a variety of therapeutics. However, further characterization of the clinical efficacy of lA therapy for the treatment of brain tumors and refinement of its potential applications are necessary. Methods We have reviewed the preclinical and clinical evidence supporting superselective intraarterial cerebral infusion (SSJACI) with BBB disruption for the treatment of brain tumors. In addition, we review ongoing clinical trials expanding the applicability and investigating the efficacy of lA therapy for the treatment of brain tumors. Results Trends in recent studies have embraced the use of SSIACI and less neurotoxic chemotherapies. The majority of trials continue to use mannitol as the preferred method of hyperosmolar BBB disruption. Recent preclinical and preliminary human investigations into the lA delivery of Bevacizumab have demonstrated its safety and efficacy as an anti-tumor agent both alone and in combination with chemotherapy. Conclusion lA drug delivery may significantly affect the way treatment are delivered to patients with brain tumors, and in particular GBM. With refinement and standardization of the techniques of lA drug delivery, improved drug selection and formulations, and the development of methods to minimize treatment-related neurological injury, lA therapy may offer significant benefits for the treatment of brain tumors.

Facilitating Change in Anorexia Nervosa: The Role of Occupational Therapy

1992 ◽  
Vol 55 (9) ◽  
pp. 334-339 ◽  
Author(s):  
Priscilla Harries
Keyword(s):  
Anorexia Nervosa ◽  
Occupational Therapy ◽  
Multidisciplinary Approach ◽  
Projective Art

Patients with anorexia nervosa benefit from a multidisciplinary approach. This article gives a brief description of, first, the illness and its treatment and, secondly, the occupational therapy techniques used at the Maudsley Unit. It then demonstrates the progress of patients through examples of projective art.

scholarly journals Nutritional Optic Neuropathies: State of the Art and Emerging Evidences

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2653
Author(s):  
Matilde Roda ◽  
Natalie di Geronimo ◽  
Marco Pellegrini ◽  
Costantino Schiavi
Keyword(s):  
Bariatric Surgery ◽  
Optic Neuropathy ◽  
Multidisciplinary Approach ◽  
State Of The Art ◽  
Signs And Symptoms ◽  
Therapeutic Strategies ◽  
Scientific Interest ◽  
Optic Nerve Atrophy ◽  
Prompt Diagnosis

Nutritional optic neuropathy is a cause of bilateral, symmetrical, and progressive visual impairment with loss of central visual acuity and contrast sensitivity, dyschromatopsia, and a central or centrocecal scotoma. The clinical features are not pathognomonic, since hereditary and toxic forms share similar signs and symptoms. It is becoming increasingly common due to the widespread of bariatric surgery and strict vegetarian or vegan diets, so even the scientific interest has recently increased. In particular, recent studies have focused on possible pathogenetic mechanisms, and on novel diagnostic and therapeutic strategies in order to prevent the onset, make a prompt diagnosis and an accurate nutritional supplementation, and to avoid irreversible optic nerve atrophy. Nowadays, there is clear evidence of the role of cobalamin, folic acid, thiamine, and copper, whereas further studies are needed to define the role of niacin, riboflavin, and pyridoxine. This review aims to summarize the etiology, diagnosis, and treatment of nutritional optic neuropathy, and it is addressed not only to ophthalmologists, but to all physicians who could come in contact with a patient with a possible nutritional optic neuropathy, being a fundamental multidisciplinary approach.

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