Cirurgia Paliativa em Pacientes com Tumor Periampular Irressecável: Estudo Retrospectivo de 5 Anos em um Hospital em São José dos Campos – SP/Surgical Palliation in Patients with Unresectable Periampullary Tumor: a Retrospective Study of 5 Years in a Hosp

1970 ◽  
Vol 3 (4) ◽  
pp. 9-20
Author(s):  
José Henrique Gomes Torres ◽  
Rosyane Rena De Freitas

Objetivo: Avaliar diferentes métodos paliativos quanto a sua resolução, complicações e sobrevida em pacientes com tumor periampular irressecável. Materiais e métodos: Estudo retrospectivo com análise dos prontuários de pacientes com tumor periampular irressecável e que foram submetidos a procedimento paliativo no Hospital Municipal Dr José de Carvalho Florence nos últimos cinco anos. Resultados: O principal tumor periampular foi o de cabeça de pâncreas, com incidência de 94%, acometendo pacientes com média de 66 anos, sem preferência por sexo. Os procedimentos mais realizados foram derivação biliar e colocação de endoprótese através de colangiopancreatografia endoscópica retrógrada, apresentando sobrevidas de 586 e 56 dias, respectivamente. Conclusão: A coledocojejunostomia foi o procedimento mais realizado e apresentou menor tempo de internação e maiores sobrevida e tempo de permanência anictérico. Pneumonia foi a complicação mais frequente.  Palavras chave: Câncer pancreático, Colangiocarcinoma, Cuidados paliativos.  Objective: To evaluate different palliative methods concerning its resolution, complications and survival in patients with unresectable periampular tumor. Materials and methods: Retrospective study analysing records of patients with unresectable periampullary tumor and who underwent palliative procedure in the Hospital Municipal Dr José de Carvalho Florence in the past five years. Results: The main periampullary tumor was the head of the pancreas, with an incidence of 94%, affecting patients with an average of 66 years old, regardless of gender. The most common procedures were bypass and biliary stent, with survival rates of 586 and 56 days, respectively. Conclusion: Coledocojejunostomy was the procedure which was the most often performed and showed a shorter hospital stay and longer survival time and time without jaundice. Pneumonia was the main complication.  Keywords: Pancreatic cancer, Cholangiocarcinoma, Palliative care  

2016 ◽  
Vol 7 (3) ◽  
pp. 24-35
Author(s):  
D A Ionkin ◽  
Yu A Stepanova ◽  
A B Shurakova ◽  
A V Chzhao

Aim: To improve the results of treatment of terminal stage pancreatic cancer. Materials and methods. Since 2012 cryosurgery was performed in 45 patients - 20 men (44.4%) and 25 women (55.6%) with pancreatic cancer. With mean age of 59 ± 3 years. The head of the pancreas was struck in 20 (44.4%) cases, a head-body - in 13 (28.9%), the body - in 12 (26.7%). The following distribution of patients depending on pacreatic cancer stages were noted: stage IV- 34 patients, stage III- 11. In 8 patients with pancreatic cancer and liver metastases simultaneous cryodestruction of tumorsof the pancreas and liver malformations were performed. Local cryodestruction has been supplemented by bypass in 29 cases (64.4%). In one case, cryosurgery was performed on segment of the portal vein after the pankreatoduoenal resection. All patients subsequently were underwent adjuvant chemotherapy, supplemented by regional chemoembolization in 10 cases.Results. We proposed indications and contraindications for cryoablation. Intraperitoneal bleeding was diagnosed in 2 (4.4%) cases. Acute pancreatitis - in 5 (11.1%) cases. Suppuration manipulation area was noted in 2 (4.4%) cases. Ascites was detected in 9 (20.0%) patients (docked within 5-8 days therapeutically). Wound supporation was observed in 2 (4.4%) cases. Complete pain relief atchieved after cryoablation was reached in 38% of cases or significant reduction of its intensity in 41%. Kaplan-Meier survival in patients with pancreatic cancer for 6 months was 56%, for 12 months - 28%, for 24 months -15% and for 28 months - 4.3%.Conclusion. Сryodestruction for cancer of the pancreas in patients with unrespectable tumors improves the quality of life of cancer patients, primarily due to decrease pain intensity. Application of chemotherapy improves quality of life and can prolong survival rates.


2015 ◽  
Vol 47 ◽  
pp. 89-96 ◽  
Author(s):  
Daniel Timofte ◽  
Vasile Bintintan ◽  
Iulia Munteanu ◽  
Mihaela Blaj ◽  
Emil Anton ◽  
...  

The pancreatic cancer is a disorder with an exponentially increased incidence, especially over the last few years. Moreover, it is estimated that almost 95% of the patients with this disease are presenting to the hospital in the advanced and unresectable stages. Also, over the past few decades the development and advance of the surgical methods and techniques have improved, with the most of the operatory actions in the chronic pancreatitis and pancreatic cancer being represented by the whipple duodeno-pancreatectomy, which in fact represents the standard resection for tumors of the duodenum, as well as the hepatopancreatic ampulla of Vater, distal choledocus and the head of the pancreas. Moreover, it is important to mention that in these cases, after an extended resection and reconstruction of the upper gastrointestinal tract, the digestive physiology will be disrupted. In addition, previous studies have shown that patients can maintain a body mass index after surgery but often this will be lower than its preoperative value. Thus, considering the aforementioned aspects, in the present mini-review we were mainly interested in presenting also the relevance of the micronutrients such as iron, selenium, vitamin D and E, zinc or copper in this complicated area of research, as well as aspects regarding the correlations between immune function and micronutrients or the pancreatic enzyme supplementation.


HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S292-S293
Author(s):  
D. Nobuoka ◽  
R. Yoshida ◽  
M. Hioki ◽  
D. Sato ◽  
T. Kojima ◽  
...  

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Angela Brenton-Rule ◽  
Daniel Harvey ◽  
Kevin Moran ◽  
Daniel O’Brien ◽  
Jonathon Webber

Abstract Background Podiatrists in New Zealand have a duty of care to assist patients in an emergency, and current cardiopulmonary resuscitation (CPR) certification is a requirement for registration. However, it is unknown how competent and confident podiatrists are in administering CPR and how they would respond in an emergency. Having a health professional who has a competent knowledge of CPR and skills in basic life support, can improve survival rates from sudden cardiac arrest. Therefore, the aim of this study was to survey New Zealand podiatrists to determine their CPR knowledge and qualifications; beliefs about the application of CPR; and perceptions of their competency in CPR. Methods This cross-sectional study used a web-based survey. Participants were New Zealand registered podiatrists with a current annual practising certificate. The 31-item survey included questions to elicit demographic information, CPR practice and attitudes, and CPR knowledge. Responses were collected between March and August 2020. Results 171 podiatrists responded to the survey. 16 % of the podiatrists (n = 28) had performed CPR in an emergency, with a 50 % success rate. Participants were predominantly female (n = 127, 74 %) and working in private practice (n = 140,82 %). Nearly half of respondents were younger than 40 years (n = 75,44 %) and had less than 10 years of clinical experience (n = 73, 43 %). Nearly all (n = 169,97 %) participants had received formal CPR training in the past two years, with 60 % (n = 105) receiving training in the past 12 months. Most respondents (n = 167,98 %) self-estimated their CPR ability as being effective, very effective, or extremely effective. Participants’ knowledge of CPR was variable, with the percentage of correct answers for CPR protocol statements ranging between 20 and 90 %. Conclusions This study provides the first insight into New Zealand podiatrists’ CPR knowledge and perceptions. Podiatrists were found to have high levels of CPR confidence but demonstrated gaps in CPR knowledge. Currently, New Zealand registered podiatrists require biennial CPR re-certification. However, resuscitation authorities in New Zealand and overseas recommend an annual update of CPR skills. Based on this study’s findings, and in line with Australia and the United Kingdom, the authors recommend a change from biennial to annual CPR re-certification for podiatrists in New Zealand. Trial registration The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620001144909).


Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3784
Author(s):  
Mark Stasiewicz ◽  
Marek Kwaśniewski ◽  
Tomasz M. Karpiński

Pancreatic cancer (PC) remains a global health concern with high mortality and is expected to increase as a proportion of overall cancer cases in the coming years. Most patients are diagnosed at a late stage of disease progression, which contributes to the extremely low 5-year survival rates. Presently, screening for PC remains costly and time consuming, precluding the use of widespread testing. Biomarkers have been explored as an option by which to ameliorate this situation. The authors conducted a search of available literature on PubMed to present the current state of understanding as it pertains to the use of microbial biomarkers and their associations with PC. Carriage of certain bacteria in the oral cavity (e.g., Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Streptococcus sp.), gut (e.g., Helicobacter pylori, Synergistetes, Proteobacteria), and pancreas (e.g., Fusobacterium sp., Enterobacteriaceae, Pseudomonadaceae) has been associated with an increased risk of developing PC. Additionally, the fungal genus Malassezia has likewise been associated with PC development. This review further outlines potential oncogenic mechanisms involved in the microbial-associated development of PC.


2021 ◽  
Vol 11 (2) ◽  
pp. 127 ◽  
Author(s):  
Beste Turanli ◽  
Esra Yildirim ◽  
Gizem Gulfidan ◽  
Kazim Yalcin Arga ◽  
Raghu Sinha

Pancreatic cancer is one of the most fatal malignancies and the seventh leading cause of cancer-related deaths related to late diagnosis, poor survival rates, and high incidence of metastasis. Unfortunately, pancreatic cancer is predicted to become the third leading cause of cancer deaths in the future. Therefore, diagnosis at the early stages of pancreatic cancer for initial diagnosis or postoperative recurrence is a great challenge, as well as predicting prognosis precisely in the context of biomarker discovery. From the personalized medicine perspective, the lack of molecular biomarkers for patient selection confines tailored therapy options, including selecting drugs and their doses or even diet. Currently, there is no standardized pancreatic cancer screening strategy using molecular biomarkers, but CA19-9 is the most well known marker for the detection of pancreatic cancer. In contrast, recent innovations in high-throughput techniques have enabled the discovery of specific biomarkers of cancers using genomics, transcriptomics, proteomics, metabolomics, glycomics, and metagenomics. Panels combining CA19-9 with other novel biomarkers from different “omics” levels might represent an ideal strategy for the early detection of pancreatic cancer. The systems biology approach may shed a light on biomarker identification of pancreatic cancer by integrating multi-omics approaches. In this review, we provide background information on the current state of pancreatic cancer biomarkers from multi-omics stages. Furthermore, we conclude this review on how multi-omics data may reveal new biomarkers to be used for personalized medicine in the future.


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