scholarly journals SURGICAL TREATMENT OPTIONS IN COMPLICATED COLO-RECTAL CANCERS OPERATED IN EMERGENCY

2019 ◽  
Vol 6 (1) ◽  
pp. 9-13
Author(s):  
Georgiana Bianca Constantin ◽  
D. Firescu ◽  
R. Bîrlă ◽  
S. Constantinoiu
Keyword(s):  
Treatment Options ◽  
Right Hemicolectomy ◽  
Late Presentation ◽  
Screening Programs ◽  
The Poor ◽  
Rectal Cancers ◽  
Curative Intention ◽  
Surgical Operations ◽  
Clinical Emergency ◽  
Hartmann Operation

Globally, the colo-rectal cancer is the 4th in frequency of all neoplasia and in Romania is the 2nd, with a yearly tendency of increasing the number of new cases. The poor symptomatology in the inchoate stages and also the deficiency of effective screening programs lead to frequently late presentation of patients, with tumors in complicated stages, when the surgical operations, very often can no longer have a curative intention. We will present the results of a retrospective study during 10 years (2007-2016) that included 431 patients with complicated colo-rectal cancers, admitted and operated in the 2nd Surgery Clinic of the Clinical Emergency County Hospital “Sf. Ap. Andrei” from Galati, Romania. In 133 cases (30,9%), most of them occlusive, it was practiced in emergency a left iliac anus, leaving the tumor in its place. The Hartmann operation was practiced in 97 cases (22,5%). Anytime it was possible, we practiced operations with radical intentions, like: right hemicolectomy, in 46 cases (10,7%), left hemicolectomy, in 13 cases (3%), segmentary colectomy with anastomosis, in 30 cases (6,9%). Regarding the surgical operations in emergency, many of them don’t have a radical intention, taking into account the local invasion of the tumors and the metastasis. In these situations, a first surgical gesture is required, as an intervention that is meant to save the patient’s life, solving only the complication.

scholarly journals Comparison of an oncology clinical decision-support system’s recommendations with actual treatment decisions

2021 ◽  
Author(s):  
Suthida Suwanvecho ◽  
Harit Suwanrusme ◽  
Tanawat Jirakulaporn ◽  
Surasit Issarachai ◽  
Nimit Taechakraichana ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Treatment Options ◽  
Stage Iv ◽  
Clinical Decision ◽  
Treatment Decisions ◽  
Therapeutic Options ◽  
Cancer Type ◽  
The Us ◽  
Rectal Cancers

Abstract Objective IBM(R) Watson for Oncology (WfO) is a clinical decision-support system (CDSS) that provides evidence-informed therapeutic options to cancer-treating clinicians. A panel of experienced oncologists compared CDSS treatment options to treatment decisions made by clinicians to characterize the quality of CDSS therapeutic options and decisions made in practice. Methods This study included patients treated between 1/2017 and 7/2018 for breast, colon, lung, and rectal cancers at Bumrungrad International Hospital (BIH), Thailand. Treatments selected by clinicians were paired with therapeutic options presented by the CDSS and coded to mask the origin of options presented. The panel rated the acceptability of each treatment in the pair by consensus, with acceptability defined as compliant with BIH’s institutional practices. Descriptive statistics characterized the study population and treatment-decision evaluations by cancer type and stage. Results Nearly 60% (187) of 313 treatment pairs for breast, lung, colon, and rectal cancers were identical or equally acceptable, with 70% (219) of WfO therapeutic options identical to, or acceptable alternatives to, BIH therapy. In 30% of cases (94), 1 or both treatment options were rated as unacceptable. Of 32 cases where both WfO and BIH options were acceptable, WfO was preferred in 18 cases and BIH in 14 cases. Colorectal cancers exhibited the highest proportion of identical or equally acceptable treatments; stage IV cancers demonstrated the lowest. Conclusion This study demonstrates that a system designed in the US to support, rather than replace, cancer-treating clinicians provides therapeutic options which are generally consistent with recommendations from oncologists outside the US.

scholarly journals Epidemiological Properties of Primary Open Angle Glaucoma in Nigeria

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Lawan Abdu
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
High Reliability ◽  
Treatment Options ◽  
Late Presentation ◽  
Open Angle ◽  
Long Term Effects ◽  
Eye Care

Background. Primary open angle glaucoma (POAG) is progressive chronic optic neuropathy in adults in which intraocular pressure (IOP) and other currently unknown factors contribute to damage. POAG is the second commonest cause of avoidable blindness in Nigeria.Pattern of Presentation. POAG is characterized by late presentation. Absence of pain which is a driving force for seeking medical help, inadequacy of trained eye care personnel, paucity of facilities, misdistribution of resources, lack of awareness, poor education, and poverty may all contribute to this. Medical and surgical treatment options available are challenging and tasking.Screening for Glaucoma. Screening is the presumptive identification of unrecognized disease (POAG) by applying test(s) which can be applied rapidly. Such test(s) should be of high reliability, validity, yield, acceptable, and cost effective. The test should ideally be sensitive, specific, and efficient. It is difficult to select a suitable test that meets these criteria. Intraocular pressure (IOP) appears to be the easiest option. But, high IOP is not diagnostic nor does normal value exclude the disease. Health education is a possible strategy in early case detection and management.Treatment of POAG. Glaucoma treatment can either be medical or surgical (this includes laser). Considering unavailability, potency, cost, and long-term effects of medication, surgery (trabeculectomy) could be a better option. Laser trabeculoplasty is available in a few centers. Viscocanalostomy is not routinely performed. Patient education is vital to success as management is for life.Conclusion. POAG remains a cause of avoidable blindness in Nigeria. There is need for long-term strategy to identify patients early and institute prompt management. Improvement in training of eye care personnel and provision of up to date equipment is essential in achieving this goal.

scholarly journals Frequency of Retinoblastoma at Lady Reading Hospital, Peshawar, Pakistan

1970 ◽  
Vol 12 (3) ◽  
pp. 140-143
Author(s):  
Zafar Iqbal ◽  
Tariq Muhammad Saeed
Keyword(s):  
Demographic Data ◽  
Treatment Options ◽  
Late Presentation ◽  
Group V ◽  
Female Ratio ◽  
Fellow Eye ◽  
Bilateral Retinoblastoma ◽  
Male Preponderance ◽  
Age Range ◽  
Male To Female

Aim: To ascertain the demographics, clinical features, and treatment options for children with retinoblastoma. Methods: This was a hospital-based cohort study of all children with retinoblastoma presenting from 1 January 2008 to 31 December 2008. Demographic data, presenting features, family history, and findings identified during examination were recorded for each patient. The tumours were classified using the Reese- Ellsworth classification system. Documentation of the tumours included examination under anesthesia, ultrasound B- scan, and computed tomography scan as well as histopathological reporting of enucleated eyes.Results: Twenty seven new patients with retinoblastoma were identified and 36 eyes were affected, with a bilaterality rate of 33%. The frequency was 4.1, with a bimodal peak of presentation of younger than 1 yearand 4 years. The mean age at diagnosis was 3.2 years (SD, 2.5 years; range, 3 months to 8 years). Most of the patients were boys, (59%) and most were in the age range of 1 to 5 years (66%). There was a male preponderance (5:1) amongst patients younger than 1 year and the male to female ratio was equal (1:1) in the 1 to 5 years age range. Leukocoria was the main presentation in 38% of eyes and 19% presented with proptosis. Enucleation/exenteration was performed for 17 unilateral eyes (94%) and 5 bilateral eyes (27%) with group V disease. Groups I and II tumours (n = 1 and n = 7 for unilateral and bilateral eyes, respectively) were treated conservatively with cryotherapy or chemotherapy alone or in combination. The commonest treatment for bilateral disease was enucleation of 1 eye and chemotherapy for the fellow eye (22%). Radiotherapy was advised for patients with histopathological evidence of optic nerve involvement (25%).Conclusions: Retinoblastoma usually affects infants and children younger than 5 years, with no sexual or racial predilection. One-third of patients demonstrate bilaterality, with leukocoria as the commonest presenting feature and proptosis as a feature of late presentation. In bilateral retinoblastoma, primary enucleation of one eye with conservative chemotherapy and/or cryotherapy of the fellow eye is advocated.

scholarly journals What we learn from randomized trials in rectal cancer and what we can trust

2014 ◽  
Vol 61 (2) ◽  
pp. 9-16
Author(s):  
Vincenzo Valentini ◽  
Francesco Cellini
Keyword(s):  
Rectal Cancer ◽  
Randomized Trials ◽  
Treatment Options ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Integrated Treatment ◽  
Treatment Schedule ◽  
Optimal Outcome ◽  
Progressive Development ◽  
Rectal Cancers

Results of the management of rectal cancer have enormously improved over the last almost forty years, by the progressive development of new integrated treatment options. nevertheless an optimization of the results is needed to raise the still sub-optimal outcome in terms of survival. several national and international guidelines address the best treatment choice overall evaluating the evidence basis available from literature. Still a certain degree of disagreement is present, particularly about the preferable preoperative rt treatment schedule. randomized trials represent the main landmark and most important tool for the scientific scenario: defining a potentially established standard of care, or suggesting the more promising approach to focus the re- search into, thus orienting the efforts of clinicians and researchers. This manuscript will mainly focus on the evidences derived from randomized clinical trial describing the main issues about the multimodal integrated treatment for rectal cancers. It will focus on both locally advanced (LA)/primary unresectable (UR), and resectable rectal cancers; some non-randomized trials of relevant the dissertation will also be mentioned.

scholarly journals THE STOMA REVERSAL AFTER HARTMANN PROCEDURE IN PATIENTS WITH COLORECTAL CANCER OPERATED IN EMERGENCY

2020 ◽  
Vol 2 (1) ◽  
pp. 25-29
Author(s):  
Georgiana Bianca Constantin ◽  
D. Firescu ◽  
D. Voicu ◽  
B. Ștefănescu ◽  
R. Mihailov ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Survival Rate ◽  
Morbidity Rate ◽  
Hartmann Procedure ◽  
Important Place ◽  
Stoma Reversal ◽  
Hartmann Reversal ◽  
Very High ◽  
Clinical Emergency ◽  
Hartmann Operation

The Hartmann procedure still has an important place in the surgical therapy of complicated colorectal cancers. The morbidity rate can be very high and many patients never undergo the stoma reversal. We conducted a retrospective study on 431 patients with colorectal cancer operated in the second clinic of General Surgery of the Clinical Emergency County Hospital Galati between 2008-2017. 42,53 % of the patients with Hartmann operation had a stoma reversal after a medium period of 5,7 months. The 5-years survival rate in patients with stoma reversal was 4,9 %. The reversal rate in our study is similar to those found in the literature in recent studies, that report percentages of 23,3 %-55,17 %. In our study, the medium period between the emergency Hartmann procedure and the reversal of the stoma was 5,7 months, which is also similar to the data in the literature. We found a 5-years survival rate of 4,9 % in patients with Hartmann reversal, much lower than others’ results. Many stomas initially intended to be temporary, may not be reversed. It is important to optimize the timing of stoma closure. A period of approximately 6 months between the initial operation and the reversal seem to be adequate.

scholarly journals Rhinosinusal mucormycosis: Literature review and some particular cases

2019 ◽  
Vol 9 (35) ◽  
pp. 129-137
Author(s):  
Carmen Badea ◽  
Codrut Sarafoleanu ◽  
Andreea Marza
Keyword(s):  
Treatment Options ◽  
Treatment Protocol ◽  
Complete Recovery ◽  
Late Presentation ◽  
Multiple Organ ◽  
Surgical Debridement ◽  
Cerebral Stroke ◽  
Significant Survival ◽  
Life Threatening ◽  
Underlying Risk

Abstract Rhinosinusal mucormycosis is a life-threatening disease caused by fungus of the order Mucorales, which commonly affects individuals with diabetes and those in immunocompromised states. It is the most common form of mucormycosis with a high mortality rate (50-80%). Treatment options include reversal of the underlying risk factors when it is possible, systemic antifungal medication and radical surgical debridement. Prognosis is reserved because of the high potential of invasiveness, so diagnosis and early treatment are essential. Herein, we make a review about the most important features of this pathology and we report two cases of rhinosinusal mucormycosis with similar presentations who followed the same treatment protocol – extended surgical debridement of the necrotic tissue combined with systemic antifungal treatment (Amphotericin B). Complete recovery was achieved in one patient, whereas in the other one, due to late presentation, massive extension and incomplete surgical debridement, the disease was complicated with multiple organ dysfunction and cerebral stroke. By presenting these cases, we would like to point out the importance of early diagnosis, appropriate medical and surgical therapy to obtain a significant survival rate in patients with this fatal disease.

scholarly journals A STUDY ON PRESENTATION AND BEHAVIOR OF COLO-RECTAL CARCINOMA IN JHARKHAND

2020 ◽  
pp. 1-2
Author(s):  
Navin Kumar Saha ◽  
Mritunjay Sarawgi ◽  
C.P. Sinha ◽  
Krishan Kumar
Keyword(s):  
Rectal Carcinoma ◽  
Young Patients ◽  
Rectal Biopsy ◽  
Late Presentation ◽  
Rectal Pain ◽  
Bowel Habits ◽  
Loss Of Weight ◽  
Age Variations ◽  
Rectal Cancers ◽  
And Behavior

Introduction: Colo-rectal carcinoma is most frequent neoplasm of Western countries. It is 3rd most common in men and 2nd most common in women. The Aim of this study is to know different presentations and age variations and its method of diagnosis and management. Materials and methods: This is a observational study including 25 patients presented in the Emergency and OPD of RIMS, Ranchi with complaints of bleeding PR, alteration of bowel habits, rectal pain and discharge, incontinence, abdominal pain and distention and loss of weight. Results: Most common age of presentation is 40-50 years, most commonly involving men. Most common presentation is alteration of bowel habits followed by bleeding PR. Diagnosis was mostly made by CECT whole abdomen and colonoscopic /Rectal biopsy. Follow-up was done by CEA levels. Conclusion: There is increased incidence of colo-rectal carcinoma in young patients and there is tendency of late presentation of colo-rectal cancers.

scholarly journals Post-traumatic Late Presentation of Morel–Lavallée: Case Report and Review of Literature

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Mohammad O Boushnak ◽  
Hussein Rabah ◽  
Mohammad H Saleh ◽  
George Al Aaraj ◽  
Samer Hajjar ◽  
...  
Keyword(s):  
Case Report ◽  
Treatment Options ◽  
Subcutaneous Fat ◽  
Late Presentation ◽  
Deep Fascia ◽  
Incision And Drainage ◽  
Post Traumatic ◽  
Proximal Thigh ◽  
The Right ◽  
Incision Drainage

Introduction: Morel–Lavallée (MLL) is an uncommon entity that is missed by many physicians, it is the result of a shearing force that leads to degloving of the subcutaneous fat from the underlying deep fascia. Case Report: We present a case of a 15-year-old male patient who presented 3 months after the initial crush injury with a large MLL lesion at the lateral aspect of the right proximal thigh. He was treated with incision and drainage with compressive dressing and a negative pressure drain. Conclusion: Diagnosis of MLL is usually clinical and can be aided with radiological tools like MRI that is the gold standard of imaging in this lesion. Several treatment options are available, ranging from conservative treatment with compressive bandages to percutaneous drainage, injection of sclerotic agents, and surgical treatment with incision, drainage, and debridement. Diagnosis and treatment should be familiar to all caregivers to prevent further complications that could be life or organ-threatening. Keywords: Morel–Lavallée, thigh trauma, chronic Morel–Lavallée, thigh mass.

Sporadic rectal cancers in young adults: Experience from a tertiary cancer center in India.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14694-e14694
Author(s):  
Monica Malik ◽  
Kesava Ramgopal Adavikolanu ◽  
Swapna Jilla ◽  
Vindhya Vasini Andra ◽  
Yugandhar Lella ◽  
...  
Keyword(s):  
Overall Survival ◽  
Young Adults ◽  
Dietary Habits ◽  
Positive Family History ◽  
Locally Advanced ◽  
Distant Metastases ◽  
Neoadjuvant Chemoradiation ◽  
Cancer Center ◽  
Screening Programs ◽  
Rectal Cancers

e14694 Background: Recent years have witnessed a trend towards an increase in incidence of rectal cancers in young adults both in western and asian populations. It has been noted that these cancers are more aggressive and associated with poorer outcomes. Methods: We conducted a retrospective analysis of young adults (age ≤ 40 years) with rectal cancers treated at our institute from 2007 to 2012. Information regarding stage, histology, treatment and outcomes were collected from patient records. Patients/family members were contacted for information regarding demographic, socioeconomic, dietary habits and occupational parameters. Disease free and overall survival was analyzed by Kaplan Meier estimates using the SPSS version 20. Results: A of total of 153 cases of rectal cancer were treated between 2007 to 2012 of which 48 patients (31%) were ≤ 40 years of age. Median age at presentation for the younger patients (≤40 years) was 30 years. There were 29 males and 19 females. None of these patients had a positive family history and no synchronous cancers were detected. Six patients were agricultural laborers and four worked in coal or cement factories. 23% of patients hailed from the coastal agricultural belt. At presentation, 41 patients had locally advanced disease and 7 had distant metastases. 25 patients received neoadjuvant chemoradiation, 17 underwent surgery and adjuvant chemoradiation and 6 were treated with palliative intent. Four patients progressed during treatment and eight had recurrent disease during follow up. Median overall survival (OS) was 21 months. 5-year OS was 37.5%. On multivariate analysis, poorly differentiated/mucinous tumors were associated with worse survival (p=0.01). Conclusions: 2-10% of colorectal cancers are reported to occur in young adults with many showing a familial association. In our series we had a higher proportion of young adults with sporadic cancers. Various occupational and environmental factors may be associated with these cancers. They are often detected in late stages and are associated with an aggressive course and unfavorable outcomes; hence early detection is of vital importance. Towards this end, identification of risk factors and screening programs need to be carried out.

scholarly journals Improving Access to Cancer Testing and Treatment in Kenya

2018 ◽  
pp. 1-8 ◽  
Author(s):  
Louise K. Makau-Barasa ◽  
Sandra B. Greene ◽  
Nicholas A. Othieno-Abinya ◽  
Stephanie Wheeler ◽  
Asheley Skinner ◽  
...  
Keyword(s):  
Policy Development ◽  
Treatment Options ◽  
Health Sector ◽  
Late Presentation ◽  
Policy Recommendations ◽  
Health Seeking ◽  
Patients With Cancer ◽  
Treatment Services ◽  
Effective Interventions ◽  
Treatment Facilities

Purpose In response to the increasing cancer burden in Kenya, this study identified barriers to patients seeking access to cancer testing and treatment and to clinicians in delivering these services. Policy recommendations based on findings are presented. Methods This qualitative study used semistructured key informant interviews. Purposive sampling was used to recruit 14 participants: seven oncology clinicians and seven support and advocacy leaders for patients with cancer. Qualitative analysis was used to identify themes. Results Seven barriers to cancer testing and treatment were identified: high cost of testing and treatment, low level of knowledge about cancer among population and clinicians, poor health-seeking behaviors among population, long distances to access diagnostic and treatment services, lack of decentralized diagnostic and treatment facilities, poor communication, and lack of better cancer policy development and implementation. Conclusion Kenyans seeking cancer services face significant barriers that result in late presentation, misdiagnosis, interrupted treatment, stigma, and fear. Four policy recommendations to improve access for patients with cancer are (1) improve health insurance for patients with cancer; (2) establish testing and treatment facilities in all counties; (3) acquire diagnosis and treatment equipment and train health personnel to screen, diagnose, and treat cancer; and (4) increase public health awareness and education about cancer to improve diagnoses and treatment. Effective cancer testing and treatment options can be developed to address cancer in a resource-constrained environment like Kenya. An in-depth look at effective interventions and policies being implemented in countries facing similar challenges would provide valuable lessons to Kenya’s health sector and policymakers.

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