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1.
《Anaesthesia and Intensive Care Medicine》2020,21(11):572-577
Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in preoperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before, during and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications. 相似文献
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Sebastian Mondaca Walid K. Chatila David Bates Jaclyn F. Hechtman Andrea Cercek Neil H. Segal Zsofia K. Stadler Anna M. Varghese Ritika Kundra Marinela Capanu Jinru Shia Nikolaus Schultz Leonard Saltz Rona Yaeger 《Clinical colorectal cancer》2019,18(1):e39-e52
Background
Treatment of advanced anal squamous cell cancer (SCC) is usually with the combination of cisplatin and 5-fluorouracil, which is associated with heterogeneous responses across patients and significant toxicity. We examined the safety and efficacy of a modified schedule, FOLFCIS (leucovorin, fluorouracil, and cisplatin), and performed an integrated clinical and genomic analysis of anal SCC.Patients and Methods
We reviewed all patients with advanced anal SCC receiving first-line FOLFCIS chemotherapy – essentially a FOLFOX (leucovorin, fluorouracil, and oxaliplatin) schedule with cisplatin substituted for oxaliplatin – in our institution between 2007 and 2017, and performed deep sequencing to identify genomic markers of response and key genomic drivers.Results
Fifty-three patients with advanced anal SCC (48 metastatic; 5 unresectable, locally advanced) received first-line FOLFCIS during this period; all were platinum-naive. The response rate was 48% (95% confidence interval [CI], 32.6%-63%). With a median follow-up of 41.6 months, progression-free survival and overall survival were 7.1 months (95% CI, 4.4-8.6 months) and 22.1 months (95% CI, 16.9-28.1 months), respectively. Among all patients with advanced anal SCC that underwent sequencing during the study period, the most frequent genomic alterations consisted of chromosome 3q amplification (51%) and mutations in PIK3CA (29%) and KMT2D (22%). No genomic alteration correlated with response to platinum-containing treatment. Although there were few cases, patients with human papillomavirus-negative anal SCC did not appear to benefit from FOLFCIS, and all harbored distinct genomic profiles with TP53, TERT promoter, and CDKN2A mutations.Conclusions
FOLFCIS appears effective and safe as first-line chemotherapy in patients with advanced anal SCC and represents an alternative treatment option for these patients. 相似文献4.
Diede L. Loopik Renée M. Ebisch Joanna IntHout Willem J. Melchers Leon F. Massuger Ruud L. Bekkers Albert G. Siebers 《International journal of cancer. Journal international du cancer》2020,147(3):897-900
Women with cervical intraepithelial neoplasia grade 3 (CIN3) have a long-lasting increased risk for noncervical high-risk human papillomavirus (hrHPV)-related (pre)malignancies. The aim of our study was to estimate this risk in women with recurrent CIN3 compared to women without a history of CIN3 and women with a single episode of CIN3. Women with a CIN3 diagnosis between 1990 and 2010 were obtained from the Dutch Pathology Registry (PALGA) and matched with a control group of women without CIN3. Analysis has been conducted in a subset of women with recurrent CIN3, defined as reoccurrence minimally 2 years post-treatment. Cases of noncervical hrHPV-related (pre)malignancies of the anus, vulva, vagina and oropharynx were identified until 2015 and incidence rate ratios (IRRs) were estimated. Then, 1,797 women with recurrent CIN3 were included with a median age of 34 years (range 18–76) and 31,594 person-years of follow-up. Women with recurrent CIN3 had an increased risk of developing noncervical hrHPV-related (pre)malignancies compared to women without CIN3 with an IRR of 25.96 (95%CI 6.32–106.58). The IRR was 2.48 (95% CI 1.87–3.30) compared to women with a single episode of CIN3. Studies on posttreatment follow-up and prophylactic hrHPV vaccination are warranted. 相似文献
5.
目的用人乳头瘤病毒杂交捕获法(hc2 HPV DNA)监测宫颈癌前病变,提高诊断率。方法hc2 HPV DNA和TCT两种方法并用检测1231例宫颈外口及颈管脱落细胞。结果1231例样本中,HPV感染率34.0%,而21~40岁年龄段略高于其他年龄段;宫颈鳞状上皮正常HPV感染率23.2%。在细胞学诊断为ASC-us、ASC-h、LSIL和HSIL组中,HPV感染率依次为50.0%、58.8%、76.7%和93.3%。TCT检测:正常+炎症1077例;asc-us 32例;ASC-h 34例;LSIL 73例,HSIL 15例。ASC-us、ASC-h、LSIL和HSIL检出率分别为2.6%、2.8%、5.9%和1.2%。统计学检验表明:HPV感染与细胞形态和结构的异常具有高度相关性(P〈0.01)。结论在宫颈鳞状上皮正常时HPV感染率最低,重度炎症时HPV感染率出现增高的趋势;当细胞形态和结构出现异常时,HPV的感染率明显增加,即HSIL〉15IL〉ASC-h〉ASC-us〉正常+炎症。 相似文献
6.
W. A. A. Tjalma M. Arbyn† J. Paavonen‡ T. R. Van Waes & J. J. Bogers§ 《International journal of gynecological cancer》2004,14(5):751-761
Persistent infection with one of the oncogenic human papillomavirus (HPV) types is a necessity for the development of cervical cancer. By HPV vaccination, cervical cancer could become a very rare disease. Two types of HPV vaccines can be distinguished: (i) therapeutic vaccines which induce cellular immunity targeted against epithelial cells infected with HPV and (ii) prophylactic vaccines inducing virus-neutralizing antibodies protecting against new but not against established infections. At present, several vaccines have been developed and tested in clinical trials. The vaccines are generally well tolerated and highly immunogenic. The current clinical data indicate that prophylactic vaccines are very effective against new persistent infections and the development of cervical intraepithelial lesions. The protection is type specific. However, the follow-up of the vaccination trials is still short. The effect of HPV vaccines on future cancer incidence will only be known after decades of follow-up. This article will address the status of recently terminated phase II and currently running phase III trials with prophylactic HPV vaccines. 相似文献
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Bo Sikström M.D. Dan Hellberg M.D. Ph.D. Staffan Nilsson M.D. Ph.D. Christina Brihmer M.D. Ph.D. Per-Anders Mårdh M.D. Ph.D. 《Archives of sexual behavior》1996,25(4):361-372
In a study of 972 women, sexual characteristics of 66 women with a cervical human papillomavirus infection (CHPI) were compared
to the remaining study population. Among a number of sexual variables that were significantly correlated with CHPI were number
of lifetime sexual partners, short partnerships, many recent partners, infidelity, casual travel sex, sexual début abroad,
oral and anal sex, and sexual abuse. In multifactorial analyses four variables remained significantly correlated with CHPI,
i.e., number of lifetime sexual partners, casual travel sex, sexual début abroad, and infidelity. It is concluded that CHPI
shows most of the epidemiological characteristics of a sexually transmitted disease. 相似文献
9.
Coupé VM Berkhof J Verheijen RH Meijer CJ 《BJOG : an international journal of obstetrics and gynaecology》2007,114(4):416-424
OBJECTIVE: To compare current cytological follow up of women treated for high-grade cervical intraepithelial neoplasia (CIN) with follow up by high-risk human papillomavirus (HPV) testing together with cytology. DESIGN: A cost-effectiveness modelling study. SETTING: Gynaecology clinics in the Netherlands. POPULATION: Women treated for high-grade CIN. METHODS: A Markov model was developed to compare six follow-up strategies with HPV testing with current cytological follow up at 6, 12, and 24 months. Model parameter estimation was based on three Dutch follow-up studies and a Dutch population-based screening cohort. MAIN OUTCOME MEASURES: The number of CIN2/3 cases missed after 5 years follow up, the number of diagnostic procedures, and costs involved. RESULTS: Strategies with adjunct HPV testing were more effective than current follow up (reduction in missed CIN2/3 cases 32-77%, corresponding to a number needed to treat of 192-455) and less inconvenient (reduction in repeat smears 28-65%). A particularly attractive strategy was HPV testing alone at 6 months and both HPV and cytological testing at 24 months after treatment. This strategy yielded a high detection rate of post-treatment CIN, did not lead to an increase in colposcopy rate, and was 49 Euro per woman cheaper than the current strategy. CONCLUSIONS: Our model supports the use of high-risk HPV testing for monitoring women treated for high-grade CIN. 相似文献
10.
原位杂交与免疫组化技术在HPV检测中的应用 总被引:5,自引:0,他引:5
目的:对两种HPV检测技术DNA原位杂交和免疫组化染色方法进行对比观察。方法:选取本院外阴尖锐湿疣病例95例,组织经固定、脱水、石蜡包埋、切片,分别采用原位杂交和免疫组化技术进行检测。结果:HPV—DNA阳性率为94.7%(90/95),阳性反应由鳞状上皮表层的空泡细胞核内延伸至棘层中下部近基底层的细胞核内;HPV—Ag阳性率为63.1%(60/95),阳性反应主要位于鳞状上皮表层的空泡细胞核内及角质层内。个别阳性细胞可在棘层出现。结论:原位杂交技术在敏感度、阳性率及阳性强度、背景染色等方面均优于免疫组化方法,为尖锐湿疣的确诊及临床治疗提供更准确、可靠的依据。 相似文献