Nephroblastoma is the most common malignant renal tumor in children and is related to an abnormal proliferation of cells resembling those of the embryonic kidney (metanephroma), hence the terminology;embryonal tumor. ...Nephroblastoma is the most common malignant renal tumor in children and is related to an abnormal proliferation of cells resembling those of the embryonic kidney (metanephroma), hence the terminology;embryonal tumor. These are tumors that remain and remain unstudied in Mali because they are common in adults in our context. Its annual incidence is estimated at approximately 1/10,000 births. Nephroblastoma is a rare or even exceptional tumor in adults. The clinical manifestation was a large swelling of the right hypochondrium;abdominal pain for a year;unquantified fever, hypertension, initial hematuria associated with burning during urination and anemia. The main clinical manifestation remained fever and abdominal pain. This renal tumor posed a diagnostic problem which was previously labeled as a mesenteric tumor in our general surgery department. The diagnosis was made by imaging: CT and magnetic resonance imaging. The treatment is multidisciplinary and combines chemotherapy, surgery with or without radiotherapy. The prognosis is poor due to late diagnosis and less effectiveness of chemotherapy compared to the child. Survival did not exceed a year and a half because the renal tumor in our patient was surgically overcome. We report a case of nephroblastoma in an 86-year-old patient with unfavorable histology (hematogenous metastases), operated on in the general surgery department and whose postoperative course was simple and who was referred to oncology for treatment.展开更多
Herein we report a patient with nephroblastoma which was successfully removed at the Sunyani Teaching Hospital CJ Oppong theatre in Ghana in sub-Saharan Africa by extended below umbilical incision. Our patient had a f...Herein we report a patient with nephroblastoma which was successfully removed at the Sunyani Teaching Hospital CJ Oppong theatre in Ghana in sub-Saharan Africa by extended below umbilical incision. Our patient had a family history of Wilms tumour predisposing him to the disease. His main symptoms were haematuria and abdominal mass which was noticed later. Examination and investigation were suggestive of a late-stage unilateral Nephroblastoma resulting in the need for nephrectomy. To reduce the need for such radical surgeries among children at an early stage, there is the need for early screening of children for Wilms tumours especially, those with family predisposition as in our case study. The case report presented here constitutes a rare case of nephroblastoma in the literature.展开更多
Objective:The incidence of Wilms’tumor(WT)among adult individuals accounts for less than 1%of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival r...Objective:The incidence of Wilms’tumor(WT)among adult individuals accounts for less than 1%of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70%for the adult patients versus 90%for the pediatric cases.The diagnosis and treatment of WT are complex in the preoperative setting;neoadjuvant chemotherapy(NAC)or robotic surgery has rarely been described.This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy.Methods:We reported a case of WT managed in a multidisciplinary setting.Furthermore,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations,a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out.Results:A 33-year-old female had a diagnosis of WT.She was scheduled to NAC,and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection,she was managed with no intraoperative rupture,a favorable surgical outcome,and a follow-up of 25 months,which did not show any recurrence.The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT.Of these,approximately 15 patients were carried out using robotic surgery in adolescents while none in adults.Moreover,NAC has not been administered before minimally invasive surgery in adults up until now.Conclusion:WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far.The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario.Notwithstanding,additional cases of adult WT need to be identified and investigated to improve the oncological outcome.展开更多
Gastric cancer is the fourth most common cancer,and the second-highest cause of cancer-related deaths worldwide.Despite extensive research to identify novel diagnostic and therapeutic agents,patients with advanced gas...Gastric cancer is the fourth most common cancer,and the second-highest cause of cancer-related deaths worldwide.Despite extensive research to identify novel diagnostic and therapeutic agents,patients with advanced gastric cancer suffer from a poor quality of life and poor prognosis,and treatment is dependent mainly on conventional cytotoxic chemotherapy.To improve the quality of life and survival of gastric cancer patients,a better understanding of the underlying molecular pathologies,and their application towards the development of novel targeted therapies,is urgently needed.Chemokines are a group of small proteins associated with cytoskeletal rearrangements,the directional migration of several cell types during development and physiology,and the host immune response via interactions with G-protein coupled receptors.There is also growing evidence to suggest that chemokines not only play a role in the immune system,but are also involved in the development and progression of tumors.In gastric cancer,CXC chemokines and chemokine receptors regulate the trafficking of cells in and out of the tumor microenvironment.CXC chemokines and their receptors can also directly influence tumorigenesis by modulating tumor transformation,survival,growth,invasion and metastasis,as well as indirectly by regulating angiogenesis,and tumor-leukocyte interactions.In this review,we will focus on the roles of CXC chemokines and their receptors in the development,progression,and metastasis of gastric tumors,and discuss their therapeutic potential for gastric cancer.展开更多
AIM:To establish the feasibility of simultaneous modulated accelerated radiation therapy(SMART) in esophageal cancer(EC).METHODS:Computed tomography(CT)datasets of 10patients with upper or middle thoracic squamous cel...AIM:To establish the feasibility of simultaneous modulated accelerated radiation therapy(SMART) in esophageal cancer(EC).METHODS:Computed tomography(CT)datasets of 10patients with upper or middle thoracic squamous cell EC undergoing chemoradiotherapy were used to generate SMART,conventionally-fractionated three-dimensional conformal radiotherapy(3DCRT)and intensity-modulated radiation therapy(cf-IMRT)plans,respectively.The gross target volume(GTV)of the esophagus,positive regional lymph nodes(LN),and suspected lymph nodes(LN±)were contoured for each patient.The clinical target volume(CTV)was delineated with 2-cm longitudinal and 0.5-to 1.0-cm radial margins with respect to the GTV and with 0.5-cm uniform margins for LN and LN(±).For the SMART plans,there were two planning target volumes(PTVs):PTV66=(GTV+LN)+0.5 cm and PTV54=CTV+0.5 cm.For the 3DCRT and cfIMRT plans,there was only a single PTV:PTV60=CTV+0.5 cm.The prescribed dose for the SMART plans was 66 Gy/30 F to PTV66 and 54 Gy/30 F to PTV54.The dose prescription to the PTV60 for both the 3DCRT and cf-IMRT plans was set to 60 Gy/30 F.All the plans were generated on the Eclipse 10.0 treatment planning system.Fulfillment of the dose criteria for the PTVs received the highest priority,followed by the spinal cord,heart,and lungs.The dose-volume histograms were compared.RESULTS:Clinically acceptable plans were achieved for all the SMART,cf-IMRT,and 3DCRT plans.Compared with the 3DCRT plans,the SMART plans increased the dose delivered to the primary tumor(66Gy vs 60 Gy),with improved sparing of normal tissues in all patients.The Dmax of the spinal cord,V20 of the lungs,and Dmean and V50 of the heart for the SMART and 3DCRT plans were as follows:38.5±2.0 vs 44.7±0.8(P=0.002),17.1±4.0 vs 25.8±5.0(P=0.000),14.4±7.5 vs 21.4±11.1(P=0.000),and 4.9±3.4vs 12.9±7.6(P=0.000),respectively.In contrast to the cf-IMRT plans,the SMART plans permitted a simultaneous dose escalation(6 Gy)to the primary tumor while demonstrating a significant trend of a lower irradiation dose to all organs at risk except the spinal cord,for which no significant difference was found.CONCLUSION:SMART offers the potential for a 6Gy simultaneous escalation in the irradiation dose delivered to the primary tumor of EC and improves the sparing of normal tissues.展开更多
AIM:To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis(UC)patients.METHODS:This was a prospective,multicenter,observational stu...AIM:To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis(UC)patients.METHODS:This was a prospective,multicenter,observational study.Between May 2010 and August 2012,49 steroid-refractory UC patients(55 flare-ups)were consecutively enrolled.All patients were treated with oral tacrolimus without a meal at an initial dose of 0.1mg/kg per day.The dose was adjusted to maintain trough whole-blood levels of 10-15 ng/m L for the first 2 wk.Induction of remission at 2 and 4 wk after tacrolimus treatment initiation was evaluated using Lichtiger’s clinical activity index(CAI).RESULTS:The mean CAI was 12.6±3.6 at onset.Within the first 7 d,93.5%of patients maintained high trough levels(10-15 ng/m L).The CAI significantly decreased beginning 2 d after treatment initiation.At 2wk,73.1%of patients experienced clinical responses.After tacrolimus initiation,31.4%and 75.6%of patients achieved clinical remission at 2 and 4 wk,respectively.Treatment was well tolerated.CONCLUSION:Rapid induction therapy with oral tacrolimus shortened the time to achievement of appropriate trough levels and demonstrated a high remission rate 28 d after treatment initiation.Rapid induction therapy with oral tacrolimus appears to be a useful therapy for the treatment of refractory UC.展开更多
文摘Nephroblastoma is the most common malignant renal tumor in children and is related to an abnormal proliferation of cells resembling those of the embryonic kidney (metanephroma), hence the terminology;embryonal tumor. These are tumors that remain and remain unstudied in Mali because they are common in adults in our context. Its annual incidence is estimated at approximately 1/10,000 births. Nephroblastoma is a rare or even exceptional tumor in adults. The clinical manifestation was a large swelling of the right hypochondrium;abdominal pain for a year;unquantified fever, hypertension, initial hematuria associated with burning during urination and anemia. The main clinical manifestation remained fever and abdominal pain. This renal tumor posed a diagnostic problem which was previously labeled as a mesenteric tumor in our general surgery department. The diagnosis was made by imaging: CT and magnetic resonance imaging. The treatment is multidisciplinary and combines chemotherapy, surgery with or without radiotherapy. The prognosis is poor due to late diagnosis and less effectiveness of chemotherapy compared to the child. Survival did not exceed a year and a half because the renal tumor in our patient was surgically overcome. We report a case of nephroblastoma in an 86-year-old patient with unfavorable histology (hematogenous metastases), operated on in the general surgery department and whose postoperative course was simple and who was referred to oncology for treatment.
文摘Herein we report a patient with nephroblastoma which was successfully removed at the Sunyani Teaching Hospital CJ Oppong theatre in Ghana in sub-Saharan Africa by extended below umbilical incision. Our patient had a family history of Wilms tumour predisposing him to the disease. His main symptoms were haematuria and abdominal mass which was noticed later. Examination and investigation were suggestive of a late-stage unilateral Nephroblastoma resulting in the need for nephrectomy. To reduce the need for such radical surgeries among children at an early stage, there is the need for early screening of children for Wilms tumours especially, those with family predisposition as in our case study. The case report presented here constitutes a rare case of nephroblastoma in the literature.
文摘Objective:The incidence of Wilms’tumor(WT)among adult individuals accounts for less than 1%of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70%for the adult patients versus 90%for the pediatric cases.The diagnosis and treatment of WT are complex in the preoperative setting;neoadjuvant chemotherapy(NAC)or robotic surgery has rarely been described.This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy.Methods:We reported a case of WT managed in a multidisciplinary setting.Furthermore,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations,a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out.Results:A 33-year-old female had a diagnosis of WT.She was scheduled to NAC,and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection,she was managed with no intraoperative rupture,a favorable surgical outcome,and a follow-up of 25 months,which did not show any recurrence.The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT.Of these,approximately 15 patients were carried out using robotic surgery in adolescents while none in adults.Moreover,NAC has not been administered before minimally invasive surgery in adults up until now.Conclusion:WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far.The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario.Notwithstanding,additional cases of adult WT need to be identified and investigated to improve the oncological outcome.
基金Supported by Basic Science Research Program through the National Research of Korea(NRF)funded by the Ministry of Education,Science and Technology,NRF-2009-0076540,NRF-2009-0067256
文摘Gastric cancer is the fourth most common cancer,and the second-highest cause of cancer-related deaths worldwide.Despite extensive research to identify novel diagnostic and therapeutic agents,patients with advanced gastric cancer suffer from a poor quality of life and poor prognosis,and treatment is dependent mainly on conventional cytotoxic chemotherapy.To improve the quality of life and survival of gastric cancer patients,a better understanding of the underlying molecular pathologies,and their application towards the development of novel targeted therapies,is urgently needed.Chemokines are a group of small proteins associated with cytoskeletal rearrangements,the directional migration of several cell types during development and physiology,and the host immune response via interactions with G-protein coupled receptors.There is also growing evidence to suggest that chemokines not only play a role in the immune system,but are also involved in the development and progression of tumors.In gastric cancer,CXC chemokines and chemokine receptors regulate the trafficking of cells in and out of the tumor microenvironment.CXC chemokines and their receptors can also directly influence tumorigenesis by modulating tumor transformation,survival,growth,invasion and metastasis,as well as indirectly by regulating angiogenesis,and tumor-leukocyte interactions.In this review,we will focus on the roles of CXC chemokines and their receptors in the development,progression,and metastasis of gastric tumors,and discuss their therapeutic potential for gastric cancer.
基金Supported by Shantou University Medical College Clinical Research Enhancement Initiative,and Research and Travel Grants from the Science and Technology Key Project of Shantou City,China,2012,No.2012-165-131
文摘AIM:To establish the feasibility of simultaneous modulated accelerated radiation therapy(SMART) in esophageal cancer(EC).METHODS:Computed tomography(CT)datasets of 10patients with upper or middle thoracic squamous cell EC undergoing chemoradiotherapy were used to generate SMART,conventionally-fractionated three-dimensional conformal radiotherapy(3DCRT)and intensity-modulated radiation therapy(cf-IMRT)plans,respectively.The gross target volume(GTV)of the esophagus,positive regional lymph nodes(LN),and suspected lymph nodes(LN±)were contoured for each patient.The clinical target volume(CTV)was delineated with 2-cm longitudinal and 0.5-to 1.0-cm radial margins with respect to the GTV and with 0.5-cm uniform margins for LN and LN(±).For the SMART plans,there were two planning target volumes(PTVs):PTV66=(GTV+LN)+0.5 cm and PTV54=CTV+0.5 cm.For the 3DCRT and cfIMRT plans,there was only a single PTV:PTV60=CTV+0.5 cm.The prescribed dose for the SMART plans was 66 Gy/30 F to PTV66 and 54 Gy/30 F to PTV54.The dose prescription to the PTV60 for both the 3DCRT and cf-IMRT plans was set to 60 Gy/30 F.All the plans were generated on the Eclipse 10.0 treatment planning system.Fulfillment of the dose criteria for the PTVs received the highest priority,followed by the spinal cord,heart,and lungs.The dose-volume histograms were compared.RESULTS:Clinically acceptable plans were achieved for all the SMART,cf-IMRT,and 3DCRT plans.Compared with the 3DCRT plans,the SMART plans increased the dose delivered to the primary tumor(66Gy vs 60 Gy),with improved sparing of normal tissues in all patients.The Dmax of the spinal cord,V20 of the lungs,and Dmean and V50 of the heart for the SMART and 3DCRT plans were as follows:38.5±2.0 vs 44.7±0.8(P=0.002),17.1±4.0 vs 25.8±5.0(P=0.000),14.4±7.5 vs 21.4±11.1(P=0.000),and 4.9±3.4vs 12.9±7.6(P=0.000),respectively.In contrast to the cf-IMRT plans,the SMART plans permitted a simultaneous dose escalation(6 Gy)to the primary tumor while demonstrating a significant trend of a lower irradiation dose to all organs at risk except the spinal cord,for which no significant difference was found.CONCLUSION:SMART offers the potential for a 6Gy simultaneous escalation in the irradiation dose delivered to the primary tumor of EC and improves the sparing of normal tissues.
文摘AIM:To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis(UC)patients.METHODS:This was a prospective,multicenter,observational study.Between May 2010 and August 2012,49 steroid-refractory UC patients(55 flare-ups)were consecutively enrolled.All patients were treated with oral tacrolimus without a meal at an initial dose of 0.1mg/kg per day.The dose was adjusted to maintain trough whole-blood levels of 10-15 ng/m L for the first 2 wk.Induction of remission at 2 and 4 wk after tacrolimus treatment initiation was evaluated using Lichtiger’s clinical activity index(CAI).RESULTS:The mean CAI was 12.6±3.6 at onset.Within the first 7 d,93.5%of patients maintained high trough levels(10-15 ng/m L).The CAI significantly decreased beginning 2 d after treatment initiation.At 2wk,73.1%of patients experienced clinical responses.After tacrolimus initiation,31.4%and 75.6%of patients achieved clinical remission at 2 and 4 wk,respectively.Treatment was well tolerated.CONCLUSION:Rapid induction therapy with oral tacrolimus shortened the time to achievement of appropriate trough levels and demonstrated a high remission rate 28 d after treatment initiation.Rapid induction therapy with oral tacrolimus appears to be a useful therapy for the treatment of refractory UC.
