Endoscopic palliative treatment of rectal cancer: our experiences with laser

Izhodišča. Paliativno zdravljenje bolnikov z neozdravljivim rakom je velik problem. Ko gre za bolnika z razširjenim rakom danke, je cilj zdravljenja preprečiti zaporo črevesa, krvavitev iz tumorja in bolečino in tako izboljšati kakovost preostalega življenja. Namen prikazane študije je bil oceniti vlogo laserja v paliativnem zdravljenju raka danke. Bolniki in metode. Od 1998 do 2005 smo z laserjem zdravili 44 bolnikov z rakom danke, ki ga ni bilo mogoče operativno zdraviti. Indikacija za zdravljenje je bila grozeča zapora, krvavitev in/ali bolečina. Rezultati. Rekanalizacijo in hemostazo smo dosegli pri 37 bolnikih, kar je v 84 %. Neuspešni smo bili pri 7 bolnikih, kar je 16 %. Opazovali smo 4 resne, vendar ne smrtne zaplete, perforacije danke z okolnim vnetjem. Vsi zapleti so bili zdravljeni konzervativno. Zaključki. Endoskopsko lasersko zdravljenje bolniki dobro prenašajo, metoda je učinkovita in varna. Je odlična metoda za paliativno zdravljenje raka danke, ki ga ni mogoče operativno zdraviti.Background. The palliative treatment of patients suffering from an incurable cancer is a common problem. In cases of advanced rectal cancer the therapeutic aims are elimination or prevention of obstruction, bleeding and pain and improvement in quality of life. The aim of our study was to evaluate the role of laser in the endoscopic palliative treatment of rectal cancer. Patients and methods. 44 patients with inoperable rectal cancer were treated with laser from 1998 to 2005. The indication for treatment included stenosis, bleeding and/or pain. Results. Recanalisation and haemostasis were achieved in 37 patients (84 %). In 7 patients (16 %) we were unsuccessful. We observed 4 serious but nonfatal complications in form of rectal perforations with inflammation. None of them needed surgical attention. Conclusions. Endoscopic laser therapy is an effective and well tolerated method in palliation of rectal cancer with low risk of complications

Celiakija pri starostniku, ugotovljena z biopsijo terminalnega ileuma

Celiakija je kronična avtoimunska bolezen, ki prizadene tanko črevo pri bolnikih z genetsko predispozicijo ob uživanju glutena. Lahko se pojavi v katerem koli starostnem obdobju pri ženskah in moških. Predstavljamo starostnika s kronično drisko in hujšanjem, pri katerem smo s histološkim izvidom vzorcev sluznice terminalnega ileuma odkrili celiakijo. Le-ta se je odkrila po kirurškem zdravljenju zapletenega zloma in med dolgotrajnim zdravljenjem z antibiotiki. Pojavili so se huda dehidracija z ortostatsko hipotenzijo, metabolna acidoza, ledvična insuficienca, motnje elektrolitov in pomanjkanje vitamina K. Ob potrjeni diagnozi celiakije govorimo o celiakalni krizi. Po brezglutenski dieti se je hitro izboljšala bolnikova telesna zmogljivost, telesna teža je pričela naraščati, laboratorijski izvidi so se usmerili k normalizaciji. S primerom želimo opozoriti, da se lahko celiakija pojavi tudi v 8. desetletju življenja in da je pri klinični sliki kronične driske nanjo potrebno tudi pomisliti

DNA polymorphisms predict time to progression from uncomplicated to complicated Crohn's disease

OBJECTIVE: Most patients with Crohn's disease (CD) are diagnosed with the uncomplicated inflammatory form of the disease (Montreal stage B1). However, the majority of them will progress to complicated stricturing (B2) and penetrating (B3) CD during their lifetimes. The aim of our study was to identify the genetic factors associated with time to progression from uncomplicated to complicated CD. PATIENTS AND METHODS: Patients with an inflammatory phenotype at diagnosis were followed up for 10 years. Genotyping was carried out using Illumina ImmunoChip. After quality control, association analyses, Bonferroni's adjustments, linear and Cox's regression, and Kaplan-Meier analysis were carried out for 111 patients and Manhattan plots were constructed. RESULTS: Ten years after diagnosis, 39.1% of the patients still had the inflammatory form and 60.9% progressed to complicated disease, with an average time to progression of 5.91 years. Ileal and ileocolonic locations were associated with the complicated CD (P=1.08E-03). We found that patients with the AA genotype at single-nucleotide polymorphism rs16857259 near the gene CACNA1E progressed to the complicated form later (8.80 years) compared with patients with the AC (5.11 years) or CC (2.00 years) genotypes (P=3.82E-07). In addition, nine single-nucleotide polymorphisms (near the genes RASGRP1, SULF2, XPO1, ZBTB44, HLA DOA/BRD2, HLA DRB1/HLA DQA1, PPARA, PUDP, and KIAA1614) showed a suggestive association with disease progression (P<10). Multivariate Cox's regression analysis on the basis of clinical and genetic data confirmed the association of the selected model with disease progression (P=5.73E-16). CONCLUSION: Our study confirmed the association between the locus on chromosome 1 near the gene CACNA1E with time to progression from inflammatory to stricturing or penetrating CD. Predicting the time to progression is useful to the clinician in terms of individualizing patients' management

Genetic polymorphism in ATG16L1 gene influences the response to adalimumab in Crohn's disease patients

Aim: To see if SNPs could help predict response to biological therapy using adalimumab (ADA) in Crohn's disease (CD). Materials & methods: IBDQ index and CRP levels were used to monitor therapy response. We genotyped 31 CD-associated genes in 102 Slovenian CD patients. Results: The strongest association for treatment response defined as decrease in CRP levels was found for ATG16L1 SNP rs10210302. Additional SNPs in 7 out of 31 tested CD-associated genes (PTGER4, CASP9, IL27, C11orf30, CCNY, IL13, NR1I2) showed suggestive association with ADA response. Conclusion: Our results suggest ADA response in CD patients is genetically predisposed by SNPs in CD risk genes and suggest ATG16L1 as most promising candidate gene for drug response in ADA treatment. Original submitted 24 September 2014; Revision submitted 1 December 201