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Alternative Therapies in Health and... Apr 2024Appendicitis (AP) is a prevalent and sudden disease, and although surgery can be effective in treating it, post-surgical care is of great importance in improving the...
BACKGROUNDS
Appendicitis (AP) is a prevalent and sudden disease, and although surgery can be effective in treating it, post-surgical care is of great importance in improving the patient's recovery.
OBJECTIVE
To analyze the impact of Failure Mode and Effect Analysis (FMEA)-based nursing on patients with AP after surgery.
METHODS
A total of 104 patients with AP who received treatment in Fuyang Shi Hospital of TCM from December 2021 to February 2023 were enrolled and randomly divided into a control group (n = 52) who received routine nursing and a research group (n = 52) who receive FMEA-based nursing. The time to recovery of bowel sounds, time to defecation by anus, time to anal exhaust, and length of stay were statistically analyzed in both groups after surgery. Pain, sleep, and psychological status of patients before and after surgery were assessed using the visual analog scale (VAS), Pittsburgh Sleep Quality Index (PSQI), and self-rating anxiety scale/self-rating depression scale (SAS/SDS). Patients' satisfaction with nursing was also investigated, and the incidence of postoperative complications was recorded.
RESULTS
After surgery, the research group showed shorter time to recovery of bowel sounds, time to defecation by anus, time to anal exhaust, and length of stay, and lower scores of VAS, PSQI, SAS, and SDS than those of the control group (P < .05). As indicated by the satisfaction survey, compared with the control group, the research group showed a larger number of patients who were very satisfied with nursing and a smaller number of patients who thought their nursing should be improved; the incidence of postoperative complications was also lower in the research group (P < .05).
CONCLUSION
For patients with AP, FMEA-based nursing improves their postoperative recovery, alleviates their pain, and ameliorates their sleep quality, which is of high clinical application value.
PubMed: 38607205
DOI: No ID Found -
The Journal of International Medical... Apr 2024Non-acquired immunodeficiency syndrome-defining cancers (NADCs) are malignancies in persons living with human immunodeficiency virus (PLWHIV) and are not primarily due... (Review)
Review
Non-acquired immunodeficiency syndrome-defining cancers (NADCs) are malignancies in persons living with human immunodeficiency virus (PLWHIV) and are not primarily due to the host's immunodeficiency. There is renewed clinical interest in long-term morbidities in PLWHIV as well as malignancies that occur in this population. We herein describe a 36-year-old woman with a 2-year history of an anal wound and right breast mass. She had been diagnosed with HIV infection prior to the development of these lesions. Clinical and laboratory evaluations led to diagnoses of breast and anal cancers. Chemotherapy and antiretroviral therapy were begun, but the patient discontinued these treatments early and was lost to follow-up. NADCs will continue to be a major clinical issue as the global population ages. This presentation of two NADCs (breast and anal cancers) in a PLWHIV further highlights the burden of multiple malignancies on the depleted health of HIV-infected patients. Early identification and treatment of HIV upon patients' presentation to cancer care sites and screening for NADCs at HIV/AIDS care sites are recommended for improved outcomes.
Topics: Female; Humans; Adult; HIV Infections; Neoplasms; Acquired Immunodeficiency Syndrome; HIV; Anus Neoplasms; Carcinoma
PubMed: 38606735
DOI: 10.1177/03000605241245011 -
Cancer Research and Treatment Apr 2024This study aimed to assess the prognostic significance of bulky nodal involvement in patients with anal squamous cell carcinoma treated with definitive chemoradiotherapy.
PURPOSE
This study aimed to assess the prognostic significance of bulky nodal involvement in patients with anal squamous cell carcinoma treated with definitive chemoradiotherapy.
MATERIALS AND METHODS
We retrospectively analyzed medical records of patients diagnosed with anal squamous cell carcinoma who underwent definitive chemoradiotherapy at three medical centers between 2004 and 2021. Exclusion criteria included distant metastasis at diagnosis, 2D radiotherapy, and salvage treatment for local relapse. Bulky N+ was defined as nodes with a long diameter of 2 cm or greater.
RESULTS
A total of 104 patients were included, comprising 51 with N0, 46 with non-bulky N+, and 7 with bulky N+. The median follow-up duration was 54.0 months (range, 6.4-162.2 months). Estimated 5-year progression-free survival (PFS), loco-regional recurrence-free survival (LRRFS), and overall survival (OS) rates for patients with bulky N+ were 42.9%, 42.9%, and 47.6%, respectively. Bulky N+ was significantly associated with inferior PFS, LRRFS and OS compared to patients without or with non-bulky N+, even after multivariate analysis. We proposed a new staging system incorporating bulky N+ as N2 stage, with estimated 5-year LRRFS, PFS, and OS rates of 81.1%, 80.6%, and 86.2% for stage I, 67.7%, 60.9%, and 93.3% for stage II, and 42.9%, 42.9%, and 47.6% for stage III disease, enhancing the predictability of prognosis.
CONCLUSION
Patients with bulky nodal disease treated with standard chemoradiotherapy experienced poor survival outcomes, indicating the potential necessity for further treatment intensification.
PubMed: 38605662
DOI: 10.4143/crt.2024.258 -
Seminars in Pediatric Surgery Apr 2024Perianal complications are common and morbid in children with Crohn's disease. In this review, we describe the epidemiology, the presentation and diagnosis, evaluation... (Review)
Review
Perianal complications are common and morbid in children with Crohn's disease. In this review, we describe the epidemiology, the presentation and diagnosis, evaluation and management. We focus on updates such as the increasing frequency of biologic medications and MRI for evaluation. We also highlight controversies on the timing and approaches to surgical techniques. Finally, perianal disease requires the coordination of multidisciplinary care with nursing, radiology, gastroenterology, and surgery to optimize outcomes - both medical and patient-centered.
Topics: Humans; Crohn Disease; Child; Anus Diseases
PubMed: 38603820
DOI: 10.1016/j.sempedsurg.2024.151402 -
The New England Journal of Medicine Apr 2024
Topics: Humans; Antineoplastic Agents; Antiviral Agents; Anus Neoplasms; Betapapillomavirus; Carcinoma, Squamous Cell; Receptors, CXCR4; Papillomavirus Infections; Primary Immunodeficiency Diseases; Warts; Gain of Function Mutation
PubMed: 38598804
DOI: 10.1056/NEJMc2213180 -
Radiologie (Heidelberg, Germany) May 2024Developmental disorders of the gastrointestinal tract comprise a broad spectrum of congenital malformations of different etiologies and locations from the mouth to the...
BACKGROUND
Developmental disorders of the gastrointestinal tract comprise a broad spectrum of congenital malformations of different etiologies and locations from the mouth to the anus.
METHODS
The authors present the most important malformations of the gastrointestinal tract on the basis of basic and current reviews.
RESULTS
Gastrointestinal developmental disorders occur both sporadically and in connection with malformation syndromes. Symptoms are highly variable and range from postnatal emergencies to asymptomatic abnormalities, which may be incidental radiological findings. Prenatal ultrasound examinations can often identify gastrointestinal developmental disorders at an early stage. Here, fetal magnetic resonance imaging can be a useful addition to the diagnostic process. In the first few days of life, simple X‑ray overview images, supplemented by images after the administration of contrast medium, are often sufficient.
CONCLUSION
Many patients with a malformation of the gastrointestinal tract require lifelong medical care, so that not only pediatric radiologists need specific knowledge about this group of diseases.
Topics: Female; Humans; Infant, Newborn; Digestive System Abnormalities; Gastrointestinal Diseases; Gastrointestinal Tract; Magnetic Resonance Imaging; Ultrasonography, Prenatal
PubMed: 38598006
DOI: 10.1007/s00117-024-01302-3 -
World Journal of Gastroenterology Mar 2024In 2000, the small bowel capsule revolutionized the management of patients with small bowel disorders. Currently, the technological development achieved by the new...
In 2000, the small bowel capsule revolutionized the management of patients with small bowel disorders. Currently, the technological development achieved by the new models of double-headed endoscopic capsules, as miniaturized devices to evaluate the small bowel and colon [pan-intestinal capsule endoscopy (PCE)], makes this non-invasive procedure a disruptive concept for the management of patients with digestive disorders. This technology is expected to identify which patients will require conventional invasive endoscopic procedures (colonoscopy or balloon-assisted enteroscopy), based on the lesions detected by the capsule, those with an indication for biopsies or endoscopic treatment. The use of PCE in patients with inflammatory bowel diseases, namely Crohn's disease, as well as in patients with iron deficiency anaemia and/or overt gastrointestinal (GI) bleeding, after a non-diagnostic upper endoscopy (esophagogastroduodenoscopy), enables an effective, safe and comfortable way to identify patients with relevant lesions, who should undergo subsequent invasive endoscopic procedures. The recent development of magnetically controlled capsule endoscopy to evaluate the upper GI tract, is a further step towards the possibility of an entirely non-invasive assessment of all the segments of the digestive tract, from mouth-to-anus, meeting the expectations of the early developers of capsule endoscopy.
Topics: Humans; Capsule Endoscopy; Endoscopy, Gastrointestinal; Intestinal Diseases; Crohn Disease; Intestine, Small; Gastrointestinal Hemorrhage
PubMed: 38596501
DOI: 10.3748/wjg.v30.i10.1270 -
The Journal of Small Animal Practice Jun 2024To report the histopathological diagnosis of both anal sacs in dogs undergoing bilateral anal sacculectomy for the treatment of unilateral apocrine gland anal sac...
Histopathological diagnosis and surgical complications following bilateral anal sacculectomy for the treatment of unilateral canine apocrine gland anal sac adenocarcinoma: 35 cases (2019-2023).
OBJECTIVES
To report the histopathological diagnosis of both anal sacs in dogs undergoing bilateral anal sacculectomy for the treatment of unilateral apocrine gland anal sac adenocarcinoma and to compare the surgical complication rate associated with this procedure in this population with previously published literature.
MATERIALS AND METHODS
Records were retrospectively reviewed for dogs that underwent bilateral anal sacculectomy for the treatment of apparently unilateral apocrine gland anal sac adenocarcinoma, at a single institute between 2019 and 2023. Clinical staging, surgical treatment, histological findings, intra- and postoperative complications were evaluated.
RESULTS
Thirty-five dogs were included. Only five of 35 (14%) dogs were found to have histologically normal contralateral anal sacs. Non-neoplastic anal sac disease was found in 23 of 35 (66%) dogs and bilateral apocrine gland anal sac adenocarcinoma was seen in seven of 35 (20%) dogs. None of the dogs diagnosed with bilateral neoplasia had evidence of bilateral neoplasia before surgery despite a thorough work-up. Complications attributable to the primary tumour removal were seen in 9% of dogs intraoperatively and 14% of dogs postoperatively, commonly tumour capsule disruption and surgical site infection, respectively.
CLINICAL SIGNIFICANCE
Bilateral anal sac disease was diagnosed histologically in the majority of presumed normal anal sacs, with 20% of cases being found to have bilateral apocrine gland anal sac adenocarcinoma. The surgical complication rates of this cohort were comparable to those reported for unilateral anal sacculectomy alone. These findings promote and encourage the use of bilateral anal sacculectomy in cases of suspected unilateral anal sac neoplasia.
Topics: Dogs; Animals; Dog Diseases; Anal Sacs; Adenocarcinoma; Retrospective Studies; Male; Female; Postoperative Complications; Anal Gland Neoplasms; Apocrine Glands
PubMed: 38594872
DOI: 10.1111/jsap.13731 -
Journal of Gastrointestinal Surgery :... Apr 2024Anal adenocarcinoma is rare with no standardized treatment regimen or staging system. Therefore, different combinations of chemotherapy, radiation, and surgery are used...
BACKGROUND
Anal adenocarcinoma is rare with no standardized treatment regimen or staging system. Therefore, different combinations of chemotherapy, radiation, and surgery are used in management. Within the staging system, tumor stage can be based on the depth of invasion, as for rectal adenocarcinoma, or size, as in anal squamous cell carcinoma. This study aimed to analyze patterns of care and clinically available staging systems for anal adenocarcinoma using a national database.
METHODS
Adults diagnosed with anal adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results database (2004-2019). In addition, 6 different treatment regimens were identified. Stages were categorized according to the American Joint Committee on Cancer classifications of rectal adenocarcinoma and anal squamous cell carcinoma.
RESULTS
Of 1040 patients, 48% were female, the median age was 67 years, and 18% had distant metastases. Chemoradiotherapy + abdominoperineal resection was the most common treatment regimen (22%). Moreover, 5-year overall survival (OS) and disease-specific survival (DSS) were the highest for local excision only (67% and 85%) and the lowest in the alternative group (34% and 48%). After adjustment, the treatment groups that did not include surgery were associated with worse 5-year OS. In multivariable analysis, the T stage based on depth of invasion showed incrementally lower OS for T2 and T3 anal adenocarcinomas.
CONCLUSION
Omission of surgical resection in combination with chemoradiotherapy was associated with worse OS and DSS, suggesting the relevance of surgery in anal adenocarcinoma management. Prognostically, rectal staging based on depth of invasion better discriminated between T stages, indicating that providers should consider using this system in practice.
Topics: Adult; Humans; Female; United States; Aged; Male; Neoplasm Staging; Anus Neoplasms; Adenocarcinoma; Rectal Neoplasms; Carcinoma, Squamous Cell; Retrospective Studies
PubMed: 38583905
DOI: 10.1016/j.gassur.2024.01.013 -
International Journal of Cancer Jul 2024Human papillomavirus (HPV) proteins may elicit antibody responses in the process toward HPV-related malignancy. However, HPV seroepidemiology in noncervical HPV-related...
Human papillomavirus (HPV) proteins may elicit antibody responses in the process toward HPV-related malignancy. However, HPV seroepidemiology in noncervical HPV-related cancers remains poorly understood, particularly in populations with a high prevalence of human immunodeficiency virus (HIV). Using a glutathione S-transferase-based multiplex serology assay, antibodies against E6, E7 and L1 proteins of HPV16 and HPV18 were measured in sera of 535 cases of noncervical HPV-related cancers (anal (n = 104), vulval (n = 211), vaginal (n = 49), penile (n = 37) and oropharyngeal (n = 134)) and 6651 non-infection-related cancer controls, from the Johannesburg Cancer Study that recruited Black South African with newly diagnosed cancer between 1995 and 2016. Logistic and Poisson regression models were used to calculate adjusted odds ratios (aOR) and prevalence ratios (aPR) and 95% confidence intervals (CI) in cases versus controls. HPV16 E6 was more strongly associated with noncervical HPV-related cancers than HPV16 L1 or E7, or HPV18 proteins: anal (females (HPV16 E6 aOR = 11.50;95%CI:6.0-22.2), males (aOR = 10.12;95%CI:4.9-20.8), vulval (aOR = 11.69;95%CI:7.9-17.2), vaginal (aOR = 10.26;95%CI:5.0-21), penile (aOR = 18.95;95%CI:8.9-40), and oropharyngeal (females (aOR = 8.95;95%CI:2.9-27.5), males (aOR = 3.49;95%CI:1.8-7.0)) cancers. HPV16-E6 seropositivity ranged from 24.0% to 35.1% in anal, vulval, vaginal and penile cancer but was significantly lower (11.2%) in oropharyngeal cancer. After adjustment for HIV, prevalence of which increased from 22.2% in 1995-2005 to 54.1% in 2010-2016, HPV16 E6 seropositivity increased by period of diagnosis (aPR for 2010-2016 vs. 1995-2006 = 1.84;95%CI:1.1-3.0). Assuming HPV16 E6 seroprevalence reflects HPV attributable fraction, the proportion of certain noncervical-HPV-related cancers caused by HPV is increasing over time in South Africa. This is expected to be driven by the increasing influence of HIV.
Topics: Humans; Male; Female; South Africa; Papillomavirus Infections; Middle Aged; Adult; Antibodies, Viral; Oncogene Proteins, Viral; HIV Infections; Human papillomavirus 16; Aged; Oropharyngeal Neoplasms; Seroepidemiologic Studies; Case-Control Studies; Human papillomavirus 18; Vulvar Neoplasms; Penile Neoplasms; Anus Neoplasms; Vaginal Neoplasms; Black People; Repressor Proteins; Neoplasms; Human Papillomavirus Viruses
PubMed: 38577820
DOI: 10.1002/ijc.34919