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P Luna-Pérez

Publications and source records attributed to P Luna-Pérez.

At least 19 recordsLinked to original sources
PubMed2001

Preoperative chemoradiation therapy and anal sphincter preservation with locally advanced rectal adenocarcinoma.

Preoperative irradiation has been used to produce tumor regression and allow complete resection of rectal cancer with a sphincter-saving procedure. To evaluate the associated toxicity, the response in the primary tumor, and the postsurgical morbidity in a group of patients with locally advanced rectal cancer treated with preoperative chemoradiation therapy and low anterior resection, 120 patients were treated with 45 Gy of preoperative radiotherapy and a bolus infusion of 5-fluorouracil 450 mg/m2 on days 1 to 5 and 28 to 32 of radiotherapy. Four to six weeks later, 16 lesions were found unresectable; 36 patients underwent abdominoperineal resection or pelvic exenteration, and in the remaining 68 a low anterior resection was performed. For the purpose of this study only the latter group was included. There were 38 men and 30 women, with a mean age of 54.7 +/- 13.1 years. Gastrointestinal and hematologic acute toxicity grade 3 to 4 occurred in 12 and 7 patients, respectively. The mean distance of the tumor above the anal verge was 8.2 +/- 2.6 cm. In 10 patients the surgical resection included neighboring pelvic organs; 16 patients (23.5%) required a temporary diverting colostomy. The main causes of surgical morbidity were clinical anastomotic leakage in seven (10%), abdominal wall infection in five (7.4%), anastomotic stenosis in three (4.5%), and intraabdominal abscess in one (1.5%). No operative deaths occurred. The postsurgical stages were as follows: no tumor in the specimen, 17 (25%); T1, 4 (6%); T2, 12 (17%); T3, 17 (25%); T4, 5 (7%); any T with N+, 9 (13%); and any T, N with M+, 4 (6%). The median and mean follow-ups were 30.0 months and 37.4 +/- 25.0 months, respectively. The local recurrence rate was 2.9%, and the distant recurrence rate was 17%. The administration of preoperative chemoradiation therapy for locally advanced rectal cancer is associated with tolerable toxicity, a high rate of response in the primary tumor that allowed anal sphincter preservation, and a low rate of local recurrence.

Adenocarcinoma↗
PubMed2000

Specific c-K-ras gene mutations as a tumor-response marker in locally advanced rectal cancer treated with preoperative chemoradiotherapy.

BACKGROUND: Forty percent of patients with colorectal cancer develop mutations in the K-ras gene. OBJECTIVE: Our objective was to evaluate whether the presence of c-K-ras gene mutations is a useful tumor-response marker in patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy. MATERIAL AND METHODS: Thirty seven patients with locally advanced rectal cancer were treated with preoperative chemoradiotherapy. Four to six weeks later, surgery was performed. Specimens were classified according to the UICC-AJC classification. A segment of the tumor was obtained to analyze specific c-K-ras gene mutations. Restriction fragment length polymorphism (RFLP) and single strand confirmation polymorphism (SSCP) techniques were used with a set of probes to detect specific c-K-ras mutations in codons 12, 13, and 61. The 37 patients were divided into Group A (with mutations) and Group B (without mutations). RESULTS: All 37 patients completed the scheduled treatment. Group A consisted of 12 patients, whose tumors were classified and specific c-K-ras mutations were located as follows: eight in codon 12, two in codon 13, and one in codon 61. Group B consisted of 25 patients. The tumors were classified and there were more early-stage tumors in Group A, whereas in Group B there were more advanced-stage tumors (P = .05, respectively). The mean follow-up was 36.2+/-18.3 months. All Group A patients survived, whereas 8 of the 25 patients in Group B died due to progressive metastatic disease. Survival in Group A was 100%, whereas in Group B it was 59% (P = .03). CONCLUSIONS: The presence of specific c-K-ras mutations is an indicator of tumor response in patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy and surgery. Therefore, responding patients may be more amenable to less radical surgical procedures based on c-K-ras mutations.

Adenocarcinoma↗
PubMed1999

Inguinal lymph node metastases from rectal adenocarcinoma.

BACKGROUND AND OBJECTIVES: The prognosis of patients with inguinal lymph node metastases from rectal adenocarcinoma is poor. The purpose of this study is to analyze the clinical behavior and response to different therapies in a group of these patients. MATERIALS AND METHODS: The medical records of 32 patients with inguinal lymph node metastases from rectal adenocarcinoma, diagnosed between January 1985 and December 1996, were retrospectively analyzed. The cohort was divided into: Group A (synchronous), and Group B (metachronous), according to the time of diagnosis. RESULTS: There were 17 males and 15 females, with a mean age of 53.5+/-13.8 years. Bilateral inguinal lymph node metastases were diagnosed in 17 patients, and unilateral in 15 patients. Fourteen of 18 patients in Group A (78%) and 13 of 14 patients (93%) in group B, respectively, had concomitantly extrapelvic metastatic disease. Seventeen patients in Group A treated with colostomy + chemoradiotherapy (45 Gy/20 fractions to the pelvis and groin area + 5-fluorouracil 450 mg/m2/weekly) had a progressive metastatic disease; the remaining patient was lost to follow-up after an abdominoperineal resection plus superficial groin dissection. Median survival was 8 months (range, 4-30 months). Overall 5-year survival was 0%. Ten patients in Group B were treated with chemoradiotherapy (50 Gy/25 fractions + 5-fluorouracil 450 mg/m2 + leucovorin 30 mg/m2); three patients received supportive care only, and one patient was treated with a groin dissection. All of them died of disseminated metastatic disease at a median of 13 months (range, 6-57 months). Overall 5-year survival was 0%. CONCLUSION: The presence of inguinal metastases in patients with rectal cancer heralds systemic disease and, due to a poor response to the different therapies, only palliative treatment should be indicated.

Adenocarcinoma↗
PubMed1999

Prognostic factors in patients with locally advanced rectal adenocarcinoma treated with preoperative radiotherapy and surgery.

Preoperative radiation therapy (PRT) prior to potential curative resection for rectal adenocarcinoma is not widely accepted. This report evaluates the prognostic factors affecting local recurrence and 5-year survival. This is a retrospective study of 214 patients with primary rectal adenocarcinoma treated from January 1986 to December 1994. A PRT dosage of 45 Gy in 20 fractions was administered to patients with clinically tethered or fixed tumors, and 4 to 8 weeks later surgery was performed (group I). Patients with clinically mobile tumors were treated by surgery alone (group II). There were 130 men and 84 women. The median age was 58 years (range 19-85 years). There were 111 patients in group I: 7 patients had no microscopic residual tumor, 80 had Dukes' A and B, and 24 had Dukes' C. There were 103 patients in group II: 70 patients were classified as Dukes' A and B and 33 as Dukes' C. The mean follow-up of the entire cohort was 62 months (range 2-132 months). Local recurrence was seen in 17% of patients in group I and 35% in group II (p = 0.002). Distant recurrence in patients with metastatic lymph nodes was seen in 79% of group I and in 34% of group II (p = 0.001). The favorable prognostic factors for local control were the administration of PRT and well differentiated cancer. The favorable prognostic factors for survival were age < 50 years and the absence of lymph node metastasis. The administration of PRT diminishes the risk of local recurrence. The presence of metastatic lymph nodes in the postirradiated specimen is an ominous prognostic factor for survival. Therefore such patients should be considered for adjuvant chemotherapy.

Adenocarcinoma↗
PubMed1998

Colorectal sarcoma: analysis of failure patterns.

BACKGROUND AND OBJECTIVES: Colorectal sarcomas (CRS) are rare and their treatment remains controversial, especially for those located in the rectum. The aim of this paper is to evaluate our experience, with special emphasis on the failure pattern after surgical therapy alone or combined with postoperative radiotherapy. MATERIALS AND METHODS: The medical records and histological slides of 13 CRS patients treated between 1986 and 1996 were reviewed retrospectively. RESULTS: The patients included eight males and five females, with a median age of 54 years; nine of their primary tumors were located in the rectum, and four in the colon. The histologies were leiomyosarcoma in nine cases and malignant fibrous histiocytoma in four cases. Surgical treatment consisted of anatomical colectomy (four); local excision (three); abdominoperineal resection (APR)(two); low anterior resection (LAR)(two); LAR en bloc with the prostate (one), and total pelvic exenteration (one). One operative death occurred. The median size of the tumors was 8 cm (range, 5-40). The tumors were graded as low, three, and high, ten. The median follow-up was 24 months. Eight patients in the overall group developed recurrences as follows: local, three; local and distant, three, and distant, two. Five out of nine patients with rectal sarcoma received adjuvant postoperative radiotherapy (PRT). Local recurrence occurred in 20% (1/5) of those who received PRT, and in 100% (3/3) of those who did not. The overall 5-year survival was 40%, and the 5-year survival for patients with low-grade tumors was 66%, as compared with 22% for those with high-grade tumors. CONCLUSIONS: The patterns of failure in CRS are combined in both local and distant sites. However, our results suggest that in rectal sarcoma, the use of surgery + PRT may reduce the local recurrence rate; in selected patients, it may allow for anal sphincter preservation.

Adult↗
PubMed1995

Patterns of recurrence in squamous cell carcinoma of the anal canal.

The objective of the study was to identify the patterns of recurrence in patients with squamous cell carcinoma of the anal canal (SCCAC) vs. the size of the primary tumor and its further possible impact on its treatment outcome. We reviewed 78 patients treated between 1975 to 1991. They were classified according to to the AJC/UICC classification. From 1975 to 1985, 16 patients were treated with radical surgery (RS). From 1985 to 1991, 43 patients were treated with radiotherapy (RT) at doses of 45 Gy/4-5 weeks, to the pelvis and a boost of 15-30 Gy to the perineum. Since 1989, in 19 selected patients, 5-FU and mitomycin-C have been added to the RT schedule (C-RT). There were 55 females and 23 males. The overall recurrence rate was 62%. In T1 tumors, no recurrences occurred. The local recurrence (LR) according to treatment approach and T were: radical surgery: T2, 50%; T3, 71%; T4, 100%. Radiation therapy: T2, 25%; T3, 41%; T4, 66%. Chemoradiation therapy: T2, 12%; T3, 40%; T4, 50%. Regional recurrences were in RS: T2, 16%; T3, 28%; T4, 100%. RT: T2, 0%; T3, 16%; T4, 33%. C-RT: T2, 0%; T3, 20%; T4, 25%. Distant recurrences were in RS: T2 and T3, 0%; T4, 66%. In RT: T2, 0%; T3, 8%; T4, 33%. In C-RT: T2, 0%; T3, 8%; T4, 50%. In T1 patients, no recurrences were observed. In T2 tumors the recurrence pattern was local. In T3 tumors it was locoregional and to the groin area. In T4 tumors it was locoregional and distant.(ABSTRACT TRUNCATED AT 250 WORDS)

Anus Neoplasms↗
PubMed1992

Local recurrence of rectal adenocarcinoma following preoperative radiation therapy and surgery.

An important therapeutic endpoint of the surgical treatment of rectal adenocarcinoma is to obtain local control. In an attempt to enhance this goal, we started a regimen of treatment consisting of preoperative radiation therapy (PRT), 45 Gy in 5 weeks, followed by surgery 4-6 weeks after termination of the PRT. Depending on the local characteristics of the tumor, either an abdominoperineal resection (APR), a posterior pelvic exenteration (PPE), and a total pelvic exenteration (TPE) were performed. All patients found with distant metastasis were excluded from this study. There were 66 patients: 40 males and 26 females. Fifty six underwent an APR, six a PPE, and four a TPE. Their median age was 56 years. Major complications were intraoperative bleeding (15%); perineal wound infection (21%); abdominal wound infection (9%). Five patients (7.5%) died within 30 days of surgery; two after APR, two after PPE and one after TPE. Median follow-up is 60 months. The overall local recurrence rate is 9.8%. Recurrences related to the Astler-Coller modification of Dukes' stage were 0/21 in A or B1, but 6/40 (15%) when the stages were B2, B3, C1, C2 and C3. In conclusion, we found this treatment approach effective in obtaining local control of the rectal adenocarcinoma and comparable to the results of other series. However, it was associated with significant morbidity and mortality.

Actuarial Analysis↗
PubMedDate not supplied

The influence of pre-operative radiation therapy on the patterns of recurrence in rectal adenocarcinoma.

From January 1976 to December 1994, we evaluated the institutional experience of local recurrence and survival in patients with rectal adenocarcinoma treated with pre-operative radiation therapy (PRT) as compared to those treated with radical surgery alone. There were 412 patients, divided into two groups: 259 patients (142 males and 117 females) in Group I and 153 patients (88 males and 65 females) in Group II. The median age was 56 years. Group I patients with locally advanced tumors, either tethered or fixed, received PRT at doses of 45 Gy delivered to the pelvis in two fields; 4 to 8 weeks later, radical surgery was performed. Patients with mobile tumors underwent radical surgery only (Group II). The operative mortality was 4.6% in Group I as compared to 1.9% in Group II (P = 0.18). At median follow-up of 89 months, there were local recurrences in 12.9% of Group I as compared to 36.2% in Group II (P = 0.0000001). The administration of PRT was associated with a low rate of local recurrence, but this improvement corresponded with a high morbidity rate, especially in patients who underwent abdominoperineal resection or pelvic exenteration.

Adenocarcinoma↗
PubMedDate not supplied

[Treatment of anastomotic leakage following low anterior resection for rectal adenocarcinoma].

BACKGROUND: The most important complication after low anterior resection for rectal cancer is the anastomotic leakage. Its frequency ranges between 0%-17% and, it's associated mortality ranges between 0%-25%. OBJECTIVE: To analyze the treatment results of the above mentioned complication. MATERIAL AND METHODS: Between January 1990 and July 1998, 176 patients with rectal cancer underwent low anterior resection. 13 (7.3%) of them developed anastomotic leakage. The results of the treatment due to, this surgical complication were analyzed. RESULTS: There were 9 males and 4 females with a mean age of 64.3 years. Seven of these patients received preoperative radiotherapy. The tumor mean size was 5.5 cm. The tumor and distance of the anastomoses were located at a mean distance of 8 cm and 5 cm respectively, above the anal verge. All patients presented one or more of the following symptoms: increase of drainage (n = 10); prolonged ileus and abdominal pain (n = 9), fever and leucocytosis (n = 8). The surgical treatments were: drainage of abdominal or pelvic cavity (n = 11); loop transversostomy (n = 9); end colostomy, and Hartmann's procedure (n = 3). One patient received only enteral nutrition. In eight patients, the surgical treatment was performed during the first 24 hours of the initial symptoms and in four after 24 hours. The mean hospital stay in the former groups was 9.2 days vs 26.8 days of the later group (p = 0.02). No mortality was observed. CONCLUSION: The early diagnosis of the following symptoms: drainage increase; prolonged ileus; postoperative abdominal pain; fever, and leucocytosis after low anterior resection, should guide us to the diagnosis of anastomotic leakage and therefore, to initiate surgical treatment during the first 24 hours as to avoid major morbidity and mortality.

Adenocarcinoma↗
PubMedDate not supplied

The surgeon as prognostic factor for local recurrence and survival in the anal sphincter preservation for mid-rectal cancer.

BACKGROUND: The prognostic factors in rectal adenocarcinoma are influenced by the tumor stage. However, it is important to evaluate the role of the surgeon as part of the prognostic factors affecting local recurrence and survival rates in a group of patients with mid-rectal cancer treated with low anterior resection at a cancer referral center, and those treated at general hospitals. MATERIALS AND METHODS: Eighty-two patients with mid rectal adenocarcinoma stage II and III who underwent low anterior resection from January 1980 to December 1995, were retrospectively analyzed. Forty-two patients were treated at a cancer center (Group I) and 40 patients were treated at general hospitals (Group II). Cox regression analysis for local recurrence and survival was performed. RESULTS: There were 42 males and 40 females with a mean age of 55.8 +/- 14.9 years. No differences were found between both groups in terms of the following: age; gender; stage; grade of differentiation; number of positive lymph nodes; infiltration of neighboring organs, and administration of adjuvant chemoradiation therapy (POST RT). However, significant differences in the number of studied lymph nodes per specimen and follow-up were found. The median follow-up for the entire group was 49 months. Local recurrence occurred in 9.5% of patients in Group I vs. 50% in Group II (p = 0.0001). The 5-year survival in Group I was 63% vs. 54% in Group II (p = 0.04). The favorable prognostic factors for local recurrence and survival were: surgical treatment at a cancer center, and no lymph node metastases. CONCLUSION: The prognostic factors for local recurrence and survival depends mainly on the surgeon and on the post-surgical tumor stage.

Adenocarcinoma↗
PubMedDate not supplied

[Cystic lymphangioma of the mesentery. Clinical, radiological, and morphological analysis].

BACKGROUND: The cystic mesenteric lymphangioma is a rare benign neoplasia, that can be misdiagnosed with others cystic intra-abdominal tumors. AIM: To shown the clinical and histopathological features of a cystic mesenteric lymphangioma. MATERIAL AND METHODS: A 17-year old male with a past history of 17 days of right lower abdominal pain, palpable mass, fever, nausea and vomitus. The initial clinical diagnosis was appendicitis, during the appendectomy a mesenteric tumor was found. The patient was then sent to a third level cancer center for further diagnosis and treatment. In an abdominal CT scan a multicystic retroperitoneal tumor was found and diagnosed as a cystic pancreatic tumor. At midline exploratory celiotomy a cystic tumor infiltrating the right colon mesenterium, duodenum, proximal jejunum, and pancreas head was found. A pancreatoduodenectomy in bloc with right hemicolectomy was performed. During the postoperative period the patient developed cholestasis due to endovenous parenteral nutritional support that improved when it was suspended. The patient was discharged without complications at the 15th postoperative day. The histopathologic diagnosis was cystic mesenteric lymphangioma. At 12 months of follow-up the patient is healthy. CONCLUSION: The cystic mesenteric lymphangioma is a rare benign tumor and its diagnosis should be included in the differential diagnosis of cystic intra-abdominal neoplasias. Due to the tumor's location, as in the current patient, the surgeon should plan the appropriate surgery as to avoid morbidity, since the objective of such treatment is curative.

Abdominal Pain↗
PubMedDate not supplied

Morbidity and mortality following abdominoperineal resection for low rectal adenocarcinoma.

BACKGROUND: Abdominoperineal resection (APR) has been the standard treatment of low rectal cancer, but it is associated with significant morbidity and mortality. AIM: To analyze the morbidity and mortality rates associated with this surgical procedure performed at a tertiary-level cancer center. MATERIALS AND METHODS: From 1995-1999, 137 patients with rectal cancer located between 0 and 8 cm from the anal verge underwent APR. Covariates were analyzed mean chi 2 and those favorable or adverse covariates affecting the perineal infection and recurrences were analyzed by logistic regression analysis. RESULTS: There were 78 males and 59 females, with a mean age of 57.4 +/- 14.6 years. Mean intraoperative hemorrhage was 739 +/- 547 mL; 51 (37.2%) patients received blood transfusion. Seventy-two patients received preoperative radiotherapy (PRT): 22, postoperative chemo-radiation therapy; 21, PRT + chemotherapy, and 22, APR only. Seventeen patients (12.4%) had major complications and 47 (34.3%) had minor complications. Twenty patients (14.6%) developed perineal wound infection. The main factors influencing these complications were administration of PRT +/- chemotherapy and age over 55 years. Operative mortality was 0.7%. Median follow-up was 32 months. Twelve patients (8.8%) had local recurrence and 35 (25.7%) had distant recurrence. Overall five-year survival was 75%. CONCLUSIONS: APR is a surgical procedure associated with significant morbidity but low postoperative surgical mortality. The main cause of morbidity was perineal would infection influenced by administration of PRT +/- chemotherapy and age over 55 years. However, this treatment association is linked with low rate of local recurrence.

Abdomen↗
PubMedDate not supplied

[The role of radical surgery in the treatment of epidermoid carcinoma of the anal canal].

In order to define the role of radical surgery in the actual treatment of epidermoid carcinoma of the anal canal (ECAC), we retrospectively reviewed the charts of patients with primary ECAC, treated with radical surgery in the Hospital de Oncología, National Medical Center IMSS. We analyzed the recurrence pattern, its treatment and the contemporary literature was reviewed. From 1975 to 1990, we treated 16 patients; 13 females, 3 males, mean age was 64 years. The presurgical stage was T2, 6; T3 7; T4, 3. An abdominoperineal resection was performed in 12 patients; a posterior pelvic exenteration in 3; a total pelvic exenteration in 1. Ten patients developed surgical complications, 4 of them were major, 2 required surgical reintervention. There was no operative mortality. We obtained local tumor control in 5/16 patients (32%); the local recurrence by stage were T2, 3/6 (50%); T3, 5/7 (71%); T4, 3/3 (100%) p = 0.04. Ten of them were located at the pelvis brim and 1 was located to the central pelvis (vagina, perineum), 9 were treated with radiation therapy (RT) a mean dose of 45 Gy, only the patient with central local recurrence obtained local tumor control. Regional recurrences were as follows: T2 patients, 1/6 (16%); T3, 2/7 (28%); T4, 2/3 (66%). The 2 patients with metachronous inguinal lymph node metastases were treated with a radical groin dissection, with tumor control. In conclusion, the radical surgical treatment is associated with a low loco-regional tumor control; the pelvic tumor relapses were located at the pelvis brim and with no response to RT. With the results herein obtained and the results with other treatment modalities such as RT and its associations with chemotherapy (C) in regard to local tumor control, the actual role of the radical surgical treatment in the salvage of central pelvic relapses to primary treatment with RT or C-RT.

Adult↗
PubMedDate not supplied

[The mechanisms of the dissemination and the treatment of ovarian metastases in colonic adenocarcinoma].

OBJECTIVE: The aims of this study are: 1) To known the frequency of ovarian metastasis, 2) to define the role of the surgical therapy and 3) to establish the mechanism of spread of colorectal cancer to the ovaries. MATERIAL AND METHODS: Between 1989 and 1993 624 patients with colorectal adenocarcinoma; were treated, 19 (7.7%) had ovarian metastasis; they were divided in 2 groups according to the diagnostic time: A) synchronous; B) metachronous. In most patients a peritoneal lavage were performed; the primary tumor was resected. RESULTS: The median age was 41.4 years. In group A: there were 9 patients; in 3 of them underwent elective surgery and in 6 an exploratory celiotomy due to colonic obstruction or perforation. The primary tumor was located in the sigmoid in 8 patients and in cecum in 1; the stage of the primary tumor was follows: B1, 2; B2, 3; C2, 4. The ovarian metastasis were located in the left ovary in 6; right, 2, and bilateral 1. The peritoneal lavage was positive in 6, and negative in 3. In group B: there were 10 patients; one underwent elective surgery and 9 exploratory celiotomy. The primary tumor was located in the sigmoid in 9, caecum in 1. The stage of the primary tumors were: B2, 4; C2 4; D, 2. The ovarian metastasis were located: left, 5; right, 1; bilateral, 4. The peritoneal lavage was positive in 6, negative in 2. The 5-year survival in group A was 16% in group B, 0%. CONCLUSION: Ovarian metastasis were associated with advanced metastatic diseases. The treatment of synchronous ovarian metastasis is the resection of primary tumor plus bilateral oophorectomy, and in metachronous metastasis it is palliative. The mechanism of spread to the ovaries is by direct implantation and hematogenous.

Adenocarcinoma↗
PubMedDate not supplied

[Proctocolectomy with ileoanal anastomosis: morbidity and functional results in patients with and without colorectal cancer].

BACKGROUND: The elective prophylaxis for colorectal cancer in patients with familial adenomatous polyposis (FAP) or with ulcerative colitis (UC) is the RPIPAA. AIMS: To evaluate the functional results and the morbidity rate in patients who underwent restorative proctocolectomy with ileal-pouch anal anastomosis (RPIPAA). METHODS: All patient underwent a proctocolectomy with a J reservoir, ileal pouch-anal anastomosis. RESULTS: There were 8 males and 3 females with a mean age of 31 years; the diagnoses were: FAP (n = 4); FAP + colorectal cancer (n = 3); metachronous colorectal cancer (n = 3) and UC + right colon cancer (n = 1). The average surgical time and the intraoperative bleeding were 5.6 h and 600 ml respectively. There were no operative deaths. The surgical complications were: section of left urether (n = 1); hemoperitoneum of 1,200 ml (n = 1); minor pelvic sepsis (n = 1); ileoanal stenosis (n = 1) and pouchitis (n = 1). Tumor staging was: Dukes A (n = 2), B1 (n = 1), B2 (n = 4). The mean follow-up was 22 months. Average of stools at the 3rd, 6th and 12th month was: 7.4, 5.6 and 3.8 respectively. Sexual function was: normal (n = 8), retrograde ejaculation (n = 2) and impotence (n = 1). The use of antidiarrheal agents in 24 hours at the third, sixth and twelfth month was 3, 2 and .8 respectively. CONCLUSIONS: The RPIPAA is associated with a low rate of morbidity and good functional results, similar to previously published results. However, these results should be taken with caution due to the small, selected and retrospective nature of the study.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

[Associated clinical features in 41 patients with anal epidermoid carcinoma, studied at a cancer center].

OBJECTIVE: To investigate the main associated clinical characteristics in a group of patients with squamous cell carcinoma of the anus. BACKGROUND: Anal carcinoma is associated with sexually transmitted viral carcinogenesis. MATERIAL AND METHODS: We analyzed the charts of patients with squamous cell carcinoma of the anus treated during 1994 and 1995. Demographic characteristics, presence of HIV-1, sexual behavior and the presence of anal warts were analyzed. RESULTS: There were 41 patients, 26 females and 15 males with a mean age of 61 and 45 years respectively. Twenty-three patients (56%) had history of anal intercourse, 17 (41%) had anal warts and 12 (29%) were HIV-1 (+). This factors were observed more frequently in the male population (p < 0.001). The patients who had anal intercourse had more frequently anal warts and HIV-1(+) compared with those who did not (p < 0.001 in both). The HIV-1 (+) patients had more frequently anal intercourse and anal warts than those HIV-1(-) (p < 0.001 in both). CONCLUSION: 1) male population develop squamous cell carcinoma of the anus earlier than female population, 2) there is a high incidence of homosexuality, anal warts and HIV-1(+) in the male population; these findings suggest different mechanism of carcinogenesis in both gender.

Aged↗
PubMedDate not supplied

[Colorectal cancer].

OBJECTIVE: To describe the multistep carcinogenesis of the colon and rectum, and updated in the screening diagnosis and treatment of colorectal cancer. BACKGROUND: Colorectal cancer is one of the most frequent malignant neoplasia in developing countries. In Mexico, is the second malignant neoplasia of the gastrointestinal tract. MATERIAL AND METHODS: A literature search was performed to known the usefulness of screening, diagnosis and treatment procedures. Also, some of our actual proceedings are described. RESULTS: No impact in decreasing the mortality rate for colorectal cancer, has been observed with the contemporary screening programs in low risk population. The recommended treatment for colorectal cancer in early stages (Dukes A and B1) is the surgical resection alone. In those patients with colon metastasizing to the lymph nodes (Dukes C), a combination of surgery + chemotherapy is recommended. In patients with rectal cancer with full penetration until the perirectal fat or with lymph node metastasis (Dukes B2 and C) a combination of surgery, chemotherapy and radiotherapy is the elective treatment. Until today, is controversial if radiotherapy should be used pre- or postoperatively. CONCLUSION: The colorectal carcinogenesis included a multistep where are involved a tumor suppressor genes and oncogenes. Surgery is the accepted treatment for early colorectal cancer. A combination of surgery + chemotherapy +/- radiotherapy is the elective treatment for locally advanced colorectal cancer.

Adolescent↗