Browsing by Subject "Adenoma"

Now showing 1 - 5 of 5
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    A novel preoperative score to predict long-term biochemical remission in patients with growth-hormone secreting pituitary adenomas
    (Elsevier, 2023) Cohen-Cohen, Salomon; Rindler, Rima; Botello Hernandez, Edgar; Donegan, Diane; Erickson, Dana; Meyer, Fredric B.; Atkinson, John L.; Van Gompel, Jamie J.; Medicine, School of Medicine
    Objective Transsphenoidal surgery (TSS) is considered the treatment of choice in most patients with growth hormone (GH)-secreting pituitary adenomas. Several preoperative factors have been studied to predict postsurgical remission. Our objective was to design a score that could be used in the preoperative setting to identify patients that will achieve long-term biochemical remission after TSS. Methods A retrospective analysis of consecutive patients with GH-secreting pituitary adenomas that underwent TSS in our institution from 2000 to 2015 who fulfilled prespecified criteria were included. Logistic regression methods were used to evaluate independent preoperative variables predicting long-term remission. Beta coefficients were used to create a scoring system for clinical practice. Results Sixty-eight patients were included, with a mean follow-up time of 87 months. Twenty (29%) patients had tumors with a Knosp grade ≥ 3A. Gross-total resection was achieved in 43 (63%) patients. Thirty-three (48%) patients had long-term biochemical remission after TSS. In a multivariate analysis, the following variables were statistically significantly associated with long-term biochemical remission: age, adenoma size (diameter), Knosp grade, GH level, and insulin growth-factor 1index 1 at diagnosis. A score of <3 out of 8 total points was identified as a cutoff associated with long-term remission, with a sensitivity of 91.4% and specificity of 72.7% (AUC 0.867, OR 28.44, 95% CI 6.94–116.47, P = < 0.001). Conclusions A novel, simple, easy-to-use scoring system was created to identify patients with the highest chances of long-term biochemical remission following TSS. This scale should be prospectively validated in a multicenter study before widespread adoption.
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    Colorectal Cancer Screening Programs in Latin America: A Systematic Review and Meta-Analysis
    (American Medical Association, 2024-02-05) Montalvan-Sanchez, Eleazar E.; Norwood, Dalton A.; Dougherty, Michael; Beas, Renato; Guranizo-Ortiz, Maria; Ramirez-Rojas, Miriam; Morgan, Douglas R.; Imperiale, Thomas F.; Medicine, School of Medicine
    Importance: Colorectal cancer (CRC) is a leading cause of cancer-related mortality globally, with increasing incidence and mortality in Latin America. CRC screening programs can reduce disease burden, but information on screening programs in Latin America is limited. Objective: To describe characteristics (eg, type of program, uptake, neoplastic yield) of CRC screening programs in Latin America. Data sources: PubMed, Ovid MEDLINE, EMBASE, Cochrane, PsycINFO, Web of Science Core Collection, LILACS, and SciELO were searched from inception to February 2023. Relevant references from bibliographies, conference proceedings, and gray literature were considered. The search strategy included English, Spanish, and Portuguese terms. Study selection: Included were studies of CRC screening programs in Latin America using fecal immunochemical test (FIT) or colonoscopy as the primary screening method. Four reviewers independently assessed study eligibility based on titles, with review of abstracts and full texts as needed. Data extraction and synthesis: Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed for data abstraction and quality assessment. Descriptive information was extracted, and data were pooled using a random-effects model. Main outcomes and measures: Program performance indicators included rates of participation and FIT positivity, adenoma detection rate (ADR), advanced adenoma detection rate (AADR), CRC detection rate, and colonoscopy quality indicators. Results: There were 17 studies included from upper middle-income and high-income countries in Latin America with a total of 123 929 participants. Thirteen studies used FIT as the initial screening method, whereas 4 used screening colonoscopy. The participation rate in FIT-based programs was 85.8% (95% CI, 78.5%-91.4%). FIT positivity rates were 15.2% (95% CI, 9.6%-21.8%) for the 50-ng/mL threshold and 9.7% (95% CI, 6.8%-13.0%) for the 100-ng/mL threshold. For FIT-based studies, the pooled ADR was 39.0% (95% CI, 29.3%-49.2%) and CRC detection rate was 4.9% (95% CI, 2.6%-7.9%); for screening colonoscopy-based studies, the pooled ADR was 19.9% (95% CI, 15.5%-24.8%) and CRC detection rate was 0.4% (95% CI, 0.1%-0.8%). Conclusions and relevance: This systematic review and meta-analysis suggests that CRC screening in upper middle-income countries in Latin America is feasible, detecting rates of neoplasia comparable with those of high-income regions. Population-based screening programs should be developed or enhanced in these settings. There is a knowledge gap regarding feasibility and yield of screening programs in lower middle-income countries.
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    EIF3i Promotes Colon Oncogenesis by Regulating COX-2 Protein Synthesis and β-Catenin Activation
    (Nature Publishing Group, 2014-08-07) Qi, Jing; Dong, Zizheng; Liu, Jianguo; Zhang, Jian-Ting; Department of Pharmacology and Toxicology, IU School of Medicine
    Translational control of gene expression has recently been recognized as an important mechanism controlling cell proliferation and oncogenesis and it mainly occurs in the initiation step of protein synthesis that involves multiple eukaryotic initiation factors (eIFs). Many eIFs have been found to have aberrant expression in human tumors and the aberrant expression may contribute to oncogenesis. However, how these previously considered house-keeping proteins are potentially oncogenic remains elusive. In this study, we investigated the expression of eIF3i in human colon cancers, tested its contribution to colon oncogenesis, and determined the mechanism of eIF3i action in colon oncogenesis. We found that eIF3i expression was up-regulated in both human colon adenocarcinoma and adenoma polyps as well as in model inducible colon tumorigenic cell lines. Over-expression of ectopic eIF3i in intestinal epithelial cells causes oncogenesis by directly up-regulating synthesis of COX-2 protein and activates the β-catenin/TCF4 signaling pathway that mediates the oncogenic function of eIF3i. Together, we conclude that eIF3i is a proto-oncogene that drives colon oncogenesis by translationally up-regulating COX-2 and activating β-catenin signaling pathway. These findings imply that protooncogenic eIFs likely exert their tumorigenic function by regulating/altering the synthesis level of down-stream tumor suppressor or oncogenes.
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    Most large colorectal polyps missed by gastroenterology fellows at colonoscopy are sessile serrated lesions
    (Thieme, 2022-05-13) Vemulapalli, Krishna C.; Lahr, Rachel E.; Rex, Douglas K.; Medicine, School of Medicine
    Background and study aims: Data on adenoma and sessile serrated lesion (SSL) miss rates for gastroenterology fellows during colonoscopy are limited. We aimed to describe the miss rate of fellows based on a second examination by a colonoscopist with a high rate of detection. Patients and methods: Second- and third-year gastroenterology fellows at a single, tertiary center performed initial examinations. A single experienced attending doctor then performed a complete examination of the colon. We recorded the size and pathology of all lesions found at both examinations and calculated the adenoma and SSL miss rates for fellows. Results: Ten trainees performed 100 examinations. Miss rates for conventional adenomas and SSLs were 30.5 % and 85.7 %, respectively. Among pre-cancerous polyps ≥ 10 mm, 10 of 14 lesions missed were SSLs. Conclusions: While conventional adenoma detection skills of gastroenterology fellows are acceptable, SSL detection is poor.
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    SSAT/AHPBA Joint Symposium on Evaluation and Treatment of Benign Liver Lesions
    (Elsevier, 2013) Chun, Yun Shin; House, Michael G.; Kaur, Harmeet; Loyer, Evelyne M.; Paradis, Valérie; Vauthey, Jean-Nicolas; Surgery, School of Medicine
    Background: Benign liver lesions are common incidental radiologic findings. Methods: Experts convened in 2011 at a Society for Surgery of the Alimentary Tract/ Americas Hepato-Pancreato-Biliary Association joint symposium to discuss the evaluation and treatment of benign liver lesions. Results: Most benign liver lesions can be accurately diagnosed with high-quality imaging, including ultrasonography, multiphase computed tomography, and magnetic resonance imaging, particularly with hepatocyte-specific contrast agents. Percutaneous biopsy is reserved for lesions that cannot be characterized radiographically, and its accuracy is improved with immunophenotypic markers. Hepatic cysts are the most commonly diagnosed benign liver lesions; these must be distinguished from malignant cystic lesions, which are rare. Among the solid benign liver lesions, hemangiomas and focal nodular hyperplasia seldom require treatment. In contrast, hepatocellular adenomas are associated with a risk for complications. A new classification system for hepatocellular adenomas based on genetic and phenotypic features can help guide patient care. In patients who are symptomatic or at risk for complications, multidisciplinary evaluation and treatment based on clinicopathologic, radiographic, and molecular analysis is needed. Conclusions: Most benign liver lesions can be accurately diagnosed radiographically and do not require treatment. Treatment is necessary for patients with symptoms or at risk for complications.