Defective apoptosis in intestinal and mesenteric adipose tissue of crohn's disease patients

Background: Crohn's disease (CD) is associated with complex pathogenic pathways involving defects in apoptosis mechanisms. Recently, mesenteric adipose tissue (MAT) has been associated with CD ethiopathology, since adipose thickening is detected close to the affected intestinal area. However, the potential role of altered apoptosis in MAT of CD has not been addressed. Aims: To evaluate apoptosis in the intestinal mucosa and MAT of patients with CD. Methods: Samples of intestinal mucosa and MAT from patients with ileocecal CD and from non-inflammatory bowel diseases patients (controls) were studied. Apoptosis was assessed by TUNEL assay and correlated with the adipocytes histological morphometric analysis. The transcriptional and protein analysis of selected genes and proteins related to apoptosis were determined. Results: TUNEL assay showed fewer apoptotic cells in CD, when compared to the control groups, both in the intestinal mucosa and in MAT. In addition, the number of apoptotic cells (TUNEL) correlated significantly with the area and perimeter of the adipose cells in MAT. Transcriptomic and proteomic analysis reveal a significantly lower transcript and protein levels of Bax in the intestinal mucosa of CD, compared to the controls; low protein levels of Bax were found localized in the lamina propria and not in the epithelium of this tissue. Furthermore, higher level of Bcl-2 and low level of Caspase 3 were seen in the MAT of CD patients. Conclusion: The defective apoptosis in MAT may explain the singular morphological characteristics of this tissue in CD, which may be implicated in the pathophysiology of the disease. © 2014 Dias et al.Crohn's disease (CD) is associated with complex pathogenic pathways involving defects in apoptosis mechanisms. Recently, mesenteric adipose tissue (MAT) has been associated with CD ethiopathology, since adipose thickening is detected close to the affected intestinal area. However, the potential role of altered apoptosis in MAT of CD has not been addressed. Aims: To evaluate apoptosis in the intestinal mucosa and MAT of patients with CD. Methods: Samples of intestinal mucosa and MAT from patients with ileocecal CD and from non-inflammatory bowel diseases patients (controls) were studied. Apoptosis was assessed by TUNEL assay and correlated with the adipocytes histological morphometric analysis. The transcriptional and protein analysis of selected genes and proteins related to apoptosis were determined. Results: TUNEL assay showed fewer apoptotic cells in CD, when compared to the control groups, both in the intestinal mucosa and in MAT. In addition, the number of apoptotic cells (TUNEL) correlated significantly with the area and perimeter of the adipose cells in MAT. Transcriptomic and proteomic analysis reveal a significantly lower transcript and protein levels of Bax in the intestinal mucosa of CD, compared to the controls; low protein levels of Bax were found localized in the lamina propria and not in the epithelium of this tissue. Furthermore, higher level of Bcl-2 and low level of Caspase 3 were seen in the MAT of CD patients. Conclusion: The defective apoptosis in MAT may explain the singular morphological characteristics of this tissue in CD, which may be implicated in the pathophysiology of the disease96e9854

Neoadjuvant Therapy And Surgery In Rectal Adenocarcinoma: Analysis Of Patients With Complete Tumor Remission [terapia Neoadjuvante E Cirurgia No Adenocarcinoma Retal: Análise Dos Pacientes Com Remissão Tumoral Completa No Reto]

Introduction: the standard treatment for locally advanced extra-peritoneal rectal adenocarcinoma, consists of neoadjuvant treatment with radiotherapy and chemotherapy followed by total mesorectal excision. Objective: evaluate, retrospectively, the patients submitted to neoadjuvant therapy and surgery that presents with total remission of the lesion in the anatomopathological examination. Methods: between 2000 and 2010, 212 patients underwent surgery at the Coloproctology Unit at DMAD at FCM-UNICAMP. They were grouped as: rectosigmoidectomy and colorectal anastomosis (n = 54), rectosigmoidectomy with coloanal anastomosis (n = 41), 114 abdominoperineal resection of the rectum (n = 114) and other (n = 3). Results: thirty (14.2%) patients (mean age 57.6 years; 60% males) showed complete remission of the rectal lesion. 4 (13.3%) had compromised lymph nodes and/or lymphatic invasion At follow-up (mean 51.9 months), 4 (13.3%) presented with local recurrence (one patient) or distant metastases (two patients had liver metastasis, one had liver and lung, and one had bone metastasis). The mean survival was 86.7%. Conclusion: patients with a complete tumor response show ed an increased survival rate, however, the same patients without evidence of residual tumors could develop local recurrence or distant metastases on a later follow-up. © 2013 Elsevier Editora Ltda. All rights reserved.334222227Castaldo, E.T., Parikh, A.A., Pinson, W., Feurer, I.D., Merchant, N.B., Improvement of survival with response to neoadjuvant radiation therapy for rectal cancer (2009) Arch Surg, 144, pp. 129-134Instituto Nacional De Câncer (INCA), , http://www2.inca.gov.br/wps/wcm/connect/tiposdecancer/site/home/colorretal/definicaoHabr-Gama, A., Perez, R.O., Nadalin, W., Sabbaga, J., Ribeiro Jr., U., de Silva Jr., A.H.S., Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: Long-term results (2004) Ann Surg, 240 (4), pp. 711-717Habr-Gama, A., Assessment and management of the complete clinical response of rectal cancer to chemoradiotherapy Colorectal Dis 20068 Suppl, 3, pp. 21-24Altenburg, F.L., Biondo-Simões, M.L.P., Bahten, L.C., A pesquisa de sangue oculto nas fezes associada a um questionário de sinais e sintomas na prevenção do câncer colorretal (2009) Rev Bras Coloproct, 29 (1), pp. 57-64Bipat, S., Glas, A.S., Slors, F.J.M., Zwinderman, A.H., Bossuyt, P.M.M., Stoker, J., Rectal cancer: Local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging - a meta-analysis (2004) Radiology, 232 (3), pp. 773-783Habr-Gama, A., Perez, R.O., Julião, G.P.S., Proscurshim, I., Gama-Rodrigues, J., Nonoperative approaches to rectal cancer: A critical evaluation (2011) Semin Radiat Oncol, 21 (3), pp. 234-239Habr-Gama, A., Perez, R.O., Julião, G.P.S., Proscurshim, I., Gama-Rodrigues, J., Complete clinical response after neoadjuvant chemoradiation for distal rectal cancer (2010) Surg Oncol Clin N Am, 19, pp. 829-845Maas, M., Beets-Tan, R.G., Lambregts, D.M., Lammmering, G., Nelemans, P.J., Engelen, S.M., Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer (2011) J Clin Oncol, 29 (35), pp. 4633-4640Smith, J.D., Ruby, J.A., Goodman, K.A., Saltz, L.B., Guillem, J.G., Weiser, M.R., Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy (2012) Ann Surg, 256 (6), pp. 965-972Wichmann, M.W., Muller, C., Meyer, G., Straus, T., Hornung, H.M., Lau-Werner, U., Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer (2002) Arch Surg, 137, pp. 206-210Medich, D., McGinty, J., Parda, D., Karlovits, S., Davies, C., Caushaj, P., Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma: Pathologic findings and clinical implications (2001) Dis Colon Rectum, 44, pp. 1123-1128Dulk, M., Velde, C.J.H., Considerations and restrictions for nonoperative treatment of rectal cancer in selected patients (2007) The Lancet Oncol, 8 (7), pp. 570-571Hiotis, S.P., Weber, S.M., Cohen, A.M., Minsky, B.D., Paty, P.B., Guillem, J.G., Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: An analysis of 488 patients (2002) J Am Coll Surg, 194, pp. 131-135Moore, H.G., Gittleman, A.E., Minsky, B.D., Wong, D., Paty, P.B., Weiser, M., Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection (2004) Dis Colon Rectum, 47, pp. 279-286Habr-Gama, A., Perez, R.O., Proscurshim, I., Santos, R.M.N., Kiss, D., Gama-Rodrigues, J., Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: Does delayed surgery have an impact on outcome? (2008) Int J Radiat Oncol Biol Phys, 71 (4), pp. 1181-1188Nyasavajjala, S.M., Shaw, A.G., Khan, A.Q., Brown, S.R., Lund, J.N., Neoadjuvant chemo-radiotherapy and rectal cancer: Can the UK watch and wait with Brazil? (2009) Colorectal Dis, 12, pp. 33-36Sloothaak, D.A., Geijsen, D.E., van Leersum, N.J., Punt, C.J., Buskens, C.J., Bemelman, W.A., Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer (2013) Br J Surg, 100 (7), pp. 933-939Pinho, M., Resposta completa à terapia neoadjuvante no câncer de reto: Apenas sorte ou um resultado previsível? (2007) Rev Bras Coloproct, 27 (4), pp. 474-478Perez, R.O., Habr-Gama, A., Gama-Rodrigues, J., Proscurshim, I., Julião, G.P.S., Lynn, P., Accuracy of positron emission tomography/computed tomography and clinical assessment in the detection of complete rectal tumor regression after neoadjuvant chemoradiation (2012) Cancer, 15, pp. 3501-3511Issa, N., Murninkas, A., Powsner, E., Dreznick, Z., Long-term outcome of local excision after complete pathological response to neoadjuvant chemoradiation therapy for rectal cancer (2012) World J Surg, 36 (10), pp. 2481-2487Belluco, C., de Paoli, A., Canzonieri, V., Sigon, R., Fornasarig, M., Buonadonna, A., Long-term outcome of patients with complete pathologic response after neoadjuvant chemoradiation for cT3 rectal cancer: Implications for local excision surgical strategies (2011) Ann Surg Oncol, 18 (13), pp. 3686-3693Campos-Lobato, L.F., Stocchi, L., Moreira, L.A., Geisler, D., Dietz, D.W., Lavery, I.C., Pathologic complete response after neoadjuvant treatment for rectal cancer decreases distant recurrence and could eradicate local recurrence (2011) Ann Surg Oncol, 18 (6), pp. 1590-1598Maas, M., Nelemans, P.J., Valentini, V., Das, P., Rödel, C., Kuo, L.J., Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: A pooled analysis of individual patient data (2010) Lancet Oncol, 11 (9), pp. 835-844Martin, S.T., Heneghan, H.M., Winter, D.C., Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer (2012) Br J Surg, 99 (7), pp. 918-928Zorcolo, L., Rosman, A.S., Restivo, A., Pisano, M., Nigri, G.R., Fancellu, A., Complete pathologic response after combined modality treatment for rectal cancer and long-term survival: A meta-analysis (2012) Ann Surg Oncol, 19 (9), pp. 2822-2832Smith, F.M., Chang, K.H., Sheahan, K., Hyland, J., O'Connell, P.R., Winter, D.C., The surgical significance of residual mucosal abnormalities in rectal cancer following neoadjuvant chemoradiotherapy (2012) Br J Surg, 99 (7), pp. 993-1001Tranchart, H., Lefèvre, J.H., Svrcek, M., Flejou, J.F., Tiret, E., Parc, Y., What is the incidence of metastatic lymph node involvement after significant pathologic response of primary tumor following neoadjuvant treatment for locally advanced rectal cancer (2012) Ann Surg Oncol, , nov 28 [Epub ahead of print]Habr-Gama, A., Perez, R.O., Proscurshim, I., Campos, F.G., Nadalin, W., Kiss, D.R., Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy (2006) J Gastrointest Surg, 10, pp. 1319-1329Stipa, F., Zernecke, A., Moore, H.G., Minsky, B.D., Wong, W.D., Weiser, M., Residual mesorectal lymph node involvement following neoadjuvant combined-modality therapy: Rationale for radical resection? (2004) Ann Surg Oncol, 11, pp. 187-19

Terapia Neoadjuvante E Cirurgia Para Câncer Do Reto. Estudo Comparative Entre Resposta Patológica Parcial E Completa

Background - The approach of locally advanced extra-peritoneal rectal adenocarcinoma implies a treatment with neoadjuvant chemoradiotherapy associated with total mesorectal excision surgery. However, the tumors respond variably to this neoadjuvant therapy, and the mechanisms for response are not completely understood. Objective - Evaluate the variables related to the complete tumor response and the outcomes of patients who underwent surgery, comparing those with partial tumor regression and those with total remission of rectal lesion, at the pathological examination. Methods - Retrospective analysis of medical records of 212 patients operated between 2000 and 2010, in which 182 (85.9%) obtained partial remission at neoadjuvant therapy (Group 1) and 30 (14.1%), total remission (Group 2). Results - No difference was found between the groups in relation to gender, ethnicity, age, tumor distance from the anal verge, occurrence of metastases and synchronous lesions on preoperative staging, dose of radiotherapy and performed surgery. In Group 2, was verified high rate of complete remission when the time to surgery after neoadjuvant therapy was equal or less than 8 weeks (P=0.027), and a tendency of lower levels of pretreatment carcinoembryonic antigen (P=0.067). In pathological analysis, the Group 1 presented in relation to Group 2, more affected lymph nodes (average 1.9 and 0.5 respectively; P=0.003), more angiolymphatic (19.2% and 3.3%; P=0.032) and perineural involvement (15.4% and 0%; P=0.017) and greater number of lymph nodes examined (16.3 and 13.6; P=0.023). In the late follow-up, Group 1 also had lower overall survival than Group 2 (94.1 months and 136.4 months respectively; P=0.02) and disease-free survival (85.5 months and 134.6 months; P=0.004). There was no statistical difference between Group 2 and Group 1 in local recurrence (15% and 3.4%, respectively) and distant metastasis (28% and 13.8%, respectively). Conclusion - In this study, the only factor associated with complete remission of rectal adenocarcinoma was the time between neoadjuvant therapy and surgery. This group of patients had less affected lymph nodes, less angiolymphatic and perineural involvement, a longer overall and disease-free survival, but no significant statistical difference was observed in local recurrence and distant metastasis. Although the complete pathologic remission was associated with better prognosis, this not implied in the cure of the disease for all patients. © 2016, IBEPEGE - Inst. Bras. Estudos Pesquisas Gastroent. All rights reserved.53316316

Long-term Outcomes Of Ileal Pouch After Secondary Diagnosis Of Crohn's Disease [resultados Da Cirurgia De Reservatórios Ileais Em Pacientes Com Doença De Crohn]

Background - Total rectocolectomy and ileal pouch-anal anastomosis is the choice surgical procedure for patients with ulcerative colitis. In cases of Crohn's disease post-operative diagnosis, it can be followed by pouch failure. Aim - To evaluate ileal pouch-anal anastomosis long-term outcome in patients with Crohn's disease. Methods - Between February 1983 and March 2007, 151 patients were submitted to ileal pouch-anal anastomosis by Campinas State University Colorectal Unit, Campinas, SP, Brazil, 76 had pre-operative ulcerative colitis diagnosis and 11 had post-operative Crohn's disease diagnosis. Crohn's disease diagnosis was made by histopathological biopsies in nine cases, being one in surgical specimen, two cases in rectal stump, small bowel in two cases, ileal pouch in three and in perianal abscess in one of them. The median age was 30.6 years and eight (72.7%) were female. Results - All patients had previous ulcerative colitis diagnosis and in five cases emergency colectomy was done by toxic megacolon. The mean time until of Crohn's disease diagnosis was 30.6 (6-80) months after ileal pouch-anal anastomosis. Ileostomy closure was possible in 10 cases except in one that had ileal pouch fistula, perianal disease and small bowel involvement. In the long-term follow-up, three patients had perineal fistulas and one had also a pouch-vaginal fistula. All of them were submitted to a new ileostomy and one had the pouch excised. Another patient presented pouch-vaginal fistula which was successfully treated by mucosal flap. Three patients had small bowel involvement and three others, pouch involvement. All improved with medical treatment. Presently, the mean follow-up is 76.5 months and all patients are in clinical remission, and four have fecal diversion. The remaining patients have good functional results with 6-10 bowel movements/day. Conclusion - Crohn's disease diagnosis after ileal pouch-anal anastomosis for ulcerative colitis may be usual and later complications such fistulas and stenosis are common. However, when left in situ ileal pouch is associated with good function.453204207Bodzin, J.H., Klein, S.N., Priest, S.G., Ileoproctostomy is preferred over ileoanal pull-through in patients with indeterminate colitis (1995) Am Surg, 61, pp. 590-593Braveman, J.M., Schoetz, D.J., Marcello, P.W., Roberts, P.L., Coller, J.A., Murray, J.J., Rusin, L.C., The fate of the ileal pouch in patients developing Crohn's disease (2004) Dis Colon Rectum, 47, pp. 1613-1619Brown, C.J., Maclean, A.R., Cohen, Z., Macrae, H.M., O'Connor, B.I., McLeod, R.S., Crohn's disease and indeterminate colitis and the ileal pouch-anal anastomosis: Outcomes and patterns of failure (2005) Dis Colon Rectum, 48, pp. 1542-1549de Oca, J., Sánchez-Santos, R., Ragué, J.M., Biondo, S., Pares, D., Osorio, A., del Rio, C., Jaurrieta, E., Long-term results of ileal pouch-anal anastomosis in Crohn's disease (2003) Inflamm Bowel Dis, 9, pp. 171-175Deutsch, A.A., McLeod, R.S., Cullen, J., Cohen, Z., Results of the pelvic-pouch procedure in patients with Crohn's disease (1991) Dis Colon Rectum, 34, pp. 475-477Fazio, V.W., Ziv, Y., Church, J.M., Oakley, J.R., Lavery, I.C., Milson, J.W., Schroeder, T.K., Ileal pouch-anal anastomoses complications and function in 1005 patients (1995) Ann Surg, 222, pp. 120-127Foley, E.F., Schoetz Jr, D.J., Roberts, P.L., Marcello, P.W., Murray, J.J., Coller, J.A., Veidenheimer, M.C., Rediversion after ileal pouch-anal anastomosis. Causes of failure and predictors of subsequent pouch salvage (1995) Dis Colon Rectum, 38, pp. 793-798Grobler, S.P., Hosie, K.B., Affie, E., Thompson, H., Keighley, M.R.B., Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn's disease (1993) Gut, 34, pp. 1384-1388Hartley, J.E., Fazio, V.W., Remzi, F.H., Lavery, I.C., Church, J.M., Strong, S.A., Hull, T.L., Delaney, C.P., Analysis of the outcome of ileal pouch-anal anastomosis in patients with Crohn's disease (2004) Dis Colon Rectum, 47, pp. 1808-1815Hyman, N.H., Fazio, V.W., Tuckson, W.B., Lavery, I.C., Consequences of ileal pouch-anal anastomosis for Crohn's colitis (1991) Dis Colon Rectum, 34, pp. 653-657Kangas E, Matikainen M, Mattila J. Is indeterminate colitis Crohn's disease in the long-term follow-up? Int Surg. 1994;79:120-3Koltun, W.A., Schoetz Jr, D.J., Roberts, P.L., Murray, J.J., Coller, J.A., Veidenheimer, M.C., Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis (1991) Dis Colon Rectum, 34, pp. 857-860Marcello, P.W., Schoetz Jr, D.J., Roberts, P.L., Murray, J.J., Coller, J.A., Rusin, L.C., Veidenheimer, M.C., Evolutionary changes in the pathologic diagnosis after the ileoanal pouch procedure (1997) Dis Colon Rectum, 40, pp. 263-269Mylonakis, E., Allan, R.N., Keighley, M.R., How does pouch construction for a final diagnosis of Crohn's disease compare with ileoproctostomy for established Crohn's proctocolitis? (2001) Dis Colon Rectum, 44, pp. 1137-1143Panis, Y., Poupard, B., Nemeth, J., Lavergne, A., Hautefeuille, P., Valleur, P., Ileal pouch/anal anastomosis for Crohn's disease (1996) Lancet, 347, pp. 854-857Parks, A.G., Nicholls, R.J., Proctocolectomy without ileostomy for ulcerative colitis (1978) Br Med J, 2, pp. 85-88Paye, F., Penna, C., Chiche, L., Tiret, E., Frileux, P., Parc, R., Pouch-related fistula following restorative proctocolectomy (1996) Br J Surg, 83, pp. 1574-1577Peyregne, V., Francois, Y., Gilly, F.N., Descos, J.L., Flourie, B., Vignal, J., Outcome of ileal pouch after secondary diagnosis of Crohn's disease (2000) Int J Colorectal Dis, 15, pp. 49-53Reese, G.E., Lovegrove, R.E., Tilney, H.S., Yamamoto, T., Heriot, A.G., Fazio, V.W., Tekkis, P.P., The effect of Crohn's disease on outcomes after restorative proctocolectomy (2007) Dis Colon Rectum, 50, pp. 239-250Regimbeau, J.M., Panis, Y., Pocard, M., Bouhnik, Y., Lavergne-Slove, A., Rufat, P., Matuchansky, C., Valleur, P., Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease (2001) Dis Colon Rectum, 44, pp. 769-778Sagar, P.M., Dozois, R.R., Wolff, B.G., Long-term results of ileal pouch-anal anastomosis in patients with Crohn's disease (1996) Dis Colon Rectum, 39, pp. 893-898Tekkis, P.P., Heriot, A.G., Smith, O., Smith, J.J., Windsor, A.C., Nicholls, R.J., Long-term outcomes of restorative proctocolectomy for Crohn's disease and indeterminate colitis (2005) Colorectal Dis, 7, pp. 218-223Tiainen J, Matikainen M. Health-related quality of life after ileal J pouch-anal anastomosis for ulcerative colitis: long-term results. Scand J Gastroenterol. 1999;34:601-5Warren, B.F., Shepherd, N.A., The role of pathology in pelvic ileal reservoir surgery (1992) Int J Colorectal Dis, 7, pp. 68-75Yu, C.S., Pemberton, J.H., Larson, D., Ileal pouch-anal anastomosis in patients with indeterminate colitis. Long-term results (2000) Dis Colon Rectum, 43, pp. 1487-149

Unusual Finding After Resection Of Rectal Adenocarcinoma: Report Of Two Cases [achado Incomum Após Ressecção De Adenocarcinoma Do Reto: Relato De Dois Casos]

Pelvic recurrence after resection of rectal adenocarcinoma is a feared complication and is associated with a worse prognosis and low resectability rates. The differential diagnosis is diff cult, as biopsy is seldom performed preoperatively. We report two cases of desmoid pelvic tumor after resection of rectal adenocarcinoma. Therapeutic options and literature review are described. © 2013 Elsevier Editora Ltda. All rights reserved.333157160Leal, R.F., Ayrizono, M.L.S., Fagundes, J.J., Oliveira, P.S.P., Ângelo, S.N., Coy, C.S.R., Góes, J.R.N., Recidiva Pélvica de Adenocarcinoma de Reto - Abordagem Cirúrgica (2008) Rev Bras Coloproct, 28 (1), pp. 040-045Shinagare, A.B., Ramaya, N.H., Jagannathan, J.P., Krajewski, K.M., Giardino, A.A., Butrynski, J.E., A to Z of Desmoid Tumors (2011) Am J Roentegnol, 197 (6), pp. 1008-1014Sakorafas, G.H., Nissotakis, C., Peros, G., Abdominal Desmoid Tumors (2007) Surg Oncol, 16 (2), pp. 131-142Escobar, C., Munker, R., Thomas, J.O., Li, B.D., Burton, G.V., Update on desmoid tumors (2012) Ann Oncol, 23 (3), pp. 562-569Wanjeri, J.K., Opeya, C.J.O., A massive abdominal wall desmoid tumor occurring in a laparotomy scar: A case report (2011) World J Surg Oncol, 9 (35), pp. 1-4Kasper, B., Strbel, P., Hohenberger, A., Desmoid tumors: Clinical features and treatment options for advanced disease (2011) Oncologist, 16 (5), pp. 682-693Bertani, E., Chiappa, A., Testori, A., Mazzarol, G., Biff, R., Martella, S., Desmoid Tumors of the Anterior Abdominal Wall: Results from a Monocentric Surgical Experience and Review of the Literature (2009) Ann Surg Oncol, 16 (6), pp. 1642-1649Spiridakis, K., Panagiotakis, G., Grigoraki, M., Kokinnos, I., Papadakis, T., Kokkinakis, T., Isolated giant mesenteric f bromatosis (intra-abdominal desmoid tumors) (2008) Case Report. G Chir, 29 (10), pp. 413-416Bonvalot, S., Desai, A., Coppola, S., Pechoux, C.L., Terrier, P., Domont, J., The treatment of desmoid tumors: A stepwise clinical approach (2012) Ann Oncol, 22 (10), pp. 158-166Leal, R.F., Silva, P.V., Ayrizono, M.L.S., Fagundes, J.J., Amstalden, E.M., Coy, C.S., Desmoid tumor in patients with familial adenomatous polyposis (2010) Arq Gastroenterol, 47 (4), pp. 373-378Valejo, F.A.M., Tiezzi, D.G., Nai, G.A., Tumor desmoide abdomino-pélvico (2008) Rev Bras Ginecol Obstet, 31 (1), pp. 35-40Duggal, A., Dickinson, I.C., Sommerville, S., Gallie, P., The management of extra-abdominal desmoids tumours (2004) Int Orthop, 28 (4), pp. 252-256Camargo, V.P., Keohan, M.L., Adamo, D.R., Antonescu, C.R., Brennan, M.F., Singer, S., (2010) Cancer, 116 (9), pp. 2258-2265Oguz, M., Bedirli, A., Gultekin, A., Dursun, A., Mentes, B.B., (2006) Dis Colon Rectum, 49 (9), pp. 1445-1448Lee, J.C., Thomas, J.M., Phillips, S., Fisher, C., Moskovic, E., (2006) Am J Roentgenol, 186 (1), pp. 247-254Sinha, A., Hansmann, A., Bhandari, S., Gupta, A., Burling, D., Rana, S., Imaging assessment of desmoid tumours in familial adenomatous polyposis: Is state-of-the-art 1.5 T MRI better than 64-MDCT? (2012) Br J Radiol, 85 (1015), pp. 254-261Kasper, B., Dimitrakopoulou-Strauss, A., Strauss, L.G., Hohenberger, P., Positron emission tomography in patients with aggressive f bromatosis/desmoid tumours undergoing therapy with imatinib (2010) Eur J Ncl Med Mol Imaging, 37 (10), pp. 1876-1882Melis, M., Zager, J.S., Sondak, V., Multimodality Management of Desmoid Tumors: How Important Is a Negative Surgical Margin? (2008) J Surg Oncol, 98 (8), pp. 594-602Middleton, S.B., Phillips, R.K.S., Surgery for Large Intra-Abdominal Desmoid Tumors (2000) Dis Colon Rectum, 43 (12), pp. 1759-1762Merchant, B.N., Lewis, J.J., Woodruff, J.M., Leung, D.H., Brennan, M.F., Extremity and trunk desmoid tumors: A multifacial analysis of outcome (1999) Cancer, 86 (10), pp. 2045-205

Quality Of Life In Patients With Ileal Pouch For Ulcerative Colitis [qualidade De Vida Em Portadores De Reservatório Ileal Por Retocolite Ulcerative]

Introduction: proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical procedure for the treatment of ulcerative colitis (UC) and is associated with the prospect of cure. Experience gained over the years has demonstrated the occurrence of a high number of complications as well as bowel disorders that can compromise quality of life (QoL). Objective: evaluate QoL in patients with IPAA for ulcerative colitis. Patients and methods: the Inflammatory Bowel Disease Questionnaire (IBDQ) was used to assess QoL in patients with IPAA after its validation in Portuguese. Results: thirty-one patients submitted to IPAA by the same group of professionals were evaluated. QoL was classified as regular in all domains evaluated (intestinal and systemic symptoms and emotional and social aspects). There were no differences in relation to gender, type of pouch or postoperative time. However, elderly patients showed a tendency toward lower scores. Having a professional activity was associated with higher scores in systemic symptoms and social aspects (p < 0.05). Patients with ileostomy showed lower values in the domains of systemic symptoms, emotional and social aspects (p <0.05). Conclusion: in all domains assessed, patients with IPAA for UC had QoL classif ed as regular. Ileostomy and lack of professional activity negatively inluenced QoL. © 2013 Elsevier Editora Ltda. All rights reserved.333113117Parks, A.G., Nicholls, R.J., Proctocolectomy without ileostomy for ulcerative colitis (1978) Br Med J, 2, pp. 85-88Góes, J.N.R., (2001) Preservação Da Arcada Vascular Marginal Do Cólon Direito Como Via Suplementar De Irrigação Sanguínea Ao Reservatório Ileal Em Posição Pélvica, , estudos de dissecção em cadáveres e de observação clínica. Tese de livre docência. FCM- UNICAMPNeumann, P.A., Mennigen, R.B., Senninger, N., Bruewer, M., Rijcken, E., Timing of restorative proctocolectomy in patients with medically refractory ulcerative colitis: The patient's point of view (2012) Dis Colon Rectum, 55, pp. 756-761van Balkom, K.A., Beld, M.P., Visschers, R.G., van Gemert, W.G., Breuking, S.O., Long-term results after restorative proctocolectomy with ileal pouch-anal anastomosis at a yong age (2012) Dis Colon Rectum, 55 (9), pp. 939-947Jota, G., Karadzov, Z., Panovski, M., Joksimovic, N., Kartalov, A., Gelevski, R., Functional outcome and quality of life after restorative proctocolectomy and ileal pouch-anal anastomosis (2011) Prilozi, 32 (2), pp. 221-230Bennis, M., Tiret, E., Surgical management of ulcerative colitis (2012) Langenbeecks Arch Surg, 397, pp. 11-17Mennigen, R., Senninger, N., Bruewer, M., Rijcken, E., Pouch function and quality of life after successful management of pouch-related septic complications in patients with ulcerative colitis (2012) Langenbeeks Arch Surg, 397, pp. 37-44Bengtsson, J., Lindholm, E., Nordgren, S., Berndtsson, I., Oresland, T., Börjesson, L., Sexual function after failed ileal pouch-anal anastomosis (2011) J Crohns Colitis, 5, pp. 407-414Leowardi, C., Hinz, U., Tariverdian, M., Kienle, P., Herfarth, C., Ulrich, A., Long-term outcome 10 years or more after restorative proctocolectomy and ileal pouch-anal anastomosis in patients with ulcerative colitis (2010) Langenbecks Arch Surg, 395, pp. 49-56Meyer, A.L.M., Teixeira, M.G., Almeida, M.G., Kiss, D.R., Nahas, S.C., Cecconello, I., Quality of life in the late follow-up of ulcerative colitis patients submitted to restorative proctocolectomy with sphincter preservation over ten years ago (2009) Clinics (São Paulo), 64, pp. 877-883Heikens, J.T., Vries, J., van Laarhoven, C.J.H.M., Quality of Life, health-related quality of life and health status in patients having restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: A systematic review (2012) Colorectal Dis, 14, pp. 536-544Wuthrich, P., Gervaz, P., Ambrosetti, P., Soravia, C., Morel, P., Functional outcome and quality of life after restorative proctocolectomy and ileo-anal pouch anastomosis (2009) Swiss Med WKLY, 139, pp. 193-19