Paraestomal hernia with gastric outlet obstruction: a case report and literature review

sem informaçãoAn 69-year-old obese woman was submitted to an abdominoperineal resection (APR) with left side end colostomy to treat a synchronic sigmoid and middle rectum cancer. Six months after APR, she develop a PH with a progressive increase of the size. The patien7sem informaçãosem informaçãosem informaçã

Cloud-Based Speech Technology for Assistive Technology Applications (CloudCAST)

The CloudCAST platform provides a series of speech recognition services that can be integrated into assistive technology applications. The platform and the services provided by the public API are described. Several exemplar applications have been developed to demonstrate the platform to potential developers and users

An innovative speech-based user interface for smarthomes and IoT solutions to help people with speech and motor disabilities

A better use of the increasing functional capabilities of home automation systems and Internet of Things (IoT) devices to support the needs of users with disability, is the subject of a research project currently conducted by Area Ausili (Assistive Technology Area), a department of Polo Tecnologico Regionale Corte Roncati of the Local Health Trust of Bologna (Italy), in collaboration with AIAS Ausilioteca Assistive Technology (AT) Team. The main aim of the project is to develop experimental low cost systems for environmental control through simplified and accessible user interfaces. Many of the activities are focused on automatic speech recognition and are developed in the framework of the CloudCAST project. In this paper we report on the first technical achievements of the project and discuss future possible developments and applications within and outside CloudCAST

Multiple Desmoid Tumors In A Patient With Gardner's Syndrome - Report Of A Case

INTRODUCTION Desmoid tumor (DT) is a common manifestation of Gardner's Syndrome (GS), although it is a rare condition in the general population. DT in patients with GS is usually located in the abdominal wall and/or intra-abdominal cavity. PRESENTATION OF CASE We report a case of a 32 years-old female patient with familial adenomatous polyposis (FAP), who was already submitted to total colectomy and developed multiple DT, located in the abdominal wall and in the left breast. The patient underwent several surgical procedures, with a multidisciplinary team of surgeons. Wide surgical resections of the left breast and the abdominal wall tumors were performed in separate steps. Polypropylene mesh reconstruction and muscle flaps were needed to cover the defects of the thoracic and abdominal walls. After partial necrosis of the adipose-cutaneous flap in the abdomen that required a new skin graft, she had a satisfactory outcome with complete healing of the surgical incisions. DISCUSSION DT is frequent in GS, however, breast localization is very rare, with few cases reported in the literature. Recurrence of DT is not negligible, even after a wide surgical resection. GS patients must be followed up closely, and clinical examination, associated with imaging studies, should be performed to detect any signs of tumor. CONCLUSION DT represents one of the most significant causes of the morbidity and mortality that affects FAP patients following colectomy. In general, the surgical procedures to excise DT are highly complex, requiring a multidisciplinary team. © 2014 The Authors.57370374Lee, B.D., Lee, W., Oh, S.H., A case report of Gardner syndrome with hereditary widespread osteomatous jaw lesions (2009) Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol, 107 (3), pp. 68-72Jonathan, B., Claire, H., Mary, T., Gardner syndrome - Review and report of a case (2005) Oral Oncol Extra, 41, pp. 89-92Fotiadis, C., Tsekouras, D.K., Sfiniadakis, J., Genetzakis, M., Zografos, G.C., Gardner's syndrome: A case report and review of the literature (2005) World Journal of Gastroenterology, 11 (34), pp. 5408-5411Gómez García, E.B., Knoers, N.V., Gardner's syndrome (familial adenomatous polyposis): A cilia-related disorder (2009) Lancet Oncol, 10 (7), pp. 727-735Cristofaro, M.G., Giudice, A., Amantea, M., Gardner's syndrome: A clinical and genetic study of a family (2013) Oral Surg Oral Med Oral Pathol Oral Radiol, 115 (3), pp. 1-6Gu, G.L., Wang, S.L., Wei, X.M., Diagnosis and treatment of Gardner syndrome with gastric polyposis: A case report and review of the literature (2008) World J Gastroenterol, 14 (13), pp. 2121-2123(2003) Breast Imaging Reporting and Data System, Breast Imaging Atlas, , American College Of Radiology 4th ed. American College of Radiology Reston, VAMerg, A., Lynch, H.T., Lynch, J.F., Hereditary colon cancer-Part i (2005) Curr Probl Surg, 42 (4), pp. 195-256Mao, C., Huang, Y., Howard, J.M., Carcinoma of the ampulla of Vater and mesenteric fibromatosis (desmoid tumor) associated with Gardner's syndrome: Problems in management (1995) Pancreas, 10 (3), pp. 239-245Cruz-Correa, M., Giardiello, F.M., Familial adenomatous polyposis (2003) Gastrointestinal Endoscopy, 58 (6), pp. 885-894. , DOI 10.1016/S0016-5107(03)02336-8, PII S0016510703023368Juhn, E., Khachemoune, A., Gardner syndrome: Skin manifestations, differential diagnosis and management (2010) Am J Clin Drematol, 11 (2), pp. 117-122Turina, M., Pavlik, C.M., Heinimann, K., Recurrent desmoids determine outcome in patients with Gardner syndrome: A cohort study of three generations of an APC mutation-positive family across 30 years (2013) Int J Colorectal Dis, 28 (6), pp. 865-872Brown, C.S., Jeffrey, B., Korentager, R., Desmoid tumors of the bilateral breasts in a patient without Gardner syndrome: A case report and review of literature (2012) Ann Plast Surg, 69 (2), pp. 220-222Leal, R.F., Silva, P.V.V.T., Ayrizono, M.L.S., Desmoid tumor in patients with familial adenomatous polyposis (2010) Arq Gastroenterol, 47, pp. 373-378Rammohan, A., Wood, J.J., Desmoid tumour of the breast as a manifestation of Gardner's syndrome (2012) Int J Surg Case Rep, 3 (5), pp. 139-142Escobar, C., Munker, R., Thomas, J.O., Update on desmoid tumors (2012) Ann Oncol, 23 (3), pp. 562-569Camargo, V.P., Keohan, M.L., D'Adamo, D.R., Clinical outcomes of systemic therapy for patients with deep fibromatosis (desmoid tumor) (2010) Cancer, 116 (9), pp. 2258-2265Xu, H.M., Han, J.G., Ma, S.Z., Related citations treatment of massive desmoid tumour and abdominal wall reconstructed with meshes in Gardner's Syndrome (2010) J Plast Recontr Aesthet Surg, 63 (6), pp. 1058-106

Comparative Study Of The Hyperbaric Hyperoxygenation In Ischemic Colonic Loops In Rats

Purpose: To analyze and to evaluate the effect of the hyperbaric hyperoxygenation in the mechanical resistance of ischemic colon of rats. Methods: Eighty rats, distributed in four groups of 20 animals in each one, were used. In group 1 (G1), the control group, ischemia was not caused. Group 2 was submitted to the lesser degree of ischemia. Group 3 was submitted to the intermediate degree of ischemia. In group 4, a bigger degree of intestinal ischemia was provoked. Each group was divided in two sub-groups of ten animals each: with hyperbaric chamber (CC) and without hyperbaric chamber (SC). The animals of the four CC subgroups were placed in an experimental hyperbaric chamber in order to inhale oxygen at 100%, at two Absolute Atmospheres, for 120 minutes, for a four-day consecutive period. The animals of the four SC subgroups were kept in environment air during the five days of the experiment. All animals have been submitted to the mechanical study of the intestinal loop by the pressure test of the rupture by liquid distension. The euthanasia occurred in the fifth post-operative day. Results: Considering the ischemia factor, the four groups were different among them (p=0.0001). There was no statistical difference between subgroups CC and SC (p=0.3461). Conclusion: The hyperbaric oxygen-therapy did not present improvement on the induced ischemia in rats upright colic loop.2228591Fagundes, J.J., Estudo comparativo da cicatrização de anastomoses cólicas realizadas com auxílio do bisturi laser de dióxido de carbono: Trabalho experimental em cães [Tese - Doutorado] (1990) Faculdade de Ciências Médicas da, , UNICAMP;Cohen, S.R., Cornell, C.N., Collins, M.H., Sell, J.E., Blanc, W.A., Altman, R.P., Healing of ischemic colonic anastomoses in the rat: Role of antibiotic preparation (1985) Surgery, 97 (4), pp. 443-446Martins Júnior, A., Guimarães, A.S., Ferreira, A.L., Efeito dos corticosteróides na cicatrização de anastomoses intestinais (1992) Acta Cir Bras, 7, pp. 28-30Furst, M.B., Stromberg, B.V., Blatchford, G.J., Christensen, M.A., Thorson, A.G., Colonic anastomoses: Bursting strength after corticosteroid treatment (1994) Dis Colon Rectum, 37, pp. 12-15Minossi, J.G., Ação do diclofenaco de sódio na cicatrização de anastomoses realizadas no íleo terminal e no cólon distal de ratos (1995) Estudo da força de ruptura, hidroxiprolina tecidual e exame histológico [Tese - Doutorado], , Universidade Estadual Paulista;Garcia, G.G., Criado, F.J.G., Persona, M.A.B., Alonso, A.G., Healing of colonic ischemic anastomoses in the rat: Role of superoxide radicals (1998) Dis Colon Rectum, 41, pp. 892-895Yazdi, P.G., Miedema, B.W., Humphrey, L., Immediate postoperative 5-FU does not decrease colonic anastomotic strength (1998) J Surg Oncol, 69, pp. 125-127Mantovani, M., Leonardi, L.S., Alcântara, F.G., Evolução da cicatrização em anastomoses do intestino grosso de cães em condições de normalidade e sob ação de drogas imunossupressoras: Estudo comparativo em cães (1979) Rev Paul Med, 94, pp. 118-126Yarimkaya, A., Apaydin, B., Unal, E., Karabicak, I., Aydogan, F., Uslu, E., Erginoz, E., Eyuboglu, E., Effects of recombinant human growth hormone and nadrolone phenylpropionate on the healing of ischemic colon anastomosis in rats (2003) Dis Colon Rectum, 46, pp. 1690-1697Greca, F.H., Biondo-Simoes, M.L.P., Paula, J.B., Noronha, L., Cunha, L.S.F., Baggio, P.V., Bittencourt, F.O., Correlação entre o fluxo sangüíneo intestinal e a cicatrização de anastomoses colônicas: Estudo experimental em cães (2000) Acta Cir Bras, 15, pp. 88-94Brito, M.V.H., Koh, I.H.J., Lamarão, L.G., Damous, S.H.B., Efeito do choque hipovolêmico na anastomose do intestino delgado de ratos (2001) Arq Gastroenterol, 38, pp. 116-124Naresse, L.E., Efeito da peritonite fecal na cicatrização do cólon distal no rato (1990) Avaliação anatomo-patológica, estudo da força de ruptura e da hidroxiprolina tecidual [Tese - Doutorado], , Universidade Estadual Paulista;Biondo-Simões, M.L.P., Greca, F.H., Bryk Junior, A., Komatsu, M.C.G., Bittencourt, F.O., Greca, L.M., Influência da peritonite sobre a síntese de colágeno em anastomoses do cólon distal: Estudo experimental em ratos (2000) Acta Cir Bras, 15, pp. 69-73Fraga, G.P., (2001) Análise de fatores de risco no tratamento de lesões de ceco com sutura primária em ratos, , Dissertaç ão, Mestrado, Faculdade de Ciências Médicas da UNICAMP;Decherney, A.H., Dizerega, G.S., Clinical problem of intraperitoneal postsurgical adhesion formation following general surgery and the use adhesion prevention barriers (1997) Surg Clin N Am, 77, pp. 671-689Wu, F.C., Ayrizono, M.L.S., Fagundes, J.J., Coy, C.S.R., Góes, J.R.N., Leonardi, L.S., Estudos biomecânicos da ação de aderências sobre anastomose cólica. Trabalho experimental em ratos (2003) Acta Cir Bras, 18, pp. 216-223Schrok, T.R., Deveney, C.H., Dunphy, J.E., Factors contributing to leakage of colonic anastomosis (1973) Ann Surg, 127, pp. 513-518Tagart, R.E., Colorectal anastomosis: Factors influencing success (1981) J R Soc Med, 74, pp. 111-118Khoury, G.A., Waxmann, B.P., Large bowell anastomoses. I. The healing process and suture anastomoses: A review (1983) Br J Surg, 70, pp. 61-63Foster, M.E., Laycock, J.R., Silver, I.A., Hypovolaemia and healing in colonic anastomosis (1985) Br J Surg, 72, p. 831Van der Ham, A.C., Kort, W.J., Weijma, I.M., Healing of ischemic colonic anastomosis: Fibrin sealant does not improve wound healing (1992) Dis Colon Rectum, 35, pp. 884-890Hamzaoglu, I., Karahasanoglu, T., Aydin, S., Sahin, D.A., Carkman, S., Sariyar, M., Alemdaroglu, K., The effects of hyperbaric oxygen on normal and ischemic colon anastomoses (1998) Am J Surg, 176, pp. 458-461Wu, F.C., Estudo dos efeitos de diferentes concentrações de oxigênio e da hiperoxigenação hiperbárica sobre anastomose cólica comprometida ou não pela isquemia: Trabalho experimental em ratos [Tese - Doutorado] (2003) Faculdade de Ciências Médicas da, , UNICAMP;Tibbles, P.M., Edelsberg, J.S., Hyperbaric-oxygen therapy (1996) N Engl J Med, 334, pp. 1642-1648Iazzetti, P.E., (1992) Hiperoxigenação hiperbárica, pp. 180-204. , Terzi RGG. Equilíbrio ácido-básico e transporte de oxigênio. São Paulo: Manole;Gordillo, G.M., Sen, C.K., Revisiting the essential role of oxygen in wound healing (2003) Am J Surg, 186 (3), pp. 259-263Dockendorf, B.L., Frazee, R.C., Peterson, W.G., Myers, D., Treatment of acute intestinal ischemia with hyperbaric oxygen (1993) South Med J, 86, pp. 518-52

Crohn's Disease Small Bowel Strictureplasties: Early And Late Results [plastias De Estenoses De Intestino Delgado Na Doença De Crohn: Resultados Imediatos E Tardios]

Background - Strictureplasty is an alternative surgical procedure for Crohn's disease, particulary in patients with previous resections or many intestinal stenosis. Aim - To analyze surgical complications and clinical follow-up in patients submitted to strictureplasty secondary to Crohn's disease. Methods - Twenty-eight patients (57.1% male, mean age 33.3 years, range 16-54 years) with Crohn's disease and intestinal stenosis (small bowel, ileocecal region and ileocolic anastomosis) were submitted to strictureplasty, at one institution, between September 1991 and May 2004. Thirteen patients had previous intestinal resections. The mean follow-up was 58.1 months. A total of 116 strictureplasties were done (94 Heineke-Mikulicz - 81%, 15 Finney - 13%, seven side-to-side ileocolic strictureplasty - 6%). Three patients were submitted to strictureplasty at two different surgical procedures and two in three procedures. Results - Regarding to strictureplasty, postoperative complication rate was 25% and mortality was 3.6%. Early local complication rate was 57.1%, with three suture leaks (10.7%) and late complication was present in two patients, both with incisional hernial and enterocutaneous fistulas (28.6%). Patients remained hospitalized during a medium time of 12.4 days. Clinical and surgical recurrence rates were 63% and 41%, respectively. Among the patients submitted to another surgery, two patients had two more operations and one had three. Recurrence rate at strictureplasty site was observed in 3.5%, being Finney technique the commonest one. Presently, 19 patients had been asymptomatic with the majority of them under medical therapy. Conclusion - Strictureplasties have low complication rates, in spite of having been done at compromised site, with long term pain relief. Considering the clinical course of Crohn's disease, with many patients being submitted to intestinal resections, strictureplasties should be considered as an effective surgical treatment to spare long intestinal resections.443215220Alexander-Williams, J., Non-resection operations for small bowel Crohn's disease (1984) Acta Gastroenterol Belg, 47, pp. 355-359Alexander-Williams, J., Surgical management of small intestinal Crohn's disease: Resection or strictureplasty (1994) Semin Colon Rectal Surg, 5, pp. 193-198Baba, S., Nakai, K., Strictureplasty for Crohn's disease in Japan (1995) J Gastroenterol, 30, pp. 135-138Crohn, B.B., Ginzburg, L., Oppenheimer, G.D., Regional ileitis. a pathologic and clinical entity (1932) JAMA, 99, pp. 1323-1329Dehn, T.C., Kettwell, M.G., Mortensen, N.J., Lee, E.C., Jewell, D.P., Ten-year experience of strictureplasty for obstructive Crohn's disease (1989) Br J Surg, 76, pp. 339-341Di Abriola, G.F., De Angeli, P., Dail'Oglio, L., Di Lorenzo, M., Strictureplasty: An alternative approach in long segment bowel stenosis Crohn's disease (2003) J Pediatr Surg, 38, pp. 814-818Dietz, D.W., Laureti, S., Strong, S.A., Hull, T.L., Church, J., Remzi, F.H., Lavery, I.C., Fazio, V.W., Safety and long term efficacy of strictureplasty in 314 patients with obstructing small bowel Crohn's disease (2001) J Am Coll Surg, 192, pp. 330-337Dietz, D.W., Fazio, V.W., Laureti, S., Strong, S.A., Hull, T.L., Church, J., Remzi, F.H., Senagore, A.J., Strictureplasty in diffuse Crohn's jejunoileitis: Safe and durable (2002) Dis Colon Rectum, 45, pp. 764-770Fazio, V.W., Galandiuky, S., Strictureplasty in diffuse Crohn's jejunoileitis (1985) Dis Colon Rectum, 28, pp. 512-518Fazio, V.W., Galandiuky, S., Jagelman, D.G., Lavery, I.C., Strictureplasty in Crohn's disease (1989) Ann Surg, 210, pp. 621-625Fazio, V.W., Tjandra, J.J., Lavery, I.C., Church, J.M., Milson, J.W., Oakley, J.R., Long-term follow-up of strictureplasty in Crohn's disease (1993) Dis Colon Rectum, 36, pp. 355-361Fazio, V.W., Marchetti, F., Church, M., Goldblum, J.R., Lavery, I.C., Hull, T.L., Milson, J.W., Secic, M., Effect of resection margins on the recurrence of Crohn's disease in the small bowel: A randomized controlled trial (1996) Ann Surg, 224, pp. 563-573Gaetini, A., De Simone, M., Resegotti, A., Our experience with strictureplasty in the surgical treatment of Crohn's disease (1989) Hepatogastroenterology, 36, pp. 511-515Gardiner, K.R., Kettewell, M.G., Mortensen, N.J., Intestinal haemorrhage after strictureplasty for Crohn's disease (1996) Int J Colorectal Dis, 1, pp. 180-182Garlock, J.H., Crohn, B.B., An appraisal of the results of surgery and treatment of regional ileitis (1945) JAMA, 127, pp. 205-211Greenstein, A.J., Sachar, D.B., Pasternack, B.S., Janowitz, H.D., Reoperation and recurrence in Crohn's colitis and ileocolitis. Crude and cumulative rates (1975) N Engl J Med, 293, pp. 685-690Greenstein, A.J., Sachar, D.B., Pucillo, A., Kreel, I., Geller, S., Janowitz, H.D., Aufses, A., Cancer in Crohn's disease after diversionary surgery. A report of seven carcinomas occurring in excluded bowel (1978) Am J Surg, 135, pp. 86-90Harvey, R.F., Bradshaw, J.M., A simple index of Crohn's disease activity (1980) Lancet, 1, p. 514Heuman, R., Boeryd, B., Bolin, T., Sjodahl, R., The influence of disease of the margin of resection on the outcome of Crohn's disease (1983) Br J Surg, 70, pp. 519-521Hurst, R.D., Michelassi, F., Strictureplasty for Crohn's disease: Techniques and long-term results (1998) World J Surg, 22, pp. 359-363Jaskowiak, N.T., Michelassi, F., Adenocarcinoma at a strictureplasty site in Crohn's disease: Report of a case (2001) Dis Colon Rectum, 44, pp. 284-287Katariya, R.N., Sood, S., Rao, P.G., Rao, P.L.N.G., Strictureplasty for tubercular strictures of the gastrointestinal tract (1977) Br J Surg, 64, pp. 496-498Laurent, S., Detry, O., Detroz, B., De Roover, A., Joris, J., Honoré, P., Louis, E., Jacquet, N., Strictureplasty in Crohn's disease: Short and long-term follow-up (2002) Acta Chir Belg, 102, pp. 253-255Lavery IC, Souza VCT. Tratamento cirúrgico da doença de Crohn. In: Souza VCTS, editor. Coloproctologia. 4 aed. Rio de Janeiro: Medsi1999. p.458-79Lee, E.C.G., Papaioannou, N., Recurrences following surgery for Crohn's disease (1980) Clin Gastroenterol, 9, pp. 419-438Lee, E.C.G., Papaioannou, N., Minimal surgery for chronic obstruction in patients with extensive or universal Crohn's disease (1982) Ann R Coll Surg Engl, 64, pp. 229-233Marchetti, F., Fazio, V.W., Ozuner, G., Adenocarcinoma arising from a strictureplasty site in Crohn's disease. Report of a case (1996) Dis Colon Rectum, 39, pp. 1315-1321Michelassi, F., Balestracci, T., Chappell, R., Block, G.E., Primary and recurrent Crohn's disease: Experience with 1379 patients (1991) Ann Surg, 214, pp. 230-240Michelassi, S., Hurst, R.D., Melis, M., Rubin, M., Cohen, R., Gasparitis, A., Hanaver, S.B., Hart, J., Side-to-side isoperistaltic strictureplasty in extensive Crohn's disease: A prospective longitudinal study (2000) Ann Surg, 232, pp. 401-408Ozuner, G., Fazio, V.W., Lavery, I.C., Milson, J.W., Strong, S.A., Reoperative rates for Crohn's disease following strictureplasty. Long-term analysis (1996) Dis Colon Rectum, 39, pp. 1199-1203Partridge, S.K., Hodin, R.A., Small bowel adenocarcinoma at the strictureplasty site in a patient with Crohn's disease: Report of a case (2004) Dis Colon Rectum, 47, pp. 778-781Pennington, L., Hamilton, S.R., Bayless, T.M., Cameron, J.L., Surgical management of Crohn's disease: Influence of disease at margin of resection (1980) Ann Surg, 192, pp. 311-318Poggioli, G., Stocchi, L., Laureti, S., Selleri, S., Marra, C., Magalotti, C., Cavallari, A., Conservative surgical management of terminal ileitis: Side-to-side enterocolic anastomosis (1997) Dis Colon Rectum, 40, pp. 234-237Poggioli, G., Pierangeli, F., Laureti, S., Ugolini, F., Indication and type of surgery in Crohn's disease (2002) Aliment Pharmacol Ther, 16, pp. 59-64Pritchard TJ, Schoetz DJ, Caushaj FP, Roberts PL, Murray JT, Coller JA, Veidenheimer MC. Strictureplasty of the small bowel in patients with Crohn's disease. An effective surgical option. Arch Surg. 1990;125:715-7Quandale, P., Gambiez, L., Colombel, J.F., Paris, J.C., Cortot, A., Long-term follow-up of strictureplasty in Crohn's disease (1994) Acta Gastroenterol Belg, 57, pp. 314-319Sayfan, J., Wilson, D.A., Allan, A., Andrews, H., Alexander-Williams, J., Recurrence after strictureplasty or resection for Crohn's disease (1989) Br J Surg, 76, pp. 335-338Serra, J., Cohen, Z., McLeod, R.S., Natural history of strictureplasty in Crohn's disease: 9-year experience (1995) Can J Surg, 38, pp. 481-485Sharif, H., Alexander-Williams, J., The role of strictureplasty in Crohn's disease (1992) Int Surg, 77, pp. 15-18Silverman, R.C., Mc Leod, R.S., Cohen, Z., Strictureplasty in Crohn's disease (1989) Can J Surg, 32, pp. 19-22Spencer, M.P., Nelson, H., Wolff, B.G., Dozois, R.R., Strictureplasty for obstructive Crohn's disease: The Mayo experience (1994) Mayo Clin Proc, 69, pp. 33-36Stebbing, J.F., Jewell, D.P., Kettlewel, M.G., Mortensen, N.J., Recurrence and reoperation after strictureplasty for obstructive Crohn's disease: Long-term results (1995) Br J Surg, 82, pp. 1471-1474Taschieri, A.M., Cristaldi, M., Elli, M., Danelli, P.G., Molteni, B., Rovati, M., Porro, G.B., Description of new "bowel-sparing" techniques for long strictures of Crohn's disease (1997) Am J Surg, 173, pp. 509-512Teixeira, M.G., Habr-Gama, A., Tratamento cirúrgico da doença de Crohn intestinal (1997) Doença inflamatória intestinal, pp. 173-187. , Habr-Gama A, editor, São Paulo: Atheneu;Tichansky, D., Cagir, B., Yoo, E., Marcus, S.M., Fry, R.D., Strictureplasty for Crohn's disease: Meta-analysis (2000) Dis Colon Rectum, 43, pp. 911-919Tjandra, J.J., Fazio, V.W., Strictureplasty for ileocolic anastomotic strictures in Crohn's disease (1993) Dis Colon Rectum, 36, pp. 1099-1103Tjandra, J.J., Fazio, V.W., Strictureplasty without concomitant resection for small bowel obstruction in Crohn's disease (1994) Br J Surg, 81, pp. 561-563Tonelli, F., Ficari, F., Strictureplasty in Crohn's disease: Surgical option (2000) Dis Colon Rectum, 43, pp. 920-926Trnka, Y.M., Glotzer, D.J., Kasdon, E.J., Goldman, H., Steer, M.L., Goldman, L.D., The long-term outcome of restorative operation in Crohn's disease. Influence of location, prognostic factors, and surgical guidelines (1982) Ann Surg, 196, pp. 345-355Whelan, G., Farmer, R.G., Fazio, V.W., Goormastic, M., Recurrence after surgery in Crohn's disease. Relationship to location of disease (clinical pattern) and surgical indication (1985) Gastroenterology, 88, pp. 1826-1833Wolf, B.G., Beart, R.W., Frydenberg, H.B., Weiland, L.H., Agrez, M.V., Ilstrup, D.M., The importance of disease-free margins in resections for Crohn's disease (1983) Dis Colon Rectum, 26, pp. 239-243Yamamoto, T., Bain, I.M., Allan, R.N., Keighley, M.R., An audit of strictureplasty for small-bowel Crohn's disease (1999) Dis Colon Rectum, 42, pp. 797-803Yamamoto, T., Keighley, M.R., Factors affecting the incidence of postoperative septic complications and recurrence after strictureplasty for jejunoileal Crohn's disease (1999) Am J Surg, 178, pp. 240-245Yamamoto, T., Keighley, M.R., Long-term results of strictureplasty without synchronous resection for jejunoileal Crohn's disease (1999) Scand J Gastroenterol, 34, pp. 180-18

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. 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