GANGRENA DE FOURNIER

A Gangrena de Fournier é uma grave infecção polimicrobiana que evolui com fasciite necrotizante, comprometendo principalmente as regiões genital, perineal e perianal. Caracteriza-se por rápida evolução e pode complicar com sepse, falência de múltiplos órgãos e óbito. A base do tratamento é o diagnóstico precoce e o desbridamento agressivo. Antibioticoterapia de amplo espectro, oxigenoterapia hiperbárica e cuidados locais são medidas complementares.Fournier´s gangrene is a serious infectious disease caused by multiple microorganisms leading to a necrotizing fasciitis of the genitals and perineum. With a rapid and progressive evolution can complicate with sepsis, multiple organ failure and death. Treatment is mainly based in early diagnosis and aggressive and extensive debridment, broadspectrum antibiotics, hyperbaric oxygen therapy, and local wound care are coadjuvants

Chronic and recurrent appendicitis: review article and cases report

A apendicite crônica e a apendicite recorrente são condições patológicas que diferem da apendicite aguda, a afecção mais comum do apêndice vermiforme. O propósito deste artigo é decifrar, com critério, os aspectos clínicos, o diagnóstico e a histopatologia da apendicite crônica e da apendicite recorrente. Os dados da literatura e as experiências, clínica e cirúrgica, dos autores, demonstradas dentre 10 pacientes com idade média entre 40 e 45 anos, com distribuição similar quanto ao sexo, sendo seis pacientes com apendicite recorrente e quatro com apendicite crônica, permitem concluir que a apendicite crônica e a recorrente já não devem ser mais uma controvérsia ou dúvida, mas um fato inequívoco, de importância clínica e acadêmica, cujos conceitos, por isso mesmo, merecem difusão na literatura científica e nas escolas médicas.Chronic and recurrent appendicitis are pathologic conditions that differ from acute appendicitis, the most common affection of the vermiform appendix. The objective of the present study was to describe in detail the clinical features, diagnosis and pathology of those conditions

Neoplasia at the site of the colostomy of patient with chagasic megacolon: case report

A neoplasia no sítio da colostomia associada ao megacólon chagásico é uma entidade rara. Os autores relatam caso de um paciente com lesão avançada, o qual foi submetido a tratamento cirúrgico e discutem aspectos relacionados a esta afecção.Neoplasia at the site of the colostomy associated with chagasic megacolon is a rare clinical event. Here, the authors report the case of a patient with advanced lesion, who had to undergo surgical treatment, and discuss aspects related to this disease

The epidemiological and clinical features of familial adenomatous polyposis in Ribeirão Preto

AbstractPurposeto study 75 familial adenomatous polyposis (FAP) patients treated in a single insti- tution in Ribeirão Preto/SP, from January 1981 to December 2011.Methodsthis is a retrospective study and the following data were collected: gender, age, main symptoms, familial history, coexisting malignancies, surgical treatment, surgical morbidity and mortality, factors related to life quality.Resultsmedian age was 29 years. Male-to-female ratio was 1.2:1. Bleeding was the most common symptom (62.6%). Colorectal cancer incidence was 25.5% (n = 19). Extracolonic neoplasia incidence was 8%. Colectomy with ileorectal anastomosis (IRA) was performed in 72% of the patients. Eighteen patients (24%) were submitted to proctocolectomy with “J-pouch” ileoanal anastomosis. In three patients (4%) proctocolectomy with terminal il- eostomy was performed. Early and late complication rate were similar (22.7% × 24%). Ileal pouch surgery exhibited tendency to a higher morbidity and mortality but no significance could be found. Overall mortality rate was 7.46%. Malignant neoplasia was the main cause of mortality, accounting for 60% of deaths.ConclusionFAP is a rare pathology in our country. Genetic counseling and proper screening programs are essential tools to early diagnosis and follow-up. Surgery is the most effective treatment and the best option to prevent malignant neoplasia

Hyperbaric oxygen therapy ameliorates TNBS-induced acute distal colitis in rats

Abstract\ud \ud Background\ud This study investigated the therapeutic effects of hyperbaric oxygen in experimental acute distal colitis focusing on its effect on the production of pro-inflammatory cytokines, nitric oxide and hypoxia-inducible factor 1alpha.\ud \ud \ud Methods\ud Colitis was induced with a rectal infusion of 150 mg/kg of TNBS under anesthesia with Ketamine (50 mg/kg) and Xylazine (10 mg/kg). Control animals received only rectal saline. After colitis induction, animals were subjected to two sessions of hyperbaric oxygen and were then euthanized. The distal intestine was resected for macroscopic analysis, determination of myeloperoxidase activity, western-blotting analyses of inducible nitric oxide synthase and cyclooxygenase-2 expression and immunohistochemical analysis of hypoxia-inducible factor 1alpha and cyclooxygenase-2. Cytokines levels in the distal intestine were measured using an enzyme-linked immunosorbent assay.\ud \ud \ud Results\ud Hyperbaric oxygen therapy attenuated the severity of acute distal colitis, with reduced macroscopic damage score. This effect was associated with prevention in the increase of pro-inflammatory cytokine production; myeloperoxidase activity, in the expression of inducible nitric oxide synthase and cyclooxygenase-2. Finally, hyperbaric oxygen inhibited the acute distal colitis-induced up-regulation of hypoxia-inducible factor 1alpha.\ud \ud \ud Conclusions\ud The results indicate that hyperbaric oxygen attenuates the severity of acute distal colitis through the down-regulation of pro-inflammatory events.This work was supported by FAEPA\ud (Fundação de Apoio ao Ensino, Pesquisa e Assistência), Ribeirão Preto\ud Medical School University of Sao Paulo, Brazil and Grant 2011/19670-0 from\ud São Paulo Research Foundation (FAPESP)