Using computed tomography colonography in patients at high risk of colorectal cancer - a prospective study in a university hospital in South America

OBJECTIVES: The purpose of our study was to report the results of the implementation of computed tomography colonography in a university hospital setting serving a Brazilian population at high risk of colorectal cancer. METHODS: After creating a computed tomography colonography service in our institution, 85 patients at high risk of colorectal cancer underwent computed tomography colonography followed by a same-day optical colonoscopy from September 2010 to May 2012. The overall accuracy of computed tomography colonography in the detection of lesions ≥6 mm was compared to that of optical colonoscopy (direct comparison). All colonic segments were evaluated using quality imaging (amount of liquid and solid residual feces and luminal distension). To assess patient acceptance and preference, a questionnaire was completed before and after the computed tomography colonography and optical colonoscopy. Fisher's exact test was used to measure the correlations between colonic distension, discomfort during the exam, exam preference and interpretation confidence. RESULTS: Thirteen carcinomas and twenty-two lesions ≥6 mm were characterized. The sensitivity, specificity and accuracy of computed tomography colonography were 100%, 98.2% and 98.6%, respectively. Computed tomography colonography was the preferred method of investigation for 85% of patients. The preparation was reported to cause only mild discomfort for 97.6% of patients. According to the questionnaires, there was no significant relationship between colonic distension and discomfort (p>;0.05). Most patients (89%) achieved excellent bowel preparation. There was a statistically significant correlation between the confidence perceived in reading the computed tomography colonography and the quality of the preparation in each colonic segment (p≤0.001). The average effective radiation dose per exam was 7.8 mSv. CONCLUSION: It was possible to institute an efficient computed tomography colonography service at a university hospital that primarily assists patients from the public health system, with high accuracy, good acceptance and effective radiation doses. Our results seem to be comparable to other centers of excellence and fall within acceptable published guidelines, showing that a successful computed tomography colonography program can be reproduced in a South American population screened in a university hospital

Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease Ligadura elástica e fotocoagulação com radiação infravermelha no tratamento ambulatorial da doença hemorroidária

PURPOSE: To compare the results of rubber band ligation and infrared photocoagulation for the treatment of hemorrhoidal disease through the analysis of the incidence of complications after each treatment and respective success rate. METHODS: Forty-eight patients with first, second or third degree hemorrhoidal disease were randomized to recieve treatment with either rubber band ligation (n=23) or infrared photocoagulation (n=25). Each patient was assessed at 1 week and 4 week intervals after treatment. We compared the incidence of complications and efficiency of each treatment modality and Qui-square, Fisher's Exact Test and Student's t Test were used to statistical analysis. RESULTS: Bleeding occured in eigth (34,7%) patients treated with rubber band ligation and in four (16,0%) after infrared photocoagulation (p=0,243). Thirteen (52,0%) patients felt pain during infrared photocoagulation and 9 (39,1%) after rubber band ligation (p=0,546). After rubber band ligation, 14 (60,8%) required medication for pain relief. One patient (4,0%) required medication after infrared photocoagulation (p<0,001). Three (13,0%) patients treated with rubber band ligator and 1 (4,0%) treated with infrared photocoagulation had symptomatic mucosal ulcers. Perianal dermatitis occured in two (8,0%) patients treated with infrared photocoagulation and one patient (4,3%) was observed to have prolapsed thrombosed piles after rubber band ligation. One month after treatment, 17 of 23 patients treated with rubber band ligation (73,9%) and 18 of 25 patients treated with infrared photocoagulation were asymptomatic. Rubber band ligation treated bleeding and prolapse in 90,0% and 82,4% respectively. Infrared photocoagulation treates bleeding and prolapse in 93,7% and 87,5% respectively. Those differences are not significant. CONCLUSION: Rubber band ligation causes significantly more pain than infrared photocoagulation during the first week after the procedures and their success rate are not different after four weeks of treatment.<br>OBJETIVO: Comparar os resultados da ligadura elástica com os da fotocoagulação com radiação infravermelha no tratamento da doença hemorroidária através da análise de suas respectivas morbidades e eficácia. MÉTODOS: Foi realizado ensaio clínico casualisado com 48 pacientes portadores de doença hemorroidária graus I, II e III. Após randomização, os pacientes foram submetidos à ligadura elástica (n=23) ou fotocoagulação com radiação infravermelha (n=25). Os pacientes compareceram para consulta ambulatorial 1 semana e 4 semanas após o procedimento. A avaliação foi feita através da análise da incidência de morbidades após cada procedimento e eficácia, com quatro semanas de acompanhamento. As análises estatísticas foram realizadas através do teste do Qui-quadrado, Teste Exato de Fisher e Teste t de Student. RESULTADOS: Dos pacientes submetidos à ligadura elástica, 34,7% (8/23) apresentou sangramento após o procedimento. Após fotocoagulação, 16,0% (4/25) tiveram sangramento (p=0,243). A incidência de pacientes com dor no momento da aplicação do procedimento foi de 52,0% (13/25) após fotocoagulação com radiação infravermelha e 39,1% (9/23) após ligadura elástica (p=0,546). No entanto, ligadura elástica foi mais dolorosa após 48 horas do procedimento (p=0,044). Após ligadura elástica, 60,8% (14/23) dos pacientes necessitaram de analgésicos contra 4,0% (1/25) após fotocoagulação com radiação infravermelha (p<0,001). Um paciente submetido à ligadura elástica (4,3%) evoluiu com trombose dos mamilos ligados. Três pacientes submetidos à ligadura elástica (13,0%) e 1 (4,0%) submetido à fotocoagulação com radiação infravermelha apresentaram úlceras sintomáticas após a aplicação dos tratamentos. Dois pacientes (8,0%) submetidos à fotocoagulação com radiação infravermelha tiveram dermatite perianal. Em relação aos resultados terapêuticos 73,9% dos pacientes submetidos à ligadura elástica e 72,0% daqueles tratados com fotocoagulação com radiação infravermelha estavam assintomáticos após 1 mês de tratamento. A ligadura elástica foi eficaz no controle do sangramento de 90,0% dos pacientes e a fotocoagulação com radiação infravermelha foi eficaz no controle do sangramento em 93,7%. No controle do prolapso, a ligadura elástica foi eficaz em 82,4% dos pacientes e a fotocoagulação com radiação infravermelha em 87,5%. Diferenças não significantes. CONCLUSÃO: A ligadura elástica causa significantemente mais dor que a fotocoagulação com radiação infravermelha na primeira semana após a aplicação dos procedimentos e a eficácia dos métodos são semelhantes após quatro semanas de tratamento

Tratamento cirúrgico do adenocarcinoma de reto por laparoscopia e por acesso convencional: estudo comparativo de tempo cirúrgico, complicações pós-operatórias, radicalidade oncológica e sobrevida

OBJETIVO: Comparar duas vias cirúrgicas (laparoscópica e convencional) para o tratamento de câncer de reto no que se refere às complicações pós-operatórias, radicalidade oncológica e sobrevida. MÉTODOS: Trata-se de estudo retrospectivo com 84 pacientes com câncer retal que foram admitidos no Hospital do Câncer de Barretos entre 2000 e 2003. Somente os indivíduos que se submeteram à operações eletivas (intenção curativa) foram incluídos. A via cirúrgica foi escolhida subjetivamente e não com base na localização do tumor. RESULTADOS: O acesso laparoscópico foi utilizado por 50% dos pacientes. Não houve diferença (P> 0,05) entre os dois grupos em relação à: idade, sexo, topografia, estádio, tratamento neoadjuvante e adjuvante, número de linfonodos regionais dissecados, tamanho da peça cirúrgica, margens cirúrgicas, transfusões de sangue, taxas de complicações pós-operatórias, dias de hospitalização e a taxa de sobrevida global. O tempo cirúrgico foi maior no grupo laparoscópico (mediana: 210x127,5min, P<0,001). Houve diminuição do tempo cirúrgico com o aumento do número de laparoscopias realizadas pela equipe (rho: -0,387, P=0,020). CONCLUSÃO: As vias laparoscópica e convencional, para o tratamento de câncer de reto, foram equivalentes em relação às complicações pós-operatórias, radicalidade oncológica e sobrevida. Contudo, o tempo cirúrgico foi maior no grupo da laparoscopia

Evaluation of breathing exercise in hormonal and immunological responses in patients undergoing abdominal surgery

PURPOSE: To evaluate the effects of sustained deep inspiration in the prevention of postoperative pulmonary complications, the hormonal and immunological responses in patients submitted to abdominal surgery. METHODS: This randomized clinical trial study included 75 patients submitted to abdominal surgery, of which 36 were randomly allocated in the experimental group and underwent sustained deep inspiration during five seconds, in three sets of ten repetitions per day. The others 39 patients were allocated in the control group and were not submitted to any breathing exercise. The following parameters were measured preoperatively, 24h and 48h postoperatively: chest x-ray, serum ACTH, cortisol, IL-4, IL-10, TNF-&#945;, forced expiratory volume in first second (FEV1), forced expiratory flow 25-75% (FEF 25-75), forced vital capacity (FVC), paO2 and paCO2. RESULTS: Mean serum cortisol in patients of the experimental and control groups before surgery were 12.8 mcg/dl (4.6-50) and 10.48 mcg/dl (1-29.1), respectively (p=0.414). The experimental group had significantly increase in serum cortisol levels, 23.6 mcg/dl (9.3-45.8), especially 24h postoperatively (p=0.049). CONCLUSION: Sustained deep inspiration in patients submitted to abdominal surgery determined important changes in serum cortisol, however, without significantly influence the postoperative pulmonary complications and the endocrine and immune response

Risk factors associated with outcome in liver retransplantation: multicentric study

BACKGROUND/AIMS: To externally validate the predictive mathematical model of survival designed by Linhares et al. (2006). METHODOLOGY: This retrospective study was conducted on 217 individuals submitted to liver retransplantation from January 2000 to December 2008 in four European centers. The following variables were obtained on the recipient: age, creatinine, urgency of retransplantation and time between transplantation and retransplantation. The Kaplan-Meier survival curve and ROC curve were used to validate the mathematical model. RESULTS: The present results showed a similar pattern of survival compared to the study of Linhares et al. (2006) concerning the biological variations, when survival curves were compared for each of the four variables analyzed between both samples. When compared, the areas below the ROC curve (aROC) of derivation (0.733) and validation samples (0.593) presented significant difference (p = 0.005), revealing low relationship of sensitivity and specificity between the two curves. Similarity was observed in Kaplan-Meier survival curves. CONCLUSION: This study allowed external validation by the Kaplan-Meier survival curves of the predictive mathematical model of survival in liver retransplantation proposed by Linhares et al. (2006). However, validation through the ROC curve, the aROC, evidenced weak discrimination ability