Adenocarcinoma of the right colon in a patient with bloom syndrome

Bloom syndrome (BS) is an inherited disorder due to mutation in BLM gene. The diagnosis of BS should be considered in patients with growth retardation of prenatal onset, a photosensitive rash in a butterfly distribution over the cheeks, and an increased risk of cancer at an early age. Clinical manifestations also include short stature, dolichocephaly, prominent ears, micrognathia, malar hypoplasia and a high-pitched voice, immunodeficiency, type II diabetes, and hypogonadism associated with male infertility and female subfertility. The aim of this report is to describe case of patient with BS who developed adenocarcinoma of the cecum, successfully treated by right colectomy. Case Report. A 40-year-old man underwent colonoscopy to investigate the cause of his diarrhea, weight loss, and anemia. The patient knew that he was a carrier of BS diagnosed at young age. The colonoscopy showed an expansive and vegetating mass with 5.5 cm in diameter, located within the ascending colon. Histopathological analysis of tissue fragments collected during colonoscopy confirmed the presence of tubular adenocarcinoma, and he was referred for an oncological right colectomy. The procedure was performed without complications, and the patient was discharged on the fifth postoperative day. Histopathological examination of the surgical specimen confirmed the presence of a grade II tubular adenocarcinoma (stage IIA). The patient is currently well five years after surgery, without clinical or endoscopic signs of relapse in a multidisciplinary approach for the monitoring of comorbidities related to BS. Conclusion. Despite the development of colorectal cancer to be, a possibility rarely described the present case shows the need for early screening for colorectal cancer in all patients affected by B

Serum Levels of Infliximab and Anti-Infliximab Antibodies in Brazilian Patients with Crohn’s Disease

OBJECTIVES: The aim of this study was to evaluate the quantitative serum level of infliximab (IFX) as well as the detection of anti-infliximab antibodies (ATIs) in patients with Crohn’s disease (CD). METHOD: Forty patients with CD under treatment at a tertiary center in southeastern Brazil were evaluated. Their use of infliximab was continuous and regular. We analyzed and compared the differences in the IFX and ATI levels between the patients with active CD (CDA) and those with CD in remission (CDR). RESULTS: There was no difference in the IFX level between the CDA and CDR groups (p40.05). Eighty percent of all patients had IFX levels above the therapeutic concentration (6-10 mg/mL). Two (9%) of the 22 patients with active disease and four (22.2%) of the 18 patients in remission had undetectable levels of IFX. Four (66.6%) of the six patients with undetectable levels of IFX had positive ATI levels; three of these patients were in remission, and one had active disease. In addition, the other two patients with undetectable levels of IFX presented ATI levels close to positivity (2.7 and 2.8 AU/ml). None of the patients with therapeutic or supratherapeutic IFX levels had positive ATI levels. CONCLUSIONS: The undetectable levels of IFX correlated with the detection of ATIs, which was independent of disease activity. Immunogenicity was not the main factor for the loss of response to IFX in our study, and the majority of patients in both groups (CDA and CDR) had supratherapeutic levels of IFX

Influence of the peritoneal lavage with bupivacaine on the survival and resistance of colonic anastomoses performed under fecal peritonitis in rats

PURPOSE: To evaluate the effects of peritoneal lavage with bupivacaine on survival and initial resistance of anastomosis on distal colon, performed under peritonitis or not. METHODS: Forty rats, weighing from 300 to 350g (321.29±11.31g), were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after induction of peritonitis by intraperitoneal injection of autologous fecal material or not. Group 1: No peritonitis and lavage with 3ml NS; Group 2: No peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3ml NS; Group 4: Peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS. Necropsies were performed on the animals that died and the time of death was recorded. Surviving animals were submitted to euthanasia on the fifth post-operative day and Total Energy of Rupture biomechanical test (TER) was applied. RESULTS: Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance. CONCLUSION: Peritonitis increased mortality and influenced negatively the resistance of colic anastomosis in rats. Peritoneal lavage with bupivacaine increased anastomotic resistance.78378

Influence of the peritoneal lavage with bupivacaine on the mortality and resistance of colonic anastomoses performed under fecal peritonitis or not : experimental study in rats

Orientadores: Maria de Lourdes Setsuko Ayrizono, Cláudio Saddy Rodrigues CoyDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A ocorrência de deiscência de anastomose intestinal está associada com aumento do tempo de internação, morbimortalidade, necessidade de reoperações, custos de assistência médico-hospitalar e sofrimento do paciente. O conhecimento dos mecanismos envolvidos na cicatrização de tecidos permite o cirurgião interferir no reparo de tecidos, prevenindo e prevendo complicações. Nosso objetivo foi avaliar os efeitos da lavagem peritoneal com bupivacaína na mortalidade e na cicatrização da anastomose em cólon descendente de ratos, em vigência de peritonite fecal ou não. Foram utilizados quarenta ratos machos Wistar, pesando entre 300-350g, distribuídos aleatoriamente em quatro grupos de dez animais cada. Foi realizada laparotomia e anastomose em cólon descendente seis horas após injeção intraperitoneal de solução fisiológica (SF) ou de fezes autólogas. Grupo 1: sem peritonite e lavagem com 3ml de SF; Grupo 2: Sem peritonite e lavagem com 8 mg/kg de bupivacaína a 0,5% (0,5ml) adicionado a 2,5ml de SF; Grupo 3: Peritonite e lavagem com 3ml de SF; Grupo 4: Peritonite e lavagem com 8 mg/kg de bupivacaína a 0,5% (0,5ml) adicionado a 2,5ml de SF. Os animais que evoluíram para óbito foram submetidos a necropsia. A eutanásia e o teste biomecânico de Energia Total de Ruptura (ETR) foram realizados no quinto dia de pós-operatório dos animais sobreviventes. O grupo 4 apresentou maior sobrevida quando comparado ao Grupo 3, sem significância estatística. O grupo 3 apresentou valores de ETR menores que os dos outros grupos, com significância estatística. Concluímos que a peritonite fecal aumentou a mortalidade e influenciou negativamente a anastomose em cólon descendente de ratos, diminuindo sua resistência intrínseca. A lavagem peritoneal com bupivacaína aumentou a resistência da anastomose em cólon descendente de ratos em vigência de peritonite fecalAbstract: Ocurrence of intestinal anastomotic dehiscence is associated with significant increase of length of stay, morbidity, mortality, need of reoperations, healthcare costs and patient's distress. The knowledge on the mechanisms involved in tissue healing allows the surgeon to interfere on tissue healing, prevent and anticipate complications. Our purpose was to evaluate the effects of peritoneal lavage with bupivacaine on survival and initial healing of anastomosis on distal colon, performed under peritonitis or not. Forty male Wistar rats, weighing from 300 to 350g, were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after intraperitoneal injection of physiological solution (NS) or autologous fecal material. Group 1: No peritonitis and lavage with 3ml NS; Group 2: No peritonitis and lavage with 0.5ml of 0.5% bupivacaine (8mg/kg) added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3ml NS; Group 4: Peritonitis and lavage with 0.5ml of 0.5% bupivacaine (8mg/kg) added to 2.5 mL of NS. Necropsies were performed on the animals that died. Surviving animals were submitted to euthanasia and Total Energy of Rupture (TER) biomechanical test on the fifth post-operative day. Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance. We concluded that fecal peritonitis increased mortality and negatively influenced anastomosis performed on descending colon in rats, decreasing its resistance. Peritoneal lavage with bupivacaine increased the resistance of colic anastomosis performed on descending colon in rats under fecal peritonitisMestradoFisiopatologia CirúrgicaMestre em Ciência

Resultados neonatais no parto vaginal espontâneo comparados aos dos partos com fórcipe de Simpson-Braun em primíparas Neonatal outcome of spontaneous deliveries as compared to Simpson-Braun forceps deliveries in nulliparous women

OBJETIVO: comparar os resultados neonatais dos partos vaginais espontâneos ou assistidos com fórcipe de Simpson-Braun em nulíparas. MÉTODO: em estudo de corte retrospectivo foram avaliados dois grupos de primíparas atendidas no Centro Obstétrico do CAISM/UNICAMP, que tiveram parto vaginal sob analgesia epidural. O grupo fórcipe foi formado por 119 pacientes que tiveram parto a fórcipe de Simpson-Braun, e o grupo normal por 114 casos de parto vaginal espontâneo. Foram estudadas as variáveis neonatais imediatas como o estado do líquido amniótico e os índices de Apgar, assim como a evolução neonatal nos primeiros dias de vida. Para análise estatística foram utilizados os testes c², exato de Fisher e t de Student para comparação de médias e considerada significativa a diferença correspondente a p<0,05. RESULTADOS: as indicações para uso do fórcipe Simpson-Braun foram: alívio materno-fetal (90 casos) e abreviação de período expulsivo (29 casos). Nas pacientes atendidas com fórcipe Simpson-Braun houve 8 casos de laceração de canal de parto (6,7%), valor semelhante ao observado no grupo de parto vaginal espontâneo. As médias de dias de internação das puérperas e neonatos foram idênticas (2,4). Os dois grupos foram semelhantes quanto aos índices de Apgar menores que 7 no primeiro (7,5 e 4,3%) e quinto minuto (1,6 e 1,7%) e quanto ao peso dos recém-nascidos (3.146 e 3.016 g). A evolução neonatal foi semelhante nos dois grupos. CONCLUSÃO: o uso do fórcipe de Simpson-Braun mostrou-se seguro, quando comparado ao parto vaginal espontâneo.<br>PURPOSE: to compare maternal and neonatal outcomes between spontaneous vaginal and Simpson-Braun forceps deliveries in nulliparous women. METHOD: a retrospective study including two groups of nulliparous women, who had vaginal delivery under peridural anesthesia in the obstetric unit of the CAISM-UNICAMP: the forceps group included 119 women who had Simpson-Braun forceps delivery, and the normal group included 114 women who delivered spontaneously. Neonatal outcomes, such as Apgar score and the evolution in the first days of life, were studied. Data were compared in both groups and, for statistical analysis, c² test, Fisher exact, and Student t tests were used. The differences were considered significant when p<0.05. RESULTS: the indications for Simpson-Braun forceps delivery were maternal-fetal relief (90 cases) and abbreviation of the expulsive period (29 cases). In the forceps group there were 8 cases (6.7%) of vaginal injuries; a similar result was observed in the normal group. The number of hospitalization days for the parturient and the newborns was identical, 2.4 days. The newborns in the two groups had similar Apgar scores inferior to 7 at the first minute (7.5 vs 4.3%) and at the fifth minute (1.6 vs1.7%). The weight in the two groups had similar results (3,146 and 3,016 g). The first days of life did not differ between the groups. CONCLUSIONS: the use of Simpson-Braun forceps was safe, when compared to spontaneous vaginal delivery

VISCERAL FAT IS INCREASED IN INDIVIDUALS WITH CROHN’S DISEASE: A COMPARATIVE ANALYSIS WITH HEALTHY CONTROLS

ABSTRACT BACKGROUND: It is known that obesity is associated with a chronic inflammatory state, but few studies have evaluated visceral fat (VF) content and its role in individuals with Crohn’s disease (CD). OBJETIVE: To compare the nutritional status, body composition and proportion of VF between CD individuals and healthy volunteers. METHODS: Cross-sectional study that enrolled individuals with Crohn’s disease and healthy controls. The stratification according to nutritional status was carried out by means of BMI. The percentage of body fat percentage (%BF) and VF were estimated by means of DEXA. VF proportion was evaluated by means of the VF/BMI and VF/%BF ratios. RESULTS: A total of 78 individuals were included. The control group was comprised of 28 healthy subjects aged 35.39±10 years old (60.7% women); mean BMI=23.94±3.34 kg/m2; mean VF=511.82±448.68 g; mean CRP=0.81±1.78 ng/mL. The CD group was comprised of 50 patients; 11 (22%) were underweight (BMI=18.20±1.97 kg/ m2; %BF=24.46±10.01; VF=217.18±218.95 g; CRP=4.12±4.84 ng/mL); 18 (36%) presented normal weight (BMI=22.43±1.48 kg/m2; %BF=30.92±6.63; VF=542.00±425.47 g and CRP=4.40±1.78 ng/mL); 21 (42%) were overweight or obese (BMI=29.48±3.78 kg/m2; %BF=39.91±7.33; VF=1525.23±672.7 g and CRP=1.33±2.06 ng/mL). The VF/BMI ratio was higher in the CD group when compared to controls (32.41±24.63 vs 20.01±16.23 g per BMI point; P=0.02). Likewise, the VF/%BF was also higher in the CD group (35.21±23.33 vs 15.60±12.55 g per percentage point; P<0.001). CONCLUSION: Among individuals with Crohn’s disease, BMI presents a direct correlation with visceral fat content. These results indicate the presence of an adiposopathy in Crohn’s disease subjects, which is evidenced by a higher visceral fat