[Show abstract][Hide abstract] ABSTRACT: Background:
Colorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening.
To assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size.
Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older.
A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia.
Polyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon.
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery 09/2014; 27(2):109-113. DOI:10.1590/S0102-67202014000200006
[Show abstract][Hide abstract] ABSTRACT: The term "gossypiboma" refers to a textile matrix surrounded by foreign body reaction. Gauze and surgical dressings are the most commonly retained materials after laparotomy.
To evaluate the incidence of abdominal gossypiboma, its causes and the preventive measures to reduce the frequence and morbimortality.
Was conducted a literature review in Medline/Pubmed in english. The survey was about the last 10 years, selecting the headings: gossypiboma, textiloma, retained foreign body and abdominal surgery. Thirty articles were considered in this review.
The incidence of gossypiboma is underreported, mostly due to the legal implications of their detection but also because many patients remain asymptomatic. Occur in 1/1000 to 1/1500 of intra-abdominal operations. Clinical presentation is variable, and depends on the location of the foreign body and on the type of inflammatory reaction presented by the host. The recommended course of treatment is excision, which can be accomplished endoscopically, laparoscopically, or via the open route, and seeks to prevent the complications that lead to a high mortality rate. The most important approach is prevention. Preventive measures required include exploration of the abdominal cavity at the end of the procedure, use of textiles with radiopaque markers and a meticulous account of surgical materials.
Gossypiboma is a former medical-legal problem, whose incidence is apparently increasing. Therefore needs to be revised to take preventive measures in the operating room.
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery 06/2013; 26(2):140-3. DOI:10.1590/S0102-67202013000200015
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Metoclopramide is often used in the treatment of postoperative nausea and vomiting, but a literature review failed to find reports on the influence of this drug on the healing of bowel anastomoses in the setting of abdominal sepsis. The aim of this study was to evaluate the effects of metoclopramide on the healing of left colonic anastomoses in rats with induced abdominal sepsis.
Materials and methods:
Forty rats were divided into two groups of 20 animals each to receive either metoclopramide (experimental group: E) or saline (control group: C). Each group was further divided into subgroups of 10 animals each to be killed on the third (E3 and C3) or seventh postoperative day (E7 and C7). A segmental resection of the left colon was performed, followed by end-to-end anastomosis. Sepsis was induced by cecal ligation and puncture. On the day of reoperation, the total number of adhesions was assessed and the anastomosed bowel segment was removed for tensile strength testing, histopathological analysis, measurement of hydroxyproline levels, and histomorphometric evaluation of collagen.
Intraoperative findings, number of intra-abdominal adhesions in the anastomosed area, and tensile strength before anastomosis rupture were similar among all subgroups at all assessments. On the third postoperative day, the anastomoses of animals treated with metoclopramide showed significantly lower hydroxyproline levels (p = 0.01) when compared with controls. Collagen content was similar among all subgroups.
Metoclopramide does not have deleterious effects on the healing of bowel anastomoses in rats subjected to experimental abdominal sepsis.
Journal of Investigative Surgery 03/2013; 26(5). DOI:10.3109/08941939.2012.748109 · 1.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effects of S-methylisothiourea hemisulfate (SMT) on the healing of colonic anastomosis in rats.
Sixty rats Wistar were distributed into two groups of 30 animals: experimental (E) and control C). The animals of experimental group received intraperitoneal SMT at 50mg/kg/dose every 12 hours for 72 hours. The control group received intraperitoneal saline at the same volume of SMT. The rats were subdivided into subgroups groups of 10 for euthanasia on the third, seventh, and 14th postoperative days (POD). We evaluated clinical and weight evolution, breaking strength and histopathology; also, a blood sample was collected for serum dosage of nitrite/nitrate.
There was more vascular neoformation (p=0.006) and granulation (p=0.002) in the E3 group, and more mononuclear infiltrates in the C3 group (p=0.041). There was also more edema in the C14 group (p=0.008). There was no statistically significant difference in breaking strength, nitrite/nitrate dosage, and the remaining histopathological parameters.
The use of S-methylisothiourea hemisulfate improved the healing of colonic anastomosis in rats on the third postoperative day by accelerating the proliferative stage of healing, but without interfering with the breaking strength of the anastomosis.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 12/2012; 27(12):892-6. DOI:10.1590/S0102-86502012001200011 · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the effect of prokinetic agents on abdominal wall wound healing in rats submitted to segmental colectomy and colonic anastomosis.
Sixty rats were randomly allocated into three groups according to the agents they would receive in the postoperative period: M (metoclopramide); B (bromopride); and C (control, saline 0.9%). Surgical procedures were performed identically in all animals, and consisted of a midline laparotomy followed by resection of a 1-cm segment of large bowel with end-to-end anastomosis. The abdominal wall was closed in two layers with running stitches. Abdominal wall samples were collected on the 3rd or 7th postoperative day for measurement of breaking (tensile) strength and histopathological assessment.
There were no statistically significant differences in tensile strength of the abdominal wall scar between groups M, B, and C, nor between the three and seven days after surgery subgroups. On histopathological assessment, there were no statistically significant between-group differences in collagen deposition or number of fibroblasts at the wound site
Use of the prokinetic drugs metoclopramide or bromopride had no effect on abdominal wall healing in rats submitted to segmental colectomy and colonic anastomosis.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 07/2012; 27(7):448-53. DOI:10.1590/S0102-86502012000700003 · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effects of bromopride on the healing of left colonic anastomoses in rats with induced abdominal sepsis.
Forty rats were divided into two groups to receive either bromopride (experimental group- E) or saline (control group- C). Each group was divided into subgroups of ten animals each to be euthanized on third (E3 and C3) or seventh day (E7 and C7) after surgery. Sepsis was induced by cecal ligation and puncture. The rats underwent segmental left colon resection and end-to-end anastomosis. Adhesion formation, tensile strength and hydroxyproline concentration were assessed. Histomorphometry of collagen and histopathological analysis were also performed.
On postoperative third day, anastomoses in bromopride-treated animals showed lower tensile strength (p=0.02) and greater reduction in hydroxyproline concentration (p=0.04) than in control animals. There was no statistical difference in these parameters on seventh day, and the remaining parameters were similar across subgroups. Collagen content was also similar across subgroups.
In the presence of abdominal sepsis, the administration of bromopride was associated with decreased tensile strength and hydroxyproline concentration in left colonic anastomoses in rats three days after surgery.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 06/2012; 27(6):370-5. DOI:10.1590/S0102-86502012000600003 · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To evaluate clinical and manometric parameters of chronic anal fissure females undergoing lateral internal sphincterotomy (LIS). METHODS: A total of eight women with chronic anal fissure who underwent LIS were included in this study. The preoperative assessment was performed one week before surgery and included general and anorectal examination, anorectal manometry, and Jorge Wexner questionnaire. The post operative follow up was made every 15 days until complete healing. Jorge Wexner questionnaires and anorectal manometry were repeated at 1 month and 3 months after the surgery. Time to healing, manometric changes and complications were assessed. RESULTS: All patients had preoperative increased anal resting pressure. The resting pressures and anal canal length were significantly decreased 3 months after surgery. Patients' complaints of itching and bleeding were also reduced. Fissures healed in 7 patients and median healing time was 45 days. No complications were observed due to the procedure. One patient had transient incontinence to flatus. CONCLUSION: Lateral internal sphincterotomy provided clinical improvement and reduced resting pressure of the internal anal sphincter in women with chronic anal fissure.
Journal of Coloproctology 06/2012; 32(2):148-153. DOI:10.1590/S2237-93632012000200010
[Show abstract][Hide abstract] ABSTRACT: Proficiency and competence of endoscopists is perhaps the mainstay of successful diagnostic and therapeutic colonoscopy.
To analyze indications, diagnostic findings, and complications of colonoscopies performed by resident physicians in a university teaching hospital.
Were analyzed 1,000 colonoscopies consecutively performed by fourth-year residents under direct supervision of experienced colonoscopists. Information on patients' demographic data, bowel preparation, indications for the procedure, success of the procedure, diagnostic findings, and complications were obtained.
A total of 596 (59.6%) female and 404 (40.4%) male patients were examined. Age ranged from 3 to 99 years (mean 53.8 years). Bowel preparation was performed with 10% mannitol solution in 978 patients (97.8%), being considered appropriate in 97.6% of cases. Main indications were: diagnosis (56.4%), therapy (9.6%), screening (17.3%), and surveillance (22%). Cecal and ileocecal valve intubation rates were 90.3 and 58.6%, respectively. Colonoscopy was normal in 45.8% of cases. The most common diagnosis was diverticulosis (18.5%), followed by polyps (17%) and malignancies (6.8%). Findings consistent with an inflammatory process were identified in 122 patients (12.2%) and vascular abnormalities were detected in 11 patients (1.1%). Other diagnoses accounted for 3.9% of cases. There were two cases (0.2%) of complications (submucosal hematoma and bleeding), both after polypectomy, with no need for surgical intervention.
The residents under supervision and guidance of specialists can perform colonoscopies with excellent success and low complication rates, with final results comparable to those achieved by fully trained endoscopists.
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery 03/2012; 25(1):9-12. DOI:10.1590/S0102-67202012000100003
[Show abstract][Hide abstract] ABSTRACT: Evaluate the effects of bromopride on abdominal wall healing of rats with induced peritoneal sepsis after segmental colectomy and colonic anastomosis.
Forty rats underwent sectioning of the left colon and end-to-end anastomosis and were divided into two groups of 20 animals for the administration of bromopride (bromopride group - B) or saline solution (control group - C). Each group was divided into subgroups of 10 animals each to be killed on the third (GB3 and GC3) or seventh postoperative day (GB7 and GC7). It was analyzed the following characteristics: breaking strength of the abdominal wall's wound; surgical and histopathological features of the abdominal wall; and clinical features of the rats.
There was no difference between the groups in relation to the weight of the rats and the breaking strength of the abdominal wall's wound. The GB7 group presented less edema and less quantity of fibrin during histopathological evaluation compared to the GC7 group.
Bromopride did not have harmful effects on the healing of abdominal wall in rats.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 12/2011; 26(6):433-7. DOI:10.1590/S0102-86502011000600005 · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effects of bromopride on the formation of adhesions and anastomotic healing in the left colon of rats.
We divided 40 rats into two groups of 20 animals, administration of bromopride (study group-E) or saline (control group-C). Each group was divided into subgroups containing 10 animals each for euthanasia in the third (C3 and E3) or the seventh (E7 and C7) postoperative days. The rats were submitted to section of the left colon and end-to-end anastomosis. On the day of reoperation, we evaluated the total amount of adhesions and removed a colonic segment containing the anastomosis for histopathological analysis, assessment of rupture strength and hydroxyproline concentration.
There was no difference between groups in relation to clinical outcome. Two animals in the study group had blocked anastomotic leakage. The animals that received bromopride had the number of intracavitary adhesions and adhesions to the anastomosis similar to the control group. The anastomoses from the group E3 animals showed lower resistance to rupture the one from the C3 group (p = 0.04). This effect did not occur on the seventh postoperative day (p = 0.37). There was no significant difference between groups in relation to histopathology and hydroxyproline concentration in the anastomoses.
The use of bromopride was associated with decreased tensile strength of left colon anastomosis in rats in the third postoperative day.
Revista do Colégio Brasileiro de Cirurgiões 11/2011; 38(6):429-34. DOI:10.1590/S0100-69912011000600011
[Show abstract][Hide abstract] ABSTRACT: To know the opinion of Medical interns, University of Brasilia on the preparatory courses for medical residency.
Application of a standardized questionnaire to students if the first year of internship.
Sixty-seven of the 74 students (90.5%) of the first two semesters of internship participated. Among them, 57 (85.1%) are enrolled or intend to enroll in preparatory courses. Only 28.4% (19 students) believe that participation in these courses disrupt the activities of the internship. Participation in preparatory courses is considered crucial to the approval in the residency exams for 36 respondents (53.7%). When asked about the most important factor for the approval in the exams, 91.0% claimed to be the period of theoretical study. But when the focus of the study is professional training, 92.5% acknowledged the activities during the internship as the most important.
Most students interviewed consider that participation in preparatory courses is important to be approved in the residency programs' admission exams and that this participation does not hinder the activities of the internship.
Revista do Colégio Brasileiro de Cirurgiões 10/2011; 38(5):349-54. DOI:10.1590/S0100-69912011000500012
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effects of metoclopramide on the formation of adhesion and the healing of left colonic anastomoses in rats.
Forty rats underwent sectioning of the left colon and end-to-end anastomosis and were divided into two groups of 20 animals for the administration of metoclopramide (experimental group - E) or saline solution (control group - C). Each group was divided into subgroups of 10 animals each to be killed on the third (E3 and C3) or seventh postoperative day (E7 and C7). Adhesion was assessed, and a colonic segment containing the anastomosis was removed for analysis of breaking strength and hydroxyproline concentration.
There were no deaths or dehiscence on the 3(rd) postoperative day. There was one death and one blocked anastomotic dehiscence in the E7 group. No significant differences between groups were found in the analysis of clinical outcome, intra-cavity adhesion, adhesion to the anastomosis or breaking strength on the 3(rd) and 7(th) postoperative day. Hydroxyproline concentration was higher in the control group on the 3(rd) (p=0.006) but not on the 7(th) postoperative day (p=0.241).
Metoclopramide did not have harmful effects on the healing of intestinal anastomoses in rats.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 08/2011; 26(4):297-302. DOI:10.1590/S0102-86502011000400009 · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the influence of sepsis in the process of wound healing in the abdominal wall.
40 rats divided into two groups of twenty animals: group of study (E) - septic, and the control group (C) - not septic. The two groups were divided into subgroups of 10 to be killed on the third day (n = 10) or seventh (n = 10) postoperative. Sepsis was induced by ligation and puncture of the cecum. We performed also the section and anastomosis in left colon. The synthesis of the abdominal wall was made with 3-0 silk thread. On the day of re-laparotomy, the abdominal wall was removed for analysis of the breaking strength and histopathological analysis.
The mean breaking strength was at third day: E group (1.44 ± 1.22) and C group (0.35 ± 0.46). At seventh day the mean breaking strength was: E group (13.01 ± 7.09) and C group (11.66 ± 7.38). There was statistical difference in tensile strength. E group at third day with control group (p = 0.019).
The induction of peritoneal sepsis reduced the breaking strength of the abdominal wall on the third day after surgery.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 01/2011; 26 Suppl 2:38-44. DOI:10.1590/S0102-86502011000800008 · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effects of abdominal sepsis on adhesion formation and colon anastomosis healing in rats.
Forty rats were distributed in two groups containing 20 rats each for left colon anastomosis in the presence (Group S) or absence (Group N) of induced sepsis by cecal ligation and puncture. Each group was divided into subgroups for euthanasia on the third (N3 and S3) or seventh (N7 or S7) post-operative day. The amount of adhesions was evaluated and a segment of the colon was removed for histopathologic analysis, bursting strength assessment, hydroxyproline and the determination of tissue collagen.
The subjects which underwent cecal ligation and puncture presented a higher amount of intra-abdominal adherences in both third (p=0,00) and seventh (p=0,00) post-operatory days. Smaller bursting strengths were found in the S3 subgroup, and greater bursting strengths were found in the S7 subgroup. There was no difference in the variations on the concentrations of hydroxyproline, tissue collagen and histopathology.
The peritoneal infection which was developed by cecal ligation and puncture raised the amount of intra-cavitary adhesions. There was a decrease in the amount of colonic anastomosis on the third post-operatory day with a following raise on the seventh without any effects on other healing parameters.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 01/2011; 26 Suppl 2:100-5. DOI:10.1590/S0102-86502011000800018 · 0.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effects of metoclopramide on abdominal wall healing in rats in the presence of sepsis.
40 rats divided into two groups of twenty animals, subdivided into two subgroups of 10 animals each: group (E) - treated with metoclopramide, and saline-treated control group. The two groups were divided into subgroups of 10 to be killed on the 3rd day (n = 10) or day 7 (n = 10) after surgery. Sepsis was induced by cecal ligation and puncture. We performed also the section and anastomosis in left colon. The synthesis of the abdominal wall was made with 3-0 silk thread. We measured the breaking strength of the abdominal wall and made the histopathological evaluation.
on 3rd day postoperative, the average breaking strength in the E group was 0.83 ± 0.66 and in group C was 0.35 ± 0.46 (p = 0.010). On the seventh day, the breaking strength in group E was 11.44 ± 5.07, in group C 11.66 ± 7.38 (p = 1.000). The E7 group showed lower inflammatory infiltration, foreign body reaction, fibrin than control.
animals treated with metoclopramide had a higher resistance of the abdominal wall on the 3rd postoperative day.
Acta cirurgica brasileira / Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 01/2011; 26 Suppl 2:92-9. DOI:10.1590/S0102-86502011000800017 · 0.66 Impact Factor