[Show abstract][Hide abstract]ABSTRACT: This is the first Brazilian Consensus on inflammatory bowel disease, carried out by the Brazilian Study Group of Inflammatory Bowel Disease, and discusses the treatment of Crohn's disease and ulcerative colitis in acute and remission phases. The first part of the text, brings out a review on the main drugs used in the treatment of inflammatory bowel disease, as well as their mechanisms of action and cautions during their use. In the second part, the committee's opinions about the most recommended medical and surgical approaches for both diseases are presented on the basis of disease activity, location and behaviour status. The recommendations here presented were widely discussed in several scientific meetings with active participation of all members of the group and were highly based on scientific evidence covered by the literature.
Full-text available · Article · Jul 2010 · Arquivos de Gastroenterologia
[Show abstract][Hide abstract]ABSTRACT: 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.
To evaluate ileal pouch-anal anastomosis long-term outcome in patients with Crohn's disease.
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.
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.
Crohn's disease diagnosis after ileal pouch-anal anastomosis for ulcerative colitis may be usual and later complications such fistulas and stenosis are common. However, when left in situ ileal pouch is associated with good function.
Full-text available · Article · Sep 2008 · Arquivos de gastroenterologia
[Show abstract][Hide abstract]ABSTRACT: Restorative proctocolectomy is the procedure of choice to treat familial adenomatous polyposis, however it can be associated to short-term and long-term postoperative complications.
To evaluate the occurrence of complications related to the surgical treatment of familial adenomatous polyposis with ileal pouch technique.
Retrospective study of 69 patients with familial adenomatous polyposis after rectocolectomy with ileal reservoir between 1984 and 2006, operated on Coloproctology Group, Medical Sciences Faculty, State University of Campinas, Campinas, SP, Brazil. The median follow-up period was 82 (2-280) months. Data obtained were surgical techniques and postoperative complications.
The morbidity and mortality were 63.8% and 2.9%, respectively. The most frequent complications were small-bowel obstruction (17.4%), anastomotic stricture (15.9%) and pelvic sepsis (10.1%). Acute ischemia of the ileal pouch (4.3%), pouchitis (2.9%) and ileal pouch-related fistula (2.9%) had poorer frequency than others.
The morbid-mortality was similar to the literatures data and it is acceptable for a complex surgery in two terms like the ileal reservoir-anal anastomosis. The small-bowel obstruction was the most frequent complication. However, ischemia of the reservoir, pouchitis and pelvic sepsis were important complications and was related to the failure of the ileal reservoir.
Full-text available · Article · Jun 2008 · Arquivos de Gastroenterologia
[Show abstract][Hide abstract]ABSTRACT: To evaluate the effect of hemorrhagic shock in colonic anastomoses in rats, with a rupture by liquid distension resistance test.
Wistar lineage rats, averaging 90 days old and weighing from 310 to 380 grams were divided into two groups. In the first group (G1), 10 animals were submitted to colonic anastomoses in normovolemic terms and the second group (G2), of 10 animals, was submitted to colonic anastomoses in hypovolemic conditions. The shock was caused by half milliliter of blood withdrawn, every two minutes, until the value of average 50 mmHg arterial pressure or a total volume corresponding 30% withdrawal of volemia was reached. Serum lactate dosages were carried out at the beginning and end of the procedure. The average serum lactate values at the end of the surgery were 1.91 mmol/l in G1 group and 3.69 mmol/l in G2 group (p<0.05). On the fifth postoperative day, the animals were euthanized. The anastomoses were evaluated with a rupture by liquid distension resistance test.
In G1, the average value of colonic rupture was 160.7 mmHg whereas in G2 it was 152.1 mmHg (p>0.05).
Hemorrhagic shock, under the established conditions of this study, had no influence on colonic anastomoses in rats evaluated with the rupture by liquid distention resistance test.
Full-text available · Article · Jun 2008 · Acta Cirurgica Brasileira
[Show abstract][Hide abstract]ABSTRACT: Pouchitis after total rectocolectomy is among the most common complications of patients with ulcerative colitis (UC). However, its frequency is quite rare in patients with familial adenomatous polyposis (FAP). We evaluated the inflammatory and pro-apoptotic activity in endoscopically normal mucosa of the ileal pouch in patients with UC and FAP.
Twenty patients (10 with UC and 10 with FAP) with "J" pouch after total proctocolectomy were studied as were 10 normal controls. Biopsies were obtained from the mucosa of the pouch of UC and FAP patients and from the normal ileum of controls. The expression levels of TNF-alpha, IL-1beta, IL-6, IL-8 and phospho-BAD were determined by immunoblotting. Activated NFkappaB was evaluated by immuno-precipitation and immunoblotting for IkappaB kinase beta.
Patients with UC had higher levels of IL-1beta, IL-6, IL-8 and TNF-alpha than patients with FAP. The level of TNF-alpha was higher in patients with UC than in patients with FAP; both patient groups had TNF-alpha levels higher than controls. Activation of NFkappaB was similar in all three groups. The expression of phospho-BAD was significantly lower in patients with FAP than in patients with UC.
As compared with patients with FAP, patients with UC presented increased levels of some pro-inflammatory cytokines, even in the absence of clinical or endoscopic signs of pouchitis. Patients with FAP presented lower levels of pro-inflammatory proteins and of phospho-BAD. These findings may explain the higher rates of progression to pouchitis in UC patients, which could correlate with mucosal atrophy that occurs in inflamed tissue.
[Show abstract][Hide abstract]ABSTRACT: A recidiva pélvica após ressecção cirúrgica do câncer do reto varia de 3% a 35% em cinco anos. A condição é de difícil manejo, sendo discutível o melhor tratamento. A radioterapia e quimioterapia podem ser utilizadas como métodos paliativos, e os melhores resultados podem ser conseguidos com a cirurgia radical. OBJETIVO: Avaliar os doentes que foram submetidos à cirurgia por recidiva pélvica no Hospital das Clínicas da Unicamp, pelo Grupo de Coloproctologia. CASUÍSTICA E MÉTODO: Entre 1999 e 2007, 26 doentes com recidiva pélvica após cirurgia para ressecção de câncer do reto foram avaliados. Dados clínicos, estadiamento oncológico, cirurgia realizada inicialmente, ressecabilidade cirúrgica da recidiva e seguimento foram analisados. RESULTADOS: A cirurgia inicial mais comum foi a retossigmoidectomia com anastomose colorretal (46,1%). Cinco de 26 doentes apresentavam perfuração tumoral na primeira cirurgia. Linfonodos positivos foram encontrados em 53,8% dos casos, e 69,2% eram T3 ou T4. Com relação à abordagem da recidiva local, a principal cirurgia realizada foi amputação abdominoperineal do reto. A cirurgia foi considerada radical em 42,3% dos 26 doentes. A ressecção do tumor foi possível em 65,4%. O seguimento médio foi de 29,4 meses, com sobrevida global de 34,6%. CONCLUSÃO: Aproximadamente dois terços dos casos com recidiva local puderam ser submetidos à ressecção visando cura, com melhora na sobrevida. Esta abordagem cirúrgica deve ser encorajada em hospitais que possuem grupos multidisciplinares especializados, para a melhora da qualidade de vida de doentes selecionados.
Full-text available · Article · Mar 2008 · Revista Brasileira de Coloproctologia
[Show abstract][Hide abstract]ABSTRACT: Local recurrence after rectal cancer resection varies between 3 to 35% in five years. The condition has difficult management, and little is known about the best treatment. Radiotherapy and chemotherapy can be used as paliative methods, and the best results are achieved with radical resection. PURPOSE: To evaluate patients submitted to surgery for pelvic recurrence by the Coloproctology Unit at Clinical Hospital of Unicamp. METHODS AND PATIENTS: Between 1999 and 2007, 26 consecutive patients with locally recurrence after rectal cancer surgery were evaluated. According to clinical data, tumor stage at the first surgery, recurrence ressecability and follow-up were analyzed. RESULTS: The most common initial surgery was retossigmoidectomy with colorectal anastomosis (46,1%). Of the 26 patients, five had tumor perforation at the first surgery. Positive lynphnodes were found in 53,8% and 69,2% were classified as T3 or T4 staging. In relation to surgery for local recurrence, the principle was abdominoperineal amputation of the rectum. Radical surgery was performed in 42,3% of the cases. The resection of the tumor was possible in 65,4%. The mean follow-up period was 29,4 months, with an overall survival of 34,6%. CONCLUSION: Approximately two-thirds of patients with locally recurrent rectal cancer can be submitted for surgical resection, improving survival. This surgical intervention should be encouraged in hospitals with multidisciplinary teams to improve quality of life in selected patients.
Full-text available · Article · Mar 2008 · Revista Brasileira de Coloproctologia
[Show abstract][Hide abstract]ABSTRACT: In developing countries, low budgets make the issue of integrating genetics into clinical practice a challenge, a situation in which the use of family history (FH) becomes important for patient care, as it is a low cost strategy and a risk assessment tool. The purpose of this study was to review medical records of patients with colorectal cancer (CRC) seen in a public University Hospital and evaluate how often FH of cancer is registered. Initially we searched a database for patients who were seen in our hospital between 2002 and 2004 with the diagnosis of CRC. We found 415 patients, 104 of whom were excluded. A total of 311 charts were reviewed and classified into 3 groups. Group A: no FH documented; group B: FH was documented, but FH of cancer was not collected; and group C: FH of cancer was documented. We also investigated what type of information was recorded, in order to verify if important elements were assessed. Ninety-eight charts (31.5%) were classified in group A, 20 (6.5%) in group B, and 193 (62%) in group C. In addition, we observed that important information regarding affected relatives was not collected in most of the charts. In conclusion, we found that although FH of cancer was recorded in 62% of charts of patients with CRC, information that could be relevant for risk assessment and management of at-risk families was missing. Our findings expose an important problem in health education that could reflect negatively in the quality of medical assistance to individuals at risk for familial cancer.
[Show abstract][Hide abstract]ABSTRACT: RACIONAL: As enteroplastias constituem alternativa cirúrgica no tratamento da estenose da doença de Crohn. OBJETIVO: Analisar, retrospectivamente, a evolução precoce e tardia do tratamento cirúrgico das estenoses do intestino delgado, segmento ileocecal ou anastomose ileocólica secundária à doença de Crohn, com emprego de plastias intestinais. MÉTODOS: Foram estudados 28 doentes, operados entre setembro de 1991 e maio de 2004, com seguimento médio pós-operatório de 58,1 meses. Dezesseis (57,1%) eram do sexo masculino, com média etária de 33,3 anos, e 13 doentes (46,4%) apresentavam ressecções intestinais prévias. Foram realizadas 116 plastias, sendo 94 (81%) à Heineke-Mikulicz, 15 (13%) do tipo Finney e 7 (6%) ileocoloplastias látero-laterais. Em 18 doentes (64,3%) realizaram-se ressecções intestinais concomitantes. RESULTADOS: Verificaram-se 14 complicações em 7 doentes (25%) e um óbito (3,6%), secundário a complicações pulmonares após reoperações por sangramento intestinal da anastomose êntero-entérica. Ocorreram duas complicações gerais (14,3%), em dois doentes (7,1%) e oito complicações locais precoces (57,1%), em sete doentes (25%), sendo a mais freqüente deiscência de plastia, em três casos (10,7%). Complicações locais tardias ocorreram em dois doentes (7,1%), ambos com hérnia incisional e fístula êntero-cutânea. Recidiva sintomática da estenose ocorreu em 17 doentes (63%) e 2 deles (7,4%), apresentaram fístulas êntero-cutâneas, sendo o índice de reoperação de 40,7%. Observaram-se quatro recidivas (3,5%), em três doentes (11,1%) em local de plastia prévia, sendo mais comum no tipo Finney (20%). CONCLUSÃO: As plastias apresentaram baixos índices de complicações e propiciam alívio dos sintomas. Uma vez que muitos doentes com doença de Crohn necessitarão de várias cirurgias ao longo da vida, as plastias intestinais constituem alternativas eficazes, com resolução dos sintomas obstrutivos, evitando-se ressecções intestinais extensas e suas conseqüências.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.
Full-text available · Article · Sep 2007 · Arquivos de Gastroenterologia
[Show abstract][Hide abstract]ABSTRACT: Strictureplasty is an alternative surgical procedure for Crohn's disease, particulary in patients with previous resections or many intestinal stenosis.
To analyze surgical complications and clinical follow-up in patients submitted to strictureplasty secondary to Crohn's disease.
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.
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.
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.
Full-text available · Article · Jul 2007 · Arquivos de Gastroenterologia
[Show abstract][Hide abstract]ABSTRACT: Evidence is accumulating for a role of folate in the aetiology of colorectal cancer (CRC). The methylenetetrahydrofolate reductase (MTHFR) gene, involved in folate metabolism, is polymorphic in humans. Since it is unknown whether the MTHFR C677T and A1298C polymorphisms alter the risk for CRC, this was the aim of our study.
Genomic DNA from 102 sporadic colorectal adenocarcinoma (SCA) patients and 300 controls was analyzed by polymerase chain reaction followed by restriction digestion for the polymorphisms analyses.
The frequencies of MTHFR C677T and A1298C genotypes were similar in patients and controls. Similar overall risks for disease were seen in individuals with the distinct MTHFR genotypes. However, an excess of the MTHFR 677TT and 677CT genotypes was seen in patients under 50 years, compared with patients at an older age (19.2 vs 13.1% and 61.6 vs 39.5%, respectively; P = 0.04). The differences were more prominent when the frequency of the 677TT plus 677CT genotype was seen in both group of patients (80.8 vs 52.6%, respectively; P = 0.01), and in younger patients compared to controls (80.8 vs 52.3%, P < 0.01). Individuals with the combined genotype had 3.82-fold (95% confidence interval, 1.41-10.42) increased risk of developing SCA under 50 years, compared with those harboring the wild-type genotype.
These results suggest a role for the MTHFR 677TT plus 677CT genotype in increasing SCA diagnosed at a low age in southeastern Brazil, but additional studies with larger sample sizes should be carried out to clarify this issue.
Article · Jul 2007 · International Journal of Colorectal Disease
[Show abstract][Hide abstract]ABSTRACT: Chronic perianal fistulas are a common clinical condition. However, their evolution into adenocarcinoma is rare. We report the case of a 68-year-old man with perineal and perianal chronic fistulas, who developed a perineal mass that extended proximally as a pararectal tumor. Diagnosis was confirmed by magnetic resonance imaging (MRI). Histopathological sections indicated extramucosal mucinous adenocarcinoma. No intestinal lesion was seen at endoscopic examination. The patient underwent abdominal perineal excision of the rectum without neoadjuvant or adjuvant therapy, and had a good postoperative outcome.
[Show abstract][Hide abstract]ABSTRACT: RACIONAL: As manifestações extracólicas, como os pólipos gastroduodenais e o tumor do duodeno, são fatores que influenciam a morbimortalidade dos doentes com polipose adenomatosa familiar no seguimento pós-retocolectomia total. OBJETIVO: Investigar a freqüência destas alterações em doentes com polipose adenomatosa familiar e verificar a eficácia do rastreamento endoscópico. MÉTODO:No período de 1984 a 2005, 62 doentes com polipose adenomatosa familiar pós-retocolectomia foram estudados retrospectivamente pelo Grupo de Coloproctologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, SP. O tempo de seguimento médio pós-operatório foi de 81,9 meses, sendo que em 53 (85,5%) foi possível analisar a ocorrência de pólipos gastroduodenais. RESULTADOS: Dos 53 doentes em seguimento, 27 (50,9%) apresentavam pólipos gastroduodenais. Em 8 (15,4%) os pólipos adenomatosos eram gástricos, 14 (27%) pólipos duodenais e 5 (9,6%) pólipos gástricos e duodenais. Dois doentes (3,8%) desenvolveram adenoma duodenal com displasia de alto grau. E outro (1,9%), adenocarcinoma em papila duodenal. CONCLUSÃO: O rastreamento endoscópico, desta forma, é de grande importância e o objetivo é detectar, o mais precocemente possível, os casos de adenocarcinoma duodenal e pólipos gastroduodenais com displasia de alto grau.
Full-text available · Article · Jun 2007 · Arquivos de Gastroenterologia
[Show abstract][Hide abstract]ABSTRACT: The extra colonic manifestations, like upper gastrointestinal tract polyps and duodenal cancer are disorders that affect long-term morbidity and mortality of patients with familial adenomatous polyposis, after rectocolectomy.
To describe the frequency of those disorders in patients with familial adenomatous polyposis and to review efficacy of upper gastrointestinal endoscopic surveillance.
Between 1984 and 2005, 62 patients with familial adenomatous polyposis after rectocolectomy, were studied retrospectively, by Coloproctology Group, Medical Sciences Faculty, State University of Campinas, SP, Brazil. It was possible to analyze 53 patients (85,5%) in this study.
Twenty seven (50,9%) of 53 patients in follow-up had upper gastrointestinal polyps. Eight (15,4%) had gastric adenomatous polyps, 14 (27%), duodenal polyps and 5 (9,6%) duodenal and gastric polyps. Two patients (3,8%) had adenomatous duodenal polyps with severe dysplasia, and one (1,9%) had adenocarcinoma of the duodenal papilla.
The upper gastrointestinal endoscopic surveillance has importance and the aim is to detect as early as possible the occurrence of duodenal adenocarcinoma and upper gastrointestinal polyps with severe dysplasia.
Full-text available · Article · Apr 2007 · Arquivos de Gastroenterologia
[Show abstract][Hide abstract]ABSTRACT: To analyze and to evaluate the effect of the hyperbaric hyperoxygenation in the mechanical resistance of ischemic colon of rats.
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.
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).
The hyperbaric oxygen-therapy did not present improvement on the induced ischemia in rats upright colic loop.
Full-text available · Article · Mar 2007 · Acta Cirurgica Brasileira
[Show abstract][Hide abstract]ABSTRACT: Eosinophils have been identified in tissues from patients with Crohn's disease (CD) and ulcerative colitis (UC) but whether they contribute to IBD pathogenesis is unknown. This study aimed to investigate the functional activity and morphological aspects of peripheral-blood eosinophils from IBD patients compared to those from healthy volunteers (HVs).
Eosinophils from HVs and CD and UC patients were purified using a Percoll gradient and then a immunomagnetic cell separator. Functional activity in inactivated and previously activated cells was investigated by measuring adhesion to fibronectin and chemotaxis to fMLP, and degranulation was measured by release of eosinophil peroxidase (EPO). Cell morphology was investigated using electron microscopy.
Eosinophil adhesion to human fibronectin in both inactivated and PAF-stimulated and PMA-stimulated eosinophils was markedly higher in patients with CD than in either patients with UC or HVs. Similarly, the chemotactic response was markedly higher in eosinophils isolated from CD patients than in those isolated from UC patients or HVs. Baseline EPO release was higher in eosinophils isolated from UC patients than in those isolated from HVs or CD patients. Stimulation with fMLP or PMA did not further increase EPO release in cells from UC or CD patients. Comparable expression of MAC- 1 and VLA-4 adhesion molecules was observed on the surfaces of eosinophils from all groups, and an greater number of granules was noted in the eosinophils from UC patients than in those from CD patients.
Our results indicate that peripheral-blood eosinophils are potentially primed and activated in IBD patients. Whether the differences in the morphology and functional responses of eosinophil from UC and CD patients reflect differences in disease phenotype remains to be elucidated.
Full-text available · Article · Feb 2007 · Inflammatory Bowel Diseases
[Show abstract][Hide abstract]ABSTRACT: Equationing the mechanical behavior of digestive tube segments be-comes important as severe complications due to its rupture could be avoided. In this work, the sigmoidal model of Boltzmann was evaluated with respect of its capability of predicting Force × Elongation curves which represent the strain pattern of colic loops of rats without anastomoses. According to the results, it was observed that the applied mathematical model was capable of reproduc-ing the mechanical behavior of this biological material, giving support to the modeling of curves and further simulations of the adverse conditions to which intestine could be submitted. Resumo. O equacionamento do comportamento mecânico de segmentos de tubo digestório é importante, pois complicações graves decorrentes de sua rup-tura poderiam ser evitadas. Em razão disso, nesse trabalho, o modelo sigmoidal de Boltzmann foi avaliado com relação a sua capacidade de predição de curvas Força × Elongação representativas do padrão de deformação de alças cóli-cas íntegras de ratos. De acordo com os resultados, observou-se que o modelo matemático foi capaz de reproduzir o comportamento mecânico desse material biológico, auxiliando na modelagem das curvas e simulações de condições ad-versas quando aplicadas no intestino.
[Show abstract][Hide abstract]ABSTRACT: Pouchitis after total retocolectomy is one of the most common complication of patients with ulcerative colitis (UC), while its frequency is quite rare in familial adenomatous polyposis (FAP). PURPOSE: To evaluate the inflammatory activity in endoscopicaly normal mucosa of the ileal pouch, by determining the expression of TNF-a and IL-1b, and the activation of NF-kB. METHODS AND PATIENTS: Twenty patients with "J" pouch after total retocolectomy were studied, being 10 patients with UC and 10 with FAP. The control group was constituted by biopsies from terminal ileum take during normal colonoscopy examination. Biopsies from mucosa of the pouch and from normal ileum were done, and they were snap-frozen in liquid nitrogen. The expression of TNF-a and IL-1b were analyzed by total extract, and NF-kB was evaluated by immunoprecipitation and immunoblot. RESULTS: Expression of TNF-a and IL-1b was increased in patients with UC, when it was compared with FAP (p<0.05). Conversely, the expression of NF-kB was increased in patients with UC, witch was not different from FAP. The control group had little expression of TNF-a (p<0.01). The activation of NF-kB (p>0.1) and the expression of IL-1b (p>0.05) were similar, when comparing UC and FAP with control group. CONCLUSION: The patients with UC presented increased levels of the studied cytokines, even without clinic and endoscope evidence of pouchitis. These findings could be a suggestion of higher susceptibility to this complication among patients with UC.
Full-text available · Article · Dec 2006 · Revista Brasileira de Coloproctologia
[Show abstract][Hide abstract]ABSTRACT: OBJETIVO: analisar os parâmetros do reflexo inibitório retoanal (RIRA) em multíparas. PACIENTES E MÉTODOS: 36 pacientes (40,7 anos), com quatro a seis partos normais (grupo 1) e 10 pacientes (38,5 anos) com três ou menos partos normais (grupo 2), foram submetidas à manometria com utilização do cateter radial, para pesquisar o RIRA na zona de mais alta pressão. RESULTADOS: houve diferença significante da pressão de repouso pré-relaxamento entre os quadrantes no grupo 2 (p = 0,02) e da pressão no ponto de máximo relaxamento entre os quadrantes do grupo 1 (p = 0,007). Comparando os grupos, não houve diferença significante entre as pressões médias de repouso (p = 0,053), porém esta diferença apareceu nos quadrantes posterior, lateral direito e esquerdo, quando testados separadamente, assim como entre os quadrantes posterior e lateral esquerdo no ponto de máximo relaxamento. CONCLUSÃO: diferenças radiais obtidas em alguns parâmetros do RIRA devem ser consideradas em seu estudo.
Full-text available · Article · Sep 2006 · Revista Brasileira de Coloproctologia
[Show abstract][Hide abstract]ABSTRACT: PURPOSE: Rectoanal reflex parameters were analyzed in multiparous. METHODS: Thirty-six patients with 4 to 6 (Group 1) and 10 patients with 1 to 3 (Group2) vaginal deliveries were submitted to anal manometry with four channel radial catheter. Various parameters of the rectoanal inhibitory reflex were analyzed in each quadrant at the anal canal highest pressure zone. RESULTS: There were significant differences in the anal pressures at the point of maximum relaxation curve among quadrants in Group 1 as well as with the anal resting pressure in Group 2. The comparision between Groups showed differences in anal resting pressure in posterior right lateral and left lateral quadrants as well as in posterior and left lateral at the maximum relaxation point. CONCLUSION: Radial differences in the anal pressure before relaxation and in rectoanal inhibitory reflex parameters are present; however there is not an obvious relevance under the clinical point of view.
Article · Sep 2006 · Revista Brasileira de Coloproctologia