Caracterización clínica y epidemiológica de los pacientes con cáncer de colon / Clinical and epidemiological characterization of patients with colon cancer

INTRODUCCIÓN. El cáncer de colon es una neoplasia del tubo digestivo considerada una de las más frecuentes en ambos sexos y que predomina en adultos mayores. OBJETIVO. Describir las características clínicas y epidemiológicas de los pacientes con cáncer de colon. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población de 1 601 y muestra de 210 datos de Historias Clínicas Electrónicas de pacientes diagnosticados con cáncer de colon, atendidos por la Unidad de Oncología del Hospital de Especialidades Carlos Andrade Marín de la ciudad de Quito en el periodo enero de 2016 a diciembre de 2019. Criterios de inclusión: diagnóstico confirmado de Cáncer de Colon, edad igual o mayor a 18 años, y disponer de todos los datos clínicos requeridos en el estudio. Se utilizó el método de muestreo probabilístico con lo que se estimó una proporción para el estudio con un intervalo de confianza del 95%, un margen de error del 5% y una frecuencia esperada del 3%, de donde se obtuvo una muestra ajustada al 10% de pérdidas. El procesamiento de datos se realizó en los programas Microsoft Excel versión 16 y el Statistical Package for Social Sciences versión 24. RESULTADOS. La mayor presentación fue en adultos mayores de 50 años, con una relación 1:1 en cuanto a sexo, y en la procedencia, se ubicó mayoritariamente en la población de la región Sierra; las personas con una actividad económica de tipo profesional fueron las más afectadas; en lo que se refiere a los antecedentes se encontró mayor relación en los personales y dentro de estos los pólipos; no hubo relación con los antecedentes quirúrgicos ni familiares. El síntoma de debut más prevalente fue el dolor abdominal; la mayoría fueron sometidos a colonoscopia; predominó la lateralidad derecha y el tipo histológico principalmente identificado fue el adenocarcinoma. CONCLUSIÓN. No se observó relación estadísticamente significante entre estadíos, evolución y tratamientos instaurados, lo que pudo estar influenciado por el muestreo al azar; y que el 53,30% de los pacientes aún se encuentra en controles.

INTRODUCTION. Colon cancer is a neoplasm of the digestive tract considered one of the most frequent in both sexes and predominantly in older adults. OBJECTIVE. To describe the clinical and epidemiological characteristics of patients with colon cancer. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population of 1 601 and sample of 210 data from Electronic Medical Records of patients diagnosed with colon cancer, attended by the Oncology Unit of the Hospital de Especialidades Carlos Andrade Marín of the city of Quito in the period January 2016 to December 2019. Inclusion criteria: confirmed diagnosis of Colon Cancer, age equal to or older than 18 years, and having all the clinical data required in the study. The probability sampling method was used with which a proportion was estimated for the study with a confidence interval of 95%, a margin of error of 5% and an expected frequency of 3%, from which a 10% loss adjusted sample was obtained. Data processing was performed in Microsoft Excel version 16 and Statistical Package for Social Sciences version 24. The greatest presentation was in adults over 50 years of age, with a 1:1 ratio in terms of sex, and in terms of origin, it was mainly located in the population of the Sierra region; people with a professional economic activity were the most affected; in terms of history, a greater relationship was found in personal history and within these, polyps; there was no relationship with surgical or family history. The most prevalent debut symptom was abdominal pain; the majority underwent colonoscopy; right laterality predominated and the histological type mainly identified was adestatistically significant relationship was observed between stages, evolution and treatment, which could be influenced by random sampling; and that 53,30% of the patients are still in controls.

Intervenciones de enfermería en pacientes con colostomía / Nursing interventions in patients with colostomies

Objetivo: Analizar las intervenciones de enfermería en pacientes con colostomía en el Hospital General Docente Ambato-Ecuador. Método: Descriptiva observacional en 12 pacientes que cumplieron con los criterios de inclusión y exclusión. Resultados: El 47% del personal de enfermería encuestado si utiliza patrones funcionales para la valoración de su paciente. Conclusión: la recolección de información de las historias clínicas se obtuvo que la mayor parte de los pacientes que presentan colostomía son hombres, bordean una edad superior a los 53 años, y la causa principal son los traumatismos graves, a partir de la encuesta se identificó que la mayor parte del personal de enfermería conoce todo lo relacionado con la colostomía, incluyendo los cuidados, complicaciones, el tipo de bolsa de colostomía que se usa, entre otros.

Objective: To analyze nursing interventions in patients with colostomy at the Hospital General Docente Ambato-Ecuador. Method: Descriptive observational study in 12 patients who met the inclusion and exclusion criteria. Results: 47% of the nursing staff surveyed used functional patterns for patient assessment. Conclusion: The collection of information from the medical records showed that most of the patients who present colostomy are men, they are over 53 years old, and the main cause is severe trauma, from the survey it was identified that most of the nursing staff knows everything related to colostomy, including care, complications, the type of colostomy bag used, among others.

Efficacy and safety of fecal microbiota transplantation for the treatment of chronic functional constipation in the elderly / 中华老年医学杂志

Objective:To evaluate the clinical efficacy and safety of fecal microbiota transplantation(FMT)for the treatment of chronic functional constipation in the elderly.Methods:A total of 33 elderly patients with chronic functional constipation were included and given three sessions of FMT.Changes in fecal characteristics, constipation, mood and quality of life in these patients were evaluated using the Bristol stool form scale(BSFS), the constipation assessment scale(CAS), patient assessment of constipation symptoms(PAC-SYM), the Zung self-rating anxiety scale(SAS), the Zung self-rating depression scale(SDS), and the patient assessment of constipation quality of life(PAC-QOL)before and 12 weeks after treatment.The clinical efficacy was based on comparison between pre-and post-treatment results for each patient.Results:Clear improvement was achieved in 33 patients 12 weeks after treatment, compared with before transplantation.Post-treatment scores of the constipation assessment scale and symptom self-assessment questionnaire for patients with constipation were(8.9±1.2)scores and(26.5±2.4)scores, respectively, significantly lower than pre-transplantation scores of(12.2±1.1)scores and(32.4±2.4)scores( t=15.034, 13.904, both P<0.001). Similarly, post-treatment scores were also lower than pre-transplantation levels for the self-rating anxiety scale[(50.4±8.4)scores vs.(57.5±9.0)scores, t=10.333, P<0.001], the self-rating depression scale[(50.6±8.4)% vs.(55.0±10.5)%, t=5.301, P<0.001], and self-assessment questionnaire for quality of life[(88.2±7.3)scores vs.(103.7±7.3)scores, t=23.300, P<0.001]. Conclusions:FMT can improve fecal characteristics and constipation symptoms, relieve anxiety and depression, improve the quality of life, and provide a new option for the treatment for elderly patients with chronic functional constipation.

Úlcera rectal solitaria como simulador de cáncer colorrectal y enfermedad de Crohn: reporte de caso / Solitary rectal ulcer simulating colorectal cancer and Crohn's disease: Case report

Resumen La úlcera rectal solitaria es una patología poco frecuente de naturaleza benigna que debe diferenciarse de otras entidades en su presentación inicial, con mecanismos fisiopatológicos definidos y con sintomatología variada. Se presenta el caso de una paciente de 31 años sin antecedentes de importancia, que consultó a nuestra institución por un cuadro de 3 años de sangrado rectal asociado con episodios de diarrea, manejada con múltiples diagnósticos.

Abstract Solitary rectal ulcer is a rare condition of benign nature that must be differentiated from other disorders with defined pathophysiological mechanisms and varied symptoms. The following is the case of a 31-year-old female patient with no relevant history, who consulted our institution due to symptoms of rectal bleeding associated with episodes of diarrhea for three years, who received multiple diagnoses.

Colitis Isquémica en Dolicomegacolon Andino

Resumen La colitis isquémica representa la forma más frecuente de isquemia intestinal ( 60-70%) como consecuencia de privación transitoria del flujo vascular por alteraciones anatómicas funcionales, locales o sistémicas. Se presenta el caso clínico de paciente de 70 años de edad procedente de La Paz Bolivia, ciudad a 3 650 m.s.n.m. a quien se diagnosticó colitis isquémica por torsión del eje mesentérico a nivel de colon sigmoides asociado a dolicomegacolon andino, procediendo a colectomía izquierda y anastomosis termino-terminal, con buena evolución.

Abstract Ischaemic colitis represents the most frequent form of intestinal ischaemia (60-70%) as a consequence of transient deprivation of vascular flow due to functional, local or systemic anatomical alterations. We present a case report of a 70-year-old patient from La Paz, Bolivia, a city at an altitude of 3 650 m.a.m.s.l., who was diagnosed with ischaemic colitis as a result of torsion of the mesenteric axis at the level of the sigmoid colon associated with Andean dolichomegacolon, followed by left colectomy and termino-terminal anastomosis, with satisfactory evolution.

Hemicolectomía radical laparoscópica: opción de mínima invasión para el cáncer de colon / Laparoscopic radical hemicolectomy: minimally invasive option for colon cancer / Hemicolectomia radical laparoscópica: opcão minimamente invasiva para cãncer de cólon

Introducción. El cáncer de colon es una de las principales causas de morbimortalidad a nivel mundial. En Colombia se presentan cerca de 145,600 casos nuevos al año. Cada vez son más los reportes de este tipo de patologías intervenidas por vía laparoscópica, aunque son pocos en Colombia. El objetivo de este artículo es mostrar el abordaje de esta patología mediante un procedimiento mínimamente invasivo: la colectomía derecha por vía laparoscópica, el cual es poco utilizado en el país. Caso clínico. Paciente de 86 años que consulta por pérdida de peso, adinamia y dolor abdominal en flanco derecho. Presenta además anemia ferropénica y sangre oculta en materia fecal. Las endoscopias digestivas muestran lesión ulcerada vegetante de aspecto neoplásico a nivel del ciego. La biopsia revela adenocarcinoma infiltrante moderadamente diferenciado con áreas de necrosis. Se realiza una colectomía derecha por técnica laparoscópica. Se hace seguimiento con neoadyuvancia por parte de Oncología Clínica. Discusión. El adenocarcinoma es uno de los cánceres primarios más comunes en el colon. La resección quirúrgica es una excelente alternativa para el manejo y tratamiento de estos tumores. En Colombia, la mayoría de estas resecciones se realizan por vía abierta. La resección por vía laparoscópica es un método que demuestra similar eficacia, ofreciendo una disminución en la respuesta inflamatoria, con mejor control del dolor y limitaciones funcionales. Conclusiones. La colectomía por vía laparoscópica para resección de tumores de colon es un método seguro, eficaz y reproducible. Sin embargo, exige tecnología de alto costo y debe ser realizada por un grupo quirúrgico con habilidad y experiencia en sutura manual laparoscópica. Cómo citar: López-Gómez LE, Dominguez ­ Alvarado GA, D ́vera Camargo D, Lozano-Eslava LA, Martínez-Rojas PA. Hemicolectomía radical laparoscópica: opción de mínima invasión para el cáncer de colon. MedUNAB. 2020;23(2): 281-287. doi: 10.29375/01237047.3829

Introduction. Colon cancer is one of the main causes of morbimortality in the world. Colombia counts near 145,600 new cases per year. The reports of laparoscopic intervention in this pathology are growing, but in Colombia there is little recent work on the matter. The aim of this article is to show how this pathology can be addressed through a minimally invasive procedure, laparoscopic right colectomy, which is not frequently used in the country. Clinical case. An 86-year-old patient consults due to weight loss, adynamia and abdominal pain on right side. Iron-deficiency anemia and hidden blood in feces was reported. The digestive endoscopies show the presence of a vegetant and ulcerated lesion of neoplastic appearance in the cecum. A biopsy revealed a moderately differentiated, invasive adenocarcinoma with areas of necrosis. A laparoscopic right colectomy is conducted. Definitive report of moderately differentiated and ulcerated, invasive, mucinous adenocarcinoma, with lesion up to the serous membrane. Follow up is conducted with neoadjuvant therapy by the Clinical Oncology service. Discussion. Adenocarcinoma is one of the most common primary cancers in the colon. Surgical still an excellent alternative for the management of this kind of tumor. In Colombia, the majority of these resections are carried out by open surgery. However, laparoscopic resection is a method that offers similar outcomes to the traditional procedure, while providing a reduction in the inflammatory response, with better pain control and control of functional limitations. Conclusions. Laparoscopic colectomy for the resection of colonic tumors is a safe, effective and reproducible method. However, it requires high-cost technology and it must be conducted by a surgical team skilled and experienced in manual laparoscopic suturing.Cómo citar: López-Gómez LE, Dominguez ­ Alvarado GA, D ́vera Camargo D, Lozano-Eslava LA, Martínez-Rojas PA. Hemicolectomía radical laparoscópica: opción de mínima invasión para el cáncer de colon. MedUNAB. 2020;23(2): 281-287. doi: 10.29375/01237047.3829

Introdução. O câncer de cólon é uma das principais causas de morbimortalidade em todo o mundo. Na Colômbia, há uma incidência aproximada de 145,600 casos novos por ano. Na Colômbia existam poucos trabalhos recentes sobre este tipo de procedimentos. O objetivo deste artigo é mostrar a abordagem de o adenocarcinoma de cólon, através de um procedimento minimamente invasivo: a colectomia direita pela via laparoscópica, pouco utilizada no país. Caso clínico. Paciente de 86 anos que apresenta perda de peso, adinamia e dor abdominal no flanco direito, anemia ferropriva e sangue oculto nas fezes. As endoscopias digestivas evidenciam a presença de uma lesão ulcerada vegetante com aparência neoplásica no nível do ceco. A biópsia revelou adenocarcinoma infiltrante moderadamente diferenciado com áreas de necrose. As imagens de extensão mostram um efeito de massa intraluminal ao nível do ceco com adenomegalia pericecal. Realizou-se uma colectomia direita laparoscópica. Relato definitivo de adenocarcinoma mucinoso infiltrante moderadamente diferenciado e ulcerado, com comprometimento da serosa. O serviço de Oncologia Clínica fez o acompanhamento neoadjuvante. Discussão. O adenocarcinoma é um dos cânceres primários mais comuns no cólon. A ressecção cirúrgica continua sendo uma excelente alternativa para a gestão e tratamento deste tipo de tumores. Na Colômbia, a maioria dessas ressecções é realizada pela via aberta. A ressecção pela via laparoscópica é um método que oferece ressecções semelhantes às do procedimento tradicional, apresentando diminuição da resposta inflamatória, com melhor controle da dor e das limitações funcionais. Conclusão. A colectomia pela via laparoscópica para ressecção de tumores de cólon é um método seguro, eficaz e reprodutível. No entanto, requer tecnologia de alto custo e deve ser realizada por um grupo cirúrgico com habilidade e experiência em sutura manual laparoscópica. Cómo citar: López-Gómez LE, Dominguez ­ Alvarado GA, D ́vera Camargo D, Lozano-Eslava LA, Martínez-Rojas PA. Hemicolectomía radical laparoscópica: opción de mínima invasión para el cáncer de colon. MedUNAB. 2020;23(2): 281-287. doi: 10.29375/01237047.3829

Asociación entre desenlaces clínicos y cumplimiento del protocolo de recuperación mejorada después de la cirugía (ERAS) en procedimientos colorrectales: estudio multicéntrico / Association between clinical outcomes and compliance with the Enhanced Recovery After Surgery (ERAS) protocol in colorectal procedures: A multicenter study

Introducción. Los protocolos de recuperación mejorada después de cirugía se han diseñado como una innovación en salud tras demostrarse que la mejora en los dispositivos médicos y la depuración de técnicas alcanzaron la meseta en disminución de complicaciones. Con estas estrategias de la medicina perioperatoria, en cirugía colorrectal se reducen la morbilidad y estancia hospitalaria. El objetivo del estudio fue evaluar si la tasa de adherencia al programa de recuperación mejorada después de la cirugía (ERAS) está asociada con los resultados quirúrgicos. Métodos. Estudio multicéntrico, observacional, retrospectivo de cohorte (2015-2019), en cinco hospitales latinoamericanos certificados por la sociedad ERAS. Se calculó la incidencia de complicaciones quirúrgicas durante el posquirúrgico inmediato (30 días) y la duración de la estancia hospitalaria. Se utilizaron análisis bivariado y regresión logística multivariada para evaluar los factores asociados con la tasa de complicaciones. Resultados. Fueron incluidos en el estudio 648 pacientes en cinco hospitales ERAS, con edad promedio de 61 años y mayor porcentaje de hombres (51 %). El cumplimiento global al protocolo ERAS fue de 75 % y la estancia promedio de 6,2 días (mediana: 4 días). Se tuvo un cumplimiento óptimo del protocolo ERAS (igual o mayor al 80 %) en 23,6 % de los pacientes. Se documentó fuga de la anastomosis en 4 %, complicaciones infecciosas en 8,4 %, íleo en 5,7 %, reingreso en 10,2 % y mortalidad de 1,1 %. El análisis multivariado mostró que los niveles de adherencia óptima al protocolo ERAS reducen significativamente la aparición de complicaciones como fuga de la anastomosis (OR 0,08; IC95% 0,01-0,48; p=0,005) y complicaciones infecciosas (OR 0,17; IC95%0,03-0,76; p=0,046).Discusión. Los resultados sugieren que un cumplimiento del programa ERAS mayor al 80 % se asocia a menor frecuencia de complicaciones en pacientes con cirugía electiva colorrectal

Introduction. Enhanced Recovery After Surgery (ERAS) protocol has been designed as an innovation in health after demonstrating that the improvement in medical devices and the refinement of techniques reached the plateau in reducing complications. With these strategies of perioperative medicine, in colorectal surgery morbidity and hospital stay are reduced. The aim of the study was to evaluate whether the rate of adherence to the ERAS protocol is associated with surgical outcomes.Methods. Multicenter, observational, retrospective cohort study (2015-2019), in five Latin American hospitals certified by the ERAS Society. The incidence of surgical complications during the immediate postoperative period (30 days) and length of hospital stay were calculated. Bivariate analyzes and multivariate logistic regression were used to assess factors associated with complication rates.Results. 648 patients were included in the study in five ERAS hospitals, with an average age of 61 years and a higher percentage of men (51%). Overall compliance with the ERAS protocol was 75% and the average stay was 6.2 days (median: 4 days). There was optimal compliance with the ERAS protocol (equal to or greater than 80%) in 23.6% of the patients. Anastomotic leak was documented in 4%, infectious complications in 8.4%, ileus in 5.7%, readmission in 10.2%, and mortality in 1.1%. Multivariate analysis showed that optimal adherence levels to the ERAS protocol significantly reduce the appearance of complications such as anastomotic leakage (OR 0.08; 95%CI 0.01-0.48; p=0.005) and infectious complications (OR 0.17; 95%CI 0.03-0.76; p=0.046).Discussion. The results suggest that compliance with the ERAS program greater than 80% is associated with a lower frequency of complications in patients with elective colorectal surgery

What do Cochrane systematic reviews say about the management of irritable bowel syndrome?

ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a clinical disorder associated with high socioeconomic burden. Despite its importance, management of IBS remains difficult and several interventions have been hypothesized as beneficial for this condition. This study identified and summarized all Cochrane systematic reviews (SRs) about the effects of interventions for managing IBS patients. DESIGN AND SETTING: Review of systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: Review of Cochrane SRs addressing interventions for IBS. RESULTS: We included six SRs assessing acupuncture, bulking agents, antispasmodics, antidepressants, herbal medicines, homeopathy, hypnotherapy and psychological therapy for IBS. The certainty of evidence ranged from unknown to moderate, mainly due to imprecision in the estimates and high risk of bias from the primary studies included. There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life, compared with sham acupuncture. There was also very low certainty of evidence that homeopathic asafoetida, used alone or in association with nux, was better than placebo regarding self-reported overall improvement. CONCLUSION: There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life. Further well-designed and well-conducted randomized clinical trials are needed in order to reduce the uncertainties regarding the most commonly used interventions for patients with IBS.

Clinical effect of combination of traditional Chinese and western medicine in the treatment of postoperative pain of anorectal disease / 中国基层医药

Objective To investigate the effect of integrated traditional Chinese and western medicine in the treatment of postoperative pain in patients with anorectal diseases. Methods From November 2015 to October 2017, 70 patients with anorectal diseases underwent surgical treatment in the First People 's Hospital of Yongkang were selected. The simple western medicine treatment was performed in 35 patients with anorectal diseases in the control group,and 35 patients in the observation group were given combined Chinese and western medicine. The total effective rate of the two groups was observed and calculated. The pain score at 2 h,6 h,12 h and 24 h after operation,the incidence rate of postoperative complications were observed. Results The total effective rate of the control group (80. 00％ ) was lower than that of the observation group (97. 14％ ),the difference was statistically significant(χ2 =5. 080,P < 0. 05). The pain scores at postoperative 2h,6h,12h,24h in the control group were (2. 0 ± 0. 5) points, (3. 6 ± 1. 0)points,(4. 5 ± 1. 0)points,(5. 0 ± 1. 2)points,respectively,which in the observation group were (1. 4 ± 0. 2)points,(2. 0 ± 0. 6)points,(2. 4 ± 0. 5)points,(2. 3 ± 0. 4)points,respectively,the differences were statistically significant(t = 6. 591,8. 116,11. 112,8. 116,all P < 0. 05). The incidence rate of postoperative complications in the control group (17. 14％ ) was higher than that in the observation group (2. 86％ ),the difference was statistically significant(χ2 = 3. 968,P < 0. 05). The total satisfaction rate of the control group (74. 29％ ) was lower than that of the observation group (94. 29％ ),the difference was statistically significant(χ2 = 5. 285,P < 0. 05). Conclusion The combination of traditional Chinese and western medicine is effective in the treatment of postoperative pain in patients with anorectal diseases,which can increase the effective rate and improve the quality of life of the patients, and it is worthy of clinical application.

Nationwide Survey for Application of ROME IV Criteria and Clinical Practice for Functional Constipation in Children

BACKGROUND: This study aimed to investigate the awareness and application of ROME IV criteria for functional constipation (FC) in real-world practices and assessed differences between pediatric gastroenterologists (PGs) and general pediatricians. METHODS: A total of 239 (47.8%) out of 500 nationwide pediatricians answered a questionnaire for diagnosis and management of pediatric FC; 60 were PGs (75% of total PGs in Korea). RESULTS: A total of 16.6% of pediatricians were aware of the exact ROME IV criteria. Perianal examination and digital rectal examination were practiced less, with a higher tendency among PGs (P 6 months (63.8%) than 1-year were lactulose (59.1%), followed by polyethylene glycol (PEG) 4000 (17.7%), and probiotics (11.8%). Prescription priority significantly differed between PGs and general pediatricians; lactulose or PEG 4000 were most commonly prescribed by PGs (89.7%), and lactulose or probiotics (75.7%) were prescribed by general pediatricians (P < 0.001). For patients aged < 1-year, lactulose (41.6%) and changing formula (31.7%) were commonly prescribed. Most participants recommended diet modification, and PGs more frequently used defecation diary (P = 0.002). CONCLUSION: Discrepancies between actual practice and Rome IV criteria and between PGs and general pediatricians were observed. This survey may help construct practice guidelines and educational programs for pediatric FC.

Enfermedad diverticular: mitos y realidades / Diverticular disease: myths and realities

Diverticulosis and diverticular disease of the colon are common conditions in Western countries. The incidence and prevalence of these diseases are increasing and becoming significant for health systems. A growing body of knowledge is shifting the paradigm of the pathogenesis and treatment of diverticular disease. Low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to diverticular disease. The risk of developing diverticulitis among individuals with diverticulosis is lower than 10 to 25%. Studies indicate that diverticular disease may become a chronic disorder in some patients, not merely an acute illness. Contrary to the advice from international guidelines, studies have not shown that a high-fiber diet protects against diverticulosis. The evidence about the use of antibiotics in uncomplicated diverticulitis is sparse and of low quality. In relation to surgery, studies support a more conservative approach to prophylactic surgery in patients with recurrent disease or chronic symptoms. Finally, new pathophysiological knowledge suggests that other treatments may be useful (mesalamine, rifaximin and probiotics). However, more research is necessary to validate the safety, effectiveness and cost-effectiveness of these strategies.

Diagnóstico y manejo de colitis ulcerosa grave: una mirada actualizada / Management of severe ulcerative colitis: an up-to-date

Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.

Clinical significance of preoperative colonoscopy for benign anal diseases / 中华消化外科杂志

Objective To investigate the clinical significance of preoperative colonoscopy for patients with benign anal diseases,and to compare the success rates of examination done by sedated colonoscopy and conventional colonoscopy.Methods The clinical data of 333 patients with benign anal disease who received preoperative colonoscopy at the Six Affiliated Hospital of Sun Yat-Sen University from April 2010 to March 2011 were retrospectively analyzed.All the patients were divided into the lesion group (120 patients) and normal group (213 patients)according to the results of colonoscopy.The measurement data and count data were analyzed using the t test and chi-square test,respectively.Results The age of patients in the lesion group was (48 ± 14) years,which was significantly older than (42 ± 14) years (t =3.75,P ＜ 0.05).The constituent ratio of patients older than 40 years in the lesion group was 72.50％ (87/120),which was significantly higher than 39.44％ (84/213) in the normal group (x2=33.59,P ＜0.05).The proportions of male and female patients were 71.67％ (86/120) and 28.33％ (34/120) in the lesion group,and 62.44％ (133/213) and 37.56％ (80/213) in the normal group,with no significant difference between the 2 groups (x2 =2.90,P ＞ 0.05).The benign anal diseases in the lesion group included polyp (80 cases),enteritis (30 cases),malignant tumor (7 cases),infflammatory bowel disease (7 cases),diverticulum (5 cases) and ulcer (1 case).The application rates of sedated colonoscopy in the lesion group and the normal goup were 51.67％ (62/120) and 54.93％ (117/213),respectively,with no significant difference between the 2 groups (x2=0.33,P ＞0.05).The success rate of terminal ileum intubation was 99.44％ (178/179) in patients who received sedated colonoscopy,which was significantly higher than 95.45％ (147/154) of patients who received conventional colonoscopy (x2 =5.61,P ＜ 0.05).Conclusion Patients with benign anal disease might complicated with colorectal lesions,and sedated colonoscopy is recommended for preoperative diagnosis,especially for patients who are older than 40 years.

Clinical application of transumbilical single-port laparoscopic colorectal operation / 中华消化外科杂志

Objective To investigate the clinical value of transumbilical single-port laparoscopic colorectal operation.Methods The clinical data of 25 patients with benign or malignant carcinoma at the upper part of the colon or rectum who were admitted to the No.4 People's Hospital of Zigong from January 2010 to December 2012 were retrospectively analyzed,and the clinical experience of transumbilical single-port laparoscopic colorectal operation was summarized.Surgical procedure was selected according to the position and nature of the lesion.Patients were followed up via out-patient examination and phone call till March 2013.Results Partial colorectal resection was done on 14 patients,radical resection of right colon on 1 patient,radical resection of transverse colon on 1 patient,radical resection of left colon on 1 patient,radical resection of sigmoid colon on 2 patients and radical rectectomy on 6 patients.The operation was successfully carried out on 22 patients,2 patients received four-port laparoscopic colorectal operation,and 1 patient was converted to open surgery.The median length of the incision of single-port laparoscopic colorectal operation was 3.8 cm (range,3.5-4.5 cm),and the operation time was (192 ± 32) minutes.The intraoperative blood loss was (61 ± 21)mL,and the median diameter of the tumor was 2.7 cm (range,1.0-5.0 cm).The median number of lymph nodes dissected was 7 (range,3-22),the mean time of postoperative anal exhaust time was 2 days (range,1-5 days),and the mean time of postoperative hospital stay was 8 days (range,6-20 days).The incidence of postoperative complications was 8.0％ (2/25),including 1 patient with wound infection and 1 patient with anastomotic leakage.The circumferential resection margins of radically resected specimens were negative in 11 patients.Twenty-two patients who received transumbilical single-port laparoscopic colorectal resection were followed up,and the median time of follow-up was 12 months.Colorectal liver metastasis was detected on 1 patient at postoperative month 10,and the other patients survived without tumor recurrence or metastases.Conclusions Transumbilical singleport laparoscopic colorectal operation is safe,micro-traumatic and feasible,and it also has less complication and good cosmetic effect.

Doença diverticular dos cólons e diverticulite aguda: o que o clínico deve saber / Diverticular disease of the colon and acute diverticulitis: what the clinician should know

A doença diverticular constitui uma das afecções benignas mais frequentes e ocasiona elevada morbidade para o paciente. Várias complicações são advindas dessa doença, e em determinadas situações elas apresentam significativa gravidade. Contudo, essa afecção é, na maioria das vezes, assintomática e poucos indivíduos estão cientes desua existência. Na vigência de inflamação dos divertículos, os pacientes procuram atendimentos de urgência com sintomatologia de diverticulite aguda. Cabe ao clínico proceder com avaliação clínica detalhada, propedêutica eficiente e instituição de terapêutica adequada. Ainda, torna-se essencial discernir sobre a necessidade da abordagem cirúrgica. Esse artigo objetiva contribuir para a atualização do conhecimento sobre o diagnóstico e o tratamento da doença diverticular e diverticulite aguda...

Diverticular disease is one of the most frequent benign diseases, with high patient morbidity. Several complications can arise from it and in certain cases they can be very severe. However, this condition is most often asymptomatic and few individuals are aware of its existence. In the presence of diverticular inflammation patients seek emergency services with symptoms of acute diverticulitis. It is up to the clinician to proceed with a detailed clinical assessment, efficient workup and start adequatetherapy. Additionally, it is essential to discern the need for a surgical approach. This article aims to contribute with an update on the diagnosis and treatment of acute diverticulitis and diverticular disease...

Improvement of cchistosomal portal hypertensive colopathy after surgical treatment

Context Data on vascular alterations in patients with hepatosplenic schistosomiasis and portal hypertensive colopathy and changes in these after surgery to decrease portal hypertension are limited. Objective The purpose of this study was to analyse the alterations of portal hypertensive colopathy previously and 6-12 months after splenectomy and gastric devascularization. Methods Twelve patients with hepatosplenic schistosomiasis who also had upper gastrointestinal bleeding were studied prospectively. Their endoscopic findings before and 6-12 months after the surgery were analysed. In addition, mucosal biopsies from ascending colon, sigmoid colon and rectum at these time points were subjected to histological and histomorphometric assessment. It was used a control group due to lack of normal pattern of the histomorphometric measures of vessels in individuals without portal hypertension. The critical level of significance adopted in all tests was of a maximum probability error of 5%. Results Surgery did not lead to significant improvement in histological and endoscopic findings. However, on histomorphometry, there was a significant decrease in the area, diameter and thickness of the vessels in mucosa at all colonic sites. Conclusion Surgery for decompression of schistosomal portal hypertension has a beneficial effect on the associated colopathy, being best indicated in patients with gastrointestinal bleeding and esophageal varices. .

Contexto Dados em relação às alterações vasculares em pacientes com esquistossomose hepatoesplênica e colopatia hipertensiva portal e suas modificações após cirurgia para atenuação da hipertensão portal são restritos. Objetivo Analisar as alterações da colopatia hipertensiva portal antes e seis a 12 meses após a esplenectomia e desvascularização gástrica. Métodos Foram estudados prospectivamente 12 pacientes com esquistossomose hepatoesplênica e antecedente de hemorragia digestiva alta. Os achados colonoscópicos antes e após 6 a 12 meses após a cirurgia foram analisados. Nesses períodos, biopsias da mucosa do cólon ascendente, sigmóide e reto foram encaminhadas para análise histológica e histomorfométrica. Foi utilizado um grupo controle pela falta de padrão de normalidade das medidas histomorfométricas das vênulas do cólon e reto em indivíduos sem hipertensão portal. O nível de significância crítica adotado em todos os testes foi de probabilidade máxima de erro de 5%. Resultados Não foram encontradas diferenças significantes na intensidade das alterações endoscópicas e histológicas nos vasos da mucosa do cólon e reto após a cirurgia. Entretanto, houve decréscimo estatisticamente significante nas áreas, diâmetros e espessuras dos vasos estudados através da histomorfometria. Conclusão Cirurgia para descompressão da hipertensão portal esquistossomótica tem efeito benéfico na colopatia associada, sendo bem indicada nos pacientes com hemorragia digestive alta e varizes esofágicas. .

The clinical preliminary study of second generation colon capsule endoscopy / 中华消化内镜杂志

Objective To investigate the diagnositic role of second generation colon capsule endoscopy in colorectal diseases.Methods After colon preparation procedure,fourteen volunteers were observed with second generation colon capsule endoscopy.During the examination,stomach and small bowel transit time,the colorectal examination time and the positive founding were recorded.Capsule excretion rate,the colon cleaning level and rate of adverse events also were assessed.Results Colorectal diseases including colon polyp,colon protrusion lesion and internal hemorrhoid were found in 7 volunteers.Stomach diseases including erosive gastritis and gastric ulcer in 10 volunteers.Small bowel diseases including small bowel polyp,ileum ulcer and small bowel protrusion lesion in 6 volunteers.Thirteen capsule were excreted within 480 minutes.The average colorectal examination time was 310 ± 125 minutes.The average stomach and small bowel transit time were 82 ± 39 minutes and 121 ± 73 minutes,respectively.The overall colon cleanliness was adequate in 7 patients.There are no severe adverse events during the examination.Conclusion The second generation capsule endoscopy can observe the colorectal mucosal changes and it might be considered as an adequate tool for colorectal diseases screening and diagnosis.

Function of colonic mucosal barrier of patients with colonic slow transit constipation / 中华消化杂志

Objective To explore the function of colonic mucosal barrier of patients with colonic slow transit constipation (STC).Methods From June 2008 to June 2012,a total of 136 patients with STC were enrolled.Among them,course of disease of 55 cases was between one and six years,of 43 cases was between six and 10 years,and of 38 cases was over 10 years.The colonic transit time of 66 cases was between three and five days,of 42 cases was between five and seven days,and of 28 cases was over seven days.Altogether,35 cases received subtotal resection of the colon.At same time,individuals who received partial resection of the colon because of single polypus were set as control group.Fasting blood and urine samples of all subjects were collected.The colonic specimens of STC patients who received surgery and control group were harvested.The urinary lactulose and mannitol ratio (L/M) was detected by high performance liquid chromatography (HPLC).The level of blood Dlactic acid (D-LAC) was tested by enzymatic spectrophotometric.The level of blood diamine oxidase (DAO) was determined by speetrophotometry.The level of endotoxin (ET) was detected by azo chromogenic substrate limulus test.The colonic epithelial cells membrane resistance (TER) and paracellular mannitol permeability (PMP) were measured with Ussing perfusion chamber.t-test was performed for comparison between groups.Results Urinary L/M of STC group and control group was 0.16±0.03 and 0.10±0.02,respectively.The level of blood D-LAC was (1.81±0.19) and (1.04±0.13) mmol/L.The level of blood DAO was (17.07±1.81) and (9.78±1.14) U/L.The level of blood ET was (64.20±6.85) and (51.30±5.90) EU/L.The TER of colonic epithelia cell was (61.23±7.76) and (75.87±9.65) Ω/cm2.The PMP of colonic epithelia cell was (3.17±0.35) ％ and (2.14 ±0.22)％.All the differences were statistically significant (t =3.185,3.378,3.863,3.201,3.125 and 3.543,all P＜0.05).Among patients with disease course between one and six years,six to 10 years and over 10 years,colonic transit time of STC between three and five days,five to seven days and over seven days,urinary L/M,blood D-LAC level and blood DAO level increased along with the disease course and colonic transit time and the differences were statistical significantly compared with control group (urinary L/M:t=1.993,2.311,2.356,2.204,2.347 and 3.673; blood D-LAC level:t=2.023,2.886,4.124,1.999,2.998 and 3.465; blood DAO level:t=1.994,2.995,4.423,2.203,3.673 and 5.211; all P＜0.05).Compared with control group,there were significant differences in blood ET level of course of STC between six and 10 years,over 10 years,colonic transit time of STC between five and seven days and over seven days (t=2.121,4.245,3.241 and 4.657,all P＜0.05).Conclusion The permeability of colonic mucosal barrier increased and which was more significant in longer colonic transit time and long course of disease.