Acute purulent pericarditis due co-infection with Staphylococcus aureus and Mycobacterium tuberculosis as first manifestation of HIV infection.

BACKGROUND: Purulent pericarditis is an unusual first manifestation of HIV-infected patients. Co-infections in this scenario are possible and challenging. Mycobacterium tuberculosis is a frequent agent in purulent pericarditis related to HIV infection but co-infection with Staphylococcus aureus is rarely reported. CASE PRESENTATION: We describe a rare case in otherwise asymptomatic 39-year-old diabetic man with acute purulent pericarditis leading to tamponade due to S. aureus and evidences of M. tuberculosis co-infection. Testing for human immunodeficiency virus was positive. CONCLUSION: Primary purulent pericarditis is a rare condition and may indicate underlying HIV infection. In this scenario, coinfection with multiple organisms are possible and patient should be tested for underlying tuberculosis in addition to standard microbiological workup.

Veia cava superior esquerda persistente: relato de caso / Persistent left superior vena cava: case report

O pleno conhecimento da anatomia vascular torácica é de suma importância para os profissionais envolvidos na realização de procedimentos invasivos como a punção de acesso venoso central. A persistência da veia cava superior esquerda é a malformação venosa torácica mais frequente, e seu diagnóstico costuma ser incidental. Apresentamos o caso de uma paciente de 14 anos em que o diagnóstico de veia cava superior esquerda persistente foi incidental em exame de imagem de controle após colocação de cateter venoso totalmente implantável. A paciente não apresentou dificuldade de infusão de quimioterapia pelo cateter e não houve complicações relacionadas ao cateter.

It is extremely important that health professionals involved in invasive procedures such as central venous access have a thorough knowledge of thoracic vascular anatomy. Persistent left superior vena cava is the most common congenital thoracic venous abnormality and is generally diagnosed as an incidental finding. We present the case of a 14-year-old female patient in whom a persistent left superior vena cava was diagnosed as an incidental finding of a control imaging exam after placement of a totally implantable venous catheter. The patient did not exhibit any difficulties with infusion of chemotherapy via the catheter and there were no complications related to the catheter.

A novel subcutaneous T-shaped bridge device for loop colostomies.

PURPOSE: To describe a novel securing device for loop colostomies, developed in our institution and report our 10-year experience. METHODS: The T-shaped support device was used in all patients who required loop colostomy and who were at an increased risk of stoma withdrawal. The device was removed on the fifth postoperative day in all patients. An analysis from a prospective database regarding early postoperative complication, from 209 patients, was conducted between 2003 and 2013. RESULTS: Bleeding, peristomal skin problems, surgical site infection, stomal ischemia/necrosis, stenosis, obstruction, retraction and early withdrawal of the stoma were not noted in all cases. Thirteen patients (6%) reported mild discomfort on the site of the skin suture. Removal of the instrument was fast and easy, with the advantage of keeping the colostomy bag. CONCLUSION: The T-shaped bridge device successfully prevented stoma withdrawal in all subjects. The device was safe and well accepted, with minor complications.

Adjunctive Hyperbaric Oxygen Therapy promotes successful healing in patients with refractory Crohn's disease.

PURPOSE: To investigate de adjunctive effect of Hyperbaric Oxygen Therapy in a group of patients with refractory Crohn's disease. METHODS: A total of 29 subjects with refractory Crohn's disease were submitted to daily sessions of Hyperbaric Oxygen Therapy, in a 2800 Sechrist Monoplace Hyperbaric Chamber (Sechrist, USA) pressurized to 2.4 ATA. Each session lasted 2 hours. The endpoint was closure of enterocutaneous fistulas and complete healing of Pyoderma Gangrenosum and perineal Crohn's disease. RESULTS: A total of 829 HBOT sessions were performed and no complications were noted. Overall success rate was 76% (22 cases). Pyoderma Gangrenosum and enterocutaneous fistulas had the highest successful healing rates (100% and 91%, respectively). Perineal Crohn's disease healing rate was 65%. CONCLUSION: Adjunctive Hyperbaric Oxygen Therapy promoted satisfactory healing in a group of patients with refractory Crohn's disease.

Serological under expression of microRNA-21, microRNA-34a and microRNA-126 in colorectal cancer.

PURPOSE: This paper describes the ability of miRNA value predict oncological outcomes in CRC patients and correlates to clinical and pathologic variables. METHODS: We prospectively analyzed the serological expression of microRNA-21, microRNA-34a, and microRNA-126 in 37 stage II - IV CRC patients and correlate to seven fit counterparts. Serological microRNAs were extracted using the miRNeasy Mini Kit(r) (Qiagen, Hilden, Germany). Quantification of microRNAs was performed using TaqMan Master Mix(r) reagent (Applied Biosystems, USA). RESULTS: We obtained serological underexpression microRNA-21, microRNA-34a, and microRNA-126 in CRC group. However, miRNAs serological values do not impact prognosis. Furthermore, miRNAs was not influenced by CEA values, TNM staging, and histological subtype. CONCLUSION: Despite lower expression of miR-21, miR-34a and miR-126 in the CRC group, no association with poor prognosis was found.

Transanal endoscopic operation for rectal cancer after neoadjuvant therapy.

PURPOSE: In this paper we report the oncological outcomes from clinical series of patients with rectal cancer submitted to local excision after neoadjuvant therapy and discuss the indications for local excision in partial clinical responders. METHODS: We analysed a prospective database of 39 patients submitted to a transanal endoscopic operation for rectal cancer after neoadjuvant chemoradiation between 2006 and 2015, comparing clinical and pathological variables, perioperative complications, recurrence rate and overall survival. RESULTS: We obtained 15.4% ypT0, 17.9% ypT1, 35.9% ypT2 and 28.2% ypT3. After a median follow-up of 24 months, tumoral recurrence was observed in 4 patients, one of them with isolated pulmonary metastasis. R0 resection was achieved in 79.5%, and postoperative complications were observed in 30.2% patients and no perioperative mortality occur. Compromise surgical margins do not affect recurrence rate, and 94.9% of patients are alive nowadays. CONCLUSION: Local excision could be associated with low recurrence rate and good overall survival. Short hospitalization time and low level of serious complications observed could be an interesting option for patients who would not tolerate a radical procedure or for those who declined a total mesorectal excision. A strict long-term follow-up must be warranted to detect early tumoral recurrence.

Comparative evaluation of oncologic outcomes in colon cancer.

PURPOSE: In this paper we report clinical variables on colon cancer series. Oncological outcomes were compared to low-income and high-income countries. METHODS: We analysed a prospective database of 51 colon cancer patients submitted to primary tumor resection between 2010 and 2011, showing clinical variables and oncologic outcomes. RESULTS: R0 resection obtained in 80.4%, 21.6% of patients was TNM stage IV, and only 13.7% showed TNM stage I. Disease-free survival was 32 months, overall survival was 46 months, and the tumoral recurrence rate was 9.8%. Univariate analysis showed association of serum CEA levels ≥ 5 ng/dl (p= 0.004), presence of metastasis at diagnosis (p= 0.012), compromised surgical margins (p < 0.001) and poorer tumor differentiation (p= 0.041) to death. Multivariate analysis identified compromised surgical margins as an independent risk factor for death due to colon cancer (P=0.003; odds ratio=0.36; 95% confidence interval=0.004-0.33). Nowadays, 62.7% of patients are alive. CONCLUSION: Recurrence rate, disease-free survival and overall survival was similar to those observed in more developed countries. Serum CEA levels ≥ 5 ng/dl, the presence of metastasis at diagnosis, compromised surgical margins and poorer tumor differentiation were associated with death. A compromised surgical margin was the only independent risk factor for death.

Comparative evaluation of oncologic outcomes in colon cancer

PURPOSE: In this paper we report clinical variables on colon cancer series. Oncological outcomes were compared to low-income and high-income countries. METHODS: We analysed a prospective database of 51 colon cancer patients submitted to primary tumor resection between 2010 and 2011, showing clinical variables and oncologic outcomes. RESULTS: R0 resection obtained in 80.4%, 21.6% of patients was TNM stage IV, and only 13.7% showed TNM stage I. Disease-free survival was 32 months, overall survival was 46 months, and the tumoral recurrence rate was 9.8%. Univariate analysis showed association of serum CEA levels ≥ 5 ng/dl (p= 0.004), presence of metastasis at diagnosis (p= 0.012), compromised surgical margins (p < 0.001) and poorer tumor differentiation (p= 0.041) to death. Multivariate analysis identified compromised surgical margins as an independent risk factor for death due to colon cancer (P=0.003; odds ratio=0.36; 95% confidence interval=0.004-0.33). Nowadays, 62.7% of patients are alive. CONCLUSION: Recurrence rate, disease-free survival and overall survival was similar to those observed in more developed countries. Serum CEA levels ≥ 5 ng/dl, the presence of metastasis at diagnosis, compromised surgical margins and poorer tumor differentiation were associated with death. A compromised surgical margin was the only independent risk factor for death.

Serological under expression of microRNA-21, microRNA-34a and microRNA-126 in colorectal cancer

PURPOSE: This paper describes the ability of miRNA value predict oncological outcomes in CRC patients and correlates to clinical and pathologic variables. METHODS: We prospectively analyzed the serological expression of microRNA-21, microRNA-34a, and microRNA-126 in 37 stage II - IV CRC patients and correlate to seven fit counterparts. Serological microRNAs were extracted using the miRNeasy Mini Kit(r) (Qiagen, Hilden, Germany). Quantification of microRNAs was performed using TaqMan Master Mix(r) reagent (Applied Biosystems, USA). RESULTS: We obtained serological underexpression microRNA-21, microRNA-34a, and microRNA-126 in CRC group. However, miRNAs serological values do not impact prognosis. Furthermore, miRNAs was not influenced by CEA values, TNM staging, and histological subtype. CONCLUSION: Despite lower expression of miR-21, miR-34a and miR-126 in the CRC group, no association with poor prognosis was found.

Transanal endoscopic operation for rectal cancer after neoadjuvant therapy

PURPOSE: In this paper we report the oncological outcomes from clinical series of patients with rectal cancer submitted to local excision after neoadjuvant therapy and discuss the indications for local excision in partial clinical responders. METHODS: We analysed a prospective database of 39 patients submitted to a transanal endoscopic operation for rectal cancer after neoadjuvant chemoradiation between 2006 and 2015, comparing clinical and pathological variables, perioperative complications, recurrence rate and overall survival. RESULTS: We obtained 15.4% ypT0, 17.9% ypT1, 35.9% ypT2 and 28.2% ypT3. After a median follow-up of 24 months, tumoral recurrence was observed in 4 patients, one of them with isolated pulmonary metastasis. R0 resection was achieved in 79.5%, and postoperative complications were observed in 30.2% patients and no perioperative mortality occur. Compromise surgical margins do not affect recurrence rate, and 94.9% of patients are alive nowadays. CONCLUSION: Local excision could be associated with low recurrence rate and good overall survival. Short hospitalization time and low level of serious complications observed could be an interesting option for patients who would not tolerate a radical procedure or for those who declined a total mesorectal excision. A strict long-term follow-up must be warranted to detect early tumoral recurrence.

A novel subcutaneous T-shaped bridge device for loop colostomies

PURPOSE: To describe a novel securing device for loop colostomies, developed in our institution and report our 10-year experience. METHODS: The T-shaped support device was used in all patients who required loop colostomy and who were at an increased risk of stoma withdrawal. The device was removed on the fifth postoperative day in all patients. An analysis from a prospective database regarding early postoperative complication, from 209 patients, was conducted between 2003 and 2013. RESULTS: Bleeding, peristomal skin problems, surgical site infection, stomal ischemia/necrosis, stenosis, obstruction, retraction and early withdrawal of the stoma were not noted in all cases. Thirteen patients (6%) reported mild discomfort on the site of the skin suture. Removal of the instrument was fast and easy, with the advantage of keeping the colostomy bag. CONCLUSION: The T-shaped bridge device successfully prevented stoma withdrawal in all subjects. The device was safe and well accepted, with minor complications.

Adjunctive Hyperbaric Oxygen Therapy promotes successful healing in patients with refractory Crohn's disease

PURPOSE: To investigate de adjunctive effect of Hyperbaric Oxygen Therapy in a group of patients with refractory Crohn's disease. METHODS: A total of 29 subjects with refractory Crohn's disease were submitted to daily sessions of Hyperbaric Oxygen Therapy, in a 2800 Sechrist Monoplace Hyperbaric Chamber (Sechrist, USA) pressurized to 2.4 ATA. Each session lasted 2 hours. The endpoint was closure of enterocutaneous fistulas and complete healing of Pyoderma Gangrenosum and perineal Crohn's disease. RESULTS: A total of 829 HBOT sessions were performed and no complications were noted. Overall success rate was 76% (22 cases). Pyoderma Gangrenosum and enterocutaneous fistulas had the highest successful healing rates (100% and 91%, respectively). Perineal Crohn's disease healing rate was 65%. CONCLUSION: Adjunctive Hyperbaric Oxygen Therapy promoted satisfactory healing in a group of patients with refractory Crohn's disease.

Biliary tract schwannoma: a rare cause of obstructive jaundice in a young patient.

Schwannoma is a tumor derived from Schwann cells which usually arises in the upper extremities, trunk, head and neck, retroperitoneum, mediastinum, pelvis, and peritoneum. However, it can arise in the gastrointestinal tract, including biliary tract. We present a 24-year-old male patient with obstructive jaundice, whose investigation with computed tomography abdomen showed focal wall thickening in the common hepatic duct, difficult to differentiate with hilar adenocarcinoma. He was diagnosed intraoperatively schwannoma of common bile duct and treated with local resection. The patient recovered well without signs of recurrence of the lesion after 12 mo. We also reviewed the common bile duct schwannoma related in the literature and evaluated the difficulty in pre and intraoperative differential diagnosis with adenocarcinoma hilar. Resection is the treatment of choice for such cases and the tumor did not recur in any of the resected cases.