ABSTRACT
OBJECTIVES: The purpose of our study was to report the results of the implementation of computed tomography colonography in a university hospital setting serving a Brazilian population at high risk of colorectal cancer. METHODS: After creating a computed tomography colonography service in our institution, 85 patients at high risk of colorectal cancer underwent computed tomography colonography followed by a same-day optical colonoscopy from September 2010 to May 2012. The overall accuracy of computed tomography colonography in the detection of lesions ≥6 mm was compared to that of optical colonoscopy (direct comparison). All colonic segments were evaluated using quality imaging (amount of liquid and solid residual feces and luminal distension). To assess patient acceptance and preference, a questionnaire was completed before and after the computed tomography colonography and optical colonoscopy. Fisher's exact test was used to measure the correlations between colonic distension, discomfort during the exam, exam preference and interpretation confidence. RESULTS: Thirteen carcinomas and twenty-two lesions ≥6 mm were characterized. The sensitivity, specificity and accuracy of computed tomography colonography were 100%, 98.2% and 98.6%, respectively. Computed tomography colonography was the preferred method of investigation for 85% of patients. The preparation was reported to cause only mild discomfort for 97.6% of patients. According to the questionnaires, there was no significant relationship between colonic distension and discomfort (p>0.05). Most patients (89%) achieved excellent bowel preparation. There was a statistically significant correlation between the confidence perceived in reading the computed tomography colonography and the quality of the preparation in each colonic segment (p≤0.001). The average effective radiation dose per exam was 7.8 mSv. CONCLUSION: It was possible to institute an efficient computed tomography colonography service at a university hospital that primarily assists patients from the public health system, with high accuracy, good acceptance and effective radiation doses. Our results seem to be comparable to other centers of excellence and fall within acceptable published guidelines, showing that a successful computed tomography colonography program can be reproduced in a South American population screened in a university hospital.
Subject(s)
Carcinoma/pathology , Colonography, Computed Tomographic/methods , Colorectal Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Brazil , Colectomy/methods , Colon/pathology , Colonic Polyps/pathology , Colonoscopy/methods , Female , Hospitals, University , Humans , Male , Middle Aged , Prospective Studies , Rectum/pathology , Reproducibility of Results , Risk Assessment , Risk Factors , Sensitivity and SpecificityABSTRACT
OBJECTIVES: The purpose of our study was to report the results of the implementation of computed tomography colonography in a university hospital setting serving a Brazilian population at high risk of colorectal cancer. METHODS: After creating a computed tomography colonography service in our institution, 85 patients at high risk of colorectal cancer underwent computed tomography colonography followed by a same-day optical colonoscopy from September 2010 to May 2012. The overall accuracy of computed tomography colonography in the detection of lesions ≥6 mm was compared to that of optical colonoscopy (direct comparison). All colonic segments were evaluated using quality imaging (amount of liquid and solid residual feces and luminal distension). To assess patient acceptance and preference, a questionnaire was completed before and after the computed tomography colonography and optical colonoscopy. Fisher's exact test was used to measure the correlations between colonic distension, discomfort during the exam, exam preference and interpretation confidence. RESULTS: Thirteen carcinomas and twenty-two lesions ≥6 mm were characterized. The sensitivity, specificity and accuracy of computed tomography colonography were 100%, 98.2% and 98.6%, respectively. Computed tomography colonography was the preferred method of investigation for 85% of patients. The preparation was reported to cause only mild discomfort for 97.6% of patients. According to the questionnaires, there was no significant relationship between colonic distension and discomfort (p>0.05). Most patients (89%) achieved excellent bowel preparation. There was a statistically significant correlation between the confidence perceived in reading the computed tomography colonography and the quality of the preparation in each colonic segment (p≤0.001). The average effective radiation dose per exam was 7.8 mSv. CONCLUSION: It was possible to institute an efficient computed ...
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma/pathology , Colonography, Computed Tomographic/methods , Colorectal Neoplasms/pathology , Brazil , Colectomy/methods , Colon/pathology , Colonic Polyps/pathology , Colonoscopy/methods , Hospitals, University , Prospective Studies , Reproducibility of Results , Risk Assessment , Risk Factors , Rectum/pathology , Sensitivity and SpecificityABSTRACT
O objetivo deste trabalho, acompanhando a linha de pesquisa da Disciplina de Gastroenterologia Círurgica da Escola Paulista de Medicina, foi o de estudar as alteraçöes agudas morfológicas e morfométricas do epitélio da mucosa retal de 60 camundongos Mus musculus, da linhagem C57BL, dos quais 45 foram expostos aos raios X, dose única de 154,8mC/Kg (600R), corpo inteiro, sendo que os 15 restantes utilizados como controle. Os camundongos foram sacrificados após 24h, 72h e 144h, sendo o reto ressecado e submetido a estudo histológico morfológico e morfométrico de seu epitélio. A análise dos resultados permitiu as seguintes conclusöes: a) as alteraçöes morfológicas das células do epitélio das criptas foram hipertrofia nuclear, picnose, criólise, cariólise, cariorréxis e hipertrofia das células califormes; b) o número das criptas diminuiu às 24h, diminuiçäo que se acentuou às 72h, havendo, no entanto, um aumento significante às 144h; c) tanto o número de mitoses quanto o índice mitótico sofreram acentuada diminuiçäo às 24h, recuperando-se a partir das 72h, e mantendo-se normal às 144h
Subject(s)
Animals , Male , Mice , Intestinal Mucosa/radiation effects , Epithelium/pathology , Epithelium/radiation effects , Mitotic Index/radiation effects , Intestinal Mucosa/pathology , Rectum/pathology , Rectum/radiation effects , Time Factors , Whole-Body IrradiationABSTRACT
De 1989 a 1992, 62 pacientes com hemorróidas de grau III foram operados com o uso exclusico de diatermia, pela técnica aberta e sem a ligadura dos pedículos. O equipamento utilizado foi o Valleylab force 2, programado para coagulaçäo 25/30. O tempo operatório foi mais curto e o sangramento durante a cirugia foi mínimo. Näo ocorreu hemorragia precoce. A dor pós-operatória foi semelhante à dos procedimentos clássicos. Como complicaçöes, observamos cinco casos de retençäo urinária, três casos de sangramento tardio e sete casos de plicomas residuais. baseados nestes resultados, concluímos que este procedimento operatório é simples e com poucas complicaçöes, podendo ser aplicado na prática diária
Subject(s)
Humans , Adult , Middle Aged , Electrocoagulation , Hemorrhoids/complications , Hemorrhoids/surgery , Anesthesia, Epidural , Postoperative Complications/therapy , Hemorrhage , Urinary Retention/etiologyABSTRACT
Apresenta-se um caso de agenesia do apêndice vermiforme observado num cadáver adulto. A revisäo da literatura mostrou que havia o registro de 79 casos até a data atual, sendo o aqui apresentado 80§. Este dado comprova a raridade desta anomalia congênita. A embriogênese do apêndice é apresentada para explicar a ocorrência
