Polypectomies: colonic endoscopic resections.

The authors present their experience with 924 colonoscopic polypectomies in 549 patients. Postpolypectomy bleeding was 0.36% without perforations. Complications associated with the procedure are analyzed; evaluating the risk, diagnosis and treatment based on a survey of the literature and personal experience.

[Colonoscopy: indications, contraindications and complications]. / Colonoscopia: indicações, contra-indicações e complicações.

The bioengeneering technological development associated with new medical information transformed colonscopy today in one of the most complete method of investigation on colorrectal diseases. The authors aim to describe the use of colonoscopy as a diagnostic and therapeutic method, its main indications and limitations. The wide utilization of colonoscopy as therapy is emphasized in the polipectomy, the identification of bleeding areas and the hemostasy. Some intervening facts are discussed as copious bleeding, perfuration and post polipectomy syndrome. Finally, the authors report the low morbidity and mortality rates in their personal experience with colonoscopy during the last decade.

[Carcinoid tumors of the common bile duct: report of a case]. / Tumor carcinóide de ducto biliar comum: relato de um caso.

The authors discuss an uncommon case in the literature of a carcinoid tumor of in the bifurcation of common hepatic duct. The tumor was surgically resected and the duct was reconstructed by Y of Roux's technic. The patient had a good evolution and no tumoral lesion was found in post operative exams during the last six months. The authors present a literature review and discuss diagnosis, treatment and prognosis.

Experimental injury to the spleen study of interaction: contamination/preservation.

Ablation of the spleen leads to a significant risk of postsplenectomy invasive sepsis. This concept has become very important in the last three decades because of awareness of the spleen's important role in immunological functions. Hence, this has led many research centers to study hemostasis of the injured spleen in order to preserve its function. The objective of this study is to analyze the use of nylon mesh for preservation of the wounded spleen in the presence or absence of local contamination. Twenty dogs were operated, randomly divided into two groups and followed postoperatively for eight weeks. A standard splenic injury was produced in all animals and hemostasis accomplished by attaching nylon mesh to the organ. Postoperatively, in one of the groups the "wounded organ + mesh" was contaminated with a bacterial count proportional to the animal's weight. The other group was not contaminated, maintaining it as control. Both groups were studied as to interaction of contamination/preservation, i.e., body weight, surgical findings, splenic size and histology, blood and tissue culture and hematological data. The dogs adequately withstood the standardized trauma regardless of local contamination. And the nylon mesh effectively arrested bleeding in all animals. At sacrifice inoculated germs were confirmed in the contaminated group by histological methods or tissue cultures. A cellular infiltrate of lymphocytes and plasmocytes was present close to the mesh only in the latter. The mesh attached to the injured spleen did not lead to abscesses, intrasplenic or intraperitoneal fluid collections. Based on analysis of the data, we can infer that local contamination of the injured spleen and the presence of non-absorbable material (nylon mesh) did not markedly alter the overall behavior of the dogs compared to the uncontaminated group.

[Penetrating trauma of the neck: prospective study of 53 cases]. / Ferimentos penetrantes cervicais: análise prospectiva de 53 casos.

The treatment of penetrating injuries of the neck is still controversial nowadays, especially when there is doubt concerning the existence of any anatomic structure lesion. The delay to indicate surgical cervical exploration may predispose the patient to have serious sequels when the esophagus or the trachea are injured. The infection which may occur in this eventuality progresses rapidly to the mediastinum, determining the patient's death. The purpose of this work was to identify and to analyze the parameters which suggest the best treatment indicated for patients with penetrating injuries of the neck. This is a non-randomized prospective study which gathered 53 patients, victims of penetrating wounds of the neck, treated at the Emergency Surgical Service of the Hospital das Clínicas, University of São Paulo School of Medicine, during a three-year period, starting in October, 1990. All the patients were evaluated by the surgical team on call who elected the selective exploration approach for the cases that did not present clear evidence of injuries in the cervical structures nor hemodynamic alterations. For the fifteen carriers of evident injuries, immediate surgical exploration was the treatment adopted. All the patients had epidemiologic data, evaluation results, hospitalization period, complications, morbidity and mortality rates, besides trauma indexes, collected. For patients whose clinical observation was allowed, endoscopic studies were also performed and compared. In order to evaluate variable correlations, statistical analysis were performed using Q square test, Student test and Z statistics, which leaded to the following conclusions: 1. Penetrating wounds of the neck were most frequent in white people aged from 20 to 30 years. They were mostly located in the right side of cervical zone II and were caused by gunshot. 2. Trauma indexes correlated with patients' clinical evolution. 3. In cases when there was doubt about the effective presence of injuries, complementary digestive and respiratory evaluations were indicated. These exams contributed for reducing the rate of unnecessary surgical explorations.

Genetics and colorectal cancer (HNPCC) in adolescence. A case report.

The authors report a case of non-polyposis colon cancer in a seventeen year old female without prior polyposis or family history. Since it was the first case in this family, HNPCC was suspected. The polymerase chain reaction (PCR) of the tumor revealed changes in four polymorphic regions. Analysis of two of them, indicated the loss of genetic material confirming instability suggestive of HNPCC. The patient underwent ileorectal anastomosis and adjuvant chemotherapy with a good outcome. The authors discuss the importance of family history, genetic and immunohistochemistry studies, and the instability of microsatellites in adolescents with colorectal cancer.

[Acute abdomen in elderly patients]. / Abdome agudo em paciente geriátrico.

Seventy nine elderly patients with acute abdominal conditions were operated on in the Emergency Service of the Hospital das Clinicas of the University of São Paulo from 1981 to 1985. Total mortality rate was 58.23%. In patients with acute vascular abdominal conditions it was 100%, in inflammatory conditions 55.17% and in intestinal obstruction 47.83%. The lowest mortality was observed in traumatic conditions (27.27%). Procrastination of operations was followed by higher mortality. In operations lasting more than three hours the mortality was significantly higher than in those lasting less than three hours. Associated diseases as well as reoperations increased the postoperative mortality.

Contribuicao ao estudo da historia natural e dos fatores de risco das hernias diafragmaticas traumaticas. / Natural history and risk factors of traumatic diaphragmatic hernia

Os autores comparam 97 casos de hernias diafragmaticas traumaticas tratadas cirurgicamente com 146 casos observados em 12276 autopsias consecutivas de pacientes vitimas de morte violenta e que nao receberam cuidados medicos, com o objetivo de detalhar a historia natural e identificar os possiveis fatores de risco implicados nesta patologia. Os adultos jovens foram os mais acometidos em ambos os grupos, sendo maior a porcentagem de individuos acima da 5a decada no autopsiado (18,5%) que no hospitalizado (8,3%). Observa-se incidencia significantemente maior de laceracoes diafragmaticas a direita no grupo autopsiado (49,6%) que no grupo hospitalizado (14,4%). As lesoes pulmonares, hepaticas e cranio-encefalicas foram mais frequentes no grupo autopsiado. As causas de obito mais frequentes foram a insuficiencia respiratoria no grupo hospitalizado (60%) e o choque hipovolemico (80%) no grupo autopsiado, tendo este ultimo uma incidencia de lesoes hepaticas de 65,1% contra 11,3% no grupo hospitalizado. Os autores comentam ainda o diagnostico, o tratamento cirurgico e as complicacoes desta patologia

Stapled anastomosis in colorectal surgery.

The authors review their experience with stapled anastomosis in colorectal and ileorectal resections for malignant and benign lesions of the large bowel. They describe the technique and results in a series of 49 patients (24 with cancer of the rectum and rectosigmoid junction; six with familial polyposis, associated with cancer in four; 12 with chagastic megacolon; three, Crohn's disease; two, ulcerative colitis; and one each, diverticular sigmoiditis and ischemic sigmoiditis). Anterior resection was performed in 38 patients and total colectomy with ileorectal anastomosis in 11. Main complications and mortality are presented. They conclude that stapled anastomosis is an efficient method for intestinal reconstruction after resection for malignant and benign lesions of the large bowel.

Polipectomia por colonoscopia: indicacoes, tecnica e resultados. / Polypectomy by colonoscopy: indications, technic and results

Os autores relatam a experiencia de 215 polipectomias por colonoscopia, realizadas em 96 pacientes. Descrevem a metodologia e a tecnica empregadas e mostram os resultados, que foram inteiramente satisfatorios. A unica complicacao foi sangramento muito discreto em dois pacientes, de resolucao espontanea. A mortalidade foi nula. Consideracoes especiais foram feitas em relacao aos casos de polipos com carcinoma, no que concerne a conduta pos-polipectomia. E apresentado um plano de controle colonoscopico a longo prazo, tanto para os doentes submetidos a polipectomia por polipos benignos e malignos, como para os que sofreram colectomia por carcinoma