Restaging of colorectal cancer based on the identification of lymph node micrometastases through immunoperoxidase staining of CEA and cytokeratins.

The present study was performed to identify tumor cells in lymph nodes from colorectal adenocarcinomas considered free of disease by the classic hematoxylin-eosin stain, based on the detection of the carcinoembryonic antigen (CEA) and cytokeratins in neoplastic epithelial cells. For this purpose, 603 lymph nodes from 46 lesions were stained by the peroxidase-antiperoxidase technique. Tumor cells were detected in 22 nodes from 12 patients, mainly in the subcapsular sinuses, permitting a restaging of these patients into two groups: those now considered to have metastatic disease and those free of metastases. However, the 5-year follow-up showed no statistical differences in survival between the two groups.

Surgery of chagasic megacolon.

Chagas' disease is an endemic clinical entity caused by Trypanosoma cruzi, a parasite that is transmitted to humans by the hematophagic Triatominae insects. It affects several million persons in Latin America, mostly in Brazil, Argentina, Chile, Paraguay, and Bolivia. Megacolon, the most common complication of intestinal trypanosomiasis, results in severe constipation, for which surgery is indicated. A variety of procedures have been proposed for the correction of this disabling condition including sigmoidectomy, abdominal rectosigmoidectomy, left colectomy, and subtotal colectomy. On long-term follow-up, however, these operations have proved to be inadequate in a significant number of cases, apparently due to preservation of the dyskinetic rectum which continues to act as a functional obstacle to the progression of the fecal bolus. On the other hand, pull-through operations, which include the removal of all or almost all of the dyskinetic rectum, or the exclusion of the rectum, as in the Duhamel-Haddad operation, have been demonstrated to be superior. The abdominoperineal endoanal pull-through resection with delayed colorectal anastomosis and the Duhamel-Haddad operation are the most accepted procedures in Brazil and other Latin American countries; their technical details are illustrated. Functional results are satisfactory. Anal continence is normal in the vast majority of cases and sexual disturbances are rare. Routine treatment of 2 main complications--fecaloma and volvulus of the sigmoid colon--are discussed.

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