Early prognostic value of an Algorithm based on spectral Variables of Ventricular fibrillAtion from the EKG of patients with suddEn cardiac death: A multicentre observational study (AWAKE).

OBJECTIVE: Ventricular fibrillation (VF)-related sudden cardiac death (SCD) is a leading cause of mortality and morbidity. Current biological and imaging parameters show significant limitations on predicting cerebral performance at hospital admission. The AWAKE study (NCT03248557) is a multicentre observational study to validate a model based on spectral ECG analysis to early predict cerebral performance and survival in resuscitated comatose survivors. METHODS: Data from VF ECG tracings of patients resuscitated from SCD will be collected using an electronic Case Report Form. Patients can be either comatose (Glasgow Coma Scale - GCS - ≤8) survivors undergoing temperature control after return of spontaneous circulation (RoSC), or those who regain consciousness (GCS=15) after RoSC; all admitted to Intensive Cardiac Care Units in 4 major university hospitals. VF tracings prior to the first direct current shock will be digitized and analyzed to derive spectral data and feed a predictive model to estimate favorable neurological performance (FNP). The results of the model will be compared to the actual prognosis. RESULTS: The primary clinical outcome is FNP during hospitalization. Patients will be categorized into 4 subsets of neurological prognosis according to the risk score obtained from the predictive model. The secondary clinical outcomes are survival to hospital discharge, and FNP and survival after 6 months of follow-up. The model-derived categorisation will be also compared with clinical variables to assess model sensitivity, specificity, and accuracy. CONCLUSIONS: A model based on spectral analysis of VF tracings is a promising tool to obtain early prognostic data after SCD.

Early prognostic value of an Algorithm based on spectral Variables of Ventricular fibrillAtion from the EKG of patients with suddEn cardiac death: A multicentre observational study (AWAKE) / Valor pronóstico precoz de un algoritmo basado en variables espectrales de la fibrilación ventricular del ECG de pacientes con muerte súbita cardiaca: estudio observacional multicéntrico (AWAKE)

Abstract Objective: Ventricular fibrillation (VF)-related sudden cardiac death (SCD) is a leading cause of mortality and morbidity. Current biological and imaging parameters show significant limitations on predicting cerebral performance at hospital admission. The AWAKE study (NCT03248557) is a multicentre observational study to validate a model based on spectral ECG analysis to early predict cerebral performance and survival in resuscitated comatose survivors. Methods: Data from VF ECG tracings of patients resuscitated from SCD will be collected using an electronic Case Report Form. Patients can be either comatose (Glasgow Coma Scale GCS --- ≤8) survivors undergoing temperature control after return of spontaneous circulation (RoSC), or those who regain consciousness (GCS = 15) after RoSC; all admitted to Intensive Cardiac Care Units in 4 major university hospitals. VF tracings prior to the first direct current shock will be digitized and analyzed to derive spectral data and feed a predictive model to estimate favorable neurological performance (FNP). The results of the model will be compared to the actual prognosis. Results: The primary clinical outcome is FNP during hospitalization. Patients will be categorized into 4 subsets of neurological prognosis according to the risk score obtained from the predictive model. The secondary clinical outcomes are survival to hospital discharge, and FNP and survival after 6 months of follow-up. The model-derived categorisation will be also compared with clinical variables to assess model sensitivity, specificity, and accuracy. Conclusions: A model based on spectral analysis of VF tracings is a promising tool to obtain early prognostic data after SCD.

Resumen Objetivo: La muerte súbita (MS) por fibrilación ventricular (FV) es una importante causa de morbilidad y mortalidad. Los métodos biológicos y de imagen actuales muestran limitaciones para predecir el pronóstico cerebral al ingreso hospitalario. AWAKE es un estudio observacional, multicéntrico, con el objetivo de validar un modelo basado en el análisis espectral del elec- trocardiograma (ECG), que predice precozmente el pronóstico cerebral y la supervivencia en pacientes resucitados y en estado de coma. Métodos: Se recogerán datos de los ECG con FV de pacientes reanimados de MS. Los pacientes pueden ser tanto supervivientes en estado de coma (Glasgow Coma Scale GCS ≤ 8) sometidos a control de temperatura tras la recuperación de circulación espontánea (RCE), como aquellos que recuperan la consciencia (GCS = 15) tras RCE; todos ellos ingresados en unidades de terapia intensiva cardiológica de 4 hospitales de referencia. Los registros de FV previos al primer choque se digitalizarán y analizarán para obtener datos espectrales que se incluirán en un modelo predictivo que estime el pronóstico neurológico favorable (PNF). El resultado del modelo se comparará con el pronóstico real. Resultados: El objetivo principal es el PNF durante la hospitalización. Los pacientes se categorizarán en 4 subgrupos de pronóstico neurológico según la estimación de riesgo obtenida en el modelo predictivo. Los objetivos secundarios son supervivencia al alta hospitalaria, y PNF y supervivencia a los 6 meses. El resultado de este modelo también se comparará con el pronóstico según variables clínicas. Conclusiones: Un modelo basado en el análisis espectral de registros de FV es una herramienta prometedora para obtener datos pronósticos precoces tras MS por FV.

Spinal Cord Injury Functional Impairment and Caregiver Mental Health in a colombian sample: An exploratory study / Deficiencias funcionales en pacientes con lesiones de la médula espinal y la salud mental del cuidador: un estudio exploratorio en una muestra colombiana

Limited literature has examined the connections between caregiver mental health and the physical and psychosocial functioning of individuals with spinal cord injury (SCI) in Latin America, despite the dearth of services and unique needs of this population. The purpose of the current study was to examine the relationships between caregiver mental health (anxiety, burden, depression, satisfaction with life, and self-esteem) and SCI physical and psychosocial functional impairments in a Colombian sample. Forty SCI caregivers were recruited from Neiva, Colombia, and completed measures of SCI impairments and their own mental health. Greater SCI impairments, and caregiver stress due to those impairments, were associated with higher caregiver depression and anxiety, although only patient psychosocial functional impairments and related caregiver stress were uniquely associated with caregiver depression. Due to the collectivist nature of and the importance of family in many Latino cultures, mental health interventions for family members who provide care for an individual with SCI having greater psychosocial impairments may be particularly important.

Poca literatura ha examinado las relaciones entre salud mental del cuidador y funcionamiento físico y psicosocial de las personas con traumatismo de médula espinal en América Latina, a pesar de la escasez de servicios y necesidades únicas de esta población. El propósito del presente estudio fue examinar las relaciones entre la salud mental del cuidador (ansiedad, sobrecarga, depresión, satisfacción con la vida y autoestima) y las discapacidades físicas y psicosociales de personas con traumatismo de médula espinal en una muestra colombiana. Cuarenta cuidadores de personas con traumatismo de médula espinal fueron reclutados en Neiva, Colombia, quienes completaron medidas de discapacidad del traumatismo de médula espinal y de su propia salud mental. Mayores niveles de discapacidad en personas con traumatismo de médula espinal y niveles de estrés del cuidador debido a esas discapacidades, fueron asociadas con mayores niveles de depresión y ansiedad en el cuidador, aunque sólo las discapacidades psicosociales de los pacientes y el estrés relacionado con el cuidador fueron asociados con la depresión en el cuidador. Debido a la naturaleza colectivista y la importancia de la familia en la mayoría de las culturas latinas, las intervenciones centradas en la salud mental de los familiares que cuidan de personas con traumatismo de la medula espinal pueden ser particularmente importantes.

Mind and body: Mental health and health related quality of life in SCI caregivers from Neiva, Colombia.

BACKGROUND: Despite the body of research on caregivers of individuals with various types of disabilities, SCI caregivers have received comparably less attention, especially in regions like Latin America. OBJECTIVE: The purpose of this study was to examine the association between HRQOL and mental health in SCI caregivers from Colombia. METHOD: A cross sectional study assessed SCI caregivers (n = 40) in Neiva, Colombia. Participants completed a measure of their HRQOL (SF-36 Health Questionnaire) and four measures of mental health (Satisfaction With Life Scale, Zarit Burden Interview, Patient Health Questionnaire-9, and State-Trait Anxiety Inventory). RESULTS: A canonical correlation between variables revealed that 64% of the variance was shared between mental health and HRQOL. The domains that loaded highest within the canonical correlation were social functioning, general health, and anxiety, indicating that SCI caregivers with higher anxiety experienced lower social functioning and lower general health. Furthermore, 15 of the 24 bivariate correlations between mental health and HRQOL were statistically significant, suggesting a strong connection between these two sets of variables. CONCLUSION: Rehabilitation professionals in Latin America should consider the development of caregiver interventions focusing on both physical and mental health, as the two constructs are closely connected through social functioning, general health, and anxiety.

The relationship between physical and mental health variables in individuals with spinal cord injury from Latin America.

BACKGROUND: Previous research has examined the health-related quality of life (HRQOL) and mental health of persons with spinal cord injury (SCI), but the majority of the research has taken place in the United States, Western Europe, and other developed countries. Limited research has been conducted with persons with SCI in Latin America. OBJECTIVE: To examine the relationship between HRQOL and mental health in persons with SCI from Neiva, Colombia. DESIGN: Cross-sectional. SETTING: Participants were recruited from the Foundation for the Integral Development of People with Disabilities, a nonprofit community organization for persons with disabilities. PARTICIPANTS: Forty persons with SCI from Neiva, Colombia. METHODS: Caregivers completed the Spanish versions of questionnaires. MAIN OUTCOME MEASURES: Participants completed self-report measures of HRQOL (SF-36 Health Questionnaire) and mental health (Satisfaction with Life Scale, Patient Health Questionnaire-9, and State Trait Anxiety Inventory). RESULTS: The hypothesis that higher HRQOL would be related to better mental health found robust support, as the canonical correlation between these 2 sets of variables uncovered that 50.4% of the variance was shared, such that persons with lower HRQOL had reduced mental health. Within this canonical correlation, anxiety, fatigue, and general health loaded most highly, suggesting that persons with SCI who experienced lower energy and reduced general health tended to have high anxiety. Additionally, 9 out of the 18 bivariate correlations between these 2 variable sets were statistically significant. CONCLUSIONS: In Latin America, SCI rehabilitation services are extremely sparse and rarely include interventions that target postinjury mental health. The current study suggests that mental health issues in patients with reduced HRQOL warrant attention in SCI rehabilitation services, especially in this region.

With a little help from my friends: social support and mental health in SCI caregivers from Neiva, Colombia.

BACKGROUND/OBJECTIVE: The purpose of this study was to examine the influence of appraisal, belonging, and tangible social support on the mental health (depression, satisfaction with life, anxiety, and burden) of Colombian spinal cord injury (SCI) caregivers. METHODS: Forty SCI caregivers from Neiva, Colombia completed questionnaires assessing their perceived social support and mental health. RESULTS: Four multiple regressions found that the three social support variables explained 42.8% of the variance in caregiver depression, 22.3% of the variance in satisfaction with life, 24.1% of the variance in anxiety, and 16.5% of the variance in burden, although the effect on burden was marginally significant. Within these regressions, higher belonging social support was uniquely associated with lower depression, and higher tangible social support was uniquely associated with higher caregiver satisfaction with life. CONCLUSIONS: Social support may have a particularly important influence on SCI caregiver mental health in Colombia, due in part to the high levels of collectivism and strong family values shown to exist in Latin America, and may therefore be an important target for SCI caregiver interventions in this region.

Comparison of mental health between individuals with spinal cord injury and able-bodied controls in Neiva, Colombia.

Although research has investigated the mental health of individuals with spinal cord injury (SCI), an overwhelming majority of this research has been conducted in the United States, Western Europe, and other developed countries. The purpose of this study was to compare the mental health of individuals with SCI with able-bodied controls in Neiva, Colombia, South America. Subjects included 40 Colombians with SCI and 42 age- and sex-matched controls (N = 82). The groups did not differ based on age, sex, years of education, or socioeconomic status. However, controls were twice as likely to be married. Four measures assessed mental health, including satisfaction with life (Satisfaction with Life Scale), depressive symptoms (Patient Health Questionnaire-9), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State-Trait Anxiety Inventory). In comparison with able-bodied controls, individuals with SCI reported significantly lower mental health on both depressive symptoms and satisfaction with life. These effect sizes were medium and large, respectively. The groups did not differ significantly on measures of self-esteem or anxiety. Mental health of individuals with SCI should be considered a central part of SCI rehabilitation interventions, particularly in Latin America.

Uso de la oxigenación hiperbárica en la fractura traumática expuesta: a propósito de un caso / Use of the hyperbaric oxygenation in the exposed traumatic fracture: apropos of a case

Mediante diversos experimentos se ha comprobado que la oxigenación hiperbárica favorece el proceso cicatrizal, evitando los retardos de consolidación y cicatrización. El objetivo fue describir la evolución de un paciente con fractura traumática expuesta, luego de la aplicación de oxigenación hiperbárica. Paciente masculino de 51 años de edad, que sufrió un accidente laboral ocasionándole fractura expuesta del tercio medio distal de cúbito y radio del antebrazo izquierdo, así como sección de músculos y vasos sanguíneos, provocándole una atrofia ósea aguda de Sudeck. Durante la evolución del paciente, después del tratamiento quirúrgico se le indicó oxigenación hiperbárica por un período de 5 meses en tres ciclos de 20 sesiones cada uno, durante el tercer ciclo se comenzó a aplicar fisioterapia y rehabilitación. Como resultado del tratamiento con oxigenación hiperbárica, fue efectivo en la disminución del tiempo de evolución de las lesiones traumáticas, lográndose mejorar la sintomatología y el estado funcional del miembro afectado en el paciente(AU)

Through diverse experiments it has been proved that the hyperbaric oxygenation facilitates scarring process avoiding consolidation and healing delays. The objective was describing the evolution of a patient with exposed traumatic fracture after applying hyperbaric oxygen treatment. Male patient aged 51 years who suffered a work accident causing a middle distal third exposed fracture of the left forearm ulna and radius as well as muscles and blood vessels section, and provoking a sharp bone Sudeck atrophy. After the surgical treatment, during the patient`s evolution, hyperbaric oxygenation was indicated for a period of 5 months in three cycles of 20 sessions each; during the third cycle physical therapy and rehabilitation began to be applied. Hyperbaric oxygenation treatment was effective, shortening traumatic lesions evolution time and improving symptoms and the patient injured member functional status(AU)

Uso de la oxigenación hiperbárica en la fractura traumática expuesta: a propósito de un caso / Use of the hyperbaric oxygenation in the exposed traumatic fracture: apropos of a case

Mediante diversos experimentos se ha comprobado que la oxigenación hiperbárica favorece el proceso cicatrizal, evitando los retardos de consolidación y cicatrización. El objetivo fue describir la evolución de un paciente con fractura traumática expuesta, luego de la aplicación de oxigenación hiperbárica. Paciente masculino de 51 años de edad, que sufrió un accidente laboral ocasionándole fractura expuesta del tercio medio distal de cúbito y radio del antebrazo izquierdo, así como sección de músculos y vasos sanguíneos, provocándole una atrofia ósea aguda de Sudeck. Durante la evolución del paciente, después del tratamiento quirúrgico se le indicó oxigenación hiperbárica por un período de 5 meses en tres ciclos de 20 sesiones cada uno, durante el tercer ciclo se comenzó a aplicar fisioterapia y rehabilitación. Como resultado del tratamiento con oxigenación hiperbárica, fue efectivo en la disminución del tiempo de evolución de las lesiones traumáticas, lográndose mejorar la sintomatología y el estado funcional del miembro afectado en el paciente.

Through diverse experiments it has been proved that the hyperbaric oxygenation facilitates scarring process avoiding consolidation and healing delays. The objective was describing the evolution of a patient with exposed traumatic fracture after applying hyperbaric oxygen treatment. Male patient aged 51 years who suffered a work accident causing a middle distal third exposed fracture of the left forearm ulna and radius as well as muscles and blood vessels section, and provoking a sharp bone Sudeck atrophy. After the surgical treatment, during the patient`s evolution, hyperbaric oxygenation was indicated for a period of 5 months in three cycles of 20 sessions each; during the third cycle physical therapy and rehabilitation began to be applied. Hyperbaric oxygenation treatment was effective, shortening traumatic lesions evolution time and improving symptoms and the patient injured member functional status.

Examining the relationship between health-related quality of life in individuals with spinal cord injury and the mental health of their caregivers in Colombia, South America.

Although considerable research has been carried out on family caregivers of individuals with various types of disabilities, spinal cord injury (SCI) caregivers have received considerably less attention in terms of research, especially in regions such as Latin America. This study examined the relationship between health-related quality of life (HRQOL) in individuals with SCI and their family caregiver's mental health in Neiva, Colombia. Thirty-four individuals with SCI and their primary caregivers (34 dyads; n=68) from the Foundation for the Integral Development of People with Disabilities in Neiva, Colombia, were included in this study. Individuals with SCI completed eight subscales of the SF-36 that assessed HRQOL. Five aspects of caregiver mental health were assessed, including burden (Zarit Burden Interview), satisfaction with life (Satisfaction with Life Scale), depression (Patient Health Questionnaire-9), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State Trait Anxiety Inventory). A series of multiple regressions uncovered strong associations among the HRQOL of individuals with SCI and various aspects of caregiver mental health. In these regressions, patient physical functioning and pain were independently related to caregiver burden; patient pain and general health were independently related to caregiver satisfaction with life; and patient pain was independently related to caregiver anxiety. HRQOL in individuals with SCI was robustly related to their caregiver's mental health, suggesting that the two sets of variables are closely linked. These findings suggest that caregiver mental health should be a central part of SCI rehabilitation interventions, especially in Latin America.

Health-related quality of life in individuals with spinal cord injury in Colombia, South America.

OBJECTIVE: To assess health-related quality of life (HRQOL) of individuals with Spinal Cord Injury (SCI) in Neiva, Colombia. DESIGN: Cross-sectional. PARTICIPANTS/METHODS: 40 Colombians with SCI and 42 age- and gender-matched controls completed the SF-36, a self-report measure composed of eight component areas (physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions). RESULTS: Compared to healthy controls, individuals with SCI had significantly lower means on five SF-36 subscales: physical functioning (22.5 vs. 94.0; p < 0.001), role limitations due to physical problems (54.4 vs. 77.4; p < 0.01), social functioning (67.5 vs. 80.1; p < 0.05), pain (65.4 vs. 79.5; p < 0.01), and general health (54.9 vs. 69.4; p < 0.01). Both groups scored similarly on the SF-36 emotional well-being subscale. CONCLUSION: Individuals with SCI from Neiva, Colombia report having poorer quality of life across various domains than healthy controls, primarily in the area of physical functioning. These findings suggest the need for rehabilitation health professionals to develop and implement interventions to improve HRQOL in individuals with SCI.

Influencia de las condiciones de vuelo en la historia natural del prolapso valvular mitral en un aviador de combate / Influence of flight conditions on the natural history of mitral valvular prolapse in a fighting pilot

Se presenta el caso de un paciente del sexo masculino, aviador de combate con diagnóstico de prolapso valvular mitral sin repercusión hemodinámica, el cual al año de habérsele diagnosticado comenzó a presentar de forma temprana complicaciones eléctricas y variaciones clínicas durante su evolución que obligaron a evaluar su grado de aptitud para el servicio activo. Esta afección frecuente en la población general es habitualmente asintomática y de buen pronóstico, y las complicaciones cardiovasculares que se derivan de ella son tardías, pero en el caso objeto de presentación estas aparecieron de forma temprana y particularmente invalidante(AU)

Influencia de las condiciones de vuelo en la historia natural del prolapso valvular mitral en un aviador de combate / Influence of flight conditions on the natural history of mitral valvular prolapse in a fighting pilot

Se presenta el caso de un paciente del sexo masculino, aviador de combate con diagnóstico de prolapso valvular mitral sin repercusión hemodinámica, el cual al año de habérsele diagnosticado comenzó a presentar de forma temprana complicaciones eléctricas y variaciones clínicas durante su evolución que obligaron a evaluar su grado de aptitud para el servicio activo. Esta afección frecuente en la población general es habitualmente asintomática y de buen pronóstico, y las complicaciones cardiovasculares que se derivan de ella son tardías, pero en el caso objeto de presentación estas aparecieron de forma temprana y particularmente invalidante

Aspectos patogénicos de la enfermedad descompresiva en buzos / Pathogenic aspects of the decompression illness in divers

En los últimos años la incidencia de la enfermedad descompresiva en Cuba se ha elevado. Para que se presente esta enfermedad los buzos deben respirar una mezcla gaseosa que contenga uno o más gases inertes (por ejemplo: nitrógeno, helio, hidrógeno), y deben permanecer un tiempo y a una profundidad determinada para que se produzca una saturación considerable de gas inerte en los tejidos. En esas condiciones es imprescindible realizar durante el ascenso paradas estáticas por el buzo para eliminar el sobrante de gas inerte que se acumula en los tejidos. Si se omiten estas paradas se producirá una sobresaturación excesiva de gas inerte que puede alcanzar el punto crítico de sobresaturación a partir del cual el gas cambia de estado y forma burbujas. Estas burbujas que pueden ser intravasculares y/o extravasculares son las responsables del cuadro sintomático de la enfermedad descompresiva(AU)

Aspectos patogénicos de la enfermedad descompresiva en buzos / Pathogenic aspects of the decompression illness in divers

En los últimos años la incidencia de la enfermedad descompresiva en Cuba se ha elevado. Para que se presente esta enfermedad los buzos deben respirar una mezcla gaseosa que contenga uno o más gases inertes (por ejemplo: nitrógeno, helio, hidrógeno), y deben permanecer un tiempo y a una profundidad determinada para que se produzca una saturación considerable de gas inerte en los tejidos. En esas condiciones es imprescindible realizar durante el ascenso paradas estáticas por el buzo para eliminar el sobrante de gas inerte que se acumula en los tejidos. Si se omiten estas paradas se producirá una sobresaturación excesiva de gas inerte que puede alcanzar el punto crítico de sobresaturación a partir del cual el gas cambia de estado y forma burbujas. Estas burbujas que pueden ser intravasculares y/o extravasculares son las responsables del cuadro sintomático de la enfermedad descompresiva

Polipos colorrectales / Colorectal polyps

Se realizaron 1316 colonoscopias donde se encontraron 61 pólipos colorrectales en el Servicio de Gastroenterología del Hospital Central de Maracaibo en un período de cinco años (1994-1998). Los 61 pólipos se analizaron para determinar su distribución por edad, sexo, tipo histológico, distribución anatómica, presencia de Displasia y/o carcinoma y el tamaño. El 72 por ciento de los pacientes se ubicaron en el grupo etario de 40 años y mayor de 60 años; 68,9 por ciento corresponde al sexo femenino. Se encontró un evidente predominio de Adenomas 59 por ciento. Los adenomas se ubicaron principalmente en Recto-Sigmoides 65,6 por ciento, se encontró displasia de alto grado en adenomas vellosos mayores de 1,1 cm en 29,4 por ciento. Esto se corresponde con múltiples estudios epidemiológicos que afirman que en grupos con alta incidencia de Cáncer de Colon debido al alto potencial maligno de estos

Lifadenectomía en cáncer gástrico / Lymphadenectomy in gastric cancer

La incidencia de cáncer gástrico está declinando mundialmente. Sin embargo a pesar de ésto en occidente la sobrevida no ha cambiado. En contraste, la Sociedad Japonesa de Investigación de Cáncer Gástrico reporta sobrevida global de hasta 50/100. Se ha considerado que la linfadenectomía extendida ha contribuido a esta mejora. La técnica ha sido aceptada desde los 60' y constituye el abordaje rutinario en Japón e incluso en algunos centros de occidente, con resultados variables

Inquérito epidemiológico das dermatoses numa instituiçäo infantil / Epidemiological inquiry of dermatosis in a orphanage institution

Os autores apresentam um inquérito epidemiológico das dermatoses mais freqüentes numa instituiçao dedicada ao cuidado de crianças abandonadas. Foram examinadas 172 crianças com idade inferior a 15 anos. O grupo das dermatozoonozes contribuiu com o maior número de casos e dentro dele a pediculose capitis ocupou o primeiro lugar.

Tumores sincrônicos e metacrônicos de cólon e reto / Synchronous and metachronous tumors of the colon and rectum

Trezentos e setenta e dois pacientes com tumores colo-retais tratados com intençäo curativa, entre janeiro de 1982 e janeiro de 1992, foram revistos para determinar-se o papel da colonoscopia e os resultados cirúrgicos em 30(8,1 por cento) pacientes com tumores múltiplos, comparando estes resultados com o grupo de lesöes únicas. A idade média dos pacientes era de 57(35-79) anos, sendo 20 homens e 10 mulheres. Dezenove pacientes tinham lesöes sincrônicas e os 11 restantes metacrônicas, sendo o reto e o cólon signóide os locais de apresentaçäo mais freqüentes (73 por cento). O diagnóstico pré-operatório correto foi realizado em 14 dos 19 pacientes com lesöes sincrönicas, e nos cinco pacientes restantes a näo realizaçäo de colonoscopia intra-operatória foi a causa de falha diagnóstica; três deles tinham lesöes previamente despercebidas ao enema baritado. Lesöes sincrônicas tendem a ser menos invasivas que as metacrônicas e a sobrevida de 5 anos (Kaplan-Meier) acha-se reduzida em pacientes com tumores múltiplos, 45 por cento versus 58 por cento, respectivamente (näo significante). Em pacientes com tumores colo-retais o exame do cólon deve ser completado através de colonoscopia intra-operatória, com o objetivo de excluir lesöes colônicas associadas e diminuir a incidência de lesöes metacrônicas "precoces"