Factors Predictive of Proximal Disease Extension and Clinical Course of Patients Initially Diagnosed with Ulcerative Proctitis in an IBD Referral Center.

BACKGROUND: This study aims to determine whether risk factors at the time of diagnosis that are found to be predictive of proximal dis- ease extension in ulcerative proctitis (UP) occur in a cohort of Brazilian patients. METHODS: This is a retrospective analysis of data from 97 patients (67% female) with UP (Montreal classification: E1) with at least 12 months of follow-up who were admitted to the Ribeirão Preto Medical School IBD referral center between January 2001 and December 2018. Proximal disease extension, which was defined as E1 progressing to E3 (pancolitis), was evaluated endoscopically during follow-up. RESULTS: A total of 29 (29.9%) patients experienced proximal disease extension. The risk factors at diagnosis associated with proximal disease extension were younger age (<40 years; P = .012), higher Mayo endoscopic score (P < .0001), higher partial Mayo score (P = .0018), and use of oral corticosteroids (P = .0016). During the follow-up period, increased disease relapse rates (P < .0001), immuno- modulators (P = .00014) or the use of biological agents (P = .00037), and colectomy (P = .0002) were all significantly higher among UP patients with proximal disease extension. CONCLUSION: Similar to what has been demonstrated in other studies, Brazilian UP patients with increased clinical and endoscopic sever- ity at the time of diagnosis are likely to evolve with both proximal extension and a more adverse clinical course. Therefore, these patients should be followed-up more carefully.

Hyperbaric oxygen therapy decreases mortality due to Fournier's gangrene: a retrospective comparative study.

There is no consensus about the role of adjunctive hyperbaric oxygen therapy (HBOT) in the management of Fournier's gangrene. The aim of this study was to compare the evolution of patients with Fournier's gangrene treated with all classical measures with and without adjuvant HBOT. A retrospective comparative study regarding the evolution of patients treated for Fournier's gangrene was conducted in two periods. In period I, from 1990 to 2002, patients received standard treatments for Fournier's gangrene, which consisted of surgical debridement, antibiotic therapy and intensive care. In period II, from 2012 to 2019, adjunctive HBOT was added to the classical management strategy. All patients were assigned into four groups according to the anatomical severity classification and the area affected after the first debridement. This classification ensured that the groups could be comparable. The total number of patients in this study was 197, and these patients were divided into control group (118/59.9%) and HBOT group (79/40.1%). The mean age, comorbidities, and anatomical severity classification were similar between the two groups. In period I, 34 out of 118 (28.8%) patients died, while in the HBOT group, 3 out of 77 (3.7%) patients died (P < 0.001). The use of adjuvant HBOT in combination with classical treatment was associated with reduced mortality. This study was approved by the Institutional Review Board and the Ethics Committee of Ribeirão Preto Medical School, University of São Paulo, Brazil (No. 08/2018) on May 2, 2018.

Proinflammatory cytokines correlate with depression and anxiety in colorectal cancer patients.

The objective of this study was to investigate whether serum cytokine levels correlate with depression and anxiety in colorectal cancer (CRC) patients. Twenty patients hospitalized for surgical resection of CRC were included in the study group and twenty healthy volunteers comprised the control group. Depression and anxiety were analyzed using the Hospital Anxiety and Depression Scale (HADS), and serum levels of IL-1ß, IL-6, IL-8, IL-10, IL-12, TNF-α, and TGF-ß were measured by Cytometric Bead Array. We found that more than half of CRC patients presented clinically significant levels of anxiety or depression, and 65% of them manifested a combination of severe anxiety and depression. CRC patients had increased serum levels of IL-1ß, IL-6, IL-8, and TNF-α but lower IL-10 concentrations. Correlation analysis between HADS score and cytokine levels revealed a positive association of anxiety and/or depression with IL-1ß, IL-6, IL-8, and TNF-α and a negative correlation with IL-10. These results indicate that circulating proinflammatory cytokines are involved in the pathophysiology of anxiety and depression in CRC patients. A better understanding of the molecular mechanisms involved in these psychological disorders will allow the design of therapeutic interventions that lead to an improved quality of life and overall survival of CRC patients.

Postmenopausal intestinal obstructive endometriosis: case report and review of the literature.

CONTEXT: Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, which is commonly detected in gynecological practice but rarely reported as a coloproctological disorder. The objective of the present report was to discuss a rare case of postmenopausal intestinal endometriosis simulating a malignant lesion, following a review of the literature. CASE REPORT: A 74-year-old woman with complaints of hematochezia and tenesmus of two months' duration accompanied by liquid feces and pelvic pain, but with no other gastrointestinal or gynecological complaints, was referred to our service. She had been menopausal for 22 years, with no hormone replacement treatment, and had undergone panhysterectomy three years before the referral to us, due to endometrial thickening and a right adnexal cyst. Five months before this referral, she had undergone laparotomy due to acute obstructive abdomen, which revealed a tumor mass involving the small bowel. Anatomopathological examination of the enterectomy suggested a hypothesis of intestinal endometriosis. A proctological examination was normal. Computed tomography of the pelvis revealed thickening of the rectosigmoid transition and colonoscopy revealed friable tumor formation in the rectum. A biopsy of the lesion revealed mucosal fragments of endometrial type, which led to a review of the previous anatomopathological examination. The patient underwent rectosigmoidectomy with protective transversotomy, with a good postoperative course, and anatomical examination confirmed the intestinal endometriosis. The patient subsequently suffered a stenosing recurrence of the lesion and has undergone colostomy since then.