RESUMO
BACKGROUND: Recent studies have shown that endoscopy fellows can perform colonoscopy effectively and safely. However, little is known about the performance of surgical residents without prior knowledge of endoscopic techniques. OBJECTIVE: To assess whether quality indicators were met at an outpatient endoscopy center and whether surgical residents, without prior upper or lower endoscopy skills, could perform colonoscopy adequately. METHODS: A prospective non-randomized cohort study was undertaken. All exams were performed either by assistant physicians or by residents. Quality measures were compared between those groups. RESULTS: A total of 2720 colonoscopies were analyzed. In the resident group, we observed older patients (57.7±12.7 years vs 51.5±14.5 years, P<0.001), a higher prevalence of screening colonoscopies (52% vs 39.4%, P<0.001) and a higher prevalence of colorectal cancer (6.4% vs 1.8%, P<0.001). The cecal intubation rate was higher in the attending group (99.9% vs 89.3%; P<0.001). The polyp detection rate was 40.8%, and no differences were observed between the studied groups. The residents had a higher rate of perforation in all exams (0.4% vs 0%; P=0.02). Postpolypectomy bleeding and 7-day readmission rates were the same (0.2%). All readmissions in 7 days occurred due to low digestive bleeding, and none required intervention. CONCLUSION: Quality indicators were met at a university outpatient endoscopy center; however, medical residents achieved lower rates of cecal intubation and higher rates of perforation than the attending physicians.
Assuntos
Ceco , Pacientes Ambulatoriais , Competência Clínica , Estudos de Coortes , Colonoscopia , Humanos , Estudos Prospectivos , UniversidadesRESUMO
BACKGROUND: The purpose of this study was to evaluate the symptoms and wellbeing of patients who underwent laparoscopic colorectal resection for deep endometriosis infiltrating the rectum and/or colon in a single reference center. METHODS: We conducted a cross-sectional survey based on a structured questionnaire. All patients underwent laparoscopic discoid resection, segmental resection or shaving for deep endometriosis in a single reference center between October 2014 and October 2019. The following topics were addressed: symptoms related to endometriosis, fertility, disease recurrence and quality of life. The Institutional Review Board approved the study and signed informed consent was required before enrollment. RESULTS: A total of 77 of 160 (48.1%) subjects agreed to answer the questionnaire and were enrolled in the study. The mean age was 36.4 years (range, 24-54 years), and 45.5% of the patients had previously undergone surgery for deep endometriosis. Complete resolution of abdominal pain was observed in 48.1% of subjects after surgery. Pelvic pain was rated on a scale of 0 (no pain) to 10 (worst pain) before and after the procedure. In this evaluation, mean pain scores were reduced after surgery (9.21 ± 1.53 × 3.99 ± 3.14; p < .001). Other positive aspects reported by interviewees were increased willingness to perform daily activities (66.2%), increased physical activity (70.1%), better work performance (72.7%), improved dyspareunia (77.9%) and increased sexual activity (71.4%). Some negative aspects reported after surgery were straining at stool (35.1%), nocturia (24.7%), liquid-feces incontinence (13%), mild urinary incontinence (13%), urinary urgency (11.7%) and flatus incontinence (7.8%). Regarding pregnancy, 59% of patients tried to conceive after surgery, and the success rate was 28.2% (46.2% spontaneous and 53.8% after in vitro fertilization or insemination). CONCLUSIONS: Laparoscopic surgery was associated with pain reduction and improved general wellbeing in patients diagnosed with deep endometriosis and bowel involvement.
Assuntos
Endometriose , Laparoscopia , Doenças Retais , Adulto , Estudos Transversais , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Complicações Pós-Operatórias , Gravidez , Qualidade de Vida , Doenças Retais/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Evacuation disorders are prevalent in the adult population, and a significant portion of cases may originate from pelvic floor muscle dysfunctions. Anorectal manometry (ARM) is an important diagnostic tool and can guide conservative treatment. OBJECTIVE: To evaluate the prevalence of pelvic dysfunction in patients with evacuation disorders through clinical and manometric findings and to evaluate, using the same findings, whether there are published protocols that could be guided by anorectal manometry. METHODS: A retrospective analysis of a prospective database of 278 anorectal manometries performed for the investigation of evacuation disorders in patients seen at the anorectal physiology outpatient clinic of Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto between January 2015 to June 2019 was conducted. The following parameters were calculated: resting pressure (RP), squeeze pressure (SP), high-pressure zone (HPZ), rectal sensitivity (RS) and rectal capacity (RC). The pressure measurements and manometric plots were reviewed to determine the diagnosis and to propose potential pelvic physical therapy procedures. Analysis of variance (ANOVA) and Fisher's exact test were used to compare the continuous variables and to evaluate the equality of variances between groups of patients with fecal incontinence (FI) and chronic constipation (CC). Results with a significance level lower than 0.05 (P-value <0.05) were considered statistically significant. Statistical analysis was performed using IBM® SPSS® Statistics version 20. RESULTS: The mean age of the sample was 45±22 years, with a predominance of females (64.4%) and economically inactive (72.7%) patients. The indications for exam performance were FI (65.8%) and CC (34.2%). Patients with FI had lower RP (41.9 mmHg x 67.6 mmHg; P<0.001), SP (85.4 mmHg x 116.0 mmHg; P<0.001), HPZ (1.49 cm x 2.42 cm; P<0.001), RS (57.9 mL x 71.5 mL; P=0.044) and RC (146.2 mL x 195.5 mL; P<0.001) compared to those of patients with CC. For patients with FI, the main diagnosis was the absence of a functional anal canal (49.7%). For patients with CC, the main diagnosis was outflow tract obstruction (54.7%). For patients with FI, the main protocol involved a combination of anorectal biofeedback (aBF) with tibial nerve stimulation (TNS) (57.9%). For patients with CC, the most indicated protocol was aBF combined with TNS and rectal balloon training (RBT) (54.7%). CONCLUSION: There was a high prevalence of pelvic floor changes in patients with evacuation disorders. There was a high potential for performing pelvic floor physical therapy based on the clinical and manometric findings.
Assuntos
Incontinência Fecal , Adulto , Idoso , Canal Anal , Constipação Intestinal/terapia , Incontinência Fecal/terapia , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Reto , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: To compare the operative outcomes of laparoscopic surgical treatment for bowel endometriosis in a public teaching hospital versus in a private referral hospital. METHODS: The indications for surgery, type and time of operation, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, and postoperative complications were evaluated. RESULTS: One hundred eighty-one patients were included (150 patients, 82.9%, in a private hospital). In the private hospital, there were more patients with infertility [56% vs. 29%; P=0.01] as an indication for surgery) and segmental resection was more common in the private hospital (48% vs. 29%, p=0.05). The average operative time (211.9±83.4 minutes vs. 128 ± 55 minutes, p<0.001) as well as the length of hospital stay (3.97±1.7 days vs. 1.56±0.85 days, p<0.001) was higher in the public hospital; the rate of conversion to open surgery was significantly lower in the private hospital (2% vs. 32.3%, p<0.001). Operations performed at the public hospital were associated with higher rates of postoperative complications (Clavien-Dindo II and II) (38.7% x 11.3%, p=0.021; OR 3.2, CI 95% 1.2-8.0). CONCLUSION: Laparoscopic surgery in private centers was associated with reductions in major complications, surgical times, lengths of stay and rates of conversion to open surgery compared to that in public teaching hospitals.
Assuntos
Endometriose , Laparoscopia , Endometriose/cirurgia , Feminino , Hospitais Privados , Hospitais Públicos , Hospitais de Ensino , Humanos , Encaminhamento e ConsultaRESUMO
Purpose To evaluate the gene expression of peroxisome proliferator activated receptors gamma (PPARG) in colorectal tumors and to correlate this data with clinical variables of the patients. Methods We analyzed the gene expression of PPARG in 50 samples of colorectal tumors using real-time reverse transcription polymerase chain reaction, and 20 adjacent normal tissue samples as control. The results of these quantifications were correlated with the respective patients' medical records' clinical information. Results PPARG expression was not different in the tumor tissue compared to the control tissue. Patients older than 60 years, histological type with mucinous differentiation, more advanced staging at the time of diagnosis, and patients who evolved with recurrence of the disease or death did not present higher PPARG expression. Conclusion Expression of PPARGD was not associated with worse prognosis.
Assuntos
Neoplasias Colorretais , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , PPAR gama , PrognósticoRESUMO
ABSTRACT BACKGROUND: Recent studies have shown that endoscopy fellows can perform colonoscopy effectively and safely. However, little is known about the performance of surgical residents without prior knowledge of endoscopic techniques. OBJECTIVE: To assess whether quality indicators were met at an outpatient endoscopy center and whether surgical residents, without prior upper or lower endoscopy skills, could perform colonoscopy adequately. METHODS: A prospective non-randomized cohort study was undertaken. All exams were performed either by assistant physicians or by residents. Quality measures were compared between those groups. RESULTS: A total of 2720 colonoscopies were analyzed. In the resident group, we observed older patients (57.7±12.7 years vs 51.5±14.5 years, P<0.001), a higher prevalence of screening colonoscopies (52% vs 39.4%, P<0.001) and a higher prevalence of colorectal cancer (6.4% vs 1.8%, P<0.001). The cecal intubation rate was higher in the attending group (99.9% vs 89.3%; P<0.001). The polyp detection rate was 40.8%, and no differences were observed between the studied groups. The residents had a higher rate of perforation in all exams (0.4% vs 0%; P=0.02). Postpolypectomy bleeding and 7-day readmission rates were the same (0.2%). All readmissions in 7 days occurred due to low digestive bleeding, and none required intervention. CONCLUSION: Quality indicators were met at a university outpatient endoscopy center; however, medical residents achieved lower rates of cecal intubation and higher rates of perforation than the attending physicians.
RESUMO CONTEXTO: Estudos recentes mostraram que médicos em treinamento podem realizar a colonoscopia de maneira eficaz e segura. No entanto, pouco se sabe sobre a performance dos médicos residentes de cirurgia sem o conhecimento prévio das técnicas endoscópicas. OBJETIVO: Avaliar se os indicadores de qualidade foram atendidos em um centro de endoscopia ambulatorial e se os residentes de cirurgia, sem habilidades anteriores em endoscopia alta ou baixa, realizaram a colonoscopia de forma adequada. MÉTODOS: Foi realizado um estudo de coorte prospectivo não randomizado. Todos os exames foram realizados por médicos assistentes ou residentes. Os indicadores de qualidade foram comparados entre esses grupos. RESULTADOS: Um total de 2.720 colonoscopias foram analisadas. No grupo de médicos residentes, observamos pacientes mais velhos (57,7±12,7 anos vs 51,5±14,5 anos, P<0,001), maior prevalência de colonoscopias de rastreamento (52% vs 39,4%, P<0,001) e maior prevalência de câncer colorretal (6,4% vs 1,8%, P<0,001). A taxa de intubação cecal foi maior no grupo de médicos assistentes (99,9% vs 89,3%; P<0,001). A taxa de detecção de pólipos foi de 40,8% e não foram observadas diferenças entre os grupos estudados. Os médicos residentes tiveram maior índice de perfuração (0,4% vs 0%; P=0,02). O sangramento pós-polipectomia e as taxas de readmissão em 7 dias foram iguais (0,2%). Todas as readmissões em 7 dias ocorreram devido a hemorragia digestiva baixa e nenhuma intervenção foi necessária. CONCLUSÃO: Os indicadores de qualidade foram alcançados em um centro de endoscopia universitário; no entanto, os médicos residentes alcançaram taxas mais baixas de intubação cecal e taxas mais altas de perfuração do que os médicos assistentes.
Assuntos
Humanos , Pacientes Ambulatoriais , Ceco , Universidades , Estudos Prospectivos , Estudos de Coortes , Colonoscopia , Competência ClínicaRESUMO
RESUMO A prática de judô integra situações variadas de contato físico e exigências específicas, tornando-o uma modalidade competitiva e com alto índice de lesões musculoesqueléticas (LME). Este estudo transversal teve por objetivo descrever a epidemiologia de LME e analisar a relação entre diferentes características e a ocorrência de lesão em judocas. A casuística integrou 111 participantes de ambos os sexos. Para tomar informações sobre lesões, utilizou-se um inquérito de morbidade referida. Para análise estatística, foi empregado o teste de Goodman de proporções multinomiais. A relação entre fatores associados com LME foi avaliada por meio de regressão logística. Foram relatados 135 LME, com prevalência de 65% (72 esportistas), totalizando 1,22 LME/atleta. A maioria dos relatos foi constituída por lesões articulares decorrentes de traumas (n=50 casos, 37%), sendo que entorse de tornozelo (25,2%) e luxação de ombro (17,8%) foram os casos com maior frequência. Entre as lesões ósseas, verificou-se maior proporção de casos graves (25 casos; 18,5%). Sexo e carga horária semanal constituíram-se como as principais características preditivas para ocorrência de LME no judô (p<0,001). Conclui-se que as lesões articulares traumáticas em tornozelo e ombro foram as principais LME no judô. Sexo masculino e maior carga horária semanal constituíram-se como as principais características preditivas de lesão entre judocas.
RESUMEN La práctica de judo integra situaciones variadas de contacto físico y exigencias específicas, tornándole una modalidad competitiva y con alto índice de lesiones músculo-esqueléticas (LME). Este estudio transversal tuvo por objectivo describir la epidemiología de LME y analizar la relación entre diferentes características y la aparición de lesión en judocas. La casuística integró 111 participantes de ambos los sexos. Para tomar informaciones sobre lesiones, se utilizó una investigación de morbilidad referida. Para análisis estadística, fue empleada la prueba de Goodman de proporciones multinomiales. La relación entre factores asociados con LME fue evaluada por medio de regresión logística. Fueron relatados 135 LME, con prevalencia de 65% (72 deportistas), totalizando 1,22 LME/atleta. La mayoría de los relatos fue constituida por lesiones articulares derivadas de traumas (n=50 casos, 37%), considerándose que esquince de tobillo (25,2%) y luxación de hombro (17,8%) fueron los casos con mayor frecuencia. Entre las lesiones óseas, se verificó mayor proporción de casos graves (25 casos; 18,5%). Sexo y carga horária semanal se constituyeron como las principales características predictivas para aparición de LME en el judo (p<0,001). Se concluye que las lesiones articulares traumaticas en tobillo y hombro fueron las principales LME en el judo. Sexo masculino y mayor carga horária semanal se constituyeron como las principales características preditivas de lesión entre judocas.
ABSTRACT Practice of judo integrates varied situations of physical contact and specific requirements, which makes it a competitive modality with a high rate of musculoskeletal injuries (MSI). This cross-sectional study aimed to describe MSI epidemiology and analyze the relationship among different characteristics and injury occurrence in judo practitioners. Casuistry was formed by 111 participants of both sexes. To gather information about injuries, a morbidity survey was used. For statistical analysis, Goodman's test of multinomial proportions was taken. Relationship among factors associated with MSI was assessed through logistic regression. We reported 135 MSI, with 65% prevalence (72 subjects), totaling 1.22 MSI/athlete. Most reports consisted of joint lesions resulting from trauma (n=50 cases, 37%); ankle sprain (25.2%) and shoulder dislocation (17.8%) were the cases with the highest frequency. Regarding bone lesions, there was higher proportion of serious cases (25 cases; 18.5%). Sex and weekly workload constituted the main predictive characteristics for MSI occurrence in Judo (p<0.001). The conclusion was that joint traumatic lesions on ankle and shoulder were the main MSI in Judo. The male sex and bigger weekly workload constituted the main predictive characteristics for lesion in Judo practitioners (p<0.001).