["Mercy lie" for the patient with cancer]. / A "mentira piedosa" para o canceroso.

The authors discussed the problem of whether or not to be completely frank with cancer patients about their diagnosis. They analysed the results of a survey of 79 doctors (Phase 1) in which they tried to find out how the doctors behaved towards the patients, their families and with themselves in the different situations caused by the illness. In the second stage (Phase 2), they also put the following question to 118 adults: If it was diagnosed that you had cancer would you like your doctor to tell you?

Prospective randomized comparison of pefloxacin and ampicillin plus gentamicin in the treatment of bacteriologically proven biliary tract infections.

One hundred and eighty-nine patients with acute cholecystitis or cholangitis requiring antibacterial therapy and surgery were randomly allocated in a prospective open study to receive either iv or oral pefloxacin (800 mg per day) or a combination of iv or oral ampicillin (4 g per day) and gentamicin (240 mg per day im). Ninety-two patients had to be withdrawn from the efficacy analysis, mainly because of negative baseline culture, but occasionally because of isolation of bacteria resistant to the study drugs. In the 97 evaluable patients (90 with cholecystitis and 7 with cholangitis) the clinical cure rates were excellent and similar for both groups: 49/50 (98%) for pefloxacin and 45/47 (95.7%) for the combination; the respective bacteriological success rates were 100% and 91.5%. Three patients in the pefloxacin group and six patients in the ampicillin-gentamicin group reported mild and transient side effects.

Acute biliary pancreatitis (ABP): endoscopic sphincteroctomy (ES)?

Acute biliary pancreatitis (ABP) has been treated by early endoscopic sphincterotomy (ES) based on the reports that immediate bilio-pancreatic duct decompression is the main treatment for the satisfactory evolution of these patients. Twenty sequential patients with perfect evidence for ABP were submitted to endoscopic therapy within 24 hours following their admission. Nineteen out of twenty (95 per cent) showed complete remission of the clinical signs and laboratorial data, reinforcing the application of the endoscopic procedure as a good alternative for these patients. There neither endoscopic complications nor deaths among our cases.

A mentira piedosa para o canceroso / Mercy lie for the patient with cancer

Os autores discutem o problema de se dizer ou nao, de forma completamente explícita, ao doente com câncer, qual o seu diagnóstico. Analisam os resultados de respostas oferecidas por 79 médicos (fase l), dos quais se procurou saber como se comportariam com seus doentes, com os familiares e, até com eles próprios, nas diferentes situaçoes criadas pela doença. Em uma fase 2, interrogaram, também, por meio de questionários, um total de 118 adultos, como gostariam que seus respectivos médicos os tratassem caso o diagnóstico de câncer estivesse presente neles, isto é, quereriam ou nao ser informados por seus médicos acerca da doença.

The influence of peroperative irrigation of the obstructed left colon in the healing of primary anastomosis: an experimental study in rats

A mortalidade observada na obstrucao aguda do colon esquerdo e alta quando o classico procedimento em tres tempos e realizado. Em recentes relatos na literatura, a utilizacao da irrigacao per-operatoria permite a realizacao de uma resseccao primaria, seguida de anastomose num unico tempo nesses casos. Na tentativa de verificar esta afirmacao, estudou-se experimentalmente, atraves de parametros fisicos e morfologicos, a cicatrizacao de anastomoses realizadas em vigencia de obstrucao aguda do colon esquerdo, valendo-se ou nao da irrigacao per-operatoria. A obstrucao foi associada com um significativo atraso no processo de cicatrizacao da mucosa nos exames macro e microscopicos da mucosa (p<0,05), porem resultados intermediarios foram observados com uso da irrigacao per-operatoria do colon. Conclui-se que a cicatrizacao esta retardada nas anastomoses realizadas na vigencia de obstrucao, porem a irrigacao per-operatoria minimiza esta condicao adversa.