Benefits of flavonoid and metronidazole use after excisional hemorrhoidectomy: a randomized double-blind clinical trial.

BACKGROUND: Excisional hemorrhoidectomy remains the most effective treatment for a significant group of patients with hemorrhoids, despite the potential for postoperative pain. The purpose of this study was to evaluate the effects of flavonoid and metronidazole use in the postoperative period on patients undergoing excisional hemorrhoidectomy. METHODS: A double-blind randomized clinical study was performed. Sixty-eight patients underwent excisional hemorrhoidectomy and were randomized into 4 groups of 17 patients each to receive double-placebo (G1), metronidazole plus placebo (G2), flavonoids plus placebo (G3) or metronidazole plus flavonoids (G4) in the postoperative period. A standard analgesic protocol was offered equally for all groups. Postoperative pain, bleeding, edema, pruritus and tenesmus were evaluated during the following three periods: from immediately after the operation until postoperative day (POD)7, from POD 8 to POD 14, and from POD 15 to POD 30. The patients were required to complete symptom questionnaires and to attend postoperative follow-up on PODs 7, 14 and 30. The effect of each drug was assessed for each symptom, and the groups were compared with each other and over time. RESULTS: There was less severe pain in all postoperative periods in the groups using flavonoids (G3 and G4, both p < 0.0001), with an observed synergistic effect of flavonoids combined with metronidazole during the first 14 days after surgery (p < 0.0001). Flavonoid use was also associated with decreased bleeding (G3, p = 0.031 and G4, p = 0.016) between the first and second postoperative weeks CONCLUSIONS: The use of flavonoids alone and in combination with metronidazole resulted in a reduction of most symptoms, particularly pain, after excisional hemorrhoidectomy. TRIAL REGISTRATION: The present study was registered in the SISNEP (document CAAE-0035.0.240.000-11), after approval by the research ethics committee (CEP) of the Hospital Felício Rocho (protocol nº393 / 11).

The role of lymph node revealing solution on the improvement of lymph node harvest in colorectal cancer specimens.

AIM: The correct analysis of lymph node status is one of the most important parameters for the accurate pathological diagnosis of colorectal cancer. Our aim was to evaluate the number of lymph nodes among the specimens obtained from colorectal resections due to colorectal cancer, before and after the routine use of a lymph node revealing solution (LNRS). METHOD: Data from 780 surgical specimens from patients of both genders with colorectal cancer were studied. The cases were divided chronologically into two groups: the conventional group included 497 specimens treated with conventional methods, i.e. without the use of the LNRS (January 2000 to July 2007), and the LNRS group included 283 specimens examined through the routine use of this solution (August 2007 to July 2012). RESULTS: Most patients were female (57.4%) with a median age of 62 years. The median lymph node number was 18, and 75.9% of the cases (592) had 12 or more nodes dissected. Lymph node metastases were noted in 334 cases (42.8%). A median of 24 lymph nodes was dissected in the LNRS group compared to 15 in the conventional group (P < 0.001). The LNRS group had 9.2% of cases with fewer than 12 lymph nodes dissected compared with 32.6% in the conventional group (P < 0.001). CONCLUSIONS: The use of the LNRS increases the number of lymph nodes obtained from colorectal cancer surgical specimens and can help to reduce the number of cases with < 12 lymph nodes.

Intussusception in adults: a retrospective study.

OBJECTIVE: Intestinal intussusception in adult patients is rare. In contrast with paediatric patients, it is usually secondary to a definable lesion, often malignant. The purpose of this study was to determine the causes and the management of intussusception in adult patients. METHOD: A retrospective review was performed looking at patients over 18 years with intestinal intussusception who were admitted to a tertiary university hospital from 1997 to 2007. RESULT: There were 16 patients (out of whom 10 were female subjects) of mean age 49 years (range 19-76). All presented with abdominal pain and in seven (46.6%) patients, this was acute. The diagnosis of intussusception was correctly made preoperatively in eight (50%) patients. Six (37.5%) patients had the lead point for the intussusception at the ileocaecal valve, five (31.25%) in the small bowel and five (31.25%) had a colonic lead point. An anatomical cause was found in 14 (87.5%). In two (12.5%), the intussusception occurred in the postoperative period without any definable lesion. Half the patients had a malignant neoplasm. All patients underwent surgery. In 14 (87.5%) patients, this was by resection and in two (12.5%), a reduction with no resection was carried out. CONCLUSION: The features of intussusception may be nonspecific and the diagnosis is often made only during laparotomy. An identifiable organic lesion is present in most cases. En bloc resection is recommended for ileocaecal and colocolic intussusception.

Tratamiento quirúrgico para la úlcera péptica a la luz de una estudio radiológico retrospectivo del tono y motilidad del estómago / A surgical alternative peptic ulcer based on a retrospective radiological study of gastric tonus and motility

Los autores hacen un análisis retrospectivo de 1085 estudios radiológicos de estómago y duodeno para estudiar la relación entre la úlcera péptica y los disturbios de tonicidad y motilidad ganstricas.Fueran observados alteraciones del tono y de la motilidad en mayor número de pacientes con úlcera péptica,en comparación con los pacientes sin úlcera .Fué verificado disminución significativa de la tonicidad del estómgo en la úlcera gástrica, sin predominio de hiper o hipomotilidad en las úlceras duodenales y gástricas.Luego del análisis ,presentan sugestiones acerca de la etiopatogenia de la enfermedad,proponiendo la técnica de vagotomía,antrectomía y anastomosis gastroduodenal a nivel de la curvatura menor,como una cirugía eficaz para la corrección de la úlcera,hoy principalmente,en la obstrucción del píloro,llevando en consideración la preservación del tono y de la motilidad gástrica

Tratamiento quirúrgico para la úlcera péptica a la luz de una estudio radiológico retrospectivo del tono y motilidad del estómago / A surgical alternative peptic ulcer based on a retrospective radiological study of gastric tonus and motility

Los autores hacen un análisis retrospectivo de 1085 estudios radiológicos de estómago y duodeno para estudiar la relación entre la úlcera péptica y los disturbios de tonicidad y motilidad ganstricas.Fueran observados alteraciones del tono y de la motilidad en mayor número de pacientes con úlcera péptica,en comparación con los pacientes sin úlcera .Fué verificado disminución significativa de la tonicidad del estómgo en la úlcera gástrica, sin predominio de hiper o hipomotilidad en las úlceras duodenales y gástricas.Luego del análisis ,presentan sugestiones acerca de la etiopatogenia de la enfermedad,proponiendo la técnica de vagotomía,antrectomía y anastomosis gastroduodenal a nivel de la curvatura menor,como una cirugía eficaz para la corrección de la úlcera,hoy principalmente,en la obstrucción del píloro,llevando en consideración la preservación del tono y de la motilidad gástrica

Outpatient haemorrhoidectomy under local anaesthesia.

OBJECTIVE: To compare early and late results and costs of outpatient haemorrhoidectomy under local anaesthesia with those of inpatient haemorrhoidectomy. DESIGN: Prospective study with historical controls. SETTING: University hospital, Brazil. SUBJECTS: 51 patients who required haemorrhoidectomy. INTERVENTIONS: Outpatient haemorrhoidectomy under local anaesthesia. MAIN OUTCOME MEASURES: Early and late results and comparative costs. RESULTS: One patient was withdrawn from the study because of hypertension and subsequently lost to follow-up. The remaining 50 patients were discharged a mean of 68 (23) minutes after operation. Twelve patients complained of severe pain, one had faecal impaction and 2 developed bleeding. One patient developed urinary retention, compared with 18 in the historical group (p < 0.001). Forty-two patients (84%) were thoroughly satisfied with their treatment. Late complications did not differ significantly from those observed in the historical group. The estimated hospital costs were US$ 313.6 for outpatient, and US$ 716 for inpatient treatment. CONCLUSION: Outpatient haemorrhoidectomy under local anaesthesia was safe and comfortable for most patients, with complication rates comparable to or better than those observed after inpatient treatment and at less than half the cost.

[Spontaneous remission of cancer of the esophagus. A case report]. / Regressão espontânea de câncer do esôfago. Relato de caso.

The authors report a case of spontaneous regression of a cervical esophagus malignant tumor, confirmed by several biopsies. They emphasize the factors which could be involved, in a general way, with the phenomenon, as well as the importance of its study.