Prevalence of anal intraepithelial lesions in patients with inflammatory bowel disease

Introduction: Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal canal associated with HPV, with a higher prevalence in immunosuppressed individuals. Patients with inflammatory bowel disease (IBD) are at potential risk for their development, due to the use of immunosuppressants and certain characteristics of the disease. Method: This is a prospective, cross-sectional, and interventional study that included 53 patients with IBD treated at a tertiary outpatient clinic, who underwent anal smear for cytology in order to assess the prevalence of AIN and associated risk factors. Results: Forty-eight samples were negative for dysplasia and 2 were positive (4%). Both positive samples occurred in women, with Crohn's disease (CD), who were immunosuppressed and had a history of receptive anal intercourse. Discussion: The prevalence of anal dysplasia in IBD patients in this study is similar to that described in low-risk populations. Literature data are scarce and conflicting and there is no evidence to recommend screening with routine anal cytology in patients with IBD. Female gender, history of receptive anal intercourse, immunosuppression and CD seem to be risk factors. (AU)

Predictive factors of low anterior resection syndrome following anterior resection of the rectum. / Síndrome da ressecção anterior do reto: fatores preditivos.

OBJECTIVE: to identify predictors of low anterior resection syndrome (LARS) that can contribute to its early diagnosis and treatment. METHODS: we conducted a retrospective cohort study of patients undergoing anterior resection of the rectum between 2007 and 2017 in the Coloproctology Service of the Federal University of Parana Clinics Hospital. We performed Receiver Operating Characteristic Curve (ROC) analysis to identify LARS predictive factors. RESULTS: we included 64 patients with complete data. The men's age was 60.1±11.4 years and 37.10% were male. Twenty patients (32.26%) had LARS. The most reported symptoms were incomplete evacuation (60%) and urgency (55%). In the univariate analysis, the distance from the anastomosis to the anal margin (p<0.001), neoadjuvant therapy (p=0.0014) and ileostomy at the time of resection (p=0.0023) were predictive of LARS. The ROC curve analysis showed a 6.5cm cut-off distance from the anastomosis to the anal margin as a predictor of LARS. CONCLUSION: distance between the anastomosis and the anal margin, neoadjuvant therapy history and preparation of stoma are conditions that can help predict the development of LARS. Guidance and involvement in patient education, as well as early management, can potentially reduce the impact of these symptoms on patients' quality of life.

OBJETIVO: identificar fatores preditivos da síndrome da ressecção anterior do reto (SRAR) que podem contribuir para o seu diagnóstico e tratamento precoces. MÉTODOS: estudo de coorte retrospectivo de pacientes submetidos à ressecção anterior do reto entre 2007 e 2017 no Serviço de Coloproctologia do Hospital de Clínicas da Universidade Federal do Paraná. Foram realizadas análises de curva ROC (Receiver Operating Characteristic Curve Analysis) ou COR (Característica de Operação do Receptor) para identificar os fatores preditivos da SRAR. RESULTADOS: foram incluídos 64 pacientes com dados completos. A idade dos homens foi de 60,1±11,4 anos e 37,10% eram do sexo masculino. Vinte pacientes (32,26%) apresentaram SRAR. Os sintomas mais relatados foram evacuação incompleta (60%) e urgência (55%). Na análise univariada, a distância da anastomose à margem anal (p<0,001), terapia neoadjuvante (p=0,0014) e confecção de ileostomia no momento da ressecção (p=0,0023) foram preditivos da SRAR. Análise da curva ROC mostrou um ponto de corte de 6,5cm na distância da anastomose à margem anal como preditor da SRAR. CONCLUSÃO: distância entre anastomose e margem anal, história de terapia neoajuvante e confecção de estoma são condições que podem ajudar a predizer o desenvolvimento da SRAR. A orientação e o envolvimento na educação do paciente, bem como, o manejo precoce podem reduzir potencialmente o impacto desses sintomas na qualidade de vida dos pacientes.

Síndrome da ressecção anterior do reto: fatores preditivos / Predictive factors of low anterior resection syndrome following anterior resection of the rectum

RESUMO Objetivo: identificar fatores preditivos da síndrome da ressecção anterior do reto (SRAR) que podem contribuir para o seu diagnóstico e tratamento precoces. Métodos: estudo de coorte retrospectivo de pacientes submetidos à ressecção anterior do reto entre 2007 e 2017 no Serviço de Coloproctologia do Hospital de Clínicas da Universidade Federal do Paraná. Foram realizadas análises de curva ROC (Receiver Operating Characteristic Curve Analysis) ou COR (Característica de Operação do Receptor) para identificar os fatores preditivos da SRAR. Resultados: foram incluídos 64 pacientes com dados completos. A idade dos homens foi de 60,1±11,4 anos e 37,10% eram do sexo masculino. Vinte pacientes (32,26%) apresentaram SRAR. Os sintomas mais relatados foram evacuação incompleta (60%) e urgência (55%). Na análise univariada, a distância da anastomose à margem anal (p<0,001), terapia neoadjuvante (p=0,0014) e confecção de ileostomia no momento da ressecção (p=0,0023) foram preditivos da SRAR. Análise da curva ROC mostrou um ponto de corte de 6,5cm na distância da anastomose à margem anal como preditor da SRAR. Conclusão: distância entre anastomose e margem anal, história de terapia neoajuvante e confecção de estoma são condições que podem ajudar a predizer o desenvolvimento da SRAR. A orientação e o envolvimento na educação do paciente, bem como, o manejo precoce podem reduzir potencialmente o impacto desses sintomas na qualidade de vida dos pacientes.

ABSTRACT Objective: to identify predictors of low anterior resection syndrome (LARS) that can contribute to its early diagnosis and treatment. Methods: we conducted a retrospective cohort study of patients undergoing anterior resection of the rectum between 2007 and 2017 in the Coloproctology Service of the Federal University of Parana Clinics Hospital. We performed Receiver Operating Characteristic Curve (ROC) analysis to identify LARS predictive factors. Results: we included 64 patients with complete data. The men's age was 60.1±11.4 years and 37.10% were male. Twenty patients (32.26%) had LARS. The most reported symptoms were incomplete evacuation (60%) and urgency (55%). In the univariate analysis, the distance from the anastomosis to the anal margin (p<0.001), neoadjuvant therapy (p=0.0014) and ileostomy at the time of resection (p=0.0023) were predictive of LARS. The ROC curve analysis showed a 6.5cm cut-off distance from the anastomosis to the anal margin as a predictor of LARS. Conclusion: distance between the anastomosis and the anal margin, neoadjuvant therapy history and preparation of stoma are conditions that can help predict the development of LARS. Guidance and involvement in patient education, as well as early management, can potentially reduce the impact of these symptoms on patients' quality of life.

Effects of hyperglycemia and aging in angiogenesis and reepithelization of colonic anastomoses in rats.

PURPOSE: To evaluate angiogenesis and reepithelization of colonic anastomoses in rats. METHODS: 82 Wistar rats, divided into: young normoglycemic, old normoglycemic and hyperglycemic. Diabetes was induced with streptozotocin. Glycemia was assessed before induction, at 24 hours and after 90 days, when a colotomy and an anastomosis were performed, assessed at days 3, 7, and 14. Samples were prepared by immuno-histochemistry (PCNA and antifactor VIII). RESULTS: Mean glycemia after 90 days streptozotocin induction was 244,95 mg/dl. Day 7, reepithelization was greater in the young group than in the old normoglycemic (p<0.0001) and old hyperglycemic (p<0.0001) groups. Day 14, the differences were significant between the young and old normoglycemic (p<0.0001) and old hyperglycemic (p<0.0001) groups. The two old groups were not significantly different. At the three periods angiogenesis was higher in the young group than in the old normoglycemic (p3=0.014; p7<0.0001; p14<0.0001) or the old hyperglycemic groups (p3=0.014, p7<0.0001; p14<0.0001). The old groups, day 3, were not different (p3=0.627), but days 7 and 14, angiogenesis was bigger in the normoglycemic group (p7=0.042; p14=0.005). CONCLUSION: Age is important in reepithelization and angiogenesis of colonic anastomoses. Hyperglycemia interferes mainly in angiogenesis.

Effects of hyperglycemia and aging in angiogenesis and reepithelization of colonic anastomoses in rats

PURPOSE: To evaluate angiogenesis and reepithelization of colonic anastomoses in rats. METHODS: 82 Wistar rats, divided into: young normoglycemic, old normoglycemic and hyperglycemic. Diabetes was induced with streptozotocin. Glycemia was assessed before induction, at 24 hours and after 90 days, when a colotomy and an anastomosis were performed, assessed at days 3, 7, and 14. Samples were prepared by immuno-histochemistry (PCNA and antifactor VIII). RESULTS: Mean glycemia after 90 days streptozotocin induction was 244,95 mg/dl. Day 7, reepithelization was greater in the young group than in the old normoglycemic (p<0.0001) and old hyperglycemic (p<0.0001) groups. Day 14, the differences were significant between the young and old normoglycemic (p<0.0001) and old hyperglycemic (p<0.0001) groups. The two old groups were not significantly different. At the three periods angiogenesis was higher in the young group than in the old normoglycemic (p3=0.014; p7<0.0001; p14<0.0001) or the old hyperglycemic groups (p3=0.014, p7<0.0001; p14<0.0001). The old groups, day 3, were not different (p3=0.627), but days 7 and 14, angiogenesis was bigger in the normoglycemic group (p7=0.042; p14=0.005). CONCLUSION: Age is important in reepithelization and angiogenesis of colonic anastomoses. Hyperglycemia interferes mainly in angiogenesis.

OBJETIVO: Avaliar a angiogênese e a reepitelização de anastomoses colônicas em ratos. MÉTODOS: 82 ratos Wistar divididos em: jovens normoglicêmicos, velhos normoglicêmicos e hiperglicêmicos. Diabetes foi induzido com estreptozotocin. Glicemia foi medida antes da indução, após 24 horas e 90 dias, quando realizou-se colotomia seguida de anastomose, a qual foi estudada no 3.°, 7.° e 14.° dia.Peças foram preparadas por imunohistoquímica (PCNA e Antifator VIII). RESULTADOS: Glicemia média após 90 dias foi de 244,95 mg/dl. No 7.° dia, a reepitelização foi maior no grupo jovem que nos grupos velho normoglicêmico (p<0,0001) e velho hiperglicêmico (p<0,0001). Dia 14, mantiveram-se as diferenças entre os grupos jovem e velhos normoglicêmico (p<0,0001) e hiperglicêmico (p<0,0001). Os dois grupos velhos não diferiram entre si. Nos três períodos a angiogênese foi maior no grupo jovem do que nos velhos normoglicêmicos (p3=0.014, p7<0.0001; p14<0.0001) e que nos velhos hiperglicêmicos (p3=0.014, p7<0.0001; p14<0.0001). No 3.° dia, os grupos velhos não foram diferentes (p3=0.627), mas no 7.° e no 14.°, a angiogênese foi maior no grupo normoglicêmico (p7=0.042; p14=0.005). CONCLUSÃO: Idade é importante para a reepitelização e angiogênese das anastomoses colônicas. Hiperglicemia interfere principalmente na angiogênese.

Estudo comparativo da populaçäo geriátrica cirúrgica no Hospital de Clínicas, Curitiba - UFPR, no intervalo de dez anos (1989 - 1999) / A ten years (1989-1999) comparative study of the surgical elderly population in the Hospital de Clínicas de Curitiba - Universidade Federal do Paraná

A populaçäo brasileira está envelhecendo. Projeçöes estatísticas mostrram que em menos de 30 anos o Brasil terá uma das maiores concentraçöes de idosos do planeta. Para avaliar o crescimento da populaçäo geriátrica cirúrgica do Hospital de Cl1nicas de Curitiba (PR), num período de dez anos(1989-1999), foram analisados retrospectivamente os dados desta populaçäo. Em 1989, 5.625 pacientes foram tratados cirúrgicamente dentro das disciplinas de Neurocirurgia, Otorrinolaringologia, Cirurgia torácica e Cardiovascular, Cirurgia geral, Cirurgia do Aparelho Digestivo, Ortopedia, Urologia e Oftalmologia. Dos pacientes, 9,7 porcento tinham idade igual ou superior a 65 anos. Em 1999, 21,1 porcento dos pacientes operados nas mesmas clínicas tinham 65 anos ou mais, demonstrando um crescimento de 11,4 porcento. As doenças que mais necessitaram de tratamento crúrgico continuaram as mesmas, ou seja, catarata senil, hiperplasia prostática benigna, doenças das vias biliares e hérnias da parede abdominal.(au)