McKittrick-Wheelock syndrome secondary to rectal adenocarcinoma

Introduction: McKittrick-Wheelock syndrome is a rare condition that arises from a hypersecretory state secondary to large colorectal tumors, mainly villous adenomas, leading to an electrolytic disorder associated with chronic diarrhea that usually persists for years. It is a relatively unknown disease that can lead to severe complications such as acute kidney injury, severe hyponatremia, and hypokalemia. In fact, it causes death in most untreated cases. Surgical removal of the tumor is the most successful treatment, and symptoms tend to disappear after proper management. Case Report: A 62-year-old man with a 2-year history of mucoid diarrhea preceded by abdominal pain presented with acute kidney injury, hyponatremia, and hypokalemia. A digital rectal examination and sigmoidoscopy were performed, and revealed a large laterally-spreading tumor in the rectum. Further investigation showed a rectal tubulovillous adenoma with secondary McKittrick-Wheelock syndrome. An anterior resection of the rectum with a colonic J-pouch and a diverting ileostomy were performed, and the patient improved with the resolution of the renal failure and electrolyte disturbances. The histopathological analysis revealed an invasive rectal adenocarcinoma. Discussion: McKittrick-Wheelock syndrome is a condition with a low incidence that needs early intervention and proper diagnosis. It is of extreme importance that this disease is included in the differential diagnoses for chronic diarrhea associated with an electrolytic disorder. (AU)

Does CO2 pneumoperitoneum in laparoscopy interfere with collagen deposition in abdominal surgical wounds?

Purpose To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats. Methods This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis. Results There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003). Conclusion At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.

Effect of preconditioning and postoperative hyperbaric oxygen therapy on colonic anastomosis healing with and without ischemia in rats.

PURPOSE: To investigate the effect of hyperbaric oxygen therapy on colonic anastomosis healing with and without ischemia in rats. METHODS: Forty female rats underwent segmental resection of 1 cm of the left colon followed by end-to-end anastomosis. They were randomly assigned to four groups (n=10 each), a sham group; two groups were submitted to Hyperbaric Oxygen therapy (HBOT) with and without induced ischemia and the induced ischemia group without HBOT. The HBOT protocol evaluated was 100% O2 at 2.4 Atmosphere absolute pressure (ATA) for 60 minutes, two sessions before as a preconditioning protocol and three sessions after the operation. Clinical course and mortality were monitored during all experiment and on the day of euthanasia on the fourth day after laparotomy. Macroscopic appearance of the abdominal cavity were assessed and samples for breaking strength of the anastomosis and histopathological parameters were collected. RESULTS: There was no statistically significant difference in mortality or anastomosis leak between the four experimental groups. Anastomosis breaking strength was similar across groups. CONCLUSION: The HBOT protocol tested herein at 2.4 ATA did not affect histopathological and biomechanical parameters of colonic anastomotic healing, neither the clinical outcomes death and anastomosis leak on the fourth day after laparotomy.

Does CO2 pneumoperitoneum in laparoscopy interfere with collagen deposition in abdominal surgical wounds?

Abstract Purpose To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats. Methods This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis. Results There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003). Conclusion At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.

Convivencia conyugal con el compañero estomizado y sus implicaciones sociales y afectivas: estudio comparativo / Convivência conjugal com o parceiro estomizado e suas implicações sociais e afetivas: estudo comparativo / Conjugal coexistence with an ostomized partner and its social and affective implications: a comparative case control study

La evaluación del problema de la estomía y sus implicaciones sociales y emocionales en la vida conyugal con un compañero estomizado es el punto de origen de este estudio. La condición de la persona con estomía permanente puede afectar actividades sociales y diarias con sus cónyuges. Objetivo: Analizar los aspectos sociales y afectivos de la convivencia diaria del cónyuge y su compañero con estomía intestinal definitiva. Método: Estudio comparativo del tipo caso-control, de naturaleza cuantitativa, realizado con cónyuges de estomizados, del Distrito Federal, Brasil. La muestra estuvo compuesta por 108 personas, siendo 36 cónyuges del estomizados llamado Grupo Caso y 72 cónyuges de no estomizados, titulado Grupo Control. Los datos fueron recolectados de octubre de 2011 a junio de 2012. Resultados: Mostraron que el Grupo Caso cuando comparado al Grupo Control, presentó menor frecuencia a restaurantes, eventos colectivos y participa menos de actividades de ocio. En cuanto a los hábitos en practicar actividades físicas, a la percepción sobre la estabilidad de la convivencia marital y a la evaluación de la relación afectiva fueron verificados índices similares en ambos grupos. Conclusión: El cónyuge y su compañero estomizado sufren cambios en la convivencia diaria, pero el vínculo conyugal y los lazos afectivos de la pareja permanecen inalterados

A avaliação do problema da estomia e suas implicações sociais e emocionais na vida conjugal com um parceiro com colostomia é o ponto de partida deste estudo. A condição da pessoa com estomia permanente pode influenciar atividades sociais e diárias com seus cônjuges. Objetivo: analisar os aspectos sociais e afetivos da convivência diária do cônjuge e seu parceiro com estomia intestinal definitiva. Método: Estudo comparativo do tipo caso controle, de natureza quantitativa, realizado com cônjuges de estomizados, pareado aos de não estomizados, do Distrito Federal, Brasil. A amostra foi composta por 108 pessoas, sendo 36 cônjuges de estomizados denominado Grupo Caso e 72 cônjuges de não estomizados, intitulado Grupo Controle. Os dados foram coletados de outubro de 2011 a junho de 2012. Resultados: Mostraram que o Grupo Caso quando comparado ao Grupo Controle, apresentou menor frequência a restaurantes, a eventos coletivos e participa menos de atividades de lazer. Quanto aos hábitos em praticar atividades físicas, à percepção acerca da estabilidade da convivência marital e à avaliação da relação afetiva, foram verificados índices semelhantes em ambos os grupos. Conclusão: O cônjuge e seu parceiro estomizado sofrem mudanças na convivência diária, mas o vinculo conjugal e os laços afetivos do casal permanecem inalterados

The evaluation of the ostomy problem and its social and emotional implications on the conjugal life with a partner with colostomy is the starting point of this study. The condition of a person with a permanent ostomy can influence social and daily activities with their spouses. Objective: To analyze the social and affective aspects of daily coexistence of the spouse and his partner with a definite intestinal ostomy. Method: Comparative study of case control type of quantitative nature, conducted with spouses of ostomized patients paired to the non ostomized in the Federal District, Brazil. The study included 108 spouses of whom 36 spouses of the ostomized called the Case Group and 72 of the non ostomized entitled Control Group. The data was collected from October 2011 to June 2012. Results: The results show that the case group when compared to the control group presented a lower frequency to restaurants, collective events and participates less in leisure activities. In regard to the habits of practicing physical activities, the perception concerning stability in marital coexistence and the evaluation of affective relation, similar rates were observed in both groups. Conclusion: The spouse and his ostomized partner suffered from changes in daily conviviality and the affective bonds of the couple remained unchanged

Improving reproducibility and external validity. The role of standardization and data reporting of laboratory rat husbandry and housing.

PURPOSE:: To identify the most relevant flaws in standardization in husbandry practices and lack of transparency to report them. This review proposes some measures in order to improve transparency, reproducibility and eventually external validity in experimental surgery experiments with rat model. METHODS:: We performed a search of scientific articles in PUBMED data base. The survey was conducted from august 2016 to January 2017. The keywords used were "reproducibility", "external validity", "rat model", "rat husbandry", "rat housing", and the time frame was up to January 2017. Articles discarded were the ones which the abstract or the key words did not imply that the authors would discuss any relationship of husbandry and housing with the reproducibility and transparency of reporting animal experiment. Reviews and papers that discussed specifically reproducibility and data reporting transparency were laboriously explored, including references for other articles that could fulfil the inclusion criteria. A total of 246 articles were initially found but only 44 were selected. RESULTS:: Lack of transparency is the rule and not the exception when reporting results with rat model. This results in poor reproducibility and low external validity with the consequence of considerable loss of time and financial resources. There are still much to be done to improve compliance and adherence of researchers, editors and reviewers to adopt guidelines to mitigate some of the challenges that can impair reproducibility and external validity. CONCLUSIONS:: Authors and reviewers should avoid pitfalls of absent, insufficient or inaccurate description of relevant information the rat model used. This information should be correctly published or reported on another source easily available for readers. Environmental conditions are well known by laboratory animal personnel and are well controlled in housing facilities, but usually neglected in experimental laboratories when the rat model is a novelty for the researcher.

Improving reproducibility and external validity. The role of standardization and data reporting of laboratory rat husbandry and housing

Abstract Purpose: To identify the most relevant flaws in standardization in husbandry practices and lack of transparency to report them. This review proposes some measures in order to improve transparency, reproducibility and eventually external validity in experimental surgery experiments with rat model. Methods: We performed a search of scientific articles in PUBMED data base. The survey was conducted from august 2016 to January 2017. The keywords used were "reproducibility", "external validity", "rat model", "rat husbandry", "rat housing", and the time frame was up to January 2017. Articles discarded were the ones which the abstract or the key words did not imply that the authors would discuss any relationship of husbandry and housing with the reproducibility and transparency of reporting animal experiment. Reviews and papers that discussed specifically reproducibility and data reporting transparency were laboriously explored, including references for other articles that could fulfil the inclusion criteria. A total of 246 articles were initially found but only 44 were selected. Results: Lack of transparency is the rule and not the exception when reporting results with rat model. This results in poor reproducibility and low external validity with the consequence of considerable loss of time and financial resources. There are still much to be done to improve compliance and adherence of researchers, editors and reviewers to adopt guidelines to mitigate some of the challenges that can impair reproducibility and external validity. Conclusions: Authors and reviewers should avoid pitfalls of absent, insufficient or inaccurate description of relevant information the rat model used. This information should be correctly published or reported on another source easily available for readers. Environmental conditions are well known by laboratory animal personnel and are well controlled in housing facilities, but usually neglected in experimental laboratories when the rat model is a novelty for the researcher.

Comparison of preoperative quality of life in breast reconstruction, breast aesthetic and non-breast plastic surgery patients: A cross-sectional study.

A breast cancer diagnosis imposes significant emotional and psychological duress. The purpose of this study is to assess the baseline quality of life (QOL) of immediate, delayed, and secondary breast reconstruction patients, comparing these results with QOL in women seeking plastic surgery for cosmetic breast, and non-breast procedures. From 2012 through 2013, immediate (group 1), delayed (group 2), and secondary (Group 3) reconstruction patients, aesthetic breast (group 4) and non-breast plastic surgery patients (group 5) answered Breast-Q questionnaires. Groups 1, 2, 3, 4, and 5 answered 141, 12, 23, 72 and 160 preoperative questionnaires respectively. There was no difference (p = NS) in breast satisfaction, psychosocial well-being, physical well-being-chest, and sexual well-being between groups 1 and 5. Group 1 had higher satisfaction with breast (p < 0.01), psychosocial (p < 0.01) and sexual well-being (p < 0.01) when compared to groups 2 and 4. Group 1 had higher satisfaction with breasts (p < 0.01) compared to group 3. Group 4 did not differ in satisfaction with breasts, psychosocial, and sexual well-being, compared to groups 2 and 3. Group 4 had lower scores in all domains, compared to groups 1 and 5 (p < 0.01). No significant difference in QOL was found between groups 2 and 3. Preoperatively, immediate reconstruction patients had similar satisfaction with breasts, psychosocial well-being, and chest physical well-being, compared to non-breast plastic surgery patients. Aesthetic breast surgery patients demonstrate similar low scores in satisfaction with breasts, psychosocial well-being, and sexual well-being to those of patients prior to delayed breast reconstruction, or secondary salvage procedures.

Effect of Hevea brasiliensis latex sap gel on healing of acute skin wounds induced on the back of rats.

OBJECTIVE: to evaluate the effect of topical delivery of latex cream-gel in acute cutaneous wounds induced on the back of rats. METHODS: we subjected sixteen rats to dermo-epidermal excision of a round dorsal skin flap, with 2.5cm diameter. We divided the animals into two groups: Latex Group: application of cream-gel-based latex throughout the wound bed on postoperative days zero, three, six and nine; CONTROL GROUP: no treatment on the wound. Photographs of the lesions were taken on the procedure day and on the 6th and 14th postoperative days, for analyzing the area and the larger diameter of the wound. We carried out euthanasia of all animals on the 14th postoperative day, when we resected he dorsal skin and the underlying muscle layer supporting the wound for histopathological study. RESULTS: there was no statistically significant difference in the percentage of wound closure, in the histopathological findings or in the reduction of the area and of the largest diameter of the wounds among the groups studied on the 14th postoperative day. CONCLUSION: according to the experimental conditions in which the study was conducted, latex cream-gel did not interfere in the healing of acute cutaneous wounds in rats.

Effect of Hevea brasiliensis latex sap gel on healing of acute skin wounds induced on the back of rats / Efeito do gel da seiva do látex da Hevea brasiliensis na cicatrização de lesões cutâneas agudas induzidas no dorso de ratos

Objective : to evaluate the effect of topical delivery of latex cream-gel in acute cutaneous wounds induced on the back of rats. Methods : we subjected sixteen rats to dermo-epidermal excision of a round dorsal skin flap, with 2.5cm diameter. We divided the animals into two groups: Latex Group: application of cream-gel-based latex throughout the wound bed on postoperative days zero, three, six and nine; Control group: no treatment on the wound. Photographs of the lesions were taken on the procedure day and on the 6th and 14th postoperative days, for analyzing the area and the larger diameter of the wound. We carried out euthanasia of all animals on the 14th postoperative day, when we resected he dorsal skin and the underlying muscle layer supporting the wound for histopathological study. Results : there was no statistically significant difference in the percentage of wound closure, in the histopathological findings or in the reduction of the area and of the largest diameter of the wounds among the groups studied on the 14th postoperative day. Conclusion : according to the experimental conditions in which the study was conducted, latex cream-gel did not interfere in the healing of acute cutaneous wounds in rats.

Objetivo : avaliar o efeito da administração tópica do gel-creme de látex em feridas cutâneas agudas induzidas no dorso de ratos. Métodos : dezesseis ratos foram submetidos à excisão dermoepidérmica de retalho cutâneo dorsal, circular com 2,5cm de diâmetro. Os animais foram distribuídos em dois grupos, um experimental e outro controle: Grupo Látex- aplicação em todo o leito da ferida do látex em base gel-creme no período zero, no terceiro, no sexto e no nono dias pós-operatórios; Grupo Controle- sem nenhum tratamento sobre a ferida. Foram feitas fotografias das lesões no dia da operação, no sexto e no 14º dia pós-operatório, para análise de área e do maior diâmetro da ferida. Realizou-se a eutanásia de todos os animais no 14º dia pós-operatório. Ressecou-se a pele dorsal e o plano muscular subjacente contendo a ferida para estudo histopatológico. Resultados : não houve diferença estatisticamente significante no percentual de fechamento, nos achados histopatológicos ou na redução da área e do maior diâmetro das feridas, entre os grupos estudados no 14º dia pós-operatório. Conclusão : nas condições experimentais em que o estudo foi realizado, o gel-creme de látex não interferiu na cicatrização de feridas cutâneas agudas em ratos.

Effects of metoclopramide on the expression of metalloproteinases and interleukins in left colonic anastomoses. An experimental study.

PURPOSE: To evaluate the effects of metoclopramide on metalloproteinases (MMP) and interleukins (IL) gene expression in colonic anastomoses in rats. METHODS: Eighty rats were divided into two groups for euthanasia on the 3rd or 7th postoperative day (POD), then into two subgroups for sepsis induction or not, and then into subgroups to receive either metoclopramide or saline solution. Left colonic anastomosis were performed and then analyzed. RESULTS: On the 3rd POD, metoclopramide was associated with increased expression of MMP-1a, MMP-13, and TNF-α. On the 7th POD, the transcripts of all MMPs, TNF-α, IL-1ß, IFN-γ, and IL-10 of the treated animals became negatively modulated. In the presence of sepsis, metoclopramide did not change MMPs and decreased IL-6, IL-1ß, IFN-γ and IL-10 gene expression on the 3rd POD. On the 7th POD, increased expression of all MMPs, IFN-γ and IL-10 and negative modulated TNF-α and IL-6 gene expression. CONCLUSION: Administration of metoclopramide increased metalloproteinases and interleukins gene expression on the 3rd postoperative day and negatively modulated them on the 7th POD. In the presence of abdominal sepsis, metoclopramide did not change MMPs and decreased ILs gene expression on the 3rd POD. On the 7th POD, the drug increased expression of all MMPs.

Effects of metoclopramide on the expression of metalloproteinases and interleukins in left colonic anastomoses. An experimental study

PURPOSE : To evaluate the effects of metoclopramide on metalloproteinases (MMP) and interleukins (IL) gene expression in colonic anastomoses in rats. METHODS : Eighty rats were divided into two groups for euthanasia on the 3rd or 7th postoperative day (POD), then into two subgroups for sepsis induction or not, and then into subgroups to receive either metoclopramide or saline solution. Left colonic anastomosis were performed and then analyzed. RESULTS : On the 3rd POD, metoclopramide was associated with increased expression of MMP-1a, MMP-13, and TNF-α. On the 7th POD, the transcripts of all MMPs, TNF-α, IL-1β, IFN-γ, and IL-10 of the treated animals became negatively modulated. In the presence of sepsis, metoclopramide did not change MMPs and decreased IL-6, IL-1β, IFN-γ and IL-10 gene expression on the 3rd POD. On the 7th POD, increased expression of all MMPs, IFN-γ and IL-10 and negative modulated TNF-α and IL-6 gene expression. CONCLUSION : Administration of metoclopramide increased metalloproteinases and interleukins gene expression on the 3rd postoperative day and negatively modulated them on the 7th POD. In the presence of abdominal sepsis, metoclopramide did not change MMPs and decreased ILs gene expression on the 3rd POD. On the 7th POD, the drug increased expression of all MMPs.

Effect of glutamine supplementation on left colon healing in rats with extrahepatic biliary obstruction.

PURPOSE: To evaluate the influence of glutamine and obstructive jaundice on left colon healing in rats. METHODS: Sixteen male rats were allocated across four groups: LG--Common bile duct ligation followed by colotomy and bowel suture on postoperative day 7. Supplementation with glutamine 2% from day 4 after duct ligation until euthanasia. L--Common bile duct ligation followed by colotomy and bowel suture on postoperative day 7. No glutamine supplementation. M--Common bile duct manipulation followed by colotomy and bowel suture on postoperative day 7. No glutamine supplementation. MG--Common bile duct manipulation followed by colotomy and bowel suture on postoperative day 7. Supplementation with glutamine 2% from day 4 after duct manipulation until euthanasia. On the day of euthanasia, bursting pressure of the sutured bowel segment was measured and samples were collected for histopathological analysis. RESULTS: There were no differences in bursting pressure among groups : LG vs. M (110 ± 28 vs. 173 ± 12; p = 0.08). Groups L and MG were not different from group M (156 ± 12 and 118 ± 22. Glutamine supplementation was associated with less edema, polymorphonuclear lymphocyte infiltration, bacterial colonies, and abscess formation, as well as with increased collagen formation. CONCLUSION: Obstructive jaundice had no negative effect and glutamine supplementation had no positive effect on colonic scar strength in rats.

Effect of glutamine supplementation on left colon healing in rats with extrahepatic biliary obstruction

PURPOSE: To evaluate the influence of glutamine and obstructive jaundice on left colon healing in rats. METHODS: Sixteen male rats were allocated across four groups: LG - Common bile duct ligation followed by colotomy and bowel suture on postoperative day 7. Supplementation with glutamine 2% from day 4 after duct ligation until euthanasia. L - Common bile duct ligation followed by colotomy and bowel suture on postoperative day 7. No glutamine supplementation. M - Common bile duct manipulation followed by colotomy and bowel suture on postoperative day 7. No glutamine supplementation. MG - Common bile duct manipulation followed by colotomy and bowel suture on postoperative day 7. Supplementation with glutamine 2% from day 4 after duct manipulation until euthanasia. On the day of euthanasia, bursting pressure of the sutured bowel segment was measured and samples were collected for histopathological analysis. RESULTS: There were no differences in bursting pressure among groups : LG vs. M (110 ± 28 vs. 173 ± 12; p = 0.08). Groups L and MG were not different from group M (156 ± 12 and 118 ± 22. Glutamine supplementation was associated with less edema, polymorphonuclear lymphocyte infiltration, bacterial colonies, and abscess formation, as well as with increased collagen formation. CONCLUSION: Obstructive jaundice had no negative effect and glutamine supplementation had no positive effect on colonic scar strength in rats. .

The effect of pelvic floor muscle training in urinary incontinent elderly women: a sistematic review / Efeito do treinamento dos músculos do assoalho pélvico na incontinência urinária de mulheres idosas: revisão sistemática

Introduction The International Continence Society (ICS) determines that the pelvic floor muscles training (PFMT) is the first-choice treatment of urinary symptoms in women. Objective The aim of this study was to systematize randomized controlled clinical trials that address the effects of PFMT in the treatment of urinary symptoms in older women using objective outcome measures. Method Systematic review search was performed eletronic the following databases: Medline, Pubmed, Lilacs, PEDro and manual research conducted in the references of the studies. Were considered eligible women aged over 60 years who performed PFMT in isolation, without the involvement of another technique. The PFMT performed in clinic or at home, with or without the supervision of a therapist and with or without the use of biofeedback as an adjunct. Considered as outcome measures urodynamic studies, voiding diary that assesses daytime urinary frequency, nocturnal urinary frequency, urinary incontinence and exchange absorbent, and, finally, the absorbent test that quantifies loss urinary grams. The assessment of methodological quality of the studies was conducted by PEDro scale. Results Three studies were reviewed in full. Only one trial was rated high methodological quality. There was significant improvement in urinary symptoms after treatment proposed in the three selected studies. Conclusion Considering the studies available so far are weak the evidence for the use of PFMT in the treatment of urinary symptoms in elderly women.

Introdução A Sociedade Internacional de Continência (SIC) determina que o treinamento dos músculos do assoalho pélvico (TMAP) seja considerado como primeira opção de tratamento dos sintomas urinários nas mulheres. Objetivo O objetivo deste estudo foi sistematizar ensaios clínicos randomizados e controlados que abordam os efeitos do TMAP no tratamento dos sintomas urinários em mulheres idosas utilizando medidas de desfecho objetivas. Método Revisão sistemática no qual foi feita uma busca eletrônica nas seguintes bases de dados: Medline, Pubmed, Lilacs, PEDro e pesquisa manual realizada nas referências bibliográficas dos estudos. Consideraram-se elegíveis mulheres idosas acima de 60 anos, que realizaram o TMAP de forma isolada, sem envolvimento de outra técnica. O TMAP realizado em ambulatório ou em domicílio, com ou sem a supervisão de um terapeuta e com ou sem o uso do biofeedback como adjuvante. Considerou-se como medidas de desfecho o estudo urodinâmico, o diário miccional que avalia a frequência urinária diurna, a frequência urinária noturna, perda urinária aos esforços e a troca de absorventes, e, por fim, o teste do absorvente que quantifica a perda urinária em gramas. A avaliação da qualidade metodológica dos estudos foi realizada pela escala PEDro. Resultados Três estudos foram revisados na íntegra. Apenas um artigo foi classificado como de alta qualidade metodológica. Houve melhora significativa dos sintomas miccionais após o tratamento proposto nos três estudos selecionados. Conclusão Considerando os estudos disponíveis até o momento são fracas as evidências favoráveis à utilização do TMAP no tratamento dos sintomas urinários de mulheres idosas.

Influence of patient age and colorectal polyp size on histopathology findings / Influência da idade do paciente e do tamanho dos pólipos colorretais nos achados histopatológicos

BACKGROUND: Colorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening. AIM: To assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size. METHODS: Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older. RESULTS: A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia. CONCLUSION: Polyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon. .

RACIONAL: O câncer colorretal é causa importante de morbimortalidade e pode desenvolver-se pela sequência adenoma-carcinoma. A videocolonoscopia é considerada método de escolha para rastreamento populacional para esta neoplasia. OBJETIVO: Avaliar as características de pólipos endoscopicamente ressecados em uma série consecutiva de pacientes submetidos à videocolonoscopia em um hospital universitário e comparar os achados histopatológicos de acordo com a idade do paciente e o tamanho dos pólipos. MÉTODO: Estudo retrospectivo transversal baseado na análise dos laudos de 1950 videocolonoscopias realizadas consecutivamente. Foram selecionados aqueles em que foram evidenciados pólipos no cólon ou reto. Procedeu-se a revisão dos prontuários para coleta de dados demográficos e da avaliação histopatológica dos espécimes. Foram comparados os achados relativos aos pólipos de até 0,5 cm com os acima de 0,6 cm. Posteriormente, foram comparados pólipos de até 1 cm com os acima de 1,1 cm. Em um terceiro momento foram realizadas comparações dos achados dos pólipos ressecados de pacientes com idade até 49 anos com aqueles retirados de pacientes acima de 50 anos. RESULTADOS: Foram ressecados pólipos colorretais em 224 dos 1950 exames avaliados (11,5%), com retirada total de 272 pólipos. Pólipos maiores de 1 cm tenderam a ser pediculados (p=0,000) e tiveram maior chance de apresentarem componente adenomatoso (p=0,001), componente viloso (p=0,000) e displasia (p=0,003). Os mesmos achados foram observados com ponto de corte de 0,5 cm. Pacientes com 50 anos ou mais apresentaram mais frequentemente pólipos sésseis (p=0,023) e localizados no cólon proximal (p=0,009). Não houve diferença significante entre os grupos em relação à histopatologia ...

Effect of vitamin K1 supplementation on left colon healing in rats with extrahepatic biliary obstruction.

PURPOSE: To evaluate the effects of vitamin K1 on wound healing in the left colon of rats with experimental biliary obstruction. METHODS: Sixteen male rats, divided into four groups of four animals each (L, M, LK, and MK), underwent colostomy followed by bowel suture in the left colon. Seven days before, animals in the L and LK groups had undergone common bile duct ligation. The animals in groups MK and LK received vitamin K1 supplementation. On day 7 after bowel suture, repeat laparotomy was performed for evaluation of colonic healing by burst pressure measurement and collection of samples for histopathological analysis. Changes in body weight were evaluated in the four groups. RESULTS: Weight loss was lower in animals supplemented with vitamin K. No significant differences were observed in burst pressure among the four groups (p>0.05). Histological analysis showed more hemorrhage and congestion in the biliary obstruction groups. Supplemented animals exhibited increased collagen formation and less edema and abscess formation. CONCLUSION: Vitamin K supplementation attenuated weight loss and improved colonic wound healing in rats.

Effect of vitamin K1 supplementation on left colon healing in rats with extrahepatic biliary obstruction

PURPOSE: To evaluate the effects of vitamin K1 on wound healing in the left colon of rats with experimental biliary obstruction. METHODS: Sixteen male rats, divided into four groups of four animals each (L, M, LK, and MK), underwent colostomy followed by bowel suture in the left colon. Seven days before, animals in the L and LK groups had undergone common bile duct ligation. The animals in groups MK and LK received vitamin K1 supplementation. On day 7 after bowel suture, repeat laparotomy was performed for evaluation of colonic healing by burst pressure measurement and collection of samples for histopathological analysis. Changes in body weight were evaluated in the four groups. RESULTS: Weight loss was lower in animals supplemented with vitamin K. No significant differences were observed in burst pressure among the four groups (p>0.05). Histological analysis showed more hemorrhage and congestion in the biliary obstruction groups. Supplemented animals exhibited increased collagen formation and less edema and abscess formation. CONCLUSION: Vitamin K supplementation attenuated weight loss and improved colonic wound healing in rats. .

Influence of patient age and colorectal polyp size on histopathology findings.

BACKGROUND: Colorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening. AIM: To assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size. METHODS: Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older. RESULTS: A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia. CONCLUSION: Polyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon.

Avaliação manométrica anorretal de mulheres adultas com diagnóstico clínico e urodinâmico de bexiga hiperativa / Anorectal manometry evaluation in adult women with clinical and urodynamic diagnostics of overactive bladder

RACIONAL: A manometria anorretal é método diagnóstico empregado na prática clínica para avaliação de distúrbios funcionais anorretais e do assoalho pélvico. As disfunções miccionais, anorretais e do assoalho pélvico tem sido consideradas como fatores contribuintes dos sintomas de bexiga hiperativa. OBJETIVO: Avaliar os resultados obtidos com manometria anorretal em mulheres adultas com diagnóstico clínico e urodinâmico de bexiga hiperativa. MÉTODOS: Vinte e cinco mulheres adultas (média de idade de 45.5±11.9 anos) com diagnóstico clínico e urodinâmico de bexiga hiperativa submeteram-se à manometria anorretal e os resultados obtidos nesta avaliação foram comparados aos de um grupo controle de 18 mulheres (média de idade de 33.9 ±10.7 anos) assintomáticas do ponto de vista urinário e sem critérios clínicos para diagnóstico de bexiga hiperativa. O grupo de mulheres com bexiga hiperativa foi denominado BH e controle C. RESULTADO: Ocorreram seis (24%) casos de contração paradoxal do puborretal no grupo BH e nenhuma no Grupo C. Houve 13 (52%) ocorrências de hipertonia de repouso isolada ou associada à hipertonia de contração no Grupo BH e sete (39%) no Grupo C. A média de pressão de repouso foi de 80.1 mmHg no Grupo BH e 67.6 mmHg no Grupo C. O total de ocorrência de hipertonia de contração no Grupo BH foi de 7(28%) e 11(61%) no Grupo C. A média de pressão de contração foi de 182.2 mmHg no Grupo BH e 148.1 mmHg no Grupo. Com relação ao reflexo inibitório retoanal, a sensibilidade e a capacidade retal máxima não houve diferença estatisticamente significante entre os dois grupos. CONCLUSÃO: As mulheres com bexiga hiperativa apresentaram maior ocorrência de contração paradoxal do puborretal em relação às do grupo controle.

BACKGROUND: Anorectal manometry is a diagnostic method often used in clinical practice for assessing functional anorectal disorders and pelvic floor. The dysfunctional voiding, anorectal and pelvic floor has been considered as contributing factors of the symptoms of overactive bladder. AIM:To evaluate the results with anorectal manometry in adult women with clinical and urodynamic diagnostics of overactive bladder. METHODS: Twenty-five adult women (mean age 45.5±11.9 years) with clinical and urodynamic diagnostic of overactive bladder underwent anorectal manometry and the results of this assessment were compared to a control group of eighteen women (mean age 33.9±10.7 years) with no urinary or intestinal disorders and without clinical criteria for diagnosis of overactive bladder. RESULTS: Paradoxical puborectalis contraction occurred in six patients in the overactive bladder group and none of the controls. There were no significant between group differences in the following manometric parameters: rectoanal inhibitory reflex, rectal sensitivity, maximum tolerable volume, resting pressure, and hypertonia at rest. Mean squeeze pressure was 182.2 mmHg in the overactive bladder group versus 148.1 mmHg in the control group. CONCLUSION: Women with overactive bladder had increased incidence of paradoxical puborectalis contraction than women in the control group.