Is urgent colonoscopy without bowel preparation really useful? Colonoscopy without bowel preparation.

Acute lower gastrointestinal bleeding (LGIB) is a common disorder which involves many problems in diagnosis and treatment. Concerning colonoscopy in an urgent context, guidelines are very specific in stating that unprepared colonoscopy has no place in the evaluation of patients with suspected LGIB. The purpose of this study was to evaluate the diagnosis and therapeutic effectiveness of urgent colonoscopy, without prior bowel preparation, in patients admitted at the hospital with acute LGIB. Were included 132 patients consecutively admitted at the Emergency Department for LGIB and who had undergone colonoscopy without prior bowel preparation. Despite the lack of preparation, cecal observation was possible in 10 patients (7.6%). More than two thirds of the diagnoses (69.1%) were established with the performance of just a left colonoscopy. In 63.6% of patients, a definitive diagnosis was established using this initial approach. In 35.6% of the individuals, biopsies were performed, which allowed the establishment of a histological diagnosis. Additionally, in 14 patients (16.7%) an active hemorrhagic focus was identified, and endoscopic hemostasis was performed. None of these 14 patients required additional procedures during the hospital stay. Only in 21 patients the initial colonoscopy was inconclusive and, consequently, it was necessary to repeat it after anterograde preparation. Even in these cases, no diagnosis was reached in 33.3%. This study revealed that unprepared colonoscopy in an urgent context could a useful procedure which allows an adequate guidance in more than half of the patients.

Genotoxicity assessment in two Amazonian estuaries using the Plagioscion squamosissimus as a biomonitor.

Genotoxicity studies in coastal ecosystems have been a priority in Environmental Risk Assessment (ERA). This research aimed to study the genotoxicity by the micronucleus test and comet assay in two Brazilian Amazon estuaries (anthropized and control) using Plagioscion squamosissimus as a biomonitor. Blood samples were collected from 54 specimens. No significant genotoxic effects were detected in the cells analyzed, although the highest occurrence (MN and DNA damages) was observed in anthropized site. The percentage of genomic damage differed between the sites studied, being always higher in anthropizes site as well. Of the nucleoids analyzed in this site, on average, 28 ± 14.42% of the cells were classified in the highest damage class. The fish analyzed in the present study are direct influenced of xenobiont agents capable of producing damage to the genetic material of aquatic organisms in both sites and, consequently, may bring consequences still little reported in studies of morphophysiological alterations in humans.

Reproductive efficiency of nellore (Bos indicus) cows subject to both FTAI and homeopathic supplementation / Eficiência reprodutiva em vacas nelore (bos indicus) submetidas à IATF e a suplementação homeopática

The aim of this work was to determine the effect of homeopathic supplementation on both ovarian dynamics and conception rate in Nellore cows subjected to fixed-time artificial insemination (FTAI). Cows (n = 150) were randomly distributed to the control (CG) and the homeopathy group (HG). The HG cows were supplemented with Pró-cio in the mineral salt for 60 days and both experimental groups were further subjected to FTAI. Cows were evaluated for ovarian dynamics (n = 16), progesterone (P4) concentration (n = 16), and conception rates (n = 150). Ovarian dynamics determined by ultrasonography and showed similar findings for CG and HG, respectively. Thus follicular diameter (8.7 ± 1.0 mm vs. 10.0 ± 0.8 mm), mean pre-ovulatory follicle volume (0.46 ± 0.15 mL vs. 0.61 ± 0.12 mL), and mean follicular growth (3.65 ± 1.41 mm vs. 4.60 ± 1.21 mm) did not differ between groups. Moreover, corpus luteum diameter was similar between groups (CG: 16.28 ± 0.7 mm vs. HG: 15.6 ± 0.8 mm; P > 0.05), although P4 levels did differ (CG: 2.55 ± 0.85 ng mL-1 vs. HG: 6.52 ± 1.19 ng mL-1; P < 0.05). The conception rate after FTAI was not affected by homeopathic supplementation (CG: 74.67 %, and did HG: 77.33 %; P > 0.05). In conclusion, the homeopathic supplementation Pró-cio increases P4 concentrations but does improve the reproductive efficiency of Nellore cows subject to FTAI.

O objetivo foi determinar o efeito da suplementação homeopática na dinâmica ovariana e taxa de concepção em vacas Nelore cows submetidas à inseminação artificial em tempo fixo (IATF). As vacas (n = 150) foram distribuídas aleatoriamente nos grupos controle (GC) e grupo homeopático (GH). As vacas do GH foram suplementadas com Pró-cio® no sal mineral mineral por 60 dias. Ambos os grupos foram submetidos à IATF. As vacas foram avaliadas quanto à dinâmica ovariana (n = 16), concentração de progesterona (P4; n = 16) e taxa de concepção (n = 150). A dinâmica ovarina foi determinada por ultra-sonografia e mostrou resultados semelhantes para o GC e o GH, respectivamente. Portanto, para diâmetro folicular (8,7 ± 1,0 mm vs. 10,0 ± 0,8 mm), volume médio do folículo pré-ovulatório (0,46 ± 0,15 mL vs. 0,61 ± 0,12 mL) e crescimento folicular médio (3,65 ± 1,41 mm vs. 4,60 ± 1,21 mm) não diferiram entre os grupos. Além disso, o diâmetro do corpo lúteo foi semelhante entre os grupos (CG: 16,28 ± 0,7 mm vs. HG: 15,6 ± 0,8 mm; P > 0.05), apesar dos níveis de P4 diferirem (CG: 2,55 ± 0,85 ng mL-1 vs. GH: 6,52 ± 1,19 ng mL-1; P < 0.05). A taxa de concepção após a IATF não foi afetada pela suplementação homeopática (GC:74.67 % vs. GH: 77.33 %; P > 0.05). Em conclusão, a suplementação homeopática com Pró-cio aumenta a concentração de P4 mas não melhora a eficiência reprodutiva de vacas Nelore cows submetidas à IATF.

Association between the location of colon polyps at baseline and surveillance colonoscopy - A retrospective study.

INTRODUCTION: Several factors are used to stratify the probability of polyp recurrence. However, there are no studies correlating the location of the initial polyps and the recurrent ones. The aim of this study was to verify whether the polyp location at the surveillance colonoscopy was correlated with the location of the previously excised polyps at the baseline colonoscopy. METHODS: A retrospective study of patients submitted to colonoscopy with presence and excision of all polyps, followed by a surveillance colonoscopy. Polyp location was divided into proximal/distal to splenic flexure and rectum. Characteristics and recurrent rates at the same colon location were also evaluated. RESULTS: Out of the 346 patients who underwent repeated colonoscopy, 268 (77.4%) had at least 1 polyp detected. For all the segments there was an increased risk of recurrent polyps in the same location and it was about four times higher in proximal (OR 3.5; CI 2.1-6.0) and distal colon segments (OR 3.8; CI 2.1-6.8), followed by three times higher in the rectum (OR 2.6; CI 1.5-4.6). No difference was found between the rates of recurrence at the same segment, taking into consideration the polyp morphology, size, polypectomy technique employed and histological classification. CONCLUSION: There seems to be a significant association between polyp location at baseline and surveillance colonoscopy.

Association between the location of colon polyps at baseline and surveillance colonoscopy - A retrospective study

Introduction: Several factors are used to stratify the probability of polyp recurrence. However, there are no studies correlating the location of the initial polyps and the recurrent ones. The aim of this study was to verify whether the polyp location at the surveillance colonoscopy was correlated with the location of the previously excised polyps at the baseline colonoscopy. Methods: A retrospective study of patients submitted to colonoscopy with presence and excision of all polyps, followed by a surveillance colonoscopy. Polyp location was divided into proximal/ distal to splenic flexure and rectum. Characteristics and recurrent rates at the same colon location were also evaluated. Results: Out of the 346 patients who underwent repeated colonoscopy, 268 (77.4%) had at least 1 polyp detected. For all the segments there was an increased risk of recurrent polyps in the same location and it was about four times higher in proximal (OR 3.5; CI 2.1-6.0) and distal colon segments (OR 3.8; CI 2.1-6.8), followed by three times higher in the rectum (OR 2.6; CI 1.5-4.6). No difference was found between the rates of recurrence at the same segment, taking into consideration the polyp morphology, size, polypectomy technique employed and histological classification. Conclusion: There seems to be a significant association between polyp location at baseline and surveillance colonoscopy (AU)

No disponible

Ampullary Metastasis From Breast Cancer: A Rare Cause of Obstructive Jaundice.

Breast cancer is the most common tumor in women and the first cause of death for malignancy in the female. Bile ducts are not among the common sites of metastasis from breast cancer. Few cases of obstructive jaundice due to metastatic breast cancer have been described in the literature and they mostly resulted from widespread liver metastases that eventually involved the bile ducts. We report an exceptional case of ampullary metastasis in the absence of liver metastases. Sporadic reports have been published about the involvement of the ampulla by breast cancer metastasis. This case emphasizes the need to consider this diagnosis in women presenting with obstructive jaundice, especially when there is a clinical possibility of breast cancer.

O cancro da mama é o tumor mais comum em mulheres e a principal causa de morte por neoplasia nesta população. A via biliar não é um local comum de metastização desta neoplasia. Poucos casos de icterícia obstrutiva devido a metástases mamárias têm sido descritos na literatura e ocorrem principalmente devido a metástases hepáticas que comprimem a via biliar. Relatamos um caso excepcional de metástase ampular na ausência de metástases hepáticas.Existem apenas relatos esporádicos do envolvimento da ampola por metástase mamárias. Este caso enfatiza a necessidade de considerar este diagnóstico perante um quadro de icterícia obstrutiva, especialmente em doentes com possível neoplasia mamária.

Portal Hypertensive Biliopathy: An Infrequent Cause of Biliary Obstruction.

INTRODUCTION: Biliary obstruction is usually caused by choledocholithiasis. However, in some circumstances, alternative or concurring unusual ethiologies such as portal hypertensive biliopathy (PHB) must be considered. CLINICAL CASE: We present the case of a 36-year-old female complaining of jaundice and pruritus. Liver function tests were compatible with biliary obstruction and the ultrasound scan of the abdomen showed dilatation of the intrahepatic biliary ducts, a dilated common bile duct (CBD) and biliary calculi. The computed tomography of the abdomen revealed a portal cavernoma encasing the CBD. DISCUSSION: Portal cavernoma, the hallmark of extrahepatic portal venous obstruction, can cause PHB. When symptomatic, chronic cholestasis is present if a dominant stricture exists whereas biliary pain and acute cholangitis occur when choledocholithiasis prevails. Management must be individualized and usually includes endoscopic therapy to address choledocholithiasis and shunt surgery for definitive treatment.

INTRODUÇÃO: A causa mais comum de icterícia obstrutiva é a coledocolitíase. No entanto, no contexto clínico adequado, devem ser consideradas etiologias alternativas ou concomitantes, nomeadamente a biliopatia hipertensiva portal (BHP). CASO CLÍNICO: Apresentamos o caso de uma doente do sexo feminino com 36 anos de idade com icterícia e prurido. O estudo bioquímico era compatível com icterícia obstrutiva e o estudo ecográfico do abdómen revelou dilatação das vias biliares intra-hepáticas e do colédoco associados a litíase biliar. A tomografia computorizada abdominal realizada mostrou a existência um cavernoma da veia porta a envolver o colédoco. DISCUSSÃO: O cavernoma da porta, no contexto de obstrução portal venosa extra-hepática pode complicar-se com BHP. Quando sintomática manifesta-se por colestase crónica caso exista uma estenose dominante ou dor biliar e/ou colangite aguda quando predomina a litíase. O tratamento definitivo é individualizado, incluindo terapêutica endoscópica visando a litíase associada e uma derivação cirúrgica venosa porto-sistémica.

Megaesôfago, megacólon e alteraçöes eletrocardiográficas em candidatos a doadores de sangue com reaçöes sorológicas positivas para doença de Chagas, no município de Santa Maria, Rio Grande do Sul / Megaesophagus, megacolon and electrocardiographic changes in applicants to blood donors with positive serological tests for Chagas disease in the municipality of Santa Maria, Rio Grande do Sul, Brazil

Os autores estudaram 251 pacientes portadores de infecçäo chagásica, voluntários de um grupo de 1.781 candidatos a doadores de sangue com sorologia positiva para doença de Chagas. Além da anamnese dirigida, a investigaçäo realizada nestes pacientes constou de ECG e exame radiológico contrastado de esôfago e de cólon. Foram observadas alteraçöes eletrocardiográficas em 35,68% dos pacientes. Entre os que se submeteram a estudo radiológico do esôfago, 8,45% apreentaram dilataçäo do órgäo e naqueles que realizaram enema baritado foram encontradas alteraçöes compatíveis com colopatia chagásica em 6,5%, perfazendo uma prevalência corrigida de "patias digestivas" de 14% dos pacientes investigados. Chama a atençäo o número elevado de pacientes com alteraçöes radiológicas de "patia" chagásica, sem queixas relacionadas ao tubo digestivo, por ocasiäo do exame