Leonardo Maciel da Fonseca

Câncer colorretal: resultados da avaliação patológica padronizada de 521 casos operados no Hospital das Clínicas da UFMG

INTRODUCTION: The incidence and mortality of colorectal cancer (CRC) have shown, worldwide, an upward trend, particularly in developed countries and urban areas of developing countries. The study of tumors pathological characteristics is important for staging and the definition of the proper therapy to be used. The aim of this study is to evaluate the pathologic features of surgical specimens of colorectal resections due CRC at Hospital das Clinicas, Universidade Federal de Minas Gerais. RESULTS: We evaluated 521 surgical specimens of colorectal resections. The mean age of patients was 62.47 (± 14.67) years, 302 (58%) were female. Tumors of the left colon were more common (340 [65.3%]). There was a predominance of adenocarcinoma (457 [87.7%]), ulcero-infiltrative (176 [33.8%]), moderately differentiated (396 [76%]), pT3 (316 [60.7%]) and pN0 (213 [40.9%]). The average number of dissected lymphonodes per surgical specimen was 22.13 (± 14.27). CONCLUSIONS: Data from our series of CRC did not differ from what was reported in the literature. In summary, the CRC was more common in women than in men, affecting most frequently the left colon, and the predominant type was moderately differentiated adenocarcinoma, pT3 and pN0

Invasão do reto por carcinoma prostático avançado com disseminação linfática simulando câncer retal: relato de caso

Prostate carcinoma is a frequent disease in the elderly and in advanced cases it can cause rectal invasion mimicking a primary rectal carcinoma. Most of patients present with significant rectal symptoms and mild to absent urinary tract symptoms. We report a case of a patient with a very aggressive locally invasive prostate carcinoma with a concomitant rectal villous tumor which was misdiagnosed and inadequately treated as a rectal cancer. The reported incidence of rectal invasion in advanced prostate cancer has varied between 1 to 11 per cent in different series. The appearance of the prostate tumor with involvement of the rectum causes difficulties in differentiating it from primary rectal carcinoma. Neither radiological nor endoscopic examination of the rectum or lower urinary tract provides a definitive diagnosis. Histopathology in both primary prostate carcinoma invasive to the rectum and primary rectal carcinoma usually is poorly differentiated adenocarcinoma.The differentiation of rectal involvement from prostatic carcinoma is essential, since therapy is quite different for the two diseases. The high incidence of prostatic carcinoma makes it important for all physicians are aware of frequency in which it involves the rectum and mimic a primary rectal neoplasm.

Análise de 33 peças cirúrgicas de colectomias laparoscópicas para câncer, durante a curva de aprendizado inicial: margens oncológicas e número de linfonodos não diferem de colectomias abertas

INTRODUCTION: Colorectal laparoscopic surgery is considered a procedure with long learning curve. Despite surgeons with experience in laparoscopic surgery are able to achieve the same oncological results obtained in open procedures, it is important to evaluate if these good results are sustained during the learning curve. The aim of this study was to evaluate the adequacy of the margins and the lymph nodes harvest in early learning curve of laparoscopic colectomies performed by specialized surgeons compared to open colectomies. METHODS: Thirty-three surgical specimens of laparoscopic resections for colorectal cancer performed during the early learning curve were evaluated. The following data were analyzed: age, sex, tumor location, pathologic classification, lymph node harvest and proximal and distal margins. Data were compared to a control group of 45 open resections for colorectal cancer. RESULTS: Age, tumor location and Dukes classification of laparoscopic and open groups were similar. Laparoscopic group had more female patients. Distal margins were similar between the groups [mean of 7,15 cm (SD ± 9,98) for open and 8,26 cm (SD ± 11,5) for laparoscopic group, p=NS]. There was no difference in the lymph nodes harvest between the groups. The mean of lymph nodes harvest of open and laparoscopic groups were 19 (SD ± 19,41) and 21 (SD ± 14,73), respectively, (p=NS). CONCLUSION: Oncologic margins and lymph nodes harvest obtained during early learning curve of laparoscopic resections were similar to open procedures. Despite the natural difficulties faced during early learning curve, oncologic criteria can be achieved when laparoscopic colorectal resections are performed by specialized surgeons working with gastrointestinal pathology team.

Ileo‐uterine fistula during pregnancy in a patient with Crohn disease: an uncommon complication

Crohn disease (CD) does not adversely affect fertility. The peak age of the onset of CD coincides with the peak age of conception. It has been estimated that approximately 25% of female patients could conceive after the diagnosis of CD.1 A 38-year old woman, gravida 5, para 4, presented a 6-year history of CD. She was under medical therapy with oral prednisone, sulfasalazine and azathioprine and had many hospitalizations to treat flare-ups of CD. During her fifth gestation, she decided by herself to discontinue the treatment for CD. She had no symptoms until the 28th week of gestation, when she was admitted at the emergency room complaining of tenderness over the uterus. She was discharged without preterm labour signs and no symptoms of CD. One week later, the patient was admitted with complaints of discharge of amniotic fluid and uterine contractions. The diagnosis of preterm amniotic rupture and preterm labour was made. An obstetric ultrasound showed singleton consistent with 29– 30weeks’ gestation, low volume of amniotic fluid and an estimated fetal weight of 1040 g. Approximately 48 h after the admission the patient presented a greenish vaginal discharge similar to a meconial fluid. A caesarean section was indicated for supposed fetal distress. During laparotomy a gross inflammation of terminal ileum was found. A colorectal surgeon was called and a diagnosis

Treatment of Anastomotic Stricture of a Handsewn Coloanal Anastomosis With Transanal Approach

755 DISEASES OF THE COLON & RECTUM VOLUME 60: 7 (2017) This video details the treatment of anastomotic stricture of a handsewn coloanal anastomosis with the transanal approach instead of a combined abdominal and perineal approach. The patient underwent a laparoscopic total mesorectal excision with handsewn side-to-end coloanal anastomosis for rectal cancer. When the ileostomy was being prepared, we realized that the colon in the pelvis was ischemic. A decision to perform another anastomosis with a nonischemic part of the colon was made. Because the nonischemic part did not reach the anus, a laparoscopic Deloyers procedure was performed. A straight handsewn coloanal anastomosis was performed. A diverting loop ileostomy was done. After the discharge, a digital examination showed a stenosis of the anastomosis on day 15 postoperation. On day 60, it was not possible to perform a colonoscopy. With a digital examination, the lumen of the colon was not found. The colonoscope was passed through the anus, but the endoscopist entered into the pelvis. The colon was adherent to the sidewall of pelvis. There were not many adhesions. There was a complete stenosis of the anastomosis with a little retraction. The video presented here shows the treatment of this complication. We decided to perform a transanal down-to-up dissection of the colon using the GelPOINT (Applied Medical, Rancho Santa Margarita, CA) transanal patch applied. A complete mobilization of the colon was performed. The adhesions were resected with blunt and sharp dissection with scissors. After the complete mobilization of the colon, we redid the coloanal anastomosis. The patient had an uneventful postoperative course. The ileostomy was closed 2 months after the transanal approach and redone anastomosis. We visualized the opportunity to treat this complication with a down-to-up dissection of the remaining colon using a new device to permit a laparoscopic approach as occurred in the recently described transanal total mesorectal excision dissection. See Video at http://links.lww.com/DCR/A298.

Numerical Analysis of an Internal Combustion Engine Using One-Dimensional Code

The work aims to model a spark ignition reciprocating Internal Combustion Engine - ICE. A code was built in Object Pascal to simulate another ICE and now it is being adapted to this research single-cylinder engine using commercial ethanol. The model describes in-cylinder gas by conservation equations, including the momentum conservation, and solves combustion wave equations, such that detonation and deflagration are calculated by the same set of formulas. Adjustments were made to get a proper discharge coefficient for the valves and represent the internal geometry. The mass flow rate calculated by the program differed in only 1% of the experimental value. The maximum pressures from combustion graphs differed in less than 1% too and their curves were similar. Other parameters of interest, also found to be close to the experimental ones, are presented and discussed. The code also showed as a good result the simulation time, which was approximately two minutes.

Câncer de reto durante gestação: relato de caso e revisão da literatura

O carcinoma colorretal associado a gestacao e um acontecimento raro, relacionado a um prognostico ruim para as mulheres. O caso descrito e de uma paciente, do sexo feminino, de 31 anos, com adenocarcinoma de reto diagnosticado na 24a semana gestacional. E apresentada uma discussao sobre conduta e atualizacao de abordagem terapeutica.

Tratamento do câncer colorretal em idosos extremos: relato de caso e revisão da literatura

Because the elderly population in Brasil is rapidly increasing, the colorectal surgeron will always manage extremely old patients, aged 75 or 85 years or older, with the diagnosis of colorectal cancer. The management of such cases is controversial. This paper reports the treatment of a 97-year-old patient with diagnosis of rectum adenocarcinoma, and presents a literature review on the best approach for old-age patients with colorectal cancer. The patient underwent a palliative laparoscopic retossigmoidectomy and colorectal anastomosis, as the specimen was resected through supra-pubic transverse incision. She was included in the fast-track rehabilitation program for colorectal surgery and had good recovery, being discharged in good clinical conditions on the third postoperative day. Pathologic examination of surgical specimen showed a rectum adenocarcinoma with invasion of the muscularis propria and metastasis in 2 of 12 dissected lymph nodes. According to the literature, in selected individuals older than 75 years, elective colorectal surgery for primary colorectal cancer can be performed with morbidity and mortality rates comparable to those of younger individuals, achieving favorable disease-free and overall long-term survival. Prognosis or contraindications to the procedure are not defined by isolate comorbidities.

Cistoadenoma de apêndice: relato de caso e revisão da literatura sobre tumores mucinosos do apêndice vermiforme

INTRODUCAO: Mucocele do apendice (MA) e uma lesao rara, caracterizada pelo acumulo de secrecao mucoide em sua luz. Diagnostico precoce e fundamental para evitar o extravasamento de secrecao mucoide na cavidade peritoneal, causando pseudomixoma peritoneal. RELATO DE CASO: Paciente sexo masculino, 62 anos com historia de dor abdominal em fossa iliaca direita ha cerca de 6 meses. Realizou uma ultra-sonografia do abdome que evidenciou no flanco direito pequena estrutura cistica compativel com MA. Colonoscopia, exames laboratoriais e dosagem do CEA encontravam-se sem alteracoes. O paciente foi submetido a laparotomia exploradora com resseccao do apendice e do seu meso em monobloco. O exame histologico mostrou tratar-se de cistoadenoma do apendice vermiforme. O paciente evoluiu sem intercorrencias. DISCUSSAO: A MA e um achado raro. As principais causas patologicas incluem cisto de retencao, mucocele secundaria a epitelio hiperplasico, cistoadenomas e cistoadenocarcinomas. A doenca e geralmente assintomatica e o diagnostico pre-operatorio e raro. O tratamento para mucocele do apendice e cirurgico e a preocupacao principal do cirurgiao e evitar o extravasamento do conteudo da mucocele na cavidade abdominal. CONCLUSAO: A MA e uma entidade incomum e com alto potencial de complicacao, usualmente curavel com tratamento cirurgico adequado.