Paulo Roberto Arruda Alves

Bowel preparation for colonoscopy: comparison of mannitol and sodium phosphate. Results of a prospective randomized study

METHOD Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750ml of 10% mannitol (Group M) or 180ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85% prepared with sodium phosphate versus 82.5% for mannitol (p=0.37). CONCLUSIONS Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure.

Role of colonoscopy in colorectal cancer

Colorectal cancer (CRC) represents the third most common malignancy throughout the world. Little or no improvement in survival has been effectively achieved in the last 50 years. Extensive epidemiological and genetic data are able to identify more precisely definite risk-groups so screening and early diagnosis can be more frequently accomplished. CRC is best detected by colonoscopy, which allows sampling for histologic diagnosis. Colonoscopy is the gold standard for detection of small and premalignant lesions, although it is not cost-effective for screening average-risk population. Colonoscopic polypectomy and mucosal resection constitute curative treatment for selective cases of invasive CRC. Similarly, alternative trans-colonoscopic treatment can be offered for adequate palliation, thus avoiding surgery.

Cirurgia colorretal eletiva sem descompressão gástrica e com realimentação precoce

Historicamente, as operacoes sobre o intestino grosso sempre foram cercadas por cuidados especiais, com o intuito de minimizar o potencial de complicacoes. Com isso, a realimentacao oral era postergada. Este trabalho teve como objetivo documentar a retirada da sonda nasogastrica logo apos o procedimento cirurgico e a adocao da realimentacao precoce. Foram acompanhados 105 pacientes submetidos a operacoes colorretais eletivas por via de acesso convencional. A media de idade foi de 59,9 anos com predominio do sexo masculino. Oitenta e cinco doentes foram operados por afeccao maligna. A operacao mais realizada foi a retossigmoidectomia com anastomose colorretal. Agua era permitida logo apos o despertar do paciente, e dieta liquida era liberada no dia seguinte e feita a progressao conforme a aceitacao, independentemente da presenca de ruidos hidroaereos ou eliminacao de flatos. Em 14 pacientes (13,3%), interrompeu-se a dieta devido a ocorrencia de nauseas ou vomitos. A mortalidade foi nula. Ocorreram complicacoes em 15 doentes (14,3%). Na serie estudada, a retirada imediata da sondanasogastrica e realimentacao precoce foi pratica segura e bem tolerada pela maioria dos pacientes.

Urinary incontinence: two cases of electronic stimulation after failing the Leadbetter technique.

Two cases of urinary incontinence treated by electrical stimulation after failing the Leadbetter technique are presented. Both were first seen bearing imperforated anus. They suffered several operations for correcting this pathology and further attempting to relieve complete urinary incontinence. After a trial with intrarectal stimulation one of them received an implant. The other continued to use the anal plug. In both cases the result has been satisfactory. Cine radiological documentation of the sphincteric action of the stimulated muscles was performed.