Anastomotic leakage is a complication of colorectal surgery. c-reactive protein (cRp) is an acutephase marker that can indicate surgical complications. We determined whether serum cRp levels in patients who had undergone colorectal surgery can be used to exclude the presence of anastomotic leakage and allow safe early discharge. We included 90 patients who underwent colorectal surgery with primary anastomosis. Serum cRp levels were measured retrospectively on postoperative days (poDs) 1-7. Patients with anastomotic leakage (n = 11) were compared to those without leakage (n = 79). We statistically analysed data and plotted receiver operating characteristic curves. the incidence of anastomotic leakage was 12.2%. Diagnoses were made on PODs 3-24. The overall mortality rate was 3.3% (18.2% in the leakage group, 1.3% in the non-leakage group; P < 0.045). CRP levels were most accurate on POD 4, with a cutoff level of 180 mg/L, showing an area under the curve of 0.821 and a negative predictive value of 97.2%. Lower CRP levels after POD 2 and levels <180 mg/L on POD 4 may indicate the absence of anastomotic leakage and may allow safe discharge of patients who had undergone colorectal surgery with primary anastomosis.
Clostridium difficile infection is a common complication following intestinal dysbiosis caused by abusive antibiotic use. It presents medical importance due to the high rates of recurrence and morbidity. Fecal microbiota transplantation is an effective alternative for the treatment of recurrent and refractory C. difficile infection and consists of introducing the intestinal microbiota from a healthy donor into a patient with this infection. The exact physiological mechanism by which fecal microbiota transplantation alters the intestinal microbiota is not well established, but it is clear that it restores the diversity and structure of the microbiota by promoting increased resistance to colonization by C. difficile. Several routes of transplant administration are being studied and used according to the advantages presented. All forms of application had a high cure rate, and the colonoscopic route was the most used. No relevant complications and adverse events have been documented, and the cost-effectiveness over conventional treatment has proven advantageous. Despite its efficacy, it is not commonly used as initial therapy, and more studies are needed to establish this therapy as the first option in case of refractory and recurrent Clostridium difficileinfection.
Background: Non-melanoma skin cancer is the most frequent tumor in Brazil and the world. One of its forms, squamous cell carcinoma (SCC) predominantly affects the old white population in areas of high exposure to the sun. Most SCCs are indolent, evolving with a cure rate higher than 90% within five years. Rarely, metastasis occurs mainly in regional lymph nodes, but it can also happen in the lungs, liver, brain, skin, and bones. There are currently many treatment options; based on the stratification of the neoplasm as high or low risk, an appropriate approach is defined. Case presentation: This report presents the case of a patient with high-risk squamous cell carcinoma affecting an area not exposed to solar radiation and without any other previous triggering factor, which is quite uncommon for this type of tumor. The rarity of the case stems from the lack of scientific reports on the occurrence of SCC in the axillary region, without a history of local chronic inflammatory lesions. The Portuguese, English, and Spanish languages were used to search the database of the main scientific platforms Pubmed, Cochrane Library, Scielo, and Lilacs, with no results similar to the case reported. Conclusion: Despite the fact that the axillary area is not sun-exposed, squamous cell skin cancer manifested as an extensive lesion that required a complex surgical resection with flap repair. Such findings highlight the importance of a thorough physical exam and work-up to diagnose lesions in their early forms which require simple resection procedures and avoid late diagnoses resulting in complex procedures. Such an approach reduces the risk of various complications like wound infection or dehiscence, flap ischemia, or necrosis, among others.
A intussuscepção jejuno-gástrica é uma rara complicação pós-gastrectomia a Billroth II ou gastrojejunostomia isolada. Apresenta elevada mortalidade quando seu diagnóstico é feito tardiamente. A etiologia mais plausível é a peristalse da alça intestinal. Geralmente apresenta-se com dor epigástrica associada a vômitos com ou sem sangue. Relatamos o caso de um paciente submetido à laparotomia exploradora para tratamento desta patologia. Descritores: Intussuscepção. Gastrectomia. Estômago.
Introdução: Lipoma esofágico é uma patologia extremamente rara e patologicamente benigna. Geralmente são assintomáticos e descobertos incidentalmente em exames de imagem. A principal localização é no terço superior do esôfago. Disfagia, massa regurgitada e sensação de desconforto na gargante são as principais queixas dos pacientes. O tratamento endoscópico é uma opção em lesões pequenas, entretanto, lesões maiores devem ser preferencialmente abordadas por cirurgia convencional. Relato do caso: Relatamos o caso de uma paciente jovem com história de disfagia e dor torácica ha 2 anos. Referia saída de lesão pela cavidade oral após episódio de tosse. Submetida a endoscopia digestiva que evidenciou lesão pediculada esofágica e tomografia computadorizada que visualizou lesão esofágica de 20 centímetros. Com base nesses achados, foi optado pelo tratamento cirúrgico. Conclusão: o lipoma esofágico é uma patologia rara e que geralmente necessita alto índice de suspeição, exame endoscópico e de imagem para o correto diagnóstico. O tratamento cirúrgico e endoscópico são as principais modalidades terapêuticas.
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