RESUMOEstomas intestinais consistem na exteriorização do íleo ou cólon para o meio externo através da parede abdominal. Anastomoses intestinais são suturas entre dois segmentos do tubo digestivo para a reconstituição do trânsito intestinal. Tipos, classificação, indicações, complicações e a técnica são discutidos.Palavras-chave: Estomas Cirúrgicos. Ileostomia. Colostomia. Anastomoses intestinais. Simpósio: FUNDAMENTOS EM CLÍNICA CIRÚRGICA -3ª ParteCapítulo V Tipos e classificação dos estomas intestinaisOs estomas intestinais podem ser temporários (transitórios) ou definitivos (permanentes).Quanto ao modo de exteriorização na parede abdominal, pode-se fazê-los de duas maneiras: 1 -em alça (duas bocas), há exteriorização de toda a alça e abertura apenas de sua parede anterior, ficando duas bocas unidas pela parede posterior; 2-terminal (uma boca), nessa situação exterioriza-se a alça já seccionada com apenas uma boca. IndicaçõesObstruções intestinais: agenesias e atresias anorretais, megacólon congênito (doença de Hirschsprung), neoplasias, volvo, doença diverticular, colite isquêmica. Definição Definição Definição Definição DefiniçãoExteriorização do íleo ou do cólon para o meio externo através da parede abdominal por tempo indeterminado Introdução Introdução Introdução Introdução IntroduçãoA confecção de um estoma intestinal é um procedimento comum nas cirurgias do trato digestivo. Os estomas do segmento distal do intestino delgado (íleo) são denominados ileostomias e os do intestino grosso são as colostomias.Os estomas intestinais são feitos em alças com mobilidade e comprimento adequados, que facilitem sua exteriorização através da parede abdominal. Dessa maneira os segmentos mais apropriados para a confecção de um estoma intestinal são o íleo, o cólon transverso e o sigmóide.

BACKGROUNDInflammatory bowel diseases (IBD) have been associated with a low quality of life (QoL) and a negative impact on work productivity compared to the general population. Information about disease control, patient-reported outcomes (PROs), treatment patterns and use of healthcare resources is relevant to optimizing IBD management.AIMTo describe QoL and work productivity and activity impairment (WPAI), treatment patterns and use of healthcare resources among IBD patients in Brazil.METHODSA multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn’s disease (CD) or ulcerative colitis (UC). At enrolment, active CD and UC were defined as having a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or calprotectin > 200 µg/g or previous colonoscopy results suggestive of inadequate control (per investigator criteria) and a 9-point partial Mayo score ≥ 5, respectively. The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L, the Inflammatory Bowel Disease Questionnaire (IBDQ), and the WPAI questionnaire. Information about healthcare resources and treatment during the previous 3 years was collected from medical records. Chi-square, Fisher’s exact and Student’s t-/Mann-Whitney U tests were used to compare PROs, treatment patterns and the use of healthcare resources by disease activity (α = 0.05).RESULTSOf the 407 patients in this study (CD/UC: 64.9%/35.1%, mean age 42.9/45.9 years, 54.2%/56.6% female, 38.3%/37.1% employed), 44.7%/25.2% presented moderate-to-severe CD/UC activity, respectively, at baseline. Expressed in median values for CD/UC, respectively, the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2, the EQ-visual analog scale score was 80.0/70.0, and the IBDQ overall score was 164.0/165.0. Moderate to severe activity, female gender, being unemployed, a lower educational level and lower income were associated with lower QoL (P < 0.05). Median work productivity impairment was 20% and 5% for CD and UC patients, respectively, and activity impairment was 30%, the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity (75.0% vs 10.0%, P < 0.001). For CD/UC patients, respectively, 25.4%/2.8% had at least one surgery, 38.3%/19.6% were hospitalized, and 70.7%/77.6% changed IBD treatment at least once during the last 3 years. The most common treatments at baseline were biologics (75.3%) and immunosuppressants (70.9%) for CD patients and 5-ASA compounds (77.5%) for UC patients.CONCLUSIONModerate to severe IBD activity, especially among CD patients, is associated with a substantial impact on QoL, work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.

No abstract

The objective of this study was to investigate whether serum cytokine levels correlate with depression and anxiety in colorectal cancer (CRC) patients. Twenty patients hospitalized for surgical resection of CRC were included in the study group and twenty healthy volunteers comprised the control group. Depression and anxiety were analyzed using the Hospital Anxiety and Depression Scale (HADS), and serum levels of IL-1β, IL-6, IL-8, IL-10, IL-12, TNF-α, and TGF-β were measured by Cytometric Bead Array. We found that more than half of CRC patients presented clinically significant levels of anxiety or depression, and 65% of them manifested a combination of severe anxiety and depression. CRC patients had increased serum levels of IL-1β, IL-6, IL-8, and TNF-α but lower IL-10 concentrations. Correlation analysis between HADS score and cytokine levels revealed a positive association of anxiety and/or depression with IL-1β, IL-6, IL-8, and TNF-α and a negative correlation with IL-10. These results indicate that circulating proinflammatory cytokines are involved in the pathophysiology of anxiety and depression in CRC patients. A better understanding of the molecular mechanisms involved in these psychological disorders will allow the design of therapeutic interventions that lead to an improved quality of life and overall survival of CRC patients.