PURPOSE: To investigate de adjunctive effect of Hyperbaric Oxygen Therapy in a group of patients with refractory Crohn's disease.

Patients with hematologic malignancies are susceptible to serious complications due to immunosuppression. Neutropenic-related infection is one of the major causes of morbidity and mortality in this group of diseases. Febrile neutropenia is a common complication of the hematologic neoplasm itself or chemotherapy, and has worse prognosis if prolonged (lasting more than 7 days) or severe (neutrophil count below 500 cells per μL). Among the usual sites of infection, we highlight the neutropenic enterocolitis and perianal infection as gastrointestinal complications of greater interest to the colorectal surgeon. Although most cases respond to conservative treatment, a portion of patients will need surgery for complete recovery.

RESUMO -Contexto -A colonoscopia e a polipectomia diminuem a incidência do câncer colorretal, assim como a mortalidade dele decorrente. O intervalo efetivo entre os exames de seguimento é determinado por características clínicas e achados endoscópicos considerados como preditivos para o desenvolvimento de lesões neoplásicas colônicas avançadas. Objetivos -Avaliar a taxa de surgimento de lesões neoplásicas avançadas em pacientes submetidos a colonoscopias de seguimento em serviço de referência. INTRODUÇÃOO câncer colorretal é a quarta neoplasia maligna mais frequente no Brasil e a terceira causa de morte por câncer (4) . O número de óbitos pela doença no nosso País supera o causado por câncer de colo uterino na população feminina (4) . Sua incidência é maior nas regiões mais ricas, particularmente nos estados do sudeste e sul (4,6) . O Ministério da Saúde considera a necessidade crescente de um programa de rastreamento para sua detecção precoce com vistas à diminuição dos índices de mortalidade.A efetividade dos diferentes métodos de rastreamento foi analisada por força-tarefa do Serviço Preventivo dos Estados Unidos. Na ocasião foram estudados e comparados, em relação a custo-efetividade, os exames de sangue oculto nas fezes, retossigmoidoscopia flexível, a combinação dos anteriores, e à colonoscopia (10,12,15,17) . Nos últimos anos, estudos comparativos têm enfatizado e indicado a colonoscopia como o exame inicial para o rastreamento do câncer colorretal devido sua melhor custo-efetividade em relação às outras opções de rastreamento, especialmente se considerados os níveis de adesão vislumbrados na Trabalho realizado na Fundação Rio

PURPOSE:In this paper we report the oncological outcomes from clinical series of patients with rectal cancer submitted to local excision after neoadjuvant therapy and discuss the indications for local excision in partial clinical responders. METHODS:We analysed a prospective database of 39 patients submitted to a transanal endoscopic operation for rectal cancer after neoadjuvant chemoradiation between 2006 and 2015, comparing clinical and pathological variables, perioperative complications, recurrence rate and overall survival. RESULTS:We obtained 15.4% ypT0, 17.9% ypT1, 35.9% ypT2 and 28.2% ypT3. After a median follow-up of 24 months, tumoral recurrence was observed in 4 patients, one of them with isolated pulmonary metastasis. R0 resection was achieved in 79.5%, and postoperative complications were observed in 30.2% patients and no perioperative mortality occur. Compromise surgical margins do not affect recurrence rate, and 94.9% of patients are alive nowadays. CONCLUSION:Local excision could be associated with low recurrence rate and good overall survival. Short hospitalization time and low level of serious complications observed could be an interesting option for patients who would not tolerate a radical procedure or for those who declined a total mesorectal excision. A strict long-term follow-up must be warranted to detect early tumoral recurrence.

Introduction. Abdominal and anorectal disorders may be the cause of clinical decompensation in neutropenic febrile patients, particularly those with hematologic diseases. Infection is a cause for concern for the colorectal surgeon. Some conditions have few manifestations and can lead to death within a short period of time. This study presents the novel colorectal disorder severity score for febrile neutropenic patients. Materials and Methods. This was a case series study analyzing the medical records of 897 patients admitted to the Hematology and Hematopoietic Stem Cell Transplant Unit in a university hospital between the years 2008 and 2013. Seventy-four episodes of febrile neutropenia in 69 patients diagnosed with an abdominal or anorectal infection site were eligible for the study. The new scoring system proposed here is based on the author’s clinical experience and an extensive literature review. In addition to the extensive literature review, effect measures were calculated, and a statistical analysis was performed. Based on an evaluation of common biological plausibility criteria, five factors were selected as the main predictors of hospital mortality in febrile neutropenic patients with colorectal disease. Results. The proposed score demonstrated increased mortality as the condition worsened as reflected by an increasing score (Fisher’s exact test: 0.001). When considering the logistic model for the probability of death by score level, the AUC value was 0.82 (0.72-0.925), and the Hosmer-Lemeshow statistic value was 2.3, p=0.806. Conclusion. The proposed scoring system allows prediction of the likelihood of death during hospitalization for febrile neutropenic patients with an abdominal and anorectal focus. New studies on the subject are required, and the proposed scoring scale must be validated on a larger and different sample of patients.