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[PMID]:28470562
[Au] Autor:Cima RR; Bergquist JR; Hanson KT; Thiels CA; Habermann EB
[Ad] Endereço:Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. cima.robert@mayo.edu.
[Ti] Título:Outcomes are Local: Patient, Disease, and Procedure-Specific Risk Factors for Colorectal Surgical Site Infections from a Single Institution.
[So] Source:J Gastrointest Surg;21(7):1142-1152, 2017 Jul.
[Is] ISSN:1873-4626
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Colorectal surgical site infections (SSIs) contribute to postoperative morbidity, mortality, and resource utilization. Risk factors associated with colorectal SSI are well-documented. However, quality improvement efforts are informed by national data, which may not identify institution-specific risk factors. METHOD: Retrospective cohort study of colorectal surgery patients uses institutional ACS-NSQIP data from 2006 through 2014. ACS-NSQIP data were enhanced with additional variables from medical records. Multivariable logistic regression identified factors associated with SSI development. RESULTS: Of 2376 patients, 213 (9.0%) developed at least one SSI (superficial 4.8%, deep 1.1%, organ space 3.5%). Age < 40, BMI > 30, ASA3+, steroid use, smoking, diabetes, pre-operative sepsis, higher wound class, elevated WBC or serum glutamic-oxalocetic transaminase, low hematocrit or albumin, Crohn's disease, and prolonged incision-to-closure time were associated with increased SSI rate (all P < 0.01). After adjustment, BMI > 30, steroids, diabetes, and wound contamination were associated with SSI. Patients with Crohn's had greater odds of SSI than other indications. CONCLUSION: Institutional modeling of SSI suggests that many previously suggested risk factors established on a national level do not contribute to SSIs at our institution. Identification of institution-specific predictors of SSI, rather than relying upon conclusions derived from external data, is a critical endeavor in facilitating quality improvement and maximizing value of quality investments.
[Mh] Termos MeSH primário: Doenças do Colo/cirurgia
Doenças Retais/cirurgia
Infecção da Ferida Cirúrgica/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Melhoria de Qualidade
Estudos Retrospectivos
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1007/s11605-017-3430-1


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[PMID]:28450390
[Au] Autor:East JE; Atkin WS; Bateman AC; Clark SK; Dolwani S; Ket SN; Leedham SJ; Phull PS; Rutter MD; Shepherd NA; Tomlinson I; Rees CJ
[Ad] Endereço:Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.
[Ti] Título:British Society of Gastroenterology position statement on serrated polyps in the colon and rectum.
[So] Source:Gut;66(7):1181-1196, 2017 07.
[Is] ISSN:1468-3288
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations-serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. : we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years ( ).
[Mh] Termos MeSH primário: Pólipos do Colo/diagnóstico
Pólipos do Colo/cirurgia
Pólipos/diagnóstico
Pólipos/cirurgia
Doenças Retais/diagnóstico
Doenças Retais/cirurgia
[Mh] Termos MeSH secundário: Adenoma/diagnóstico
Adenoma/genética
Adenoma/cirurgia
Polipose Adenomatosa do Colo/diagnóstico
Benchmarking
Biomarcadores/análise
Transformação Celular Neoplásica
Colite/complicações
Pólipos do Colo/genética
Colonoscopia
Ilhas de CpG/genética
DNA/isolamento & purificação
Metilação de DNA
Fezes/química
Seres Humanos
Parassimpatolíticos/uso terapêutico
Pólipos/genética
Lesões Pré-Cancerosas/diagnóstico
Lesões Pré-Cancerosas/cirurgia
Doenças Retais/genética
Terminologia como Assunto
Conduta Expectante
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (Parasympatholytics); 9007-49-2 (DNA)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1136/gutjnl-2017-314005


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[PMID]:27770550
[Au] Autor:Sultan AH; Monga A; Lee J; Emmanuel A; Norton C; Santoro G; Hull T; Berghmans B; Brody S; Haylen BT
[Ad] Endereço:Urogynaecologist and Obstetrician, Croydon University Hospital, Croydon, United Kingdom.
[Ti] Título:An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction.
[So] Source:Neurourol Urodyn;36(1):10-34, 2017 01.
[Is] ISSN:1520-6777
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The terminology for anorectal dysfunction in women has long been in need of a specific clinically-based Consensus Report. METHODS: This Report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted on Committee by experts in their fields to form a Joint IUGA/ICS Working Group on Female Anorectal Terminology. Appropriate core clinical categories and sub classifications were developed to give an alphanumeric coding to each definition. An extensive process of twenty rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for anorectal dysfunction, encompassing over 130 separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific anorectal investigations and imaging (ultrasound, radiology and MRI) has been included whilst appropriate figures have been included to supplement and help clarify the text. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION: A consensus-based Terminology Report for female anorectal dysfunction terminology has been produced aimed at being a significant aid to clinical practice and a stimulus for research. Neurourol. Urodynam. 36:10-34, 2017. © 2016 Wiley Periodicals, Inc., and The International Urogynecological Association.
[Mh] Termos MeSH primário: Canal Anal
Ginecologia/normas
Doenças Retais/classificação
Doenças Retais/fisiopatologia
Terminologia como Assunto
Urologia/normas
[Mh] Termos MeSH secundário: Canal Anal/diagnóstico por imagem
Canal Anal/fisiopatologia
Consenso
Exame Retal Digital
Feminino
Seres Humanos
Doenças Retais/diagnóstico
Doenças Retais/diagnóstico por imagem
Sociedades Médicas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE
[do] DOI:10.1002/nau.23055


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[PMID]:29173260
[Au] Autor:Caycedo-Marulanda A; Jiang HY; Kohtakangas EL
[Ad] Endereço:From the Department of Surgery, Health Sciences North, Sudbury, Ont. (Caycedo-Marulanda, Jiang, Kohtakangas); and the Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, Ont. (Caycedo-Marulanda, Jiang, Kohtakangas).
[Ti] Título:Transanal minimally invasive surgery for benign large rectal polyps and early malignant rectal cancers: experience and outcomes from the first Canadian centre to adopt the technique.
[So] Source:Can J Surg;60(6):416-423, 2017 Dec.
[Is] ISSN:1488-2310
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Transanal minimally invasive surgery (TAMIS) has emerged as a relatively new technique in treating early cancer and benign lesion of the rectum. The technique is likely to be widely adopted, surpassing other comparable techniques owing to its simple setup and cost-effectiveness. We assessed the outcomes of TAMIS at our centre. METHODS: We retrospectively reviewed prospectively collected data on 50 patients who underwent TAMIS for benign, malignant T1 or T2 cancers that were unfit for radical surgery over a 4-year period. Outcomes, including 30-day complications and recurrence, as well as our ability to implement and integrate this technique at our centre were assessed. RESULTS: All 50 TAMIS procedures were successful. The average lesion was 7 cm from the anal verge, the average tumour size was 2.5 cm, the average duration of surgery was 73 minutes, the average length of stay was 1.1 days, and the margin negativity was 84%. Major indications in our series included 25 lesions that were too large for endoscopic resection, 14 early cancers or high-grade dysplasia, 10 margin checks postpolypectomy, 6 cases of recurrent polyposis, and 4 medically unfit patients. There were no deaths. The rate of short-term complications, including rectal bleeding, reoperation and urinary retention, was 16%. The rate of long-term complications, including anal incontinence and stenosis, was 4%. Benign and malignant recurrence rates were 2% and 6%, respectively. Overall long-term requirement for invasive procedures, low anterior resection or abdominoperineal resection, was 12%. CONCLUSION: To our knowledge, this is the first Canadian study showing TAMIS to be an efficient and safe procedure for the treatment of well-selected patients with rectal lesions. Outcomes from our centre are comparable with those found in the literature.
[Mh] Termos MeSH primário: Pólipos/cirurgia
Doenças Retais/cirurgia
Neoplasias Retais/cirurgia
Cirurgia Endoscópica Transanal
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Estadiamento de Neoplasias
Neoplasias Retais/patologia
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:29202966
[Au] Autor:Donnez O; Roman H
[Ad] Endereço:Institut du sein et de Chirurgie gynécologique d'Avignon, Polyclinique Urbain V (Elsan Group), Avignon, France, and Pôle de recherche en gynécologie, IREC institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. Electronic address: pr.olivier.donnez@gmail.com.
[Ti] Título:Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection?
[So] Source:Fertil Steril;108(6):931-942, 2017 Dec.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Deep endometriosis (DE) remains the most difficult endometriotic entity to treat. Medical treatment for DE can reduce symptoms but does not cure the disease, and surgical removal of the lesion is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Although several surgical techniques such as laparoscopic bowel resection, disc excision, and rectal shaving have been described, there is no consensus regarding the choice of technique or the timing of surgery. Our review of publications reporting results and complications of surgery for rectovaginal DE reveals a relatively higher complication rate after bowel resection compared with shaving and disc excision, especially for rectovaginal fistulas, anastomotic leakage, delayed hemorrhage, and long-term bladder catheterization. Data show that shaving is feasible even in advanced disease. The risk of immediate complications after shaving and disc excision is probably lower than after colorectal resection, allowing for better functional outcomes. The presumed higher risk of recurrence related to shaving has not been demonstrated. For these reasons, surgeons should consider rectal shaving as a first-line surgical treatment of rectovaginal DE, regardless of nodule size or association with other digestive localizations. When the result of rectal shaving is unsatisfactory (rare cases), disc excision may be performed either exclusively by laparoscopy or by using transanal staplers. Segmental resection may ultimately be reserved for advanced lesions responsible for major stenosis or for several cases of multiple nodules infiltrating the rectosigmoid junction or sigmoid colon.
[Mh] Termos MeSH primário: Tomada de Decisão Clínica
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Endometriose/cirurgia
Procedimentos Cirúrgicos em Ginecologia/métodos
Laparoscopia
Seleção de Pacientes
Doenças Retais/cirurgia
Doenças Vaginais/cirurgia
[Mh] Termos MeSH secundário: Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Endometriose/complicações
Endometriose/diagnóstico
Feminino
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos
Seres Humanos
Laparoscopia/efeitos adversos
Masculino
Complicações Pós-Operatórias/etiologia
Doenças Retais/diagnóstico
Fatores de Risco
Resultado do Tratamento
Doenças Vaginais/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE


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[PMID]:29202965
[Au] Autor:Vercellini P; Buggio L; Somigliana E
[Ad] Endereço:Department of Clinical Sciences and Community Health, Università degli Studi; and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: paolo.vercellini@unimi.it.
[Ti] Título:Role of medical therapy in the management of deep rectovaginal endometriosis.
[So] Source:Fertil Steril;108(6):913-930, 2017 Dec.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Defining whether medical therapy is effective in women with deep rectovaginal endometriosis and in which circumstances it can be considered an alternative to surgery is important for patients and physicians. Numerous observational and some randomized controlled studies demonstrated that different hormonal drugs improved pain and other symptoms in approximately two-thirds of women with deep rectovaginal endometriosis. Because major differences in the effect size of various compounds were not observed, much importance should be given to safety, tolerability, and cost of medications when counseling patients. Progestins seem to offer the best therapeutic balance when long-term treatments are planned. Women should be informed that hormonal drugs control but do not cure endometriosis and that, to avoid surgery, they should be used for years. Medical therapy is not an alternative to surgery in women with hydronephrosis, severe subocclusive bowel symptoms, and in those wishing a natural conception. A progestin should systematically be chosen as a comparator in future randomized trials on novel medications for deep endometriosis. In the meantime, the use of existing drugs should be optimized, and medical and surgical treatments could be viewed as subsequent stages of a stepwise approach. In general, there is no absolute "best" choice, and women must be thoroughly informed of potential benefits, potential harms, and costs of different therapeutic options and allowed to choose what they deem is better for them.
[Mh] Termos MeSH primário: Endometriose/tratamento farmacológico
Endométrio/efeitos dos fármacos
Hormônios/uso terapêutico
Doenças Retais/tratamento farmacológico
Doenças Vaginais/tratamento farmacológico
[Mh] Termos MeSH secundário: Animais
Biópsia
Colposcopia
Endometriose/complicações
Endometriose/diagnóstico
Endometriose/fisiopatologia
Endométrio/patologia
Endométrio/fisiopatologia
Estrogênios/uso terapêutico
Feminino
Hormônios/efeitos adversos
Seres Humanos
Progestinas/uso terapêutico
Doenças Retais/complicações
Doenças Retais/diagnóstico
Doenças Retais/fisiopatologia
Resultado do Tratamento
Doenças Vaginais/complicações
Doenças Vaginais/diagnóstico
Doenças Vaginais/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Estrogens); 0 (Hormones); 0 (Progestins)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE


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[PMID]:28745710
[Au] Autor:Krylov NN; Lyatifova LV
[Ad] Endereço:First Moscow State medical University named after I.M. Sechenov, Moscow, Russia.
[Ti] Título:[Autoplasmotherapy in coloproctology].
[Ti] Título:Autoplazmoterapiia v koloproktologii..
[So] Source:Khirurgiia (Mosk);(7):61-64, 2017.
[Is] ISSN:0023-1207
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Mh] Termos MeSH primário: Terapia Biológica/métodos
Doenças do Colo/terapia
Plasma Rico em Plaquetas
Doenças Retais/terapia
[Mh] Termos MeSH secundário: Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171130
[Lr] Data última revisão:
171130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.17116/hirurgia2017761-64


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[PMID]:28803643
[Au] Autor:Gani F; Cerullo M; Zhang X; Canner JK; Conca-Cheng A; Hartzman AE; Husain SG; Cirocco WC; Traugott AL; Arnold MW; Johnston FM; Pawlik TM
[Ad] Endereço:Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
[Ti] Título:Effect of surgeon "experience" with laparoscopy on postoperative outcomes after colorectal surgery.
[So] Source:Surgery;162(4):880-890, 2017 Oct.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although the relationship between laparoscopic surgery and improved clinical outcomes has been well established across a variety of procedures, the effect of operative experience with laparoscopic surgery remains less defined. The present study sought to assess the comparative benefit of laparoscopic colorectal surgery relative to surgeon volume. METHODS: Commercially insured patients aged 18 to 64 years undergoing a colorectal resection were identified using the MarketScan Database from 2010-2014. Multivariable logistic regression analysis was used to calculate and compare postoperative mortality/morbidity by operative approach relative to surgeon volume. RESULTS: A total of 21,827 patients were identified who met inclusion criteria. The median age among patients was 53 years (interquartile range: 46-59) with a slight majority of patients being female (n = 11,248, 51.5%). Laparoscopic operations were performed in 49.2% of patients (n = 10,756), whereas 50.7% (n = 11,071) underwent an open colorectal resection. On multivariable analysis, laparoscopic surgery was associated with 64% decreased odds of developing a postoperative complication or mortality (odds ratio = 0.36, 95% confidence interval, 0.32-0.41, P < .001). Patients who underwent colectomy performed by a higher operative volume surgeon (high versus low: odds ratio = 0.68, 95% confidence interval, 0.61-0.77, P < .001) demonstrated decreased odds of developing a postoperative complication/mortality. Interestingly the potential decrease in risk-adjusted morbidity/mortality between laparoscopic and open surgery was somewhat greater among high-operative-volume surgeons (odds ratio = 0.29, 95% confidence interval, 0.25-0.34, P < .001) and intermediate-operative-volume surgeons (odds ratio = 0.30, 95% confidence interval, 0.25-0.36, P < .001) compared with low-operative-volume surgeons (odds ratio = 0.36, 95% confidence interval, 0.32-0.41, P < .001). CONCLUSION: Although laparoscopic surgery was associated with improved postoperative clinical outcomes, the effect of laparoscopic surgery varied somewhat according to surgeon volume.
[Mh] Termos MeSH primário: Competência Clínica
Doenças do Colo/cirurgia
Laparoscopia
Doenças Retais/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Colectomia
Doenças do Colo/mortalidade
Doenças do Colo/patologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Padrões de Prática Médica
Doenças Retais/mortalidade
Doenças Retais/patologia
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE


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[PMID]:28705066
[Au] Autor:Dwarkasing RS; Verschuuren SI; van Leenders GJLH; Braun LMM; Krestin GP; Schouten WR
[Ad] Endereço:1 Department of Radiology and Nuclear Medicine, Section of Abdominal Imaging, Erasmus MC, University Hospital Rotterdam, Rm Ca-220, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
[Ti] Título:Primary Cystic Lesions of the Retrorectal Space: MRI Evaluation and Clinical Assessment.
[So] Source:AJR Am J Roentgenol;209(4):790-796, 2017 Oct.
[Is] ISSN:1546-3141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The purpose of this study was to assess the a priori chance that primary cystic lesions of the retrorectal space are malignant and to investigate MRI characteristics that indicate malignancy. MATERIALS AND METHODS: Patients referred to a center for colorectal surgery were recruited from 2000 to 2014. Lesions were proven by clinical assessment and histopathology. MRI was performed at 1.5 T with examinations evaluated by two radiologists. Interobserver agreement was assessed (Cohen kappa) and differences between malignant and benign lesions calculated (Fisher exact test). RESULTS: Twenty-eight patients (22 women, six men; age range, 18-70 years) with 31 lesions were included. Lesions were categorized as tailgut cysts (n = 16, 52%), teratomas (n = 9, 29%), lesions of colorectal origin (n = 4, 13%), or neurogenic lesions (n = 2, 6%). Five patients (18%) had malignant lesions. Colorectal lesions had the highest percentage of malignancy (3/4, 75%). A solid tissue component was found in all five (100%) malignant lesions and two (8%) of the benign lesions, which were both teratomas (p < 0.05). Sensitivity and specificity for malignancy according to the presence of a solid tissue component was 100% (5/5) and 92% (24/26). For unilocularity, multilocularity, debris, septa, and wall thickening, differences were not significant. Interobserver agreement was excellent (κ = 1) for all characteristics except debris (κ = 0.795). CONCLUSION: The majority of retrorectal cystic lesions are benign. The presence of a solid tissue component should raise suspicion for malignancy.
[Mh] Termos MeSH primário: Cistos/diagnóstico por imagem
Imagem por Ressonância Magnética
Doenças Retais/diagnóstico por imagem
Neoplasias Retais/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.2214/AJR.16.17329


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[PMID]:28690206
[Au] Autor:Ohman KA; Wan L; Guthrie T; Johnston B; Leinicke JA; Glasgow SC; Hunt SR; Mutch MG; Wise PE; Silviera ML
[Ad] Endereço:Department of Surgery, Washington University School of Medicine, St Louis, MO.
[Ti] Título:Combination of Oral Antibiotics and Mechanical Bowel Preparation Reduces Surgical Site Infection in Colorectal Surgery.
[So] Source:J Am Coll Surg;225(4):465-471, 2017 Oct.
[Is] ISSN:1879-1190
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgical site infections (SSI) are a common complication after colorectal surgery. An infection prevention bundle (IPB) was implemented to improve outcomes. STUDY DESIGN: A standardized IPB that included the administration of oral antibiotics with a mechanical bowel preparation, preoperative shower with chlorhexidine, hair removal and skin preparation in holding, antibiotic wound irrigation, and a "clean-closure" protocol was implemented in January 2013. Data from the American College of Surgeons NSQIP were analyzed at a single academic institution to compare pre-IPB and post-IPB SSI rates. In January 2014, a prospective database was implemented to determine compliance with individual IPB elements and their effect on outcomes. RESULTS: For the 24 months pre-IPB, the overall SSI rate was 19.7%. During the 30 months after IPB implementation, the SSI rate decreased to 8.2% (p < 0.0001). A subset of 307 patients was identified in both NSQIP and our prospective compliance databases. Elements of IPB associated with decreased SSI rates included preoperative shower with chlorhexidine (4.6% vs 16.2%; p = 0.005), oral antibiotics (3.4% vs 15.4%; p < 0.001), and mechanical bowel preparation (4.4% vs 14.3%; p = 0.008). Patients who received a full bowel preparation of both oral antibiotics and a mechanical bowel preparation had a 2.7% SSI rate compared with 15.8% for all others (p < 0.001). On multivariate analysis, full bowel preparation was independently associated with significantly fewer SSI (adjusted odds ratio 0.2; 95% CI 0.1 to 0.9; p = 0.006). CONCLUSIONS: Implementation of an IPB was successful in decreasing SSI rates in colorectal surgery patients. The combination of oral antibiotics with a mechanical bowel preparation was the strongest predictor of decreased SSI.
[Mh] Termos MeSH primário: Antibioticoprofilaxia
Catárticos/uso terapêutico
Doenças do Colo/cirurgia
Cuidados Pré-Operatórios
Doenças Retais/cirurgia
Infecção da Ferida Cirúrgica/prevenção & controle
[Mh] Termos MeSH secundário: Administração Oral
Adulto
Idoso
Antibacterianos/administração & dosagem
Protocolos Clínicos
Feminino
Seres Humanos
Laparoscopia
Masculino
Meia-Idade
Infecção da Ferida Cirúrgica/epidemiologia
Irrigação Terapêutica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cathartics)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170711
[St] Status:MEDLINE



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