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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

The role of DNA methylation in the development of colorectal neoplasia

Wong, Justin Jong Leong, Medical Sciences, Faculty of Medicine, UNSW January 2008 (has links)
DNA methylation is increasingly recognised as a significant epigenetic event that may initiate and drive the process of neoplasia in humans. In the colon, DNA methylation of key genes is common in a subset of colorectal cancers. The extent to which DNA methylation at various genes contributes to initiation of colorectal neoplasms is less clear. This study sought to clarify the biological and clinicopathological significance of methylation of various genes in the development of sporadic and familial colorectal neoplasia. Quantitative methylation-specific PCR (qMSP) assays (capable of detecting down to a measureable proportion of 0.1% of the total input DNA) were developed to determine the presence of CpG methylation at a given gene. Methylation of MLH1-C was found in the apparently normal mucosa samples from seven of 104 (7%) of individuals with sporadic colorectal cancer (CRC) showing microsatellite instability (MSI). No methylation of MLH1-C was found in the biological samples of individuals with microsatellite stable (MSS) counterparts (n=131). MLH1-C methylation may be a field defect that predisposes to the development of sporadic colorectal neoplasia, particularly those demonstrating MSI. Methylation of three of five genes within the 3p22 region including AB002340, MLH1, ITGA9, PLCD1 and DLEC1 (regional 3p22 methylation) was found in 83% of sporadic MSI (n=86) and 12% of MSS cancers demonstrating BRAF V600E mutation (n=42). Regional 3p22 correlated strongly with CpG island methylator phenotype (CIMP), and other clinicopathological characteristics typical of CIMP. Thus, regional 3p22 methylation and CIMP may be overlapping phenomena. Regional 3p22 methylation and the BRAF V600E mutation were found in normal colonic mucosa of four individuals with sporadic MSI CRC, and these cases also had multiple synchronous serrated polyps. These molecular aberrancies may predispose some individuals to the development of metachronous serrated neoplasia. Germline epimutations of APC do not contribute towards the development of FAP, AFAP, or hyperplastic polyposis syndromes. However, APC methylation in normal colonic mucosa of these individuals may represent a field defect in the development of futher neoplasms. In conclusion, different patterns of DNA methylation in normal colonic mucosa may represent a field defect important in the development of different subtypes of colorectal neoplasia.
2

The role of DNA methylation in the development of colorectal neoplasia

Wong, Justin Jong Leong, Medical Sciences, Faculty of Medicine, UNSW January 2008 (has links)
DNA methylation is increasingly recognised as a significant epigenetic event that may initiate and drive the process of neoplasia in humans. In the colon, DNA methylation of key genes is common in a subset of colorectal cancers. The extent to which DNA methylation at various genes contributes to initiation of colorectal neoplasms is less clear. This study sought to clarify the biological and clinicopathological significance of methylation of various genes in the development of sporadic and familial colorectal neoplasia. Quantitative methylation-specific PCR (qMSP) assays (capable of detecting down to a measureable proportion of 0.1% of the total input DNA) were developed to determine the presence of CpG methylation at a given gene. Methylation of MLH1-C was found in the apparently normal mucosa samples from seven of 104 (7%) of individuals with sporadic colorectal cancer (CRC) showing microsatellite instability (MSI). No methylation of MLH1-C was found in the biological samples of individuals with microsatellite stable (MSS) counterparts (n=131). MLH1-C methylation may be a field defect that predisposes to the development of sporadic colorectal neoplasia, particularly those demonstrating MSI. Methylation of three of five genes within the 3p22 region including AB002340, MLH1, ITGA9, PLCD1 and DLEC1 (regional 3p22 methylation) was found in 83% of sporadic MSI (n=86) and 12% of MSS cancers demonstrating BRAF V600E mutation (n=42). Regional 3p22 correlated strongly with CpG island methylator phenotype (CIMP), and other clinicopathological characteristics typical of CIMP. Thus, regional 3p22 methylation and CIMP may be overlapping phenomena. Regional 3p22 methylation and the BRAF V600E mutation were found in normal colonic mucosa of four individuals with sporadic MSI CRC, and these cases also had multiple synchronous serrated polyps. These molecular aberrancies may predispose some individuals to the development of metachronous serrated neoplasia. Germline epimutations of APC do not contribute towards the development of FAP, AFAP, or hyperplastic polyposis syndromes. However, APC methylation in normal colonic mucosa of these individuals may represent a field defect in the development of futher neoplasms. In conclusion, different patterns of DNA methylation in normal colonic mucosa may represent a field defect important in the development of different subtypes of colorectal neoplasia.
3

A colonoscopia com e sem auxílio de métodos de cromoscopia no diagnóstico das lesões planas, deprimidas e elevadas do cólon e reto / Colonoscopy making or not use of chromoscopy methods on the diagnosis of flat, depressed and augmented colorectal lesions

Tafner, Edmar 16 March 2011 (has links)
O câncer colorretal (CCR) é uma das maiores causas de óbito no mundo industrializado, com uma incidência anual de 800.000 casos novos, o que significa 8,5% de todos os novos e 12% das mortes relacionadas a essa doença. No Brasil, excluindo-se os cânceres de pele não melanoma, o CCR é o quarto mais freqüente entre os homens e o terceiro entre as mulheres. O risco de desenvolver CCR é de aproximadamente 5% a 6% na população ocidental. Existem evidências epidemiológicas de redução do CCR em 60% -90% quando a colonoscopia com polipectomia é usada preventivamente A colonoscopia ainda é o melhor método para o diagnóstico precoce do CCR e das lesões precursoras. Contudo existem falhas de detecção não desprezíveis. O objetivo deste estudo foi comparar o resultado do exame detalhado da mucosa do cólon e do reto através da colonoscopia convencional, da cromoendoscopia e do NBI, na detecção de lesões elevadas, deprimidas e planas em pacientes submetidos ao exame sem antecedentes pessoais e ou familiares. Entre janeiro de 2007 e outubro de 2009 foram selecionados 181 pacientes divididos aleatoriamente em três grupos: A: 48 pacientes, controle; B: 29 pacientes, NBI; C: 104 pacientes, cromoscopia difusa. Pode-se observar que dos 181 pacientes examinados 38 (21%) não apresentavam lesões. Os 143 pacientes com lesão, apresentaram um número médio de 2,65 lesões, com mínimo de 1 e máximo de 7 lesões. Nos total dos 181 pacientes e no conjunto dos 143 pacientes com lesões não foi observada diferença estatisticamente significante entre os três grupos A, B e C para a idade, o tempo reto-ceco e o tempo ceco-reto, enquanto que para a altura, peso e conseqüente IMC houve variação estatística. O tamanho médio das 379 lesões encontradas nos 143 pacientes, avaliado pelo seu diâmetro foi de 5,45 ± 2,84 mm, sem variação estatística entre os grupos, entre os hemicólons e entre os hemicólons nos grupos. Os tamanhos das lesões foram reunidos em três intervalos distintos: até 5 mm (76,30%), de 6 a 10 mm (19,50%) e de 11 a 20 mm (4,20%). Do total de 379 lesões, 203 (53,6%) mostraram-se neoplásicas e 176 (46,4%) não neoplásicas. O tamanho médio das 203 lesões neoplásicas foi de 5,96 mm, e das 176 não neoplásicas, 4,87 mm. As lesões neoplásicas mostraram-se maiores que as não neoplásicas, com significância estatística. Nos grupos não houve variação significante entre neoplasia e não neoplasia, mas diferença significante entre o tamanho das neoplasias e não neoplasias. Não houve diferença estatística entre os tamanhos das lesões nos dois hemicólons, mas com diferença significante entre os tamanhos das lesões neoplásicas e não neoplásicas. O mesmo se observa quando os segmentos do cólon são analisados individualmente. Os dois segmentos que apresentaram diferença significante, especificamente, quanto ao tamanho das lesões neoplásicas e não neoplásicos foram o sigmóide e o transverso. Nota-se que todas as lesões subpediculadas e as lesões plano-elevadas com depressão central eram neoplásicas. As lesões planas e neoplásicas são proporcionalmente mais visíveis no hemicólon direito nos grupos B (85,7%) e C (67,9%), sem diferença estatística. As hipóteses diagnósticas das lesões feitas durante o exame colonoscópico foram comparadas com os resultados histopatológicos. Pode-se observar que no grupo A sensibilidade de 82,7%, especificidade de 59%, com taxa de concordância de 72,5 %, considerada regular, no grupo B sensibilidade de 92,3%, especificidade de 61,9%, com concordância de 78,7 %, regular e no C sensibilidade de 88,8%, especificidade de 79,3%, taxa de concordância de 84,2%, considerada boa. Proporcionalmente o grupo C tem maior número de pacientes com três ou mais lesões e três ou mais lesões neoplásicas, mas sem valor estatístico. Conclui-se que não houve diferença estatística entre os 181 pacientes examinados e os 143 pacientes com lesões, quanto aos dados gerais, não houve diferenças significativas quanto ao número relativo, ao tipo e ao tamanho das lesões. As lesões neoplásicas apresentam-se maiores quando comparadas às não-neoplásicas, com significância estatística. A concordância entre a hipótese diagnóstica colonoscópica e a histologia é maior no grupo da cromoscopia / Colorectal cancer (CRC) is one of the largest causes of death on the industrialized world. Its annual incidence of 800.000 new cases means 8,5% of all the new ones and 12% of deaths related to this disease. In Brazil, excluding the non-melanoma skin-cancers, CRC is the fourth more frequent among men and the third one among women. The risk for developping CRC is approximately of 5 to 6% on the Western population. There are epidemiological evidences for reducing CRC on 60-90% when colonoscopy with polypectomy is used preventively. Colonoscopy is still the best method both for the early dyagnosis of CRC and precursor lesions. However, there are non-contemptible failures on the detection. This paper purpose was comparing the result of colon and rectum mucous membrane detailed test through conventional colonoscopy, chromoendoscopy and NBI, on the detection of augmented, depressed and flat lesions in patients submitted to it without any personal or familiar antecedents. Between January 2007 and October 2009 181 patients were selected randomically and divided into 3 groups: A: 48 control patients; B: 29 patients, NBI; C: 104 patients, diffuse chromoscopy. It is observed that, from the 181 examined patients, 38 (21%) didnt present lesions. The 143 patients with lesion, presented an average number of 2,65 lesions, with a minimum of 1 and a maximum of 7 lesions. On the total of the 181 patients and on the whole of the 143 patients with lesions it was not observed any statistically significant difference among the three groups A, B and C as for Age, the Rectum-Cecum Time and the Cecum-Rectum Time, while there was a statistical variation for Height, Weight and consequent bmi. The average size of the 379 lesions found on the 143 patients, assessed by its diameter was of 5,45 mm (2.14 in.) + 2,84 mm (1,11 in), without any statistical variation among the groups, among the hemicolons and among the hemicolons in the groups. The size of the lesions were gathered into three distinct intervals: up to 5 mm [1.9 in.] (76,30%), from 6 mm [2.3 in.] to 10 mm [3.9 in] (19,50%) and from 11 to 20 mm [4.3 to 7.8 in] (4,20%). From the total of 379 lesions, 203 (53,6%) revealed themselves neoplastic and 176 (46,4%) non-neoplastic. The average size of the 203 neoplastic lesions was of 5,96 mm (2.34 in.), and of the 176 non-neoplastic ones, 4,87 mm [12,36 in]. Neoplastic lesions have shown larger than the non-neoplastic ones, with a stastistical significance. On the groups there is any significant variation between neoplasia and non-neoplasia, but a significant difference between the neoplasias and non-neoplasias size. There was any statistical difference among the lesion size on both hemicolons, however, a significant difference among the sizes of neoplastic and non-neoplastic ones. The same is observed when colon segments were analyzed individually. The two segments that have presented significant lesions, specifically on what concerns the size of neoplastic and non-neoplastic ones were the Sigmoid and the Transverse. It is observed that all the subpediculated lesions and the flat-augmented ones with a central depression were neoplastics. The flat and neoplastic lesions are proportionally more visible on the right hemicolon at groups B (85,7%) and C (67,9%), without any statistical difference. The diagnostic hypotheses of the lesions grown during the colonoscopic test were compared to the histopathological results. On control group (A) it is observed a 82,7% sensibility, a 59% specificity with a concordance rate of 72,5%, considered regular. On group B it is observed a 92,3% sensibility, a 61,9% specificity, with a regular concordance rate of 78,7%. On group C it is observed a 88,8% sensibility, a 79,3% specificity, a 84,2% concordance rate, considered good. Proportionally group C has a larger number of patients with 3 or more lesions and or more neoplastic lesions, but with no statistical value. On what concerns general data, it is concluded that there wasnt any statistical difference among the 181 patients examined and the 143 ones presenting lesions as for the relative number, the type and size of the lesions. Neoplastic lesions appear to be larger when compared to non-neoplastic ones, with a statistical significance. The concordance between the colonoscopic diagnostic hypothesis and the histology is larger on chromoscopy group
4

A colonoscopia com e sem auxílio de métodos de cromoscopia no diagnóstico das lesões planas, deprimidas e elevadas do cólon e reto / Colonoscopy making or not use of chromoscopy methods on the diagnosis of flat, depressed and augmented colorectal lesions

Edmar Tafner 16 March 2011 (has links)
O câncer colorretal (CCR) é uma das maiores causas de óbito no mundo industrializado, com uma incidência anual de 800.000 casos novos, o que significa 8,5% de todos os novos e 12% das mortes relacionadas a essa doença. No Brasil, excluindo-se os cânceres de pele não melanoma, o CCR é o quarto mais freqüente entre os homens e o terceiro entre as mulheres. O risco de desenvolver CCR é de aproximadamente 5% a 6% na população ocidental. Existem evidências epidemiológicas de redução do CCR em 60% -90% quando a colonoscopia com polipectomia é usada preventivamente A colonoscopia ainda é o melhor método para o diagnóstico precoce do CCR e das lesões precursoras. Contudo existem falhas de detecção não desprezíveis. O objetivo deste estudo foi comparar o resultado do exame detalhado da mucosa do cólon e do reto através da colonoscopia convencional, da cromoendoscopia e do NBI, na detecção de lesões elevadas, deprimidas e planas em pacientes submetidos ao exame sem antecedentes pessoais e ou familiares. Entre janeiro de 2007 e outubro de 2009 foram selecionados 181 pacientes divididos aleatoriamente em três grupos: A: 48 pacientes, controle; B: 29 pacientes, NBI; C: 104 pacientes, cromoscopia difusa. Pode-se observar que dos 181 pacientes examinados 38 (21%) não apresentavam lesões. Os 143 pacientes com lesão, apresentaram um número médio de 2,65 lesões, com mínimo de 1 e máximo de 7 lesões. Nos total dos 181 pacientes e no conjunto dos 143 pacientes com lesões não foi observada diferença estatisticamente significante entre os três grupos A, B e C para a idade, o tempo reto-ceco e o tempo ceco-reto, enquanto que para a altura, peso e conseqüente IMC houve variação estatística. O tamanho médio das 379 lesões encontradas nos 143 pacientes, avaliado pelo seu diâmetro foi de 5,45 ± 2,84 mm, sem variação estatística entre os grupos, entre os hemicólons e entre os hemicólons nos grupos. Os tamanhos das lesões foram reunidos em três intervalos distintos: até 5 mm (76,30%), de 6 a 10 mm (19,50%) e de 11 a 20 mm (4,20%). Do total de 379 lesões, 203 (53,6%) mostraram-se neoplásicas e 176 (46,4%) não neoplásicas. O tamanho médio das 203 lesões neoplásicas foi de 5,96 mm, e das 176 não neoplásicas, 4,87 mm. As lesões neoplásicas mostraram-se maiores que as não neoplásicas, com significância estatística. Nos grupos não houve variação significante entre neoplasia e não neoplasia, mas diferença significante entre o tamanho das neoplasias e não neoplasias. Não houve diferença estatística entre os tamanhos das lesões nos dois hemicólons, mas com diferença significante entre os tamanhos das lesões neoplásicas e não neoplásicas. O mesmo se observa quando os segmentos do cólon são analisados individualmente. Os dois segmentos que apresentaram diferença significante, especificamente, quanto ao tamanho das lesões neoplásicas e não neoplásicos foram o sigmóide e o transverso. Nota-se que todas as lesões subpediculadas e as lesões plano-elevadas com depressão central eram neoplásicas. As lesões planas e neoplásicas são proporcionalmente mais visíveis no hemicólon direito nos grupos B (85,7%) e C (67,9%), sem diferença estatística. As hipóteses diagnósticas das lesões feitas durante o exame colonoscópico foram comparadas com os resultados histopatológicos. Pode-se observar que no grupo A sensibilidade de 82,7%, especificidade de 59%, com taxa de concordância de 72,5 %, considerada regular, no grupo B sensibilidade de 92,3%, especificidade de 61,9%, com concordância de 78,7 %, regular e no C sensibilidade de 88,8%, especificidade de 79,3%, taxa de concordância de 84,2%, considerada boa. Proporcionalmente o grupo C tem maior número de pacientes com três ou mais lesões e três ou mais lesões neoplásicas, mas sem valor estatístico. Conclui-se que não houve diferença estatística entre os 181 pacientes examinados e os 143 pacientes com lesões, quanto aos dados gerais, não houve diferenças significativas quanto ao número relativo, ao tipo e ao tamanho das lesões. As lesões neoplásicas apresentam-se maiores quando comparadas às não-neoplásicas, com significância estatística. A concordância entre a hipótese diagnóstica colonoscópica e a histologia é maior no grupo da cromoscopia / Colorectal cancer (CRC) is one of the largest causes of death on the industrialized world. Its annual incidence of 800.000 new cases means 8,5% of all the new ones and 12% of deaths related to this disease. In Brazil, excluding the non-melanoma skin-cancers, CRC is the fourth more frequent among men and the third one among women. The risk for developping CRC is approximately of 5 to 6% on the Western population. There are epidemiological evidences for reducing CRC on 60-90% when colonoscopy with polypectomy is used preventively. Colonoscopy is still the best method both for the early dyagnosis of CRC and precursor lesions. However, there are non-contemptible failures on the detection. This paper purpose was comparing the result of colon and rectum mucous membrane detailed test through conventional colonoscopy, chromoendoscopy and NBI, on the detection of augmented, depressed and flat lesions in patients submitted to it without any personal or familiar antecedents. Between January 2007 and October 2009 181 patients were selected randomically and divided into 3 groups: A: 48 control patients; B: 29 patients, NBI; C: 104 patients, diffuse chromoscopy. It is observed that, from the 181 examined patients, 38 (21%) didnt present lesions. The 143 patients with lesion, presented an average number of 2,65 lesions, with a minimum of 1 and a maximum of 7 lesions. On the total of the 181 patients and on the whole of the 143 patients with lesions it was not observed any statistically significant difference among the three groups A, B and C as for Age, the Rectum-Cecum Time and the Cecum-Rectum Time, while there was a statistical variation for Height, Weight and consequent bmi. The average size of the 379 lesions found on the 143 patients, assessed by its diameter was of 5,45 mm (2.14 in.) + 2,84 mm (1,11 in), without any statistical variation among the groups, among the hemicolons and among the hemicolons in the groups. The size of the lesions were gathered into three distinct intervals: up to 5 mm [1.9 in.] (76,30%), from 6 mm [2.3 in.] to 10 mm [3.9 in] (19,50%) and from 11 to 20 mm [4.3 to 7.8 in] (4,20%). From the total of 379 lesions, 203 (53,6%) revealed themselves neoplastic and 176 (46,4%) non-neoplastic. The average size of the 203 neoplastic lesions was of 5,96 mm (2.34 in.), and of the 176 non-neoplastic ones, 4,87 mm [12,36 in]. Neoplastic lesions have shown larger than the non-neoplastic ones, with a stastistical significance. On the groups there is any significant variation between neoplasia and non-neoplasia, but a significant difference between the neoplasias and non-neoplasias size. There was any statistical difference among the lesion size on both hemicolons, however, a significant difference among the sizes of neoplastic and non-neoplastic ones. The same is observed when colon segments were analyzed individually. The two segments that have presented significant lesions, specifically on what concerns the size of neoplastic and non-neoplastic ones were the Sigmoid and the Transverse. It is observed that all the subpediculated lesions and the flat-augmented ones with a central depression were neoplastics. The flat and neoplastic lesions are proportionally more visible on the right hemicolon at groups B (85,7%) and C (67,9%), without any statistical difference. The diagnostic hypotheses of the lesions grown during the colonoscopic test were compared to the histopathological results. On control group (A) it is observed a 82,7% sensibility, a 59% specificity with a concordance rate of 72,5%, considered regular. On group B it is observed a 92,3% sensibility, a 61,9% specificity, with a regular concordance rate of 78,7%. On group C it is observed a 88,8% sensibility, a 79,3% specificity, a 84,2% concordance rate, considered good. Proportionally group C has a larger number of patients with 3 or more lesions and or more neoplastic lesions, but with no statistical value. On what concerns general data, it is concluded that there wasnt any statistical difference among the 181 patients examined and the 143 ones presenting lesions as for the relative number, the type and size of the lesions. Neoplastic lesions appear to be larger when compared to non-neoplastic ones, with a statistical significance. The concordance between the colonoscopic diagnostic hypothesis and the histology is larger on chromoscopy group
5

Virulenzfaktoren von E.coli aus gewaschenen Kolonbiopsien von Patienten mit kolorektalen Neoplasien

Gudzuhn, Andrej 27 July 2004 (has links)
Hintergrund: Die Pathogenese nicht-familiärer kolorektaler Neoplasien ist heute noch nicht bekannt. Die Besonderheiten der Epidemiologie der Erkrankung sprechen für die Beteiligung von Umweltfaktoren, wie sozioökonomischer Faktoren, der Ernährung oder der bakteriellen Flora des Darmes. Eine intrazelluläre, von E.coli dominierte Flora wurde in Kolonbiopsien dieser Patienten beschrieben. Methoden: Es wurden Virulenzfaktoren von Escherichia coli untersucht, die aus gewaschenen koloskopischen Biopsien von 43 Patienten mit kolorektalen Adenomen und Karzinomen isoliert worden waren. 100 Stämme wurden mittels PCR auf Gene für folgende Virulenzfaktoren untersucht: s-Fimbrien (sfa), pyelonephritisassoziierter Pilus (pap), Hämolysin A (hlyA), hitzestabiles und -labiles Toxin (ST, LT, EAST), Intimin (eae), Verotoxin (stx), Invasionsplasmid (ipa), cytolethal distending toxin (cdt) und cytotoxic necrotizing factor 1 (cnf1). Für die Kontrollgruppe wurden E.coli aus Biopsien von 55 Patienten mit chronisch-entzündlichen Darmerkrankungen (CED) und unspezifischer Kolitis, von 16 Patienten mit Colon irritabile (IBS) und aus Stuhlproben von 29 gesunden Probanden isoliert und untersucht. Ergebnisse: Bei 69% der Patienten mit kolorektalen Karzinomen und bei 58% der Patienten mit kolorektalen Adenomen wurde mindestens einer der Virulenzfaktoren gefunden, dagegen nur bei 25 bis 39% der IBS- und CED- Patienten sowie der gesunden Probanden (p / Background: Pathogenesis of non-hereditary colorectal neoplasia is poorly understood. The differences in regional incidence indicate an influence of environmental factors, as socio-economic conditions, nutrition and intestinal flora. An intracellular flora with a predominance of Escherichia coli in colon biopsies has been described in these patients. Methods: We studied virulence factors of Escherichia coli isolated from washed colonoscopic biopsies of 43 patients with colorectal carcinoma and adenoma. 100 strains of E.coli were isolated and used for detection of a broad range of virulence genes by PCR encoding: s-fimbriae (sfa), pyelonephritis-associated pili (pap), hemolysin A (hlyA), heatstable and heatlable toxins (ST, LT, EAST), verotoxin (stx), invasionplasmidantigen (ipaH), intimin (eae), cytolethal distending toxin (cdt) and cytotoxic necrotizing factor 1 (cnf1). E.coli from biopsies of 55 patients with inflammatory bowel disease (IBD) and non-specific colitis, of 16 patients with irritable bowel syndrom (IBS) and from stool samples of 29 healthy individuals were isolated and examined as controls. Results: The prevalence of virulent strains bearing at least one of the tested genes was 69% in colorectal carcinoma and 58% in colorectal adenoma, but only 25 to 39% of IBD and IBS patients and healthy individuals (p
6

Aspectos clínicos e patológicos de pacientes com tumores colorretais diagnosticados durante cirurgia abdominal de urgência / Clincal and pathological features of patients with colorectal cancer diagnosed during emergency abdominal surgery

SANTOS, Alex Caetano dos 25 April 2011 (has links)
Made available in DSpace on 2014-07-29T15:29:11Z (GMT). No. of bitstreams: 1 Dissertacao Alex Caetano dos Santos.pdf: 982242 bytes, checksum: f685e405b1e872acdf53a2790d29d70b (MD5) Previous issue date: 2011-04-25 / Context In 85% of the cases, colorectal cancer is diagnosed at an advanced stage during investigation of symptomatic patients. Currently, 10% to 33% of the cases may present emergency situations (obstruction or perforation), requiring immediate surgical treatment, and may result in higher mortality compared with elective surgical procedures. Objective Analyze clinical and pathological features of patients with colorectal cancer diagnosed during emergency abdominal surgery at the Hospital de Urgências de Goiânia. Methods We studied 107 patients operated on between January 2006 and June 2010 presenting with histologically confirmed colorectal malignancy. Results This series consisted of 58 women and 49 men with mean age of 59.81 ± 17.08 years. The most frequent symptoms were: abdominal pain (97.2%), no bowel movements (81.3%), vomiting (76.6%), and anorexia (40.2%). Clinical preoperative diagnosis was divided into five groups: obstructive acute abdomen (n = 68), obstructive acute perforation (n = 21), obstructive acute inflammation (n = 13), abdominal sepsis (n = 3), and severe gastrointestinal bleeding (n = 2). Tumors were located in the rectosigmoid (51.4%), transverse colon (19.6%), ascending colon (12.1%), descending colon (11.2%), and 5.6% of the cases presented association of two colon tumors (synchronic tumors). Histopathological examination revealed the presence of adenocarcinoma in 98.1% of the cases. The surgical treatments were: tumor resection with colostomy (85%), tumor resection with primary anastomosis (10.3%), and colostomy without tumor resection (4.7%). Immediate mortality occurred in 33.4% of the patients. Bivariate analysis of sex, tumor location and stage showed no relation to death (p > 0.05%). Conclusions Colorectal cancer in patients who underwent emergency surgery due to acute abdominal complication was more prevalent in females and elderly individuals with nonspecific colonic complaints. Adenocarcinoma of the rectosigmoid was the most frequent condition. Despite the high mortality rate, surgical treatment of colorectal cancer was indicated due to intestinal occlusion. / Contexto Em 85% dos casos, o câncer colorretal é diagnosticado em estádio avançado durante a investigação de pacientes sintomáticos. Atualmente, 10% a 33% dos casos podem apresentar situações emergenciais (obstrução ou perfuração), necessitando de intervenção cirúrgica imediata, podendo resultar em mortalidade operatória maior do que a cirurgia eletiva. Objetivo Analisar os aspectos clínicos e patológicos de pacientes com câncer colorretal operados em urgência, no Hospital de Urgência de Goiânia. Métodos Foram estudados 107 pacientes operados entre janeiro de 2006 e junho de 2010 com diagnóstico histológico de neoplasia maligna colorretal. Resultados A amostra foi constituída de 58 mulheres e 49 homens com idade média de 59,81 ± 17,08 anos. Os sintomas mais frequentes foram: dor abdominal (97,2%), parada de eliminação de gases e fezes (81,3%), vômitos (76,6%) e anorexia (40,2%). Na avaliação pré-operatória foram diagnosticados: abdome agudo obstrutivo (n = 68), abdome agudo perfurativo (n = 21), abdome agudo inflamatório (n = 13), sepse abdominal (n = 3) e hemorragia digestiva grave (n = 2). Os tumores estavam localizados no retossigmoide (51,4%), cólon transverso (19,6%), cólon ascendente (12,1%), cólon descendente (11,2%) e em 5,6% dos casos houve associação de dois tumores no intestino (tumores sincrônicos). Os exames histopatológicos revelaram a presença de adenocarcinoma em 98,1% dos casos. Os tratamentos cirúrgicos adotados foram: ressecção tumoral com colostomia (85%), ressecção tumoral com anastomose primária (10,3%) e colostomia sem ressecção tumoral (4,7%). Houve mortalidade imediata em 33,4% dos casos. Na análise bivariada, as variáveis sexo, localização e estádio tumoral apresentaram p > 0,05% em relação ao óbito. Conclusão O câncer colorretal operado em urgência teve maior prevalência no sexo feminino e nos idosos com queixas inespecíficas. O diagnóstico histopatológico na quase totalidade foi adenocarcinoma localizado no retossigmoide. Embora a mortalidade seja elevada, o tratamento cirúrgico do câncer colorretal deve ser realizado.

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