Luis Roberto Manzione Nadal

Introduction The literature converges regarding the use of C-reactive protein (CRP) tests between postoperative days (PODs) 3 and 5 of elective procedures. In this period, they have great sensitivity and negative predictive value (NPV) for severe and anastomotic complications about two days before the first clinical sign. The few studies on colorectal urgency suggest that, despite the different initial values according to the surgical indication, following POD 3, the level of CRP is similar to that of elective procedures. However, given the heterogeneity of the studies, there is no consensus on the cutoff values for this use. Objective To validate the use and propose a PO CRP cut-off value in urgent colorectal procedures as an exclusion criterion for complications of anastomosis or the abdominal cavity. Method Retrospective analysis of the medical records of 308 patients who underwent urgent colorectal surgical procedures between January 2017 and December 2019. The following data were considered: age, gender, surgical indication, type of procedure performed, complications, CRP levels preoperatively and from POD 1 to 4, and the severity of the complications. We compared the CRP levels and the percentage variations between the preoperative period and PODs 1 to 4 as markers of severe complications using the receiver operating characteristic (ROC) curve. Results The levels of CRP on POD4, and their percentage drops between PODs 2 to 4 and PODs 3 to 4, were better to predict severe complications. A cutoff of 7.45 mg/dL on POD 4 had 91.7% of sensitivity and NPV. A 50% drop between PODs 3 and 4 had 100% of sensitivity and NPV. Conclusion Determining the level of CRP is useful to exclude severe complications, and it could be a criterion for hospital discharge in POD 4 of emergency colorectal surgery.

Pneumoperitoneum is often caused by perforation of hollow viscera, but when an etiology is not identified, it is said to

Aim: to evaluate the presence of subclinical HPV-induced anal lesions with anal cytology, High-Resolution Anoscopy (HRA) and HPV genotyping by polymerase chain reaction (PCR) in the follow-up of treated condylomata acuminata (CA). Methods: seventy-nine male patients were included. One month after anal CA eradication, the patients underwent brush samples collection for anal cytology and PCR, and HRA with biopsy of acetowhite lesions. These methods were compared within all patients and between groups, according to Human Immunodeficiency Virus (HIV) infection status: HIV-negative; HIV-positive with TCD4 count above and below 350 cells/mm3. Results: the most frequent HPV types were 6 and 16. HPV DNA was isolated in 92%. HIV infection was associated with a higher number of oncogenic HPV types (p=0.038). All patients with negative PCR had negative HRA and cytology. There were no differences in cytological, HRA or histopathological findings between groups. Conclusion: the association of the findings of cytopathology, HRA and genotyping of HPV refined the diagnosis of HPV-induced lesions. The degree of immunodeficiency was not associated with increase in remnant HPV-induced anal lesions.

O crescimento recente da incidência da sífilis, principalmente nos últimos 15 anos com a emergência da AIDS, parece conduzir ao aumento dos casos atípicos observados na prática médica diária. A freqüência da co-infecção HIV/sífilis entre homossexuais masculinos em grandes centros urbanos varia entre 20 e 70%; nesses casos, com úlceras persistentes e rápida progressão para os estádios mais tardios. Dentre as complicações mais graves da doença não tratada ou mal conduzida encontra-se a neurolues, que pode produzir manifestações neurológicas e psiquiátricas variadas, por vezes incapacitantes. O diagnóstico pode ser feito pela punção liquórica, pela qual se avaliam a celularidade, as proteínas e se realizam testes treponêmicos e não-treponêmicos. O exame do LCR deveria ser realizado em todos os doentes com sorologia positiva para sífilis, ou doença neuropsiquiátrica, ou oftálmica, ou terciária, ou naqueles em que a terapia falhou e nos doentes infectados pelo HIV com sífilis latente ou de duração ignorada. Entretanto, a neurolues é improvável quando o VDRL sérico estiver negativo. Nesses casos, a punção do liquor não é recomendada. Há razoável certeza quando houver síndrome neuropsiquiátrica associada com VDRL liquórico positivo.