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Coronavirus disease-19 (COVID-19) patients with severe complications present comorbidities like cardiovascular-disease, hypertension and type-2 diabetes mellitus (DM), sharing metabolic alterations like insulin resistance (IR) and dyslipidemia. Our objective was to evaluate the association among different components of the lipid-lipoprotein profile, such as remnant lipoprotein (RLP)-cholesterol, in patients with COVID-19, and to analyze their associations with the severity of the disease and death. We studied 193 patients (68 (29-96) years; 49.7% male) hospitalized for COVID-19 and 200 controls (46 (18-79) years; 52.5% male). Lipoprotein profile, glucose and procalcitonin were assessed. Patients presented higher glucose, TG, TG/HDL-cholesterol and RLP-cholesterol levels, but lower total, LDL, HDL and no-HDL-cholesterol levels (p < 0.001). When a binary logistic regression was performed, age, non-HDL-cholesterol, and RLP-cholesterol were associated with death (p = 0.005). As the COVID-19 condition worsened, according to procalcitonin tertiles, a decrease in all the cholesterol fractions (p < 0.03) was observed with no differences in TG, while levels of RLP-cholesterol and TG/HDL-cholesterol increased (p < 0.001). Lower levels of all the cholesterol fractions were related with the presence and severity of COVID-19, except for RLP-cholesterol levels and TG/HDL-cholesterol index. These alterations indicate a lipid metabolic disorder, characteristic of IR states in COVID-19 patients. RLP-cholesterol levels predicted severity and death in these patients.

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Cyclic vomiting syndrome is a benign, chronic, functional gastrointestinal pathology that manifests clinically with intense nausea and vomiting interspersed with asymptomatic periods. Its diagnosis is made according to the Rome IV criteria, which require the presence of at least 2 episodes of vomiting in the past 6 months or 3 or more episodes in the past year, with the corresponding exclusion of secondary causes that can explain the vomiting. We present the case of a 44-year-old man who consulted for intermittent nausea and vomiting of 1 year evolution with hydroelectrolytic repercussion and multiple emergency consultations. The diagnosis of cyclic vomiting syndrome was made and treatment with amitriptyline was started due to its neuromodulatory effect to prevent the recurrence of episodes. After 6 months of establishing it, the patient is asymptomatic.

El síndrome de vómitos cíclicos es una patología gastrointestinal funcional crónica, benigna, que se manifiesta clínicamente con náuseas y vómitos intensos que intercalan con periodos asintomáticos. Su diagnóstico se realiza de acuerdo con los criterios de Roma IV, que requieren la presencia de al menos 2 episodios de vómitos en los últimos 6 meses o 3 o más episodios en el último año, con la correspondiente exclusión de causas secundarias que puedan explicar los síntomas. Se presenta el caso de un hombre de 44 años que consulta por náuseas y vómitos intermitentes de 1 año de evolución, con repercusión hidroelectrolítica y múltiples consultas en emergencia. Se realiza el diagnóstico de síndrome de vómitos cíclicos y se inicia tratamiento con amitriptilina, por su efecto neuromodulador para prevenir la recurrencia de los episodios. Luego de 6 meses de instaurado el mismo, el paciente se presenta asintomático.

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Cyclic vomiting syndrome is a benign, chronic, functional gastrointestinal pathology that manifests clinically with intense nausea and vomiting interspersed with asymptomatic periods. Its diagnosis is made according to the Rome IV criteria, which require the presence of at least 2 episodes of vomiting in the past 6 months or 3 or more episodes in the past year, with the corresponding exclusion of secondary causes that can explain the vomiting. We present the case of a 44-year-old man who consulted for intermittent nausea and vomiting of 1 year evolution with hydroelectrolytic repercussion and multiple emergency consultations. The diagnosis of cyclic vomiting syndrome was made and treatment with amitriptyline was started due to its neuromodulatory effect to prevent the recurrence of episodes. After 6 months of establishing it, the patient is asymptomatic.

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RESUMEN El síndrome de intestino irritable es una enfermedad funcional intestinal frecuente a nivel mundial, pero con pocos estudios de prevalencia. Su diagnóstico es clínico y se basa en criterios acordados internacionalmente que han cambiado con el tiempo, actualmente regidos por el Consenso de Roma IV. Objetivo : Recabar y actualizar datos disponibles de prevalencia de América Latina para entender mejor el comportamiento regional de SII. Materiales y métodos : Se realizó una búsqueda de trabajos originales, autodefinidos de prevalencia, en las bases de datos Pubmed y Lilacs así como presentaciones en congresos de trabajos originales. Resultados : Se encontraron 27 estudios según los criterios de búsqueda establecidos. De ellos, 16 eran en población general. Dos trabajos incluyeron el estudio de prevalencia de más de una población constituyendo finalmente 22 referencias desarrolladas en 9 países. La prevalencia promedio total para América Latina fue 15,4%. La prevalencia promedio encontrada por criterios de Roma II fue 23,5%; por Roma III 11,8% y por Roma IV 6,98%. Conclusión : Esta es la primera revisión en reunir datos de prevalencia de síndrome de intestino irritable en población general de nueve países de América Latina. La prevalencia promedio encontrada fue 15%. La variabilidad fue amplia y los criterios diagnósticos utilizados hicieron la mayor diferencia.

ABSTRACT Although irritable bowel syndrome is a common functional bowel disease worldwide, few prevalence studies have been published. Diagnosis is clinical and based on internationally agreed criteria that have changed over time. Currently the Rome IV Consensus is used as the international reference. Objective : Collect and update available prevalence data from Latin America to better understand the regional behavior of irritable bowel syndrome. Materials and methods : A search was carried out for original works, self-defined on prevalence, in the Pubmed and Lilacs databases. Presentations or posters at congresses of original works were also considered. Results : According to the established search criteria, 27 studies were found. Of these, 16 were in the general population. Two studies included the study of the prevalence of more than one population, for which reason 22 prevalence data were obtained from 9 countries. The total average prevalence for Latin America was 15.4%. The average prevalence found by the Rome II criteria was 23.5%; by Rome III 11.8% and by Rome IV 6.98%. Conclusion : This is the first review to collect data on the prevalence of irritable bowel syndrome in the general population from nine Latin American countries. The average prevalence found was 15%. The variability was wide and the diagnostic criteria used made the biggest difference.

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Although irritable bowel syndrome is a common functional bowel disease worldwide, few prevalence studies have been published. Diagnosis is clinical and based on internationally agreed criteria that have changed over time. Currently the Rome IV Consensus is used as the international reference. OBJECTIVE: Collect and update available prevalence data from Latin America to better understand the regional behavior of irritable bowel syndrome. MATERIALS AND METHODS: A search was carried out for original works, self-defined on prevalence, in the Pubmed and Lilacs databases. Presentations or posters at congresses of original works were also considered. RESULTS: According to the established search criteria, 27 studies were found. Of these, 16 were in the general population. Two studies included the study of the prevalence of more than one population, for which reason 22 prevalence data were obtained from 9 countries. The total average prevalence for Latin America was 15.4%. The average prevalence found by the Rome II criteria was 23.5%; by Rome III 11.8% and by Rome IV 6.98%. CONCLUSION: This is the first review to collect data on the prevalence of irritable bowel syndrome in the general population from nine Latin American countries. The average prevalence found was 15%. The variability was wide and the diagnostic criteria used made the biggest difference.

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BACKGROUND: Evidence indicates that low-grade inflammation can alter gastrointestinal motor and sensory function and might contribute to the genesis of symptoms in IBS. OBJECTIVE: To examine relationships between IBS, disease antibodies and cytokine titers in celiac patients and a control group. MATERIALS AND METHODS: IBS, CD activity and serum levels of IL-6, IL-8 and IL12/23p40 were determined in celiac patients and controls. RESULTS: 123 celiac patients were included, 89% were female. 59% demonstrated disease activity and 32% met IBS criteria. Prevalence of IBS was not different between patients who adhered or did not adhere to GFD as well as between patients with or without positive antibodies. Celiac patients had increased levels of IL-6, IL-8 and IL12/23p40 as compared to controls. Higher levels of cytokines were found in celiac patients with IBS than in those without IBS. No difference in levels of cytokines was found between patients with and without CD positive antibodies. A significant negative correlation between the mental component of QoL and IL-6 and IL12/23p40 levels was found, but not with IL-8. CONCLUSION: Higher levels of inflammatory cytokines were found in CD patients with IBS than in either those without IBS or controls, indicating that IBS symptoms are associated with an increase in the inflammatory response and a decrease in quality of life of CD patients. These differences in cytokine levels were not related to CD antibodies status suggesting that IBS, in CD, is related to a different inflammatory process than that which is relevant to CD.

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ABSTRACT Background: Evidence indicates that low-grade inflammation can alter gastrointestinal motor and sensory function and might contribute to the genesis of symptoms in IBS. Objective: To examine relationships between IBS, disease antibodies and cytokine titers in celiac patients and a control group. Materials and methods: IBS, CD activity and serum levels of IL-6, IL-8 and IL12/23p40 were determined in celiac patients and controls. Results: 123 celiac patients were included, 89% were female. 59% demonstrated disease activity and 32% met IBS criteria. Prevalence of IBS was not different between patients who adhered or did not adhere to GFD as well as between patients with or without positive antibodies. Celiac patients had increased levels of IL-6, IL-8 and IL12/23p40 as compared to controls. Higher levels of cytokines were found in celiac patients with IBS than in those without IBS. No difference in levels of cytokines was found between patients with and without CD positive antibodies. A significant negative correlation between the mental component of QoL and IL-6 and IL12/23p40 levels was found, but not with IL-8. Conclusion: Higher levels of inflammatory cytokines were found in CD patients with IBS than in either those without IBS or controls, indicating that IBS symptoms are associated with an increase in the inflammatory response and a decrease in quality of life of CD patients. These differences in cytokine levels were not related to CD antibodies status suggesting that IBS, in CD, is related to a different inflammatory process than that which is relevant to CD.

RESUMEN Antecedentes: la evidencia indica que la inflamación de bajo grado puede alterar la función motora y sensorial gastrointestinal y puede contribuir a la aparición de síntomas en el SII. Objetivo: Examinar la relación entre SII, anticuerpos contra enfermedades y títulos de citocinas en pacientes celíacos y un grupo de control. Materiales y métodos: se determinaron los síntomas de SII, actividad de CD y niveles séricos de IL-6, IL-8 e IL12 / 23p40 en pacientes celíacos y controles. Resultados: se incluyeron 123 pacientes celíacos, el 89% eran mujeres. El 59% demostró actividad de la enfermedad y el 32% cumplió con los criterios del SII. La prevalencia del SII no fue diferente entre los pacientes que se adhirieron o no se adhirieron a GFD, así como entre los pacientes con o sin anticuerpos positivos. Los pacientes celíacos tenían niveles aumentados de IL-6, IL-8 e IL12 / 23p40 en comparación con los controles. Se encontraron niveles más altos de citocinas en pacientes celíacos con SII que en aquellos sin SII. No se encontraron diferencias en los niveles de citocinas entre pacientes con y sin anticuerpos CD positivos. Se encontró una correlación negativa significativa entre el componente mental de la calidad de vida y los niveles de IL-6 e IL12 / 23p40, pero no con IL-8. Conclusión: Se encontraron niveles más altos de citocinas inflamatorias en pacientes con EC con SII que en aquellos sin SII o controles, lo que indica que los síntomas del SII están asociados con un aumento en la respuesta inflamatoria y una disminución en la calidad de vida de los pacientes con CD. Estas diferencias en los niveles de citocinas no estaban relacionadas con el estado de los anticuerpos contra la CD, lo que sugiere que el SII, en la CD, está relacionado con un proceso inflamatorio diferente al que es relevante para la CD.

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INTRODUCTION: Despite the widespread use of small-bowel capsule endoscopy (CE), there is still limited data on its utility and effectiveness for the diagnosis and management of patients with iron-deficiency anemia (IDA). AIM: To assess the diagnostic yield of CE and the factors predicting positive findings in patients with IDA. METHODS: Patients with unexplained IDA and negative upper and lower endoscopy were included. A positive diagnostic yield was considered when CE diagnosed one or more lesions that could explain the IDA. Sex, age, NSAID consumption, blood transfusion requirement, and ferritin and hemoglobin levels were recorded. RESULTS: In total, 120 CE were included (mean age 58.5 years; F/M 82:38). Mean hemoglobin levels were 9 g/dL and mean ferritin levels were 15.7 ng/mL. Positive findings were present in 50 % of patients. The most frequent was angiodysplasia (45 %). Despite several baseline variables being significantly associated with positive findings, using a logistic regression model, it was verified that male sex (OR 3.93; 95 %CI 1.57 - 9.86), age (OR 1.03; 95 %CI 1.00 - 1.06), and hemoglobin levels (OR 0.73; 95 %CI 0.57 - 0.94) were the variables having an independent effect on the probability of obtaining positive findings. Age older than 50 years (OR 14.05; 95 %CI 1.69 - 116.23) and male sex (OR 3.63; 95 %CI 1.29 - 10.17) were the variables which increased the risk of diagnosing angiodysplasia. CONCLUSIONS: CE is a useful technique in patients with IDA. To improve its yield, it is necessary to select patients carefully. Male sex, older age, and low hemoglobin levels were associated with a risk of positive finding in this group of patients. The risk of diagnosing angiodysplasia increased with male sex and older age.

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Introducción: el cáncer colorrectal (CCR) es la tercera causa de muerte por cáncer en hombres y la segunda causa de muerte por cáncer en mujeres de nuestro país. Se ha sugerido que los pacientes con hernias de pared abdominal tendrían más posibilidades de asociar CCR, lo que ha llevado a recomendar por parte de numerosas sociedades científicas la realización de videocolonoscopía (VCC) para búsqueda de CCR previo a la resolución quirúrgica de las hernias. Estudios más recientes han cuestionado esta indicación, no recomendando la realización de VCC en pacientes con hernias de la pared abdominal sin otra sintomatología. Objetivo: Específico. Establecer la prevalencia de CCR y lesiones preneoplásicas en pacientes en valoración preoperatoria de hernias de pared abdominal. Secundario. Establecer si existe asociación estadística entre CCR y la aparición de hernias abdominales. Material y método: se realizó un estudio retrospectivo de casos controles que incluyó a pacientes que concurrieron en el período comprendido entre enero de 2006 y febrero de 2014 al servicio de Endoscopía Digestiva del Hospital de Clínicas. Se definieron como casos los pacientes a quienes se les había indicado una VCC previa a la reparación quirúrgica de su hernia de pared abdominal y se definieron como controles al grupo de pacientes que concurrió al mismo servicio en el mismo período a realizarse VCC para tamizaje de cáncer de colon. Resultados: en el grupo de casos se incluyeron 225 pacientes. En este, 55 VCC (24,4%) fueron incompletas por diversos motivos (56,4% por intolerancia). Se encontraron dos pacientes (0,9%) con cáncer de colon (uno cáncer de colon ascendente y el otro cáncer de colon descendente). En el grupo control se incluyeron 230 pacientes. En este grupo, un paciente (0,43%) presentó cáncer de colon ascendente; 21 VCC (9,1%) fueron parciales debido a intolerancia en el mayor porcentaje de los casos. Discusión: está demostrada la relación entre patologías que aumentan la presión intraabdominal y la posterior aparición de hernias, por lo que se podría pensar que un CCR sintomático pueda desencadenar la aparición de las mismas; sin embargo, no existe fundamento que sustente que un CCR asintomático pueda provocar lo mismo. En este estudio no hubo diferencias significativas en la frecuencia de CCR entre el grupo de casos y controles. Conclusiones: la decisión de realizar o no una VCC debería seguir los lineamientos habituales recomendados por las sociedades científicas respecto al screening de CCR y no basarse en la sola presencia de las hernias para realizar dicho estudio.

Abstract Introduction: colorectal cancer is the third cause of death for cancer in men and the second cause of cancer in women in our country. It has been suggested that patients with abdominal wall hernias would have more chances of associating colorectal cancer, what has led many scientific societies to recommend patients to undergo a video colonoscopy to look for colorectal cancer prior to the surgical treatment of the hernia. More recent studies have questioned such indication, and do not recommend the video colonoscopy I patients with abdominal wall hernias in the absence of other symptoms. Objective: Specific. To determine the prevalence of colorectal cancer and pre-neoplastic lesions in patients during preoperative assessment of abdominal wall hernias. Secondary. To determine if there is a statistical connection between colorectal cancer and abdominal wall hernias. Method: we conducted a retrospective study of control cases, which included patients who were seen at the Digestive Endoscopy Unit of the University Hospital between January 2006 and February 2014. Cases were defined between when a colonoscopy had been indicated prior to the surgical repair of their abdominal wall hernia, and the control group was made up of patients who were seen at the same unit, during the same period of time, seeking for a video colonoscopy for a colorectal cancer screening. Results: 225 patients were included in the cases group. Within this group, 55 video colonoscopies (24.4%) were incomplete for several reasons (56.4% due to intolerance). Two patients (0.9%) were diagnosed with colorectal cancer (one of cancer in the ascending colon and the other one cancer in the descending colon). 230 patients were included in the control group. In this group, one patient (0.43%) presented cancer in the ascending colon, 21 colorectal cancer (9.1%) were partial given to intolerance, in most cases. Discusion: the association between conditions that increase intra-abdominal pressure and result in hernias has been proved; and for this reason it could be thought that a symptomatic colorectal cancer could cause them. However, there is no evidence that indicates that an asymptomatic colorectal cancer could cause the same. In this study there were no meaning differences in the frequency of colorectal cancer between the case and the control groups. Conclusions: the decision as to whether to perform a video colonoscopy or not should follow the usual guidelines recommended by the scientific societies regarding the colorectal cancer screening instead of basing the decis0ion on the presence of hernias.

Resumo Introdução: a radio-quimioterapia é uma opção de tratamento curativo do carcinoma de cérvix, particularmente em pacientes do meio hospitalar uruguaio cujo diagnóstico é feito em estádios localmente avançados. O objetivo deste trabalho é analisar os resultados terapêuticos e a toxicidade crônica deste tratamento no Centro Hospitalario Pereira Rossell (CHPR). Método: foram incluídas 164 pacientes portadoras de carcinoma cérvico-uterino que completaram o tratamento de radio-quimioterapia no período junho de 2006 - novembro de 2008. A radioterapia externa (RTE) foi feita por irradiação pélvica (concomitante com cisplatina semanal) e braquiterapia (BT) útero-vaginal. A dose biológica efetiva para tumor, reto e bexiga foi calculada. A taxa de controle loco-regional e a sobrevida aos cinco anos foram calculadas e também as complicações crônicas utilizando o método de Kaplan-Meier. Resultados: a sobrevida global obtida foi de 67% aos cinco anos, mostrando diferenças significativas entre o estádio II (78%) e o estádio III (49%) (Log-rank test, p = 0,0002). A taxa de complicações crônicas graus 3-4, de acordo com a RTOG (Radiation Therapy Oncology Group), foi 1,8% para as urinarias e 3,7% para as digestivas. O controle local inicial foi de 89% e a persistência da lesão de 10,3%; recidiva loco-regional (RL) em todo o período: 19,5%; metástases com ou sem RL: 10,3%. Conclusões: a eficácia terapêutica da radioquimioterapia no câncer de cérvix no nosso meio foi confirmada. A maioria das recidivas ou persistências foi devida a falta de controle loco-regional depois do tratamento inicial. O tratamento foi bem tolerado, com baixa porcentagem de complicações crônicas, comparável a referências internacionais.

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Introducción: el cáncer colorrectal (CCR) es la tercera causa de muerte por cáncer en hombres y la segunda causa de muerte por cáncer en mujeres de nuestro país. Se ha sugerido que los pacientes con hernias de pared abdominal tendrían más posibilidades de asociar CCR, lo que ha llevado a recomendar por parte de numerosas sociedades científicas la realización de videocolonoscopía (VCC) para búsqueda de CCR previo a la resolución quirúrgica de las hernias. Estudios más recientes han cuestionado esta indicación, no recomendando la realización de VCC en pacientes con hernias de la pared abdominal sin otra sintomatología. Objetivo: Específico. Establecer la prevalencia de CCR y lesiones preneoplásicas en pacientes en valoración preoperatoria de hernias de pared abdominal. Secundario. Establecer si existe asociación estadística entre CCR y la aparición de hernias abdominales. Material y método: se realizó un estudio retrospectivo de casos controles que incluyó a pacientes que concurrieron en el período comprendido entre enero de 2006 y febrero de 2014 al servicio de Endoscopía Digestiva del Hospital de Clínicas. Se definieron como casos los pacientes a quienes se les había indicado una VCC previa a la reparación quirúrgica de su hernia de pared abdominal y se definieron como controles al grupo de pacientes que concurrió al mismo servicio en el mismo período a realizarse VCC para tamizaje de cáncer de colon. Resultados: en el grupo de casos se incluyeron 225 pacientes. En este, 55 VCC (24,4%) fueron incompletas por diversos motivos (56,4% por intolerancia). Se encontraron dos pacientes (0,9%) con cáncer de colon (uno cáncer de colon ascendente y el otro cáncer de colon descendente). En el grupo control se incluyeron 230 pacientes. En este grupo, un paciente (0,43%) presentó cáncer de colon ascendente; 21 VCC (9,1%) fueron parciales debido a intolerancia en el mayor porcentaje de los casos. Discusión: está demostrada la relación entre patologías que aumentan la presión intraabdominal y la posterior aparición de hernias, por lo que se podría pensar que un CCR sintomático pueda desencadenar la aparición de las mismas; sin embargo, no existe fundamento que sustente que un CCR asintomático pueda provocar lo mismo. En este estudio no hubo diferencias significativas en la frecuencia de CCR entre el grupo de casos y controles. Conclusiones: la decisión de realizar o no una VCC debería seguir los lineamientos habituales recomendados por las sociedades científicas respecto al screening de CCR y no basarse en la sola presencia de las hernias para realizar dicho estudio.(AU)

Abstract Introduction: colorectal cancer is the third cause of death for cancer in men and the second cause of cancer in women in our country. It has been suggested that patients with abdominal wall hernias would have more chances of associating colorectal cancer, what has led many scientific societies to recommend patients to undergo a video colonoscopy to look for colorectal cancer prior to the surgical treatment of the hernia. More recent studies have questioned such indication, and do not recommend the video colonoscopy I patients with abdominal wall hernias in the absence of other symptoms. Objective: Specific. To determine the prevalence of colorectal cancer and pre-neoplastic lesions in patients during preoperative assessment of abdominal wall hernias. Secondary. To determine if there is a statistical connection between colorectal cancer and abdominal wall hernias. Method: we conducted a retrospective study of control cases, which included patients who were seen at the Digestive Endoscopy Unit of the University Hospital between January 2006 and February 2014. Cases were defined between when a colonoscopy had been indicated prior to the surgical repair of their abdominal wall hernia, and the control group was made up of patients who were seen at the same unit, during the same period of time, seeking for a video colonoscopy for a colorectal cancer screening. Results: 225 patients were included in the cases group. Within this group, 55 video colonoscopies (24.4%) were incomplete for several reasons (56.4% due to intolerance). Two patients (0.9%) were diagnosed with colorectal cancer (one of cancer in the ascending colon and the other one cancer in the descending colon). 230 patients were included in the control group. In this group, one patient (0.43%) presented cancer in the ascending colon, 21 colorectal cancer (9.1%) were partial given to intolerance, in most cases. Discusion: the association between conditions that increase intra-abdominal pressure and result in hernias has been proved; and for this reason it could be thought that a symptomatic colorectal cancer could cause them. However, there is no evidence that indicates that an asymptomatic colorectal cancer could cause the same. In this study there were no meaning differences in the frequency of colorectal cancer between the case and the control groups. Conclusions: the decision as to whether to perform a video colonoscopy or not should follow the usual guidelines recommended by the scientific societies regarding the colorectal cancer screening instead of basing the decis0ion on the presence of hernias.(AU)

Resumo Introdução: a radio-quimioterapia é uma opção de tratamento curativo do carcinoma de cérvix, particularmente em pacientes do meio hospitalar uruguaio cujo diagnóstico é feito em estádios localmente avançados. O objetivo deste trabalho é analisar os resultados terapêuticos e a toxicidade crônica deste tratamento no Centro Hospitalario Pereira Rossell (CHPR). Método: foram incluídas 164 pacientes portadoras de carcinoma cérvico-uterino que completaram o tratamento de radio-quimioterapia no período junho de 2006 - novembro de 2008. A radioterapia externa (RTE) foi feita por irradiação pélvica (concomitante com cisplatina semanal) e braquiterapia (BT) útero-vaginal. A dose biológica efetiva para tumor, reto e bexiga foi calculada. A taxa de controle loco-regional e a sobrevida aos cinco anos foram calculadas e também as complicações crônicas utilizando o método de Kaplan-Meier. Resultados: a sobrevida global obtida foi de 67% aos cinco anos, mostrando diferenças significativas entre o estádio II (78%) e o estádio III (49%) (Log-rank test, p = 0,0002). A taxa de complicações crônicas graus 3-4, de acordo com a RTOG (Radiation Therapy Oncology Group), foi 1,8% para as urinarias e 3,7% para as digestivas. O controle local inicial foi de 89% e a persistência da lesão de 10,3%; recidiva loco-regional (RL) em todo o período: 19,5%; metástases com ou sem RL: 10,3%. Conclusões: a eficácia terapêutica da radioquimioterapia no câncer de cérvix no nosso meio foi confirmada. A maioria das recidivas ou persistências foi devida a falta de controle loco-regional depois do tratamento inicial. O tratamento foi bem tolerado, com baixa porcentagem de complicações crônicas, comparável a referências internacionais.(AU)

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AIM: To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection (ESD), thus contributing to its subsequent application in human patients. METHODS: This study/learning process was carried out in 3 phases: Phase I: Ex vivo animal; Phase II: In vivo animal; Phase III: Humans. One endoscopist performed 30 gastric ESDs in porcine models, and later 5 gastric ESDs in 5 patients. The ESD was done following the method practiced at the National Cancer Center in Tokyo, Japan. Technical aspects, size, time and speed of ESD, as well as complications were registered. In patients, their clinical, endoscopic and histologic evolution was additionally added. RESULTS: Thirty en bloc ESDs were carried out in animal models. The mean ± SD size of the pieces was of 28.4 ± 1.2 mm, and the time of ESD was 41.7 ± 2.4 min. The time of ESD in the first 15 procedures was 43.0 ± 3.0 min whereas in the next 15 procedures, the time was 40.3 ± 3.9 min, P = 0.588. The speed in the first 15 ESDs was 1.25 ± 0.11 cm(2)/min vs 2.12 ± 0.36 cm(2)/min in the remaining 15, P = 0.028. There were no complications. In patients, 5 lesions were resected en bloc. The size of the pieces was 25.2 ± 5.1 mm and the time was 85.0 ± 25.6 min. Endoscopic and histological controls did not show evidence of residual neoplastic tissue. CONCLUSION: A sequential ESD training program of a unique endoscopist, based on the practice in porcine models, contributed to learning ESD for its subsequent application in humans, yielding good results in efficacy and safety.

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