Clínica Pfeifer | Blog do Dr. Gustavo Kuhn Pfeifer - - Clínica Pfeifer Blog do Dr. Gustavo Kuhn Pfeifer Doutor, a colo...Clínica Pfeifer | Blog do Dr. Gustavo Kuhn Pfeifer - - Clínica Pfeifer Blog do Dr. Gustavo Kuhn Pfeifer Doutor, a colonoscopia pode ser incompleta? sábado, 06/06/2015 “Doutor, a colonoscopia pode ser incompleta?” Isto me foi perguntado por um paciente incrédulo, há alguns dias, em meu consultório. “Sim“, eu respondi. “Ela pode ser incompleta e isso acontece mais frequentemente do que você imagina.” Depois, para tranquilizá-lo, expliquei que o exame que havia realizado comigo havia sido “mais do que completo”, e que qualquer médico competente na matéria, em qualquer parte do mundo, mesmo não compreendendo português, comprovaria minha afirmação, bastando, para isso, apenas olhar a documentação fotográfica anexada ao laudo de sua colonoscopia. Mas, “documentação fotográfica em colonoscopia” será matéria de um “post”, mais adiante. Voltando ao tema em questão, a verdade é que, diferentemente do que a maioria das pessoas imagina, muitas colonoscopias realizadas em nosso meio, e no mundo inteiro, são incompletas, com segmentos variados do intestino grosso não sendo atingidos, portanto, não sendo observados. Como já escrito em outro “post”, esse exame é operador-dependente, portanto, a habilidade e a “expertise” do médico que o realiza fazem toda a diferença, muitos desses profissionais sendo muito ruins, mesmo. Isto é bastante preocupante porque a colonoscopia é considerada como teste padrão-ouro na prevenção e no diagnóstico precoce do câncer colorretal, único câncer que pode ser prevenido dentre os quatro mais incidentes no nosso meio. Nos Estados Unidos (USA) é a segunda maior causa de morte por câncer. Trabalho prospectivo publicado em revista médica internacional (GUT 2004; 53:277-283) demonstrou que apenas 56,9% de 9223 colonoscopias realizadas em centros médicos do Reino Unido tinham sido completas, dado perturbador. Concluindo com uma situação extrema, o médico para a realização da colonoscopia deve ser escolhido de maneira bastante criteriosa, pois ele pode fazer a diferença entre a vida e a morte de um paciente. Tags: câncer colorretal, câncer de intestino, colonoscopia, colonoscopia incompleta, diagnóstico, exame do intestino, prevenção Publicado em COLONOSCOPIA | 2 Comments » Prevenção de Câncer Colorretal domingo, 07/09/2014 Hoje, eu vou escrever sobre uma das atividades que mais realizo em minha Clínica: a prevenção do câncer colorretal. O câncer colorretal abrange tumores que se originam nos cólons e no reto, sendo tratável e, na maioria dos casos, curável, quando detectado precocemente. Dos quatro cânceres mais incidentes no Rio Grande do Sul e em sua capital, Porto Alegre, segundo estimativas do INCA (Instituto Nacional de Câncer), ele é o único passível de prevenção primária. Os demais, cânceres de próstata, de mama e de pulmão, são apenas suscetíveis de diagnóstico precoce, estando a doença já estabelecida. E como isso se explica? Bem, a prevenção primária impede a ocorrência da doença, removendo suas causas. No caso dos cânceres de cólons e de reto, acredita-se que a grande maioria das lesões, se não, a totalidade, tem origem em uma lesão precursora benigna, o pólipo adenomatoso. Esclarecendo, quando uma pessoa, submetida a uma colonoscopia, tem um pólipo dessa natureza detectado e removido pelo médico, não mais existe a possibilidade da mesma evoluir para câncer. Por esta razão, organizações de saúde do mundo todo recomendam exames de prevenção do câncer colorretal, em especial, a colonoscopia. Entretanto, não é incomum, ouvirmos pacientes questionando a necessidade da realização desse exame na ausência de sintomas. Presto, aqui, portanto, o mesmo esclarecimento dado repetidas vezes em meu consultório. Os exames, de uma maneira geral, podem ser solicitados com a finalidade de prevenção ou de diagnóstico. Nos casos de prevenção, buscamos detectar doenças assintomáticas; nos casos de diagnóstico, a pessoa apresenta alterações da saúde (sinais e sintomas), e os exames são, então, indicados para identificação de doença manifesta. Tags: câncer colorretal, colonoscopia, pólipos, prevenção Publicado em CÂNCER COLORRETAL | Leave a Comment » Remoção de Pólipo do Intestino Grosso quarta-feira, 01/08/2012 Neste vídeo, um pólipo pediculado (o tumor avermelhado), provavelmente localizado em um segmento do intestino grosso denominado cólon transverso, é identificado durante uma colonoscopia. Na sequência, através do orifício do canal de biópsia, situado na extremidade do aparelho, uma agulha é exteriorizada, sendo realizada a injeção de uma solução na submucosa da parede intestinal, abaixo da lesão, com o intuito de aumentar a distância entre a superfície mucosa e a camada muscular própria, minimizando o risco de perfuração intestinal quando da excisão subsequente do tumor. Em um momento seguinte, através do mesmo orifício do colonoscópio, uma alça metálica é projetada, envolvendo o pólipo, estrangulando seu pedículo e, finalmente, seccionando o mesmo – polipectomia – com a passagem de corrente elétrica, evidente pelo aparecimento de fumaça. O pólipo, agora, já separado da parede intestinal, é finalmente removido do organismo, em conjunto com o colonoscópio, após ser capturado com uma pinça metálica em forma de cesta, para ser analisado em um laboratório de anatomia patológica. Tags: cólons, intestino grosso, pólipo, polipectomia, reto Publicado em Polipectomia de Cólon | Leave a Comment » Entrevista com Tânia Carvalho segunda-feira, 23/07/2012 Clique aqui para ver a entrevista Tags: coloproctologista, divertículos, doenças anorretais, entrevista, proctologia, proctologista Publicado em ENTREVISTAS | Leave a Comment » Recomendação para a Prevenção de Câncer dos Cólons e do Reto na Mulher domingo, 15/07/2012 Em artigo publicado na revista Obstetrics&Gynecology em março de 2011, o Colégio Americano de Ginecologistas e Obstetras (ACOG) emitiu uma opinião de comitê, encorajando ginecologistas e obstetras a recomendarem rastreamento (screening) de câncer colorretal nas mulheres, haja vista que, naquele país, no gênero feminino, ele é o terceiro câncer mais incidente e que mais mata. A matéria aponta a colonoscopia como exame de eleição, embora sugira outras alternativas.Existe um consenso entre as organizações de saúde de que o rastreamento, como método de prevenção, pode reduzir esses números, primariamente pela diminuição da incidência da doença avançada, com a detecção de cânceres em fase inicial, além da remoção dos pólipos adenomatosos, suas lesões precursoras. Estudos randomizados prospectivos tem confirmado esse benefício, mostrando reduções nas taxas de mortalidade associadas com a detecção precoce e remoção dos pólipos colorretais.O ACOG recomenda que a colonoscopia seja realizada aos 50 anos nas mulheres que apresentam risco semelhante ao da população em geral para a doença. Este exame é considerado o mais indicado, porque os cólons e o reto podem ser completamente examinados em um único momento, sendo possível a realização de biópsias e a remoção de pólipos (polipectomias) na mesma ocasião.No estado do Rio Grande do Sul e em sua capital, Porto Alegre, de alguns anos para cá, segundo o Instituto Nacional de Câncer (INCA), o câncer dos cólons e do reto é o segundo mais incidente nas mulheres e o terceiro, nos homens. Face a esses dados, consideramos que se as mulheres, até um passado recente, eram educadas para a prevenção dos cânceres de mama e de colo de útero, atualmente, devem incluir a prevenção do câncer colorretal nessa relação de prioridades. Tags: câncer colorretal, colonoscopia, mulher, pólipos, prevenção Publicado em CÂNCER COLORRETAL | 2 Comments » Hemorróidas: sinais e sintomas quinta-feira, 07/06/2012 Pacientes com hemorróidas habitualmente procuram atendimento médico por sangramento, prolapso, incontinência anal e prurido (coceira), além de dor associada à trombose hemorroidária.Sangramento – habitualmente ocorre com a evacuação, é vermelho vivo, podendo ser observado no papel higiênico, na superfície das fezes, gotejando ou esguichando no vaso sanitário. Na maioria das vezes, é a primeira manifestação da doença, usualmente não acompanhado por dor anal. Sangramento anal espontâneo pode ocorrer na fase avançada da moléstia. É importante salientar que sangramento hemorroidário crônico pode causar anemia secundária.Prolapso – por prolapso, entenda-se a eversão do tecido de revestimento do canal anal com exteriorização das hemorróidas internas. É esta manifestação que determinará o grau da doença hemorroidária crônica. Quando o prolapso das hemorróidas internas é permanente, o processo inflamatório na mucosa exposta causa produção aumentada de muco e consequente sensação de umidade na região anal.Incontinência anal – o prolapso hemorroidário permanente pode determinar algum grau de incontinência anal, com perda de matéria fecal.Prurido – este sintoma está mais frequentemente associado a hemorróidas mais avançadas, pela umidade local determinada pela perda de muco, algum grau de incontinência anal e higiene anal inadequada. Este sintoma também pode ser consequência de higiene exagerada com papel, com erosão da pele da região.Dor – a doença hemorroidária crônica determina algum grau de desconforto anal em até um pouco mais de metade dos casos, segundo alguns relatos médicos, porém a dor aguda mais intensa está habitualmente associada a uma complicação, a trombose hemorroidária externa, interna ou mista. Tags: hemorróidas, manifestações, sinais, sintomas Publicado em hemorróidas: sinais e sintomas | 6 Comments » Hemorróidas: Generalidades e Classificação domingo, 03/06/2012 Todas as pessoas apresentam projeções (coxins) de mucosa ricamente vascularizadas no canal anorretal que contribuem para o fechamento do ânus, portanto auxiliando na continência para gases (flatus) e fezes. Essas saliências estão classicamente localizadas nas posições anterior e posterior direitas e lateral esquerda. Somente quando essas formações apresentam alterações que causam manifestações como sangramento e prolapso, dentre outras, tornando-se, portanto, sintomáticas, é que passam a constituir doença conhecida popularmente como hemorróidas. Embora, constipação e esforço excessivo sejam geralmente fatores citados como envolvidos na gênese dessa moléstia, suas reais causas são ainda desconhecidas. De qualquer maneira, hemorróidas não são varizes, como muitos, mesmo médicos, ainda hoje, insistem em dizer. O que parece ocorrer, por alguma razão, é a fragmentação ou degeneração do tecido de sustentação desses coxins vasculares anorretais, determinando que a mucosa fique mais frouxamente fixada à parede muscular, determinando seu deslocamento inferior (prolapso) para a fenda anal.Classicamente, as hemorróidas são distinguidas em internas e externas, podendo também ser mistas. As internas, são revestidas por mucosa, enquanto que, as externas, têm revestimento cutâneo. São as primeiras que classicamente definem os graus da doença. Desta maneira:Mais adiante, vamos abordar as manifestações diversas, agudas e crônicas, nas pessoas com doença hemorroidária. Até lá, então. Tags: ânus, classificação, graus, hemorróidas Publicado em hemorróidas: generalidades e classificação | Leave a Comment » Como saber se o médico é realmente especialista? sábado, 02/06/2012 Muitas vezes, pessoas consultam com um determinado médico, acreditando erroneamente que o mesmo seja especialista. Os pacientes podem ser induzidos a consultar com pretensos especialistas por informações equivocadas de conhecidos, de outros médicos e, até mesmo, de hospitais. Ingênuos, acabam, como no dito popular, “levando gato por lebre”. O Conselho Federal de Medicina determina no art. 4º de sua resolução nº 1634/2002 que “o médico só pode declarar vinculação com especialidade ou área de atuação quando for possuidor do título ou certificado a ele correspondente, devidamente registrado no Conselho Regional de Medicina”. O próprio CÓDIGO DE ÉTICA MÉDICA reforça essa disposição em seu Art. 115, vedando ao médico “… Anunciar títulos científicos que não possa comprovar e especialidade ou área de atuação para a qual não esteja qualificado e registrado no Conselho Regional de Medicina.”. O Manual de publicidade médica (Resolução CFM nº 1.974/11) vai mais longe, determinando que, em seu artigo 3º, “É vedado ao médico: a) Anunciar, quando não especialista, que trata de sistemas orgânicos, órgãos ou doenças específicas, por induzir a confusão com divulgação de especialidade; b) Anunciar aparelhagem de forma a lhe atribuir capacidade privilegiada…”.Já de algum tempo, qualquer pessoa pode verificar qual ou quais especialidades determinado médico possui, sendo suficiente, para isso, saber parte ou todo o nome do profissional, ou seu número de inscrição no Conselho Regional de Medicina, bastando acessar os “sites” do Conselho Federal de Medicina ou do Conselho Regional; neste estado, o CREMERS. Assim, pelo menos, o paciente terá a informação correta que contribuirá para a tomada de decisão de qual profissional escolher para cuidar de sua saúde. Tags: ética, código de ética médica, consulta, especialidade médica, fraude, propaganda, propaganda enganosa Publicado em Meu Médico é Especialista? | 8 Comments » Trombose hemorroidária externa domingo, 02/10/2011 Trombose hemorroidária externa ulceradaO termo “trombose hemorroidária externa” implica em evento agudo com coagulação do sangue no interior das veias – trombose – do plexo hemorroidário externo ou subcutâneo (na porção revestida por pele e não, por mucosa). O paciente queixa-se do aparecimento súbito de uma saliência dolorosa no ânus e frequentemente relaciona o início do quadro com esforço exagerado necessário para expulsar as fezes.A dor é contínua, aumentando de intensidade ao evacuar e ao sentar. Pode haver sangramento espontâneo, consequência de ulceração da pele e exposição parcial do trombo.Ao exame, a trombose hemorroidária externa apresenta-se usualmente como um inchaço oval na pele da margem anal, através da qual muitas vezes a cor azulada do trombo pode ser apreciada. Algumas vezes pode ser mais difusa, comprometendo a maior parte ou toda a circunferência anal.Na maioria das vezes, sua resolução é espontânea, com desaparecimento da dor após alguns dias, embora a saliência possa permanecer por semanas. Mesmo após o desaparecimento completo do trombo, a pele pode não retornar ao seu estado anterior, um plicoma anal permanecendo como sequela do ocorrido.O tratamento pode ser clínico ou cirúrgico. A conduta a ser adotada dependerá de cada caso, com a participação do paciente na tomada de decisão, após este ser adequadamente informado. Em minha experiência, habitualmente, cremes ou pomadas comumente indicados para tratar hemorróidas não amenizam a dor ou aceleram a resolução desses casos agudos. Analgésicos e antiinflamatórios, higiene anal com água após as evacuações – que devem ser de fezes formadas e macias – e emprego tópico de certos medicamentos manipulados, constituem os pilares do tratamento conservador.Tentativas de introduzir a trombose hemorroidária externa no canal anal são infrutíferas e equivocadas, pois não se trata de uma hemorróida interna que se exteriorizou pelo ânus (prolapso), não devendo ser realizadas.Concluindo, a trombose hemorroidária externa pode ocorrer em pessoas de quaisquer idades, independentemente de apresentarem doença hemorroidária crônica. Tags: hemorróidas, trombose Publicado em trombose hemorroidária externa | 1.254 Comments » Fissura Anal Crônica domingo, 26/06/2011 A fissura anal é uma solução de continuidade (ferida) no tegumento do canal anal anatômico (abaixo da linha pectínea), mais frequentemente localizada na linha mediana posterior. Manifesta-se por sangramento e dor anal ao evacuar, podendo esta persistir após, por alguns instantes ou horas. É mais comum em adultos jovens ou de meia-idade, afetando homens e mulheres em proporções semelhantes.Evacuações de fezes muito endurecidas ou diarréicas podem causar seu aparecimento. Entretanto, frequentemente, não se identifica um fator precipitante.A fissura anal, quando crônica, apresenta características facilmente identificáveis pelo médico especialista como: forma de gota, bordas enduradas, plicoma anal sentinela, papila anal aumentada de volume e exposição de fibras do músculo esfíncter interno do ânus em sua base. Também pode haver formação de uma fístula subcutânea, com eliminação de pus. O diagnóstico baseia-se principalmente no exame físico, devendo outras hipóteses diagnósticas serem consideradas como doenças inflamatórias intestinais, doenças sexualmente transmissíveis, câncer de ânus, entre outras. A história habitualmente relatada pelo paciente conduz à hipótese diagnóstica de fissura anal crônica, confirmada pelo exame físico.A fissura anal crônica comporta-se como uma úlcera isquêmica, o que explicaria sua localização mais frequente na parede posterior do canal anal que, segundo alguns estudos, tem circulação sanguínea mais pobre. O espasmo do músculo enfíncter interno do ânus, que normalmente ocorre nesta moléstia, reduziria ainda mais a vascularização. Todos os tratamentos são direcionados para reduzir o tônus desse músculo, o que melhoraria a irrigação sanguínea local e levaria ao alívio dos sintomas e à cicatrização da pele. Manutenção de evacuações regulares de fezes formadas e macias e alívio da dor compõem as medidas restantes do tratamento clínico.O relaxamento do músculo esfíncter interno do ânus pode ser obtido com a aplicação tópica de fármacos a base de nitratos (nitroglicerina, isosorbide) ou bloqueadores dos canais de cálcio (nifedipina, diltiazem), devendo o tratamento ser continuado por seis a oito semanas. Cefaléia é um efeito colateral frequente em pacientes em tratamento com nitroglicerina. Dietas e laxativos, quando necessários, além de medicamentos analgésicos, complementam a terapia.O tratamento cirúrgico fica habitualmente reservado para aqueles casos nos quais as fissuras anais não cicatrizam com o tratamento clínico. A cirurgia de eleição, considerada padrão-ouro, é a “esfincterotomia anal interna lateral” e consiste na secção parcial do músculo esfíncter interno do ânus. A cura é obtida em quase cem por cento dos casos, mas existe o risco de o paciente apresentar algum grau de incontinência anal após.Atualmente, as principais associações européias e americanas de gastroenterologistas e coloproctologistas recomendam que o emprego de toxina botulínica deve anteceder o tratamento cirúrgico naqueles pacientes que não obtiveram cura com o tratamento tópico com nitratos e bloqueadores dos canais de cálcio. Artigos científicos têm revelado ótimos resultados. Este tratamento já está sendo realizado em nossa clínica. Tags: dor anal, ferida no ânus, fissura anal, sangramento anal Publicado em Fissura Anal Crônica | 747 Comments » « Entradas mais antigas Arquivos Categorias DOENÇA DIVERTICULAR DOS CÓLONS (1) ENTREVISTAS (1) MOLÉSTIAS ANAIS (5) Plicomas Anais (1) UTILIDADE PÚBLICA (1) Blogroll Prevenção do câncer colorretal Meta Blog no WordPress.com. Entries (RSS) and Comments (RSS). Publicar em Cancelar Ver mais
Dr. Claudio M. Martins - - Dr. Claudio M. Martins Dr. Cl?udio Meneghello Martins ? m?dico psiquiatra, tendo se formado...Dr. Claudio M. Martins - - Dr. Claudio M. Martins Dr. Cl?udio Meneghello Martins ? m?dico psiquiatra, tendo se formado em 1979 pela Faculdade de Medicina da PUCRS. Ap?s especializou-se em Psiquiatria pelo Curso de Especializa??o da Faculdade de Medicina da UFRGS, que concluiu em 1982. Em 1990, conclui o Mestrado de Psiquiatria pelo "Institute of Psychiatry" da Universidade de Londres. Em 1997, é fundador do "CELP Cyro Martins" que divulga a obra do seu pai Cyro Martins. Ver mais. Você é favorável a extinção dos hospitais psiquiátricos? Sim Não Votar Resultado parcial. A maconha n?o ? benigna: alerta da AAP aos pais e adolescentes Sugerido rastreio no consult?rioO relat?rio pede aos pediatras que rastreiem os pacientes adolescentes para uso de drogas, como publicado anteriormente na declara??o da pol?tica de Rastreio, Interven??o Breve e Encaminhamento.O rastreio deve ser feito em todas as consultas de rotina do adolescente, ou "sempre que h? preocupa??o de que o uso de maconha pode ser um problema", disse o Dr. Ammerman. Ele tamb?m sugeriu que, mesmo antes do in?cio do rastreio, os pediatras devem levantar a quest?o com os pacientes de uma forma adequada ? idade.As t?cnicas de entrevista motivacional podem ser usadas tanto para apoiar pacientes que optaram por se abster quanto para desen . Leias mais.Outras Not?cias Not?cias 15/03 -A maconha n?o ? benigna: alerta da AAP aos pais e adolescentes 05/05 -XIII JORNADA CELPCYRO SOBRE SA?DE MENTAL & II SIMP?SIO CCYM 29/05 -XII JORNADA CELPCYRO SOBRE SA?DE MENTAL 29/05 -XII JORNADA CELPCYRO SOBRE SA?DE MENTAL 14/05 -XI JORNADA CELPCYRO SOBRE SA?DE MENTAL- PSIQUIATRIA CONTEMPOR?NEA; AVAN?OS E DESAFIOS 11/11 -Elei??es na Associa??o Brasileira de Psiquiatria(ABP) Ver mais. 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