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Background: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium., Methods: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO 2 ), lactate levels, and non-invasive cerebral oxygenation (rSO 2 ), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p<0.05)., Results: We studied 28 patients, age 73±7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p=0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO 2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65±10% vs. 74±5%; p=0.08), but the delta-ScvO 2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p=0.043). Post-operative lactate and rSO 2 variables were not associated with delirium., Conclusions: Our pilot study suggests an association between delta ScvO 2 and post-operative delirium, and a tendency to lower post-operative ScvO 2 in patients who developed delirium. Further studies are necessary to elucidate this association., (Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

The aim of the present study is bring to the colo-proctologists and clinicians the importance of the correct interpretation of ano-rectal pain. Sometimes this pain is so characteristic that it becomes pathognomonic of some diseases. The authors detail the rectal and anal canal innervation and distinguish 2 opposite types of pain in this region: a cutaneous or superficial and a visceral or deep pain. The pain sensation depends of 2 components: perception through physiologic mechanism and reaction through basically psychogenic mechanism. The authors discuss the characteristics of the pain in many anorectal diseases, like inflammatory ones, piles, tumors and very complex neuralgias found in some psychotic patients.

Two cases are reported of primary sclerosing cholangitis (PSC) observed in the Institute of Gastroenterology of São Paulo-Brazil. These are presented together with a review of the relevant medical literature. Called our attention the delay for a definite diagnosis and the main symptoms that brought the patients to medical care. These were undoubtedly the progressive obstructive jaundice and severe pruritus. The role of the retrograde cholangio-pancreatography for definition of the diagnosis was presented.