Techniques in electromanometry of the upper esophageal sphincter

The various pull-through techniques used to measure pressure and length of the upper esophageal sphincter have not been studied in depth. Because of the importance of obtaining further information about these techniques, a group of 25 dogs was submitted to upper esophageal sphincter pressure and length measurements by three different pull-through techniques (two of the continuous type and one of the station type), each with three replications per animal, to determine possible differences among techniques. A single introduction provided reliable results, with no sequential effect of the measurements or of any one technique on resting pressure. However, each technique yielded different sphincter lengths, higher values being obtained when the continuous techniques were used.

Flora do delgado em megas chagásicos: estudo pelo teste do H2 respiratório.

The author use the H2 breath test to study the small bowel microflora of chagasic patients with megaesophagus and/or megacolon. Compare this group with a control one. Find a significant increase (P < 0.05) in the small bowel flora of chagasic group. It is concluded that H2 breath is a simple and useful test to detect alteration in intestinal flora.

MANIPULANDO A DISFAGIA DE ORIGEN FARINGOESOFAGICA

Non-neoplastic dysphagia originated from motor deficit in the pharynx and from several disorders in the upper esophagus is studied taking into account the basic mechanisms of deglutition in the pharingoesophageal segment. Three groups of patients with dysphagia were investigated with the purpose of discussing the causes of ths symptom. Clinical examinations and electromanometry of the upper digestive tree, test of the laringeal elevation and clinical test of the bolus propulsion through pharynx were carried out. Emotional alterations, gastroesophageal lesions and motor disturbances in the digestive tree, among other, may cause dysphagia and other associated and secondary symptoms. This study points out the role of Otolaryngology in the investigation of swallowing disorders.

Reorganizacao do processo condilar da articulacao temporomandibular apos condilectomia unilateral, em camundongos tratados com zidovudina (AZT)

In order to analyze the reorganization of the condylar process after unilateral condylectomy in animals which have received AZT, 30 albino mice, 30 days old were used. The condylectomized animals were divided in two groups, one have received distilled water and the other AZT, orally during 10 days. After 5, 10, 15, 30 and 45 days of the surgery the animals of both groups were sacrificed, their heads removed and fixed in 10% formalin. After decalcification the pieces received histological routine treatment to be included in paraffin. The slices were stained by hematoxylin/eosin method. The analysis of results showed that: 1. the condylar repair is similar on both groups; 2. the results reaffirm those found in the literature, that the articulation after condylectomy is located in an anterior position and that the articular disc is not a determinant factor on condylar reorganization.

Dilatacao pneumatica no megaesofago avancado. Resultados do sequimento tardio

Six patients with advanced Chagas' megaesophagus with poor condition for surgical indication due to severe malnutrition and concomitant diseases were submitted to pneumatic dilatation with the aid of the endoscope. The method consists in leading the tip of the pneumatic dilatator into the cardia with the tip of the endoscope. Insufflation of the balloon must be slow and progressive with visualization of the mucosa of the cardia after insufflating of 2 pounds of air pressure. An excellent symptomatic relief was seen in the five-year follow-up but without improvement in the degree of the esophageal dilatation.

Foreign body in the tracheobronchial tree

A 20-year experience with the treatment of 74 patients (83.8% children) for foreign body aspiration is reviewed. The object of this review is to show the clinical manifestations, the radiological findings, the nature and distribution in the bronchial tree, and complications due to longstanding (months or years) foreign bodies in the bronchial tree. The most common foreign bodies found were peanuts (13.5%), corn (13.5%), and beans (13.5%). The most frequent clinical manifestation was choking (67.5%), and the most frequent radiological finding was atelectasis (41.8%). The most serious complication was bronchiectasis needing resection in six patients who had the foreign body retained for years in the bronchial tree. In conclusion, in spite of an obvious foreign body in the tracheobronchial tree many cases are not diagnosed, and a longstanding foreign body in the airway may be responsible for irreversible complications.

Observações clínicas, anatomopatológicas e tratamento de seis casos de dermovilite exsudativa vegetante crônica (cancro da ranilha) de cqüinos

Chronic hypertrophic pododermatitis cases in six horses of different breeds, aging 14 months to 19 years are described. The lesion begun with a infiltrative tissue in the frog and sole regions of the hoof, characterized by a fast and disorganized growth, with a papillary aspect, white colored in the roots and dark on the extremity, with a necrotic secretion and an extremely fetid odor. Microscopically, an exuberant epidermic proliferative tissue was observed, intermingled with little connective tissue. The horses were divided into two treatment groups. In the first group, including three young mares and a foal, showing lesions in only one limb, a surgical resection of the invasive mass was performed, followed by cauterization of the remaining edges and subsequent daily local application of antiseptic substances. In three of these horses, recurrence of the initial lesion occurred, with fast growth of hyperplasic tissue, affecting almost all the frog and half of the sole. Two horses developed contraction deformities of the hoof. In the second group, one male and one female, each with lesions in two limbs, after surgical debridement of the tissue, the animals received daily applications of picric acid 5%, associated to local use of oxitetracyclin. Although one of these cases required a second surgical intervention for removal of the mass, the horses showed after a period of two to three months total absence of the infiltrative tissue. The use of local picric acid 5% and oxitetracyclin associated to previous surgical debridement showed to be more efficient than the use of antiseptic substances in the treatment of chronic hypertrophic pododermatitis.

Brazilian consensus on gastroesophageal reflux disease: Proposals for assessment, classification, and management

The Brazilian Consensus on Gastroesophageal Reflux Disease considers gastroesophageal reflux disease to be a chronic disorder related to the retrograde flow of gastroduodenal contents into the esophagus and/or adjacent organs, resulting in a variable spectrum of symptoms, with or without tissue damage. Considering the limitations of classifications currently in use, a new classification is proposed that combines three criteria - clinical, endoscopic, and pH-metric - providing a comprehensive and more complete characterization of the disease. The diagnosis begins with the presence of heartburn, acid regurgitation, and alarm manifestations (dysphagia, odynophagia, weight loss, GI bleeding, nausea and/or vomiting, and family history of cancer). Also, atypical esophageal, pulmonary, otorhinolaryngological, and oral symptoms may occur. Endoscopy is the first approach, particularly in patients over 40 yr of age and in those with alarm symptoms. Other exams are considered in particular cases, such as contrast radiological examination, scyntigraphy, manometry, and prolonged pH measurement. The clinical treatment encompasses behavioral modifications in lifestyle and pharmacological measures. Proton pump inhibitors in manufacturers' recommended doses are indicated, with doubling of the dose in more severe cases of esophagitis. The minimum time of administration is 6 wk. Patients who do not respond to medical treatment, including those with atypical manifestations, should be considered for surgical treatment. Of the complications of gastroesophageal reflux disease, Barrett's esophagus presents a potential development of adenocarcinoma; biopsies should be performed, independent of Barrett's esophagus extent or location. In this regard the designation short Barrett's is not important in terms of management and prognosis. © 2002 by Am. Coll. of Gastroenterology.

Hepatic bleeding induced by streptokinase and heparin in a patient with acute myocardial infarction

Although rare, major bleeding is the most important side effect of thrombolytic therapy in acute myocardial infarction (AMI) (Levine et al., 1995). Spontaneous hepatic bleeding in normal liver after thrombolytic administration has rarely been reported in literature. To our knowledge, there are only three cases of hepatic bleeding related to thrombolytic therapy in AMI. In these, the used drugs were anisolylated plasminogen streptokinase activator complex (APSAC) (Garcia-Jiménez et al., 1997; Fox et al., 1991) and rt-PA (Garcia-Jiménez et al., 1997). We report a case of hepatic bleeding after streptokinase followed by units over 60 minutes). The next day, the patient developed third-degree atrioventricular block and a temporary pacemaker was inserted. Twenty-seven hours after streptokinase infusion, the patient complained of refractory chest pain that was interpreted as post-myocardial infarction angina; clotting screen was normal and intravenous heparin was started (80 U/kg followed by 18 U/kg/hour). After four hours of heparin administration, the patient presented abdominal pain and distension, and his blood pressure and hematocrit level dropped. Abdominal ultrasonography revealed free fluid in the peritoneal cavity (about 3,000 mL). A laparotomy disclosed blood in the abdominal cavity with bleeding from the right lateral hepatic segment, which was removed. The remaining abdominal viscera were normal and there was no other evidence of hemorrhage. The partial liver resection presented subcapsular hemorrhage with small parenchymal hemorrhage. Histopathological examination also revealed focal areas of ischemic centrilobular necrosis. The patient died of multiple organ system failure 21 days after admission. Copyright © 2002 By PJD Publications Limited.

Collagen fibers in human prostatic lesions: histochemistry and anisotropies

The present study focuses on establishing patterns of collagen fibers distribution in prostatic nodular hyperplasia and adenocarcinomas, in comparison with the normal tissue. Sections of prostatic transurethral resection were subjected to Gömöri's method for collagen fibers and reticulin and analyzed under ordinary and polarized light microscopy. Controls and hyperplastic regions present collagen fibers with variable thickness that run in different directions, establishing a tridimensional network. These fibers exhibit birefringence and dichroism thus demonstrating their fibrillar integrity. On the other hand, increased variability in collagen fiber distribution and anisotropical properties occur in adenocarcinomas evaluated in accordance with the Gleason's score. In some of their areas, a well-defined collagen network delimitates the base of transformed epithelial cells whereas in other areas the collagen fibers are disorganized and do not establish a boundary between the epithelial structures and the stroma. In these areas, collagen is found in the stroma. It was also observed that adenocarcinoma tumor cells rest on a scaffold of thin and dendritic collagen fibers. Collagen fibers of the prostatic stroma of the adenocarcinomas may show a modification in arrangement and fibrillar compactness. In prostatic nodular hyperplasia, there is no change in collagen molecular integrity, since collagen affinity for silver and collagen birefringence are similar to controls. In adenocarcinoma with high dedifferentiation degree, thin and branched strongly argyrophilic and birefringent collagen fibers are detected in regions of cell proliferation. In the adjacent stroma, hyaline plaques are indicative of matrix degradation or remodellation.

Surgical treatment of metachronous metastases in different organs following radical nephrectomy

Renal clear cell carcinoma (RCCC) is a neoplasia resistant to radio and chemotherapy, with surgical treatment being the procedure that is recognized for its curative treatment. This case report demonstrates the success of an aggressive surgical treatment for consecutive and late metachronous metastases following radical nephrectomy. Case report: Asymptomatic 50-year old man. During a routine examination, an incidental mass was found by renal ultrasonography. He underwent right radical nephrectomy due to RCCC in June 1992. During the follow-up metastases were evidenced in cerebellum on the seventh year, and in left lung and pancreas on the eighth year following the radical nephrectomy, with all of them successfully treated by surgical excision. Comments: The surgical excision of consecutive and late metachronous metastases in different organs arising from RCCC is feasible, being a good therapeutic alternative in selected cases.

Nuclear phenotypes and morphometry of human secretory prostate cells: A comparative study of benign and malignant lesions in Brazilian patients

Prostatic lesions in Brazilian patients with benign prostatic hyperplasia (BPH, 26 cases) or adenocarcinoma (AC, 25 cases) were compared by qualitative microscopy and morphometric analysis. In 12 cases of BPH, prostate regions with no histological alterations were considered as controls (Ct). Archival material consisted of formalin-fixed, paraffin-embedded specimens obtained from prostatic transurethral resection and radical prostatectomy. Haematoxylin/eosin (HE)-stained sections were used to estimate the nuclear areas, perimeters and form factor values. HE-stained sections from AC specimens were also used for Gleason grading. BPH, AC and Ct could be discriminated by their nuclear areas and nuclear perimeters, but not by the nuclear form factor parameter. No significant differences were found when the AC data were compared using the combined version or the predominant grade version of the Gleason score (p = 0.8380 for nuclear area; p = 0.6076 for nuclear perimeter; p = 0.9202 for nuclear form factor; n = 200 nuclei per patient). This finding indicates that there is extensive heterogeneity in the size and shape of the nucleus in AC cells. These results also show that although the nuclear morphometry served to discriminate BPH and AC from each other and from Ct, it was not sufficient to correlate AC lesions with their respective Gleason scores in the human population analyzed.

Esofagopatia chagásica complicada com esôfago de Barrett

Gastroesophageal reflux disease (GERD) is an uncommon condition in chagasic esophagopathy not previously treated. In this report, a case of chagasic esophagopathy associated to GERD and complicated with Barrett's esophagus is described. Potential pathophysiologic mechanisms underlying the condition are presented and commented.

Associação entre o achado de cárdia incompetente à endoscopia digestiva alta e presença de esofagite de refluxo

Incompetent cardia (IC) or loose cardia is not uncommon at endoscopic examination but its meaning is not clear. Such incompetence could facilitate gastroesophageal reflux and the appearance of esophagitis as a consequence. The aim of this study is to investigate if there is an association between IC and reflux esophagitis (RE). A review was made of 395 consecutive endoscopic reports of adult males and females performed at the Botucatu Clinics Hospital, of the Unesp - University of the State of São Paulo. Diagnosis of IC is defined by the endoscopic image in which the cardia is partially opened and/or involves the endoscope in a loose manner. Esophagitis characterization was based in the Los Angeles classification. The statistical analysis showed a significant association between CI and RE (p < 0.0001). Although there is not a clear explanation for this association, some hypotheses could be suggested involving hypotonic LES, diaphragmatic crura ineffectiveness and TLESR disorders as conditions able not only to keep the cardia relaxed but also to the reflux followed by esophagitis.

Effect of different dye solutions on the evaluation of the sealing ability of Mineral Trioxide Aggregate.

Alkaline materials have shown incompatibility with methylene blue dye in leakage experiments. The goal of the present study was to analyze the effect of different dyes on the evaluation of the apical sealing ability of Mineral Trioxide Aggregate root-end fillings. Fifty-six extracted human canines were submitted to root canal instrumentation and obturation. After apical resection, retrograde cavities were prepared and teeth were randomly divided into four experimental (n = 13) and two control groups (n = 2). The following root-end filling materials were used: groups 1 and 2--Pro Root MTA (Dentsply), groups 3 and 4--zinc oxide-eugenol cement (ZOE). Teeth in groups 1 and 3 were immersed in 2% methylene blue solution, while teeth in groups 2 and 4 were immersed in 0.2% rhodamine B in a reduced pressure environment for 48 hours. Teeth were then longitudinally sectioned and leakage was evaluated. Results were submitted to statistical analysis (ANOVA and Tukey's test). Group 1 presented the least leakage (p < 0.05). It was concluded that the evaluation of the sealing ability of MTA is influenced by the dye used, since this material presented better sealing ability when evaluated with Methylene Blue, but was similar to ZOE when evaluated with rhodamine B.