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.

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.

Paracoccidioidomicose intestinal: Relato de caso

The authors report a case of intestinal involvement of paracoccidioidomycosis and discuss the symptoms, diagnosis and treatment in a patient thought to have colonic cancer. The differential diagnosis should be considered with cancer.

Adenocarcinoma de apêndice: Relato de dois casos e revisão da literatura

Background: The adenocarcinoma of the appendix is a rare disease, generally identified as an acute appendicitis in the clinical presentation. Preoperative diagnosis is extremely difficult and uncommon. Objective: To present two cases of adenocarcinoma of the appendix, unique for presenting in early ages, and a complete literature review on this topic. Cases report: First case: a 24-year-old man submitted to appendectomy for acute inflammatory abdomen. Sent to hospital due to a histopathological diagnosis of mucinous adenocarcinoma of the appendix. Right hemicolectomy, epiploectomy, ganglion and partial abdominal wall resection were performed. The patient is now in chemotherapy. Second case: a 32-year-old man presented, during appendectomy, with vegetant lesion on the apex of the appendix. The histopathological study revealed the presence of adenocarcinoma of the appendix. Right hemicolectomy with ganglion resection was performed. The patient does not present signs of recurring disease. Conclusion: The macroscopic and clinical similarity between adenocarcinoma of the appendix and acute appendicitis makes it important to check out histopathological study results. The cases above reinforce this requirement, as the authors have found adenocarcinoma of the appendix in young patients.

Úlcera de cameron como causa incomum de anemia por deficiência de ferro

Cameron ulcers are chronic linear lesions willing on the mucosal folds, the level of diaphragmatic impression, in patients with hiatal hernia. Its clinical relevance is due to the potential risk of gastrointestinal complications, such as acute or chronic bleeding and anemia. Usually, the diagnosis is incidental by upper gastrointestinal endoscopy. Proton pump inhibitors are essential for the conduct of cases and the administration of iron when the anemia is associated. Already, the benefit of surgery is in refractory cases. We present a case of this entity of a 50-year-old patient in postmenopausal who developed anemia due to iron deficiency and normal initial endoscopy.

Tomografia por biosusceptometria de corrente alternada

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)