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.

Laparoscopic Heller Myotomy and Fundoplication in Patients with Chagas' Disease Achalasia and Massively Dilated Esophagus

Laparoscopic Heller myotomy and fundoplication is considered today the treatment of choice for achalasia. The optimal treatment for end-stage achalasia with esophageal dilation is still controversial. This multicenter and retrospective study aims to evaluate the outcome of laparoscopic Heller myotomy in patients with a massively dilated esophagus. Eleven patients (mean age, 56 years; 6 men) with massively dilated esophagus (esophageal diameter greater than 10 cm) underwent a laparoscopic Heller myotomy and anterior fundoplication between 2000 and 2009 at three different institutions. Preoperative workup included upper endoscopy, esophagram, and esophageal manometry in all patients. Average follow-up was 31.5 months (range, 3 to 60 months). Two patients (18%) had severe dysphagia, four patients (36%) had mild and occasional dysphagia to solid food, and five patients (45%) were asymptomatic. All patients gained or kept body weight, except for the two patients with severe dysphagia. Of the two patients with severe dysphagia, one underwent esophageal dilatation and the other a laparoscopic esophagectomy. They are both doing well. Heller myotomy relieves dysphagia in the majority of patients even when the esophagus is massively dilated.

Esophagectomy and substitution of the thoracic esophagus in dogs

OBJETIVO: Avaliar, em cadáveres de cães, uma técnica para remoção do esôfago torácico sem toracotomia e dois métodos de substituição do esôfago torácico. MÉTODOS: Foram utilizados 27 cadáveres de cães. Estes foram aleatoriamente divididos em três grupos de nove animais, em que se estudou: G1 - esofagectomia torácica total pelo método de invaginação retrógrada; G2 - esofagectomia torácica total com substituição esofágica pelo estômago inteiro; G3 - esofagectomia torácica total com substituição esofágica por um gastrotubo confeccionado de acordo com a técnica de Büchler de gastroplastia por rotação do fundo. Após a ressecção esofágica no grupo 1, a integridade da rota intratorácica foi avaliada por endoscopia e solução de azul de metileno a 1%. RESULTADOS: A ruptura da pleura visceral ocorreu em todos os animais, especialmente no terço caudal. Entretanto, a rota transtorácica mediastinal permitiu a elevação de ambos os substitutos esofágicos (G2 e G3) para a realização da anastomose com a extremidade caudal do esôfago cervical. CONCLUSÕES: A substituição por estômago inteiro apresentou menor tensão na anastomose, maior facilidade e rapidez comparada à técnica de gastroplastia por rotação do fundo. Os resultados em cadáveres suportam a realização de estudos clínicos para validação da técnica.

Morphological and functional evaluation of distal esophagus of rabbits submitted to esophageal infusion with caustic soda

A ingestão de substâncias cáusticas constitui importante situação de emergência, tendo em vista a gravidade de suas seqüelas. OBJETIVO: Estudar as alterações morfológicas e funcionais do esôfago de coelhos submetidos à infusão esofágica com soda cáustica (NaOH). MÉTODOS: 88 coelhos foram divididos em 4 grupos: G1 (n=22) foi submetido à infusão esofágica com água destilada; G2, G3 e G4 foram submetidos a infusão esofágica com NaOH a 2%, 4% e 6%, respectivamente. Alterações morfológicas foram estudadas em 12 animais de cada grupo e as alterações manométricas, nos 10 animais restantes. Foram feitas análises do esfíncter inferior do esôfago (EIE), número e amplitude das contrações no terço distal do esôfago. Estes estudos foram realizados antes (momento 1 - M1) e aos 30 minutos, 6 horas e 24 horas após a infusão esofágica (momentos M2, M3 e M4, respectivamente). RESULTADOS: Avaliação macroscópica: G1 - sem alterações; G2 - edema, hiperemia e descamação; G3 - aumento do calibre do esôfago, úlceras, descamação da mucosa; G4 - lesões semelhantes as do G3, porém mais intensas, áreas de extensa hemorragia. Avaliação funcional: a pressão no EIE foi mais elevada em M2 no grupo 2; o número das contrações no terço distal do esôfago foi menor em G3 e G4, e a amplitude das contrações foi menor em G4. CONCLUSÕES: 1) a infusão esofágica com NaOH constitui excelente modelo experimental de esofagite cáustica no coelho; 2) a infusão esofágica com NaOH causa lesões na parede do esôfago, com gravidade proporcional a concentração da solução; 3) a infusão causou espasmo do EIE em M2 e redução do número e amplitude das contrações no terço distal do esôfago.

Mate attenuates DNA damage and carcinogenesis induced by diethylnitrosamine and thermal injury in rat esophagus

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Proventricular dilatation disease (PDD) and megaesophagus in a blue-fronted Amazon parrot (Amazona aestiva) - case report.

The present article relates the occurrence of Proventricular Dilatation Disease (PDD) in a 20 years old blue-fronted amazon parrot (Amazona aestiva). The bird was raised in captivity and was examined at the Ornitopathology Laboratory of São Paulo State University's Veterinarian Hospital, São Paulo State, Brazil. The parrot clinically presented regurgitation, tremors and dyspnea. This is the first case of PDD followed by megaesophagus in a blue-fronted amazon parrot (A. aestiva). This pathological case was not described in birds at all.

The effect of gastric dilatation in rats submitted to gasified water ingestion under the hepatic metabolic function

INTRODUÇÃO: O excesso de peso na população aumentou de forma significante nas últimas décadas e as bebidas gasosas tornaram-se um fator ambiental importante no comportamento alimentar das pessoas, sendo os EUA, México e Brasil, nesta ordem, os três maiores paises produtores e consumidores de refrigerantes. OBJETIVO: Investigar os efeitos da dilatação gástrica em ratos submetidos a ingestão de água gaseificada, veículo uniforme para todos os refrigerantes, sobre parâmetros metabólicos da função hepática. MÉTODOS: Foram constituídos dois grupos de 15 ratos acompanhados por 15 semanas. Ao Grupo-I, foram oferecidos 200 g/dia de ração ad libitum e 100 ml de água não gaseificada em 3 períodos diários, ao Grupo-II, foram oferecidos 200 g/dia de ração ad libitum e 100 ml de água gaseificada em 3 períodos diários; em cada grupo,foram calculados a média (x) e o desvio padrão (s); para todos os atributos estudados foi utilizado o método estatístico de teste t pareado, comparando-se GI com GII, testando-se o efeito dos tipos de água. RESULTADOS: Os resultados identificaram que os animais que foram submetidos ao tratamento com água gaseificada (Grupo-II), apresentaram um aumento de transaminase glutâmica pirúvica (TGP) e fosfatase alcalina p<0,01), tendência de aumento da transaminase glutâmica oxalacética (TGO) (0,10>p>0,05) e aumento da área gástrica com alterações morfológicas macroscópicas como o desaparecimento do pregueamento mucoso característico. CONCLUSÃO: A água gaseificada favoreceu o aumento da área gástrica com conseqüente desaparecimento macroscópico do pregueamento mucoso do órgão, que ocasionou alterações metabólicas da função hepática.

Outcome of superficial squamous cell carcinoma of the esophagus: a clinicopathological study

PURPOSE: To analyze the clinicopathological features and outcome of patients with pathologically proven superficial squamous cell carcinoma of the esophagus. METHODS: A total of 234 consecutive cases of esophageal carcinoma in a 15-year period were reviewed. RESULTS: Superficial esophageal cancer was found in five patients (2.1%). They were four men and one woman and the mean age was 52.5 years. Smoking and alcohol were the main risk factors. Achalasia due to Chagas disease occurred in one patient and a second primary tumor developed in the larynx in another patient. Four patients underwent esophagectomy and one patient received chemoradiotherapy. The histopathologic diagnosis was of squamous cell carcinoma in all cases. Intramucosal tumor (Tis) was identified in three cases and superficially invasive carcinoma in two cases. Four patients are free of disease with survival times of two, four, six and nine years. The patient who developed laryngeal cancer died six years after esophagectomy. CONCLUSION: Long-term survival in patients with esophageal cancer is related to early diagnosis. Therefore, a less aggressive surgical approach, such as endoscopic resection, may be a good option for these patients, if depth of tumor invasion can be accurately predicted by the new imaging tools.

TOXIC DILATATION OF THE COLON IN CHAGAS-DISEASE

Toxic megacolon occurs in colitis of differing aetiology. This report describes 15 patients with chagasic megacolon with this complication. The clinical signs and symptoms in all patients were pain and progressive abdominal distension accompanied by fever, severe toxaemia and shock. Seven patients developed this clinical pattern after manual removal of faeces. The remaining patients had pain and abdominal distension followed by signs of severe toxaemia when first examined. Nine patients underwent total colectomy with ileostomy (one death), four partial colectomy (all died) and two received medical treatment (both died). At autopsy, three of the four patients undergoing partial colectomy had residual colitis and enteritis. The surgical procedure of choice for this complication of chagasic megacolon is total colectomy.

Effect of ion reduction of sodium, calcium and potassium on spontaneous contraction of the esophagus of Pomacea lineata SPIX, 1827 (Mollusca-Gastropoda-Prosobranchia)

The invertebrate's musculature still presents many elusive points, especially in molluscs that generally present smooth and cracked fibers with peculiar characteristics. It was found that the molluscs reactions to the ion variation in the bathing are not very clear, mainly in view of the isolated reduction or equivalent of the ions. Suspended in bath, the isolated esophagus of the P. lineata exhibited spontaneous activity. This rhythmic activity was sensitive to the ion variation of the perfusion liquid, evidenced by alterations in the spontaneous contractions. The equivalent reduction of the ion reduced the spontaneous activity, evidenced by the amplitude reduction of the response, besides maintaning an organ contraction, primarily in the reductions below 50%. When the isolated reductions of the Na, Ca or K ion were performed, occurred interference in the spontaneous contractions of the organs, principally in amplitude of the response and maintenance of the contracture in reductions of 50 and 25% of the ion.

Histoplasmose do esôfago: Relato de caso

The authors report a case of a patient with complaint of progressive disphagia. Stenoses of lower third of esophagus was revealed by radiological and endoscopic examinations. Fungi were showed in biopsy of lesion, with demonstration of Histoplasm capsulate by tissue culture. Endoscopic dilatation was performed because especific medical treatment failed but esophageal rupture was observed. Partial esophagectomy was performed with symptoms remission.

Effect of metoclopramide, ranitidine, and droperidol on the lower sphincter of the esophagus. Experimental study on the opossum (Didelphis albiventris)

Electromanometric measures of the gastroesophageal junction were performed in 20 adult, male and female, anesthetised opossums. The electromanometric examinations were performed according the intermitent pull through technique. The research was divided in four groups, according to the drug to be analysed: group 1 (20 animals) IM injection of physiological solution (control group); group 2 (20 animals) IM injection of metoclopramide; group 3 (20 animals) IM injection of ranitidine; group 4 (20 animals) IM injection of droperidol. Electromanometry was done 15 minutes before the drug injection, just after the injection and 15, 30, 45 and 60 minutes after the injection. In each one of the moments the pressure of the lower esophageal sphincter (LES-mmHg) was analysed. Considering LES pressure the results observed were: in group 1 it was not observed any significative alteration after IM injection of physiologic solution; in group 2 it was observed significative pressure increase, 15 minutes after metoclopramide IM injection; in group 3 it was observed pressure increase, being significative at 15 and 30 minutes after IM injection; in group 4 it was observed significative increase in LES pressure in every moment, 15 minutes after droperidol IM injection.

Preferential infection sites of Cysticercus bovis in cattle experimentally infected with Taenia saginata eggs

The preferential sites of infection of Cysticercus bovis were evaluated in the skeletal muscle and entrails of 25 cattle that were experimentally infected with Taenia saginata (2 x 10(4) eggs). Two other animals were not inoculated (control). Ninety days after inoculation, all the cattle were euthanized. The carcasses were deboned and dissected into 26 anatomical sections (masseter muscles, brain, tongue, esophagus, heart, diaphragm, lungs, liver, kidneys, spleen, top sirloin butt, bottom sirloin butt, outside round, top (inside) round, transversus abdominus, top sirloin cap, strip loin, full tenderloin, eye of round, knuckle, shoulder clod, foreshank, shank, chuck, back ribs, and tail muscles). The dissected tissues were sliced into 5 mm sections. From the 25 cattle, 9258 C. bovis (cysticerci) were recovered; 75.02% (6946) of these were recovered from skeletal muscles and 24.98% (2312) from the entrails. A high parasitism level was found in the shoulder clod (12.55%), heart (11.02%), liver (9.48%), masseter muscles (8.51%), chuck (8.25%), strip loin and full tenderloin (7.26%), knuckle (6.63%), and back ribs (5.53%), totaling 69.23% (5738) of all of the detected cysticerci. on the other hand, there was a low C. bovis parasitism level in the brain, spleen, tail muscles, kidneys, esophagus, and diaphragm, representing just 3.9% of the total number of cysticerci. Given these results, we conclude that specific skeletal musculature regions, such as the shoulder blade, chuck, strip loin and full tenderloin, knuckle, back ribs and top round, which are not officially examined in many countries, are effective sites to efficiently screen C. bovis infection. To date, these regions have not been considered as preferential sites of C. bovis infection. Based on our work, however, these regions deserve greater attention from health inspectors because they contained a greater number of Cysticercus than the other regions of carcasses that are parasitized by T. saginata larvae. (c) 2010 Elsevier Ltd. All rights reserved.

Steinernema brazilense n. sp (Rhabditida: Steinernematidae), a new entomopathogenic nematode from Mato Grosso, Brazil

A new entomopathogenic nematode, Steinernema brazilense n. sp., was isolated from a single soil sample collected from a natural forest in Mato Grosso do Sul state, Brazil. S. brazilense n. sp. is characterized morphologically by features of infective juveniles (IJ), males and females. For the IJ, body length averaging 1157 (1023-1284) mu m, distance from anterior end to excretory pore 95 (87-102) mu m, from anterior end to end of esophagus 148 (139-153) mu m, tail length 85 (80-104) mu m, D% and E% values 63 (58-70) and 106 (95-118.0), respectively. Lateral field pattern variable; the formula for the arrangement of ridges from head to tail is: 2, 4, 6, 8, 6, 2. For the male, the diagnostic characters include spicule averaging 83 (75-89) mu m; D% about 65; the ratio SW% about 192. The length of spicule head is greater than width. Lateral field with one narrow ridge. First generation females are characterized by the presence of a ventral postanal swelling. S. brazilense n. sp. is morphologically close to Steinernema diaprepesi. It can be differentiated from S. diaprepesi by its longer IJ body length (1157 vs 1002 mu m), longer distance from anterior end to excretory pore (1110 vs 75 mu m), a longer tail length (103 vs 83 mu m); males of the new species with longer spicule (83 vs 79 mu m). The new species can be distinguished further from other members of Steinernema glaseri group by characteristics of rDNA of ITS and D2D3 regions. Published by Elsevier B.V.