Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?

to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were male (60%). Indications were 18 tumors of the distal esophagus and esophagogastric junction (90%) and two with invasion of gastric fundus (10%) in patients with previous gastrectomy. Preoperative colonoscopy to exclude colonic diseases was performed in ten cases. the surgical technique consisted of median laparotomy and left cervicotomy, followed by transhiatal esophagectomy associated with D2 lymphadenectomy. The reconstructions were performed with eight esophagocoloduodenoplasty and the others were Roux-en-Y esophagocolojejunoplasty to prevent the alkaline reflux. Three cases were stage I / II, while 15 cases (85%) were stages III / IV, reflecting late diagnosis of these tumors. The operative mortality was 5 patients (25%): a mediastinitis secondary to necrosis of the transposed colon, abdominal cellulitis secondary to wound infection, severe pneumonia, an irreversible shock and sepsis associated with colojejunal fistula. Four patients died in the first year after surgery: 3 (15%) were due to tumor recurrence and 1 (5%) secondary to bronchopneumonia. The 5-year survival was 15%. the total esophagogastrectomy associated with esophagocoloplasty has high morbidity and mortality, requiring precise indication, and properly selected patients benefit from the surgery, with the risk-benefit acceptable, contributing to increased survival and improved quality of life.To analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were426360365sem informaçãosem informaçã

Esophageal mucosal resection versus esophagectomy: a comparative study of surgical results in patients with advanced megaesophagus

The surgical treatment of advanced megaesophagus has no consensus, being esophagectomy the more commonly used method. Since it has high morbimortality--inconvenient for benign disease -, in recent years an alternative has been introduced: the esophageal mucosal resection. To compare early and late results of the two techniques evaluating the operative time, length of ICU stay; postoperative hospitalization; total hospitalization; intra- and postoperative complication rates; mortality; and long-term results. Were evaluated retrospectively 40 charts, 23 esophagectomies and 17 mucosectomies. In assessing postoperative results, interviews were conducted by using a specific questionnaire. Comparing the means of esophagectomy and mucosal resection, respectively, the data were: 1) surgical time--310.2 min and 279.7 min (p > 0.05); 2) length of stay in ICU--5 days and 2.53 days (p 0.05); 4) length of hospital stay after surgery--19.05 days and 14.94 days (p> 0.05); 5) presence of intraoperative complications--65% and 18% (p 0.05). In the assessment of late postoperative score (range 0-10) esophagectomy (n = 5) obtained 8.8 points and 8.8 points also got mucosal resection (n = 5). Esophageal mucosal resection proved to be good alternative for surgical treatment of megaesophagus. It was advantageous in the immediate postoperative period by presenting a lower average time in operation, the total hospitalization, ICU staying and complications rate. In the late postoperative period, the result was excellent and good in both operations.The surgical treatment of advanced megaesophagus has no consensus, being esophagectomy the more commonly used method. Since it has high morbimortality--inconvenient for benign disease -, in recent years an alternative has been introduced: the esophageal m2812831sem informaçãosem informaçã

Laparoscopic antireflux surgery in patients with extra esophageal symptoms related to asthma

Asthma, laryngitis and chronic cough are atypical symptoms of the gastroesophageal reflux disease. To analyze the efficacy of laparoscopic surgery in the remission of extra-esophageal symptoms in patients with gastroesophageal reflux, related to asthma. Were reviewed the medical records of 400 patients with gastroesophageal reflux disease submitted to laparoscopic Nissen fundoplication from 1994 to 2006, and identified 30 patients with extra-esophageal symptoms related to asthma. The variables considered were: gender, age, gastroesophageal symptoms (heartburn, acid reflux and dysphagia), time of reflux disease, treatment with proton pump inhibitor, use of specific medications, treatment and evolution, number of attacks and degree of esophagitis. Data were subjected to statistical analysis, comparing the pre- and post-surgical findings. The comparative analysis before surgery (T1) and six months after surgery (T2) showed a significant reduction on heartburn and reflux symptoms. Apart from that, there was a significant difference between the patients with daily crises of asthma (T1 versus T2, 45.83% to 16.67%, p=0.0002) and continuous crises (T1, 41.67% versus T2, 8.33%, p=0.0002). Laparoscopic Nissen fundoplication was effective in improving symptoms that are typical of reflux disease and clinical manifestations of asthma.Asthma, laryngitis and chronic cough are atypical symptoms of the gastroesophageal reflux disease. To analyze the efficacy of laparoscopic surgery in the remission of extra-esophageal symptoms in patients with gastroesophageal reflux, related to asthma. W2729295sem informaçãosem informaçã

Efeito do ensacamento dos frutos no controle de pragas e doenças e na qualidade e maturação de maçãs ‘Fuji Suprema’.

O objetivo deste trabalho foi avaliar a eficiência de embalagens de diferentes materiais para a proteção contra pragas e doenças e seu efeito sobre a qualidade físico-química, maturação e teor de cálcio (Ca) em maçãs ‘Fuji Suprema’. O experimento foi desenvolvido nas safras de 2007/2008 e 2008/2009, em pomar manejado sob o sistema orgânico, localizado na região de São Joaquim (SC). O pomar era composto por plantas de dez anos de idade da cultivar Fuji Suprema, sobre porta-enxerto ‘Marubakaido’, com interenxerto ‘EM-9’. Depois do raleio manual, aproximadamente 40 dias após a plena floração, os frutos foram ensacados com embalagens plásticas transparentes microperfuradas ou de tecido não texturizado (TNT). Os frutos foram mantidos ensacados até a colheita. A testemunha foi constituída por frutos não ensacados. Na colheita, os frutos foram avaliados quanto aos danos provocados por mosca-das-frutas (Anastrepha fraterculus), mariposa oriental (Grapholita molesta) e lagarta enroladeira (Bonagota salubricola). As doenças foram avaliadas pela incidência de sarna da macieira (Venturia inaequalis), podridão amarga (Colletotrichum gloeosporioides) e podridão carpelar (Alternaria sp., Fusarium sp.). Também foi avaliada a incidência de distúrbios fisiológicos “russeting” e “bitter pit”, atributos físico-químicos de maturação e qualidade e o teor de Ca nos frutos. Independentemente do tipo de embalagem verificou-se que o ensacamento é prática eficaz na proteção contra o ataque de insetos, mas não reduz a incidência e o desenvolvimento de doenças nos frutos. Na safra de 2008/2009, o ensacamento dos frutos aumentou o teor de Ca e reduziu a incidência de “bitter pit”, e aumentou a incidência do “russeting”. O ensacamento dos frutos antecipou a maturação, especialmente com embalagem plástica transparente microperfurada, e reduziu a coloração vermelha, especialmente com embalagem TNT

Surgical Gastrostomy: Current Indications And Complications In A University Hospital [gastrostomia Cirúrgica: Indicações Atuais E Complicações Em Pacientes De Um Hospital Universitário]

Objective: To analyze the surgical gastrostomies performed at a public University Hospital, their indications and complications. Methods: We conducted a retrospective, nonrandomized review of medical records of patients who underwent surgical gastrostomy from 2007 to 2011; Results:, In the period of studied, 86 patients underwent surgical gastrostomies for enteral nutrition. The Stamm technique was employed in all cases. Men constituted 76 (88%) of the cases and the mean age was 58.4 years, the maximum age being 87 years and the minimum 19. We observed 16 (18.60%) minor complications, 17 (19.76%) serious complications and 8 (9.3%) perioperative deaths. Conclusion: Surgical gastrostomy, while considered a smaller procedure, is not without complications and mortality. The Stamm technique, despite the complications reported, is easy to perform and to handle, as well as safe.406458462Witzel, O., Zur technik der magenfistulaeinlegung (1891) Zbl Chir, 18, pp. 601-604Stamm, M., Gastrostomy: A new method (1894) Med News, 65, p. 324Grant, J.P., Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy (1988) Ann Surg, 207 (5), pp. 598-603Gauderer, M.W., Ponsky, J.L., Izant Jr., R.J., Gastrostomy without laparoscopy: A percutaneous endoscopic technique (1980) J Pediatr Surg, 15 (6), pp. 872-875Kwon, R.S., Banerjee, S., Desilets, D., Diehl, D.L., Farraye, F.A., Enteral nutrition access devices (2010) Gastrointest Endosc, 72 (2), pp. 236-248. , ASGE Technology CommitteeHerman, L.L., Hoskins, W.J., Shike, M., Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel (1992) Gastrointest Endosc, 38 (3), pp. 314-318Möller, P., Lindberg, C.G., Zilling, T., Gastrostomy by various techniques: Evaluation of indications, outcome, and complications (1999) Scand J Gastroenterol, 34 (10), pp. 1050-1054Wollman, B., D'Agostino, H.B., Walus-Wigle, J.R., Easter, D.W., Beale, A., Radiologic, endoscopic, and surgical gastrostomy: An institutional evaluation and meta-analysis of the literature (1995) Radiology, 197 (3), pp. 699-704Ljungdahl, M., Sundbom, M., Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: A prospective, randomized trial (2006) Surg Endosc, 20 (8), pp. 1248-1251Pisano, G., Calò, P.G., Tatti, A., Farris, S., Erdas, E., Licheri, S., Surgical gastrostomy when percutaneous endoscopic gastrostomy is not feasible: Indications, results and comparison between the two procedures (2008) Chir Ital, 60 (2), pp. 261-266Martins, F.P., Sousa, M.C.B., Ferrari, A.P., New "introducer" PEG-gastropexy with T fasteners: A pilot study (2011) Arq Gastroenterol, 48 (4), pp. 231-235Ocaña, L.F.O., Crocifoglio, V.A., La gastrostomía laparoscópica como una alternative a la gastrostomía endoscópica percutánea (1995) Rev Gastroenterol Mex, 60 (4), pp. 218-220Bergstrom, L.R., Larson, D., Zinsmeister, A.R., Sarr, M.G., Silverstein, M.D., Utilization and outcomes of surgical gastrostomies and jejunostomies in an era of percutaneous endoscopic gastrostomy: A population- based study (1995) Mayo Clin Proc, 70 (9), pp. 829-836Nicholson, F.B., Korman, M.G., Richardson, M.A., Percutaneous endoscopic gastrostomy: A review of indications, complications and outcome (2000) J Gastroenterol Hepatol, 15 (1), pp. 21-25Shellito, P.C., Malt, R.A., Tube gastrostomy. Techniques and complications (1985) Ann Surg, 201 (2), pp. 180-185Cox, W.D., Gillesby, W.J., Gastrostomy in postoperative decompression: Indications and methods (1967) Am J Surg, 113 (2), pp. 298-302Cosentini, E.P., Sautner, T., Gnant, M., Winkelbauer, F., Teleky, B., Jakesz, R., Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies (1998) Arch Surg, 133 (10), pp. 1076-1083Rustom, I.K., Jebreel, A., Tayyab, M., England, R.J., Stafford, N.D., Percutaneous endoscopic, radiological and surgical gastrostomy tubes: A comparison study in head and neck cancer patients (2006) J Laryngol Otol, 120 (6), pp. 463-466Grilo, A., Santos, C.A., Fonseca, J., Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting (2012) Arq Gastroenterol, 49 (3), pp. 227-231Zorrón, R., Flores, D., Meyer, C.A.F., Castro, L.M., Madureira, F.A.V., Madureira, F.D., Single-wound gastrostomy: A simple method as an option for endoscopy (2005) Rev Col Bras Cir, 32 (3), pp. 153-15

Evidence that oxidative stress is increased in patients with X-linked adrenoleukodystrophy

AbstractX-linked adrenoleukodystrophy (X-ALD) is a hereditary disorder of peroxisomal metabolism biochemically characterized by the accumulation of very long chain fatty acids (VLCFA), particularly hexacosanoic acid (C26:0) and tetracosanoic acid (C24:0) in different tissues and in biological fluids. The disease is clinically characterized by central and peripheral demyelination and adrenal insufficiency, which is closely related to the increased concentrations of these fatty acids. However, the mechanisms underlying the brain damage in X-ALD are poorly known. Considering that free radical generation is involved in various neurodegererative disorders, like Parkinson disease, multiple sclerosis and Alzheimer's disease, in the present study we evaluated various oxidative stress parameters, namely chemiluminescence, thiobarbituric acid reactive species (TBA-RS), total radical-trapping antioxidant potential (TRAP), and total antioxidant reactivity (TAR) in plasma of X-ALD patients, as well as the activities of the antioxidant enzymes catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) in erythrocytes and fibroblasts from these patients. It was verified a significant increase of plasma chemiluminescence and TBA-RS, reflecting induction of lipid peroxidation, as well as a decrease of plasma TAR, indicating a deficient capacity to rapidly handle an increase of reactive species. We also observed a significant increase of erythrocytes GPx activity and of catalase and SOD activities in fibroblasts from the patients studied. It is therefore proposed that oxidative stress may be involved in pathophysiology of X-ALD

Lipid-laden multilocular cells in the aging thymus are phenotypically heterogeneous

Intrathymic lipid-laden multilocular cells (LLMC) are known to express pro-inflammatory factors that might regulate functional activity of the thymus. However, the phenotype of ageassociated intrathymic LLMC is still controversial. In this study, we evaluated LLMC density in the aging thymus and better characterized their distribution, ultrastructure and phenotype. Our results show an increased density of LLMC in the thymus from 03 to 24 months of age. Morphologically, intrathymic LLMC exhibit fibroblastoid fusiform, globular or stellate shapes and can be found in the subcapsular region as well as deeper in the parenchyma, including the perivascular area. Some parenchymal LLMC were like telocytes accumulating lipids. We identified lipid droplets with different electrondensities, lipofuscin granules and autolipophagosomelike structures, indicating heterogeneous lipid content in these cells. Autophagosome formation in intrathymic LLMC was confirmed by positive staining for beclin-1 and perilipin (PLIN), marker for lipid droplet-associated proteins.We also found LLMC in close apposition to thymic stromal cells, endothelial cells, mast cells and lymphocytes. Phenotypically, we identified intrathymic LLMC as preadipocytes (PLIN+PPARγ2+), brown adipocytes (PLIN+UCP1+), macrophages (PLIN+Iba-1+) or pericytes (PLIN+NG2+) but not epithelial cells (PLIN- panCK+). These data indicate that intrathymic LLMC are already present in the young thymus and their density significantly increases with age. We also suggest that LLMC, which are morphologically distinct, establish direct contact with lymphocytes and interact with stromal cells. Finally, we evidence that intrathymic LLMC correspond to not only one but to distinct cell types accumulating lipids