Avaliação manométrica do esfíncter inferior do esôfago de coelhos submetidos a fundoplicatura total e parcial

OBJETIVO: Analisar o efeito das fundoplicaturas total e parcial sobre a pressão e comprimento do esfíncter inferior do esôfago (EIE). MÉTODOS: Foram estudados 30 coelhos machos da raça Norfolk. Os animais foram divididos em 3 grupos de 10, na dependência da operação[cirurgia] realizada. Grupo 1 (controle)-laparotomia mediana (LM) e dissecção da transição gastroesofágica; grupo 2- LM e fundoplicatura total, e grupo 3-LM e fundoplicatura parcial. Todos os animais foram submetidos à manometria esofágica (ME) segundo a técnica de tração intermitente da sonda e infusão contínua dos cateteres com água destilada. A ME foi realizada em dois momentos: M1 (pré-operatório) e M2 (pós-operatório), e permitiu a análise da pressão (mmHg) e comprimento (cm) do EIE. RESULTADOS: Nos animais do grupo 1 não foi observada alteração da pressão e comprimento do EIE. Naqueles do grupo 2 (fundoplicatura total) foi observado aumento da pressão (69,7%) e do comprimento (81,8%) do EIE. Nos coelhos do grupo 3 (fundoplicatura parcial) houve aumento da pressão (58%) e do comprimento (100%) do EIE. CONCLUSÕES: As fundoplicaturas total e parcial acarretam aumento da pressão e comprimento de EIE. O incremento da pressão e comprimento de EIE independe do tipo de fundoplicatura utilizada.PURPOSE: To analyze the effect of total and partial fundoplication on the pressure and length of the lower esophageal sphincter (LES). METHODS: Thirty male rabbits (Norfolk race) were studied. The animals were divided in three groups, according to the surgical procedure. Group 1 (Control)-medium laparotomy (ML) and dissection of gastroesophageal transition; Group 2-ML and total fundoplication; Group 3-ML and partial fundoplication. All the animals were submitted to esophageal manometry (EM) using the intermittent pull through technique and continuous infusion of the catheters with destilled water. The esophageal manometry was performed in two moments: M1 (pre operative period) and M2 (post operative period), and allowed us LES analyse the pressure (mmHg) and length (cm). RESULTS: In animals of group 1 no change in LES pressure and length was observed. In those of groups 2 (total fundoplication) an increase of LES pressure (69,7%) and length (81,8%) was observed. In rabbits of group 3 (partial fundoplication) there was an increase of LES pressure (58%) and length (100%) of the LES. CONCLUSIONS: The total and partial fundoplications cause an increase of LES pressure and length. This increase doesn't depend on the type of fundoplication performed

Câncer do esôfago em paciente com megaesôfago chagásico

RACIONAL: O megaesôfago constitui problema de saúde pública em nosso país, pois acomete indivíduos em sua fase de maior produtividade. Os doentes com essa afecção podem apresentar em sua evolução associação com câncer do esôfago. OBJETIVO: Analisar os aspectos clínicos e epidemiológicos de pacientes com megaesôfago e câncer do esôfago. MÉTODOS: Foram avaliados de maneira retrospectiva 20 pacientes com megaesôfago e câncer (grupo 1) e 20 com câncer do esôfago (grupo 2). Estudaram-se os dados demográficos, hábitos (etilismo e tabagismo), tipo histológico do tumor, localização da lesão, diferenciação celular, estádio, tratamento e sobrevida. RESULTADOS: Não foi observada diferença entre os grupos, com relação à idade, sexo, localização da lesão, tipo histológico do tumor, diferenciação celular, estádio e sobrevida. Com relação aos hábitos de vida, a associação de etilismo e tabagismo foi observada em maior número de pacientes com câncer do esôfago sem o antecedente de megaesôfago. CONCLUSÃO: As características clínicas dos pacientes com megaesôfago e câncer não diferem daqueles com neoplasia maligna esofágica não associada ao megaesôfago, principalmente no que se refere ao prognóstico desfavorável frente ao tratamento instituído. Nos pacientes com megaesôfago o tumor pode se localizar em qualquer porção do órgão.BACKGROUND: Megaesophagus constitutes a public health problem in our country since it affects individuals in the most productive phase of their lives. During the development of the disease, people suffering from it may present association with esophageal cancer. AIM: To analyze the clinical and epidemiological aspects of patients with megaesophagus and esophageal cancer. METHODS: Twenty patients with megaesophagus and cancer (group 1) and 20 patients with esophageal cancer (group 2) were retrospectively analyzed. Demographic data, habits (alcoholism and smoking), tumor histological type, lesion location, cellular differentiation, staging, treatment and survival were assessed. RESULTS: No difference was observed between the groups in relation to age, sex, lesion location, tumor histological type, cellular differentiation, staging or survival. As regards habits, the association of alcoholism with smoking was observed in a larger number of patients with esophageal cancer without the megaesophagus antecedent. CONCLUSION: The clinical characteristics of patients with megaesophagus and cancer do not differ from those of patients with malignant esophageal neoplasia, particularly as regards the unfavorable prognosis with the instituted treatment. Patients with megaesophagus may present esophageal tumor at any part of the organ

Atrophic gastritis: Risk factor for esophageal squamous cell carcinoma in a Latin-American population

AIM: To study the association between atrophic gastritis (AG) and esophageal squamous cell carcinoma (ESCC) in a Latin-America population. METHODS: A case-control study was performed at two reference Brazilian hospitals including patients diagnosed with advanced ESCC and dyspeptic patients who had been subjected to upper gastrointestinal endoscopy, with biopsies of the gastric antrum and body. All cases with ESCC were reviewed by a single pathologist, who applied standard criteria for the diagnosis of mucosal atrophy, intestinal metaplasia, and dysplasia, all classified as AG. The data on the patients' age, sex, smoking status, and alcohol consumption were collected from clinical records, and any missing information was completed by telephone interview. The association between AG and ESCC was assessed by means of univariate and multiple conditional logistic regressions. RESULTS: Most patients were male, and the median age was 59 years (range: 37-79 years) in both the ESCC and control groups. Univariate analysis showed that an intake of ethanol greater than 32 g/d was an independent risk factor that increased the odds of ESCC 7.57 times (P = 0.014); upon multiple analysis, alcohol intake of ethanol greater than 32 g/d exhibited a risk of 4.54 (P = 0.081), as adjusted for AG and smoking. Smoking was shown to be an independent risk factor that increased the odds of ESCC 14.55 times (P = 0.011) for individuals who smoked 0 to 51 packs/year and 21.40 times (P = 0.006) for those who smoked more than 51 packs/year. Upon multiple analyses, those who smoked up to 51 packs/year exhibited a risk of 7.85 (P = 0.058), and those who smoked more than 51 packs/year had a risk 11.57 times higher (P = 0.04), as adjusted for AG and alcohol consumption. AG proved to be a risk factor that increased the odds of ESCC 5.33 times (95%CI: 1.55-18.30, P = 0.008) according to the results of univariate conditional logistic regression. CONCLUSION: There was an association by univariate conditional logistic regression between AG and ECSS in this sample of Latin-American population. © 2013 Baishideng

Perfurações esofágicas

RACIONAL: Dentre as perfurações do trato gastrointestinal, as lesões do esôfago são as de pior prognóstico. OBJETIVO: Avaliar os aspectos etiológicos, diagnósticos e terapêuticos de pacientes com perfuração esofágica atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. MÉTODOS: Avaliação retrospectiva de pacientes internados no período de janeiro de 1999 a dezembro de 2006. Foram estudados 24 pacientes (18 homens e 6 mulheres) com idade média de 52 anos. Os pacientes foram divididos em dois grupos de 12. O Grupo 1 compreendia os pacientes cuja perfuração ocorreu na evolução de câncer do esôfago e o Grupo 2 os pacientes com perfuração devida a causas diversas. No Grupo 2 as causas foram: procedimento endoscópico em três casos, fundoplicatura em três, ingestão de corpo estranho em dois, balão de Blackmore em um, ingestão de antiinflamatório em um, pós-operatório de diverticulectomia em um, ferimento por arma de fogo em um. O esôfago torácico foi o local mais acometido (12 pacientes no Grupo 1 e sete no Grupo 2. em cinco pacientes do Grupo 1 foi realizada entubação transtumoral e nos demais gastrostomia ou jejunostomia. No Grupo 2, o procedimento realizado nas perfurações do esôfago torácico foi esofagectomia. RESULTADOS: A mortalidade operatória no Grupo 1 foi de 25% e no Grupo 2 de 8,33%. Conclusão - a) A lesão do esôfago cervical apresenta, em geral, evolução favorável; b) a conduta cirúrgica, mesmo quando realizado em fase não precoce (primeiras 24 horas), resulta em boa resolução.BACKGROUND:- Among perforations of the gastrointestinal tract, esophageal lesions are of worst prognosis. AIM: To evaluate the etiology, frequency, diagnosis and therapeutic applied in patients with esophageal perforations assisted at the clinical hospital of the Botucatu School of Medicine - UNESP. METHODS: This is a retrospective assessment of patients hospitalized from January 1999 to December 2006. Twenty-four patients (18 males and 6 females) with a mean age of 52 years were studied. Patients were divided into 2 groups of 12 individuals each: Group 1: patients whose perforation occurred during esophageal cancer development, and Group 2: patients with perforation resulting from various causes. In Group 2, the causes were endoscopic procedure (3), fundoplication (3), foreign body ingestion (2), Blackmore balloon (1), anti-inflammatory drug ingestion (1), diverticulectomy postoperative period (1), firearm wound (1). Thoracic esophagus was the most frequently affected site 12 patients in Group 1 and 7 in Group 2. In 5 patients from Group 1, transtumoral intubation was performed, and gastrostomy or jejunostomy was carried out in the others. In Group 2, the procedure adopted for thoracic perforations was esophagectomy. RESULTS: Operative mortality in Group 1 was 25%, and in Group 2 it was of 8.33%. CONCLUSIONS: a) Cervical esophageal lesion generally presents favorable development; b) surgical treatment, even when performed at a non-early phase (first 24 hours) results in good evolution

Carcinoma de pequenas células do esôfago: estudo clínico patológico de dois casos

RACIONAL: O carcinoma de pequenas células primário do esôfago é tumor raro, agressivo, morfologicamente indistinguível de seu correspondente no pulmão. OBJETIVO: Apresentar os aspectos clínico-patológicos de dois pacientes com carcinoma de pequenas células do esôfago. RELATO DE CASOS: Paciente 1: masculino, 56 anos com disfagia progressiva há seis meses e emagrecimento, com antecedentes de tabagismo e etilismo. A endoscopia mostrou lesão vegetante dos 30 aos 40 cm da arcada dentária superior e o exame anatomopatológico, diagnosticou neoplasia maligna indiferenciada de pequenas células com marcadores imunoistoquímicos positivos para cromogranina e sinaptofisina, caracterizando a linhagem neuroendócrina da neoplasia. Após dois ciclos de quimioterapia (cisplatina e etoposide) associada à radioterapia ele apresentou remissão da disfagia. Paciente 2: masculino, 55 anos, com queixas de pirose, disfagia, rouquidão há seis meses, com emagrecimento de 10 kg no período. A endoscopia mostrou lesão vegetante à 30 cm da arcada dentária superior, obstrutiva. O exame anatomopatológico revelou carcinoma de pequenas células, com os mesmos marcadores imunoistoquímicos positivos para linhagem neuroendócrina. Tomografia computadorizada mostrou metástases hepáticas. Frente ao estadio avançado da doença optou-se pela indicação de gastrostomia. O paciente desenvolveu pneumonia e faleceu dois meses após o diagnóstico. CONCLUSÃO: A evolução dos portadores de carcinoma de pequenas células do esôfago depende do estadiamento da doença e apesar da alta agressividade biológica, este tumor apresenta boa resposta à quimioterapia associada à radioterapia.BACKGOUND: Small-cell Carcinoma of the Esophagus is a rare tumor, aggressive, and morphologically indistinguishable from its correspondent well-known tumor in the lung. AIM: To present the clinical-pathological aspects of two patients presenting small-cell carcinoma of the esophagus. CASES REPORT: Patient 1- a 55-year-old man presenting progressive dysphagia for 6 months, weight loss, and previous smoking and alcohol abuse history. Endoscopy showed a polypoid lesion, located 30 to 40 cm from the superior arcade. Anatomopathological analysis revealed undifferentiated small-cell carcinoma and positive immunohistochemical staining for neuroendocrine markers, including chromogranin and synaptophysin. The patient presented dysphagia remission after two cycles of chemotherapy (cisplatin and etoposide) and radiotherapy. Patient 2 - a 55-year-old man complaining pirosis, dysphagia, and hoarseness for 6 months, associated to a 10 kg weight loss. Endoscopy showed an obstructive polypoid lesion located 30 cm from the superior dental arcade. Anatomopathological study revealed small-cell carcinoma and positive immunohistochemical staining for neuroendocrine tumor. Computed tomography showed liver metastases. Considering the advanced stage of the tumor, gastrostomy was performed. The patient developed pneumonia and died within two months. CONCLUSION: The evolution of patients presenting small-cell carcinoma of the esophagus depends on the tumor staging. Despite of its aggressiveness, the respective tumor responds positively to combined chemo-radiotherapy