Esofagite eosinofílica / Eosinophilic esophagitis

A esofagite eosinofílica (EoE), primeiramente descrita em 1978 como uma doença rara, vem, nos últimos anos, sendo cada vez mais diagnosticada em pacientes com disfagia, impactação alimentar e/ou pirose. Há controvérsia quanto ao aumento de incidência da EoE. Ele é atribuído, em algumas séries, ao maior conhecimento da doença por parte dos médicos (maior número de diagnósticos), embora alguns defendam que ocorre um aumento real do número de casos.

Eosinophilic esophagitis that was first described in 1978 as a rare disease, it has been increasingly diagnosed in patients with dysphagia, food impaction and/or heartburn. There is controversy regarding the increased incidence of eosinophilic esophagitis. In some cases, it is attributed to a greater knowledge about the disease by doctors (large number of diagnostics), however some people support that it occurs a real increase number of cases.

Doença de Crohn gastroduodenal-relato de quatro casos e revisao da literatura / Doença de Crohn gastroduodenal - relato de quatro casos e revisao da literatura

BACKGROUND: Crohn's disease can affect all the gastrointestinal tract, but gastroduodenal involvement is rarely seen (0.5 to 13 per cent). OBJECTIVES: Report clinical, radiological and endoscopic findings and treatment of four patients with gastroduodenal Crohn's disease and review the literature. PATIENTS AND METHODS: Four patients (one male of 24 years old three females of 37, 66 and 74 years old) with epigastric pain, weight loss and low grade fever were referred to the University Hospitals of Federal University of Rio de Janeiro and Fluminese Federal University. Two had also mild intermittent diarrhea and arthritis/arthralgia and the third developed pyloric obstruction and received surgical treatment. Anemia was observed in only one (the young female). Barium x-ray studies showed aphthous ulcers in stomach and duodenum with distal ileum lesions and deformity in both. Upper gastrointestinal endoscopy revealed aphthous ulcers in stomach and geographic duodenal ulcers. Polypoid lesions and serpiginous ulcers within gastric antrum were observed in the young female. Colonoscopy was performed in two patients and disclosed an ulcerated ileitis in one and ulcerated pancolitis in other. Histopathology findings of biopsy specimens were inconclusive (granulomas were not found) and other causes of granulomatous disease were ruled out. Corticosteroids and proton pump inhibitors were started and two patients had their disease controlled. The other patient developed pyloric obstruction and had to be operated. CONCLUSIONS: Gastroduodenal Crohn's disease has distinct clinical, therapeutic and prognostic features. Advances in endoscopic methods and recognition of new histopathologic criteria for diagnosis have revealed an incidence higher than previously reported.

Cirrose e deficiência de Alfa1-Antitripsina: estudo clinicopatológico de dois casos com análise ultra-estrutural / Cirrhosis and alpha-1 antitrypsin deficiency: clinico-pathological study of two cases with ultraestructural analysis

Aspectos clinicolaboratoriais e achados na microscopia óptica e eletrônica do fígado de duas pacientes idosas com cirrose e deficiência de alfa1-antitripsia näo -suspeitada foram relatados. Foram encontradas inclusöes eosinofílicas PAS-positivas e diastase-resistentes nos hepatócitos ao exame histológico do fígado. Ultra-estruturalmente as inclusöes correspondiam a material amorfo que preenchia totalmente as cisternas dilatadas do retículo endoplasmático. Os autores chamam a atençäo para a necessidade de se procurar essas inclusöes à microscopia óptica e caracterizá-las por imunofluorescência, imunoperoxidase e(ou) microscopia eletrônica.

Volvo gástrico agudo associado a hérnia paraesofageana / Acute gastric volvulus associated with paraesophageal hernia

É relatado um caso de volvo gástrico agudo em associaçäo a hérnia paraesofageana, onde descreve-se a pouca freqüência da patologia, sua abordagem cirúrgica e aspectos da classificaçäo. Ressalta-se a tríade de sintomas que pode definir essa entidade e o excelente resultado obtido com o tratamento precoce

Hiperplasia linforreticular reativa e benigna do estômago, tipo nodular: apresentaçäo de dois casos / Reactive and benign lymphoreticular hyperplasia of the stomach, nodular type: presentation of 2 cases

Relatam-se dois casos de hiperplasia linforreticular reativa e benigna do estômago, tipo nodular, e enfatizam-se os principais aspectos clínicos, radiológicos, endoscópicos e histopatológicos. Acentua-se que a correlaçäo endoscópica e histopatológica é fundamental para o diagnóstico dessa entidade

Metástases cutâneas de adenocarcinoma de duodeno: relato de um caso / Cutaneous metastasis of duodenal adenocarcinoma: report of a case

Apresenta-se um caso de metástases cutâneas de adenocarcinoma duodenal, com ampla documentaçäo, enfatizando-se a raridade dessas lesöes nesse tipo de tumor