ABSTRACT
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.
Subject(s)
Humans , Male , Female , Allergens/immunology , Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/physiopathology , Food Hypersensitivity , Adrenal Cortex Hormones/therapeutic use , Deglutition Disorders , Endoscopy, Digestive System/methods , Gastroesophageal Reflux , Histological Techniques , Immunologic Factors , Leukotriene Antagonists , ManometryABSTRACT
BACKGROUND: In the last few years studies have demonstrated that hiatal hernias have an important role in the pathogenesis of reflux disease, promoting reflux by many different mechanisms, emphasizing that the larger the hiatal hernia, the higher the reflux intensity and erosive esophagitis prevalence. AIM: To correlate the size of hiatal hernias (small or large) with reflux intensity (measured by pH monitoring parameters) in patients with non-erosive and erosive reflux disease. PATIENTS AND METHODS: We reviewed pH monitoring from patients with typical reflux symptoms (heartburn) previously submitted to upper endoscopy. Reflux intensity was measured by the % of total time of pH < 4 (%TT) and by % of time of pH < 4 in upright (%UT) and supine (%ST) positions. Patients were classified as non-erosive reflux disease if no erosive esophagitis was found in endoscopy and pH monitoring was abnormal and as erosive reflux disease if they had erosive esophagitis. Hiatal hernias were classified as small if their size ranged from 2 to 4 cm and large if > or = 5 cm. RESULTS: A total of 192 patients were included, being 115 in erosive reflux disease group and 77 in non-erosive reflux disease group. In erosive reflux disease patients, there were 94 (81%) with small hiatal hernias and 21 (19%) with large ones and in non-erosive reflux disease patients there were 66 (85%) with small and 11(15%) with large hiatal hernias. In erosive reflux disease group, the %TT, %UT and %ST were of 13.1 +/- 7.1; 13.4 +/- 7.4 and 12.3 +/- 11.5 in small hiatal hernias and 20.2 +/- 12.3; 17.8 +/- 14.1 and 20.7 +/- 14.1 in large hiatal hernias, respectively (P < 0.05 for %TT and %TS). In non-erosive reflux disease patients, %TT, %UT and %ST were 9.6 +/- 4.8; 10.8 +/- 6.8 and 8.6 +/- 7.3 in small hiatal hernias and of 14.6 +/- 13.3; 11.2 +/- 7.5 and 18.1 +/- 21.0 in large hiatal hernias respectively (P < 0.05 for %TT and %TS). CONCLUSION: Large hiatal hernias increase acid exposure time only in supine position in erosive esophagitis patients and in non-erosive patients.
Subject(s)
Esophagitis, Peptic/etiology , Gastroesophageal Reflux/etiology , Hernia, Hiatal/complications , Esophagitis, Peptic/physiopathology , Esophagoscopy , Female , Gastroesophageal Reflux/physiopathology , Hernia, Hiatal/pathology , Humans , Hydrogen-Ion Concentration , Male , Manometry , Severity of Illness Index , Time FactorsABSTRACT
In the past two decades, major improvements in blood safety have been achieved, particularly for HIV and hepatitis C virus (HCV). A prospective study was carried out between 1996 and 1999 in Brazil to determine the incidence of post-transfusion infection in surgery patients caused by HCV. One hundred sixty-four patients who received a blood transfusion during cardiac surgery were followed for six months and blood samples collected before and after surgery were assessed to investigate HCV infection. Alanine aminotransferase levels were serially determined, as well as clinical data related to hepatitis. Prior to surgery, HCV infection was detected by anti-HCV ELISA III in 6 patients. Any post-surgical samples which were positive by a third generation ELISA test were confirmed by immunoblot and reverse-transcription polymerase chain reaction (RT-PCR), as were the pre-transfusion samples to exclude pre-transfusion HCV infection not detected by ELISA screening. Results indicated that one patient who was previously considered negative for HCV antibody in the pre-surgical sample was later found to be positive for HCV by RT-PCR in that sample. Seroconversion for HCV antibody after surgery was observed in two patients, one of them with clinical hepatitis; their genotypes were 1a and 1b. The overall prevalence of HCV infection was 4.26% (7/164) and the incidence rate of HCV infection after surgery was 1.27% (2/157). This study shows a high rate of HCV infection acquired post-transfusion in a cohort of surgery patients in Brazil and suggests that better screening methods such as viral RNA assessment may be effective in lowering this rate.
Subject(s)
Cardiac Surgical Procedures , Hepatitis C/etiology , Transfusion Reaction , Brazil/epidemiology , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Hepatitis C Antibodies/blood , Humans , Incidence , Prospective Studies , RNA, Viral/bloodABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Aged , Crohn Disease/diagnosis , Duodenal Diseases/diagnosis , Colonoscopy , Crohn Disease , Crohn Disease/therapy , Duodenal Diseases , Duodenal Diseases/therapy , Duodenal Ulcer , Duodenal Ulcer/pathology , Endoscopy, Gastrointestinal , Stomach Ulcer , Stomach Ulcer/pathologyABSTRACT
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.
Subject(s)
Humans , Adult , Middle Aged , alpha 1-Antitrypsin/deficiency , Liver Cirrhosis/diagnosis , Liver Cirrhosis/etiology , Liver/ultrastructure , HyalinABSTRACT
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
Subject(s)
Aged , Humans , Male , Hernia, Diaphragmatic/complications , Stomach Volvulus/complications , Hernia, Diaphragmatic/surgery , Stomach Volvulus/surgeryABSTRACT
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
Subject(s)
Adult , Humans , Female , Gastric Mucosa/pathology , Gastritis, Atrophic/pathology , Hyperplasia , GastroscopyABSTRACT
Apresenta-se um caso de metástases cutâneas de adenocarcinoma duodenal, com ampla documentaçäo, enfatizando-se a raridade dessas lesöes nesse tipo de tumor
