Synergistic lipid-lowering effects of alfalfa meal as an adjuvant to the partial ileal bypass operation.

Partial ileal bypass (PIB) and ingestion of alfalfa are both known to lower plasma cholesterol (C) levels. During an 18-week period, the combined effects of both were studied in four randomized groups of rabbits receiving C-free, hypercholesterolemia-inducing, semisynthetic diets 3 weeks after sham or PIB surgery. The diets, with or without alfalfa, had similar overall compositions of fat, protein, carbohydrate, and fiber. We measured blood C, triglycerides (T), and lipoprotein fractions of both C and T at biweekly intervals. In vivo liver and small-bowel synthesis of C, fatty acids (FA), and nonsaponifiable lipids (NSL) were determined with radioactive 14C-acetate at the end of the study. The results were evaluated by means of analysis of variance using unweighted cell means. The combined PIB and alfalfa modalities significantly lower C levels in serum, plasma, low-density lipoproteins, and high-density lipoproteins by 66%, 71%, 85%, and 35%, respectively. However, due to alfalfa, a significant increase of 49% was observed in plasma T when both treatments were combined. Liver FA synthesis was significantly decreased (65%) with PIB and increased (161%) with alfalfa; when the two treatments are combined, a nonsignificant response was observed. Similarly, this inverse relationship for PIB and alfalfa was seen for C and NSL synthesis. Small-bowel FA synthesis was significantly decreased (72%) by the combination of PIB and alfalfa. We conclude that alfalfa suppresses, in part, the physiologic rebound effect of PIB surgery by increasing hepatic C and NSL synthesis; inversely, PIB surgery inhibits the additive effect in the liver synthesis of FA produced by alfalfa. Alfalfa and PIB alone, and synergistically, decrease total small-bowel lipid synthesis, specifically that of FA. Alfalfa is an effective adjuvant to PIB for reducing total and lipoprotein C fractions.

Megaesofago chagasico: tratamento pela cardioplastia a Thal. / Megaesophagus in Chaga's disease: treatment using the Thal's cardioplasty

Os autores relatam a experiencia no tratamento do megaesofago chagasico pela tecnica de Thal modificada, atraves do estudo de 195 pacientes operados no periodo de maio de 1971 a maio de 1980. A maioria dos pacientes era constituida por adultos jovens do sexo masculino procedentes do meio rural que se apresentavam em mas condicoes nutricionais e com megaesofago avancado.Descrevem detalhadamente a sistematizacao da tecnica operatoria salientando a sua facil execucao por via abdominal, a necessidade duma ampla esofagogastrostomia, a confeccao da roseta que ira atuar como valvula anti-refluxo e o remendo da brecha gastroesofagica com o fundo gastrico. Discutem as complicacoes pos-operatorias imediatas salientando a baixa mortalidade (2, 5%), cuja principal responsavel foi a deiscencia de anastomose. Os resultados tardios foram avaliados atraves de entrevista orientada por meio de interrogatorio padrao e atraves de estudos radiologicos, endoscopicos e eletromanometricos, sendo enfantizado os criterios clinicos estabelecidos pela interpretacao do interrogatorio

Chagas' megaesophagus: manometric studies before and after Thal's fundic patch operation.

The authors present their experience with manometric studies, before and after Thal's fundic patch operation, in patients with Chagas' megaesophagus. The preoperative studies showed in the majority of the patients synchronous, waves of normal duration, that had low peak pressure and were repetitive (vigorous achalasia). The postoperative studies showed disappearance of the vigorous achalasia in over half the patients and increase of the contraction peak pressure in one patient.