Helicobacter pylori after surgery for duodenal ulcer.

BACKGROUND/AIMS: The role of Helicobacter pylori as a cause of peptic ulcer is still subject to controversy. The Kock's postulates have not been yet fulfilled; the bacteria can be found in normal persons, and it persists in the stomach after the ulcer is healed. MATERIAL AND METHODS: The authors analyzed 41 persons formerly submitted to surgery (after 8 years and 4 months, as a mean), 31 to highly selective vagotomy, and 10 to truncal or selective vagotomy plus gastroduodenal drainage. All of them were asymptomatic, or had symptoms not related to ulcer relapse. RESULTS: At endoscopy the ulcers were healed in all 41 individuals, and there was evidence of gastritis in three. The histopathological exam showed gastritis in all biopsy specimens. The search of H. pylori by urease method and by Giemsa staining was positive in 40. CONCLUSION: It was concluded that the gastric acid secretion reduced by vagotomy was the main factor to healing the ulcer, not subordinated to H. pylori.

Nonocclusive intestinal ischemia and necrosis after correction of interatrial communication with cardiopulmonary bypass. A rare and catastrophic complication.

The authors present a case of massive, nonocclusive intestinal ischemia and necrosis after surgery for correction of interatrial communication with cardiopulmonary bypass in a 22-year-old woman. This is an extremely serious complication that generally occurs in older patients. The literature mentions its occurrence in patients subjected to aortic valve replacement who have low cardiac output and in patients undergoing myocardial revascularization. Its occurrence in a young person with simple congenital cardiopathy is rare.

[Hospital infection at a private hospital in Ribeirão Preto, São Paulo, Brazil]. / Infecção hospitalar em hospital privado de Ribeirão Preto, São Paulo.

The aim of this work is to prospectively evaluate the incidence of infection, from June 1986 to June 1987, in 640 patients submitted to surgical treatment at the São Francisco Hospital, in Ribeirão Preto, São Paulo, Brazil. The overall incidence of infection was 10.31%. The incidence of wound abscess was 6.25%, and urinary infection 5.75%. In the surgical procedures considered as clean, the infection rate was 8.62%, in the clean-contaminated 14.81%, in the contaminated 8.33%, and in the dirty 16.94%. The antimicrobian drugs contributed to increase the infection rate. The hospital infection rate for the patients at infirmaries was 10.88%, and for the patients at private rooms 4.92%. The mortality rate due to hospital infection was 12.12%. The authors stress that a constant attention with the hospital infection is needed to verify the infection rate to be able to make a control program of the asepsis, antisepsis and sterilization methods, as well as to improve the operative techniques and the patient's management during the pre, per and postoperative period.

Evolutive and prognostic aspects in gastric cancer. Analysis of 189 cases.

The cases of 189 patients treated at the Surgery Service for gastric carcinoma from January 1960 to December 1978 and followed until April 1984 were reviewed in terms of evolutive behavior. Correlations between sex, age, duration of symptoms, site of tumors, lymph node metastases, stage of tumors, operability, resectability, treatment and survival were attempted. With respect to age, of the patients not operated on, survival was longer for more advanced age; the opposite occurred for the group of patients who were operated on. The impairment of lymph nodes was decisive in shortening survival; men were affected more than women and had a worse prognosis. When the tumors were located in the proximal third of the stomach, the survival rate was longer than when they were located in the distal portion and middle third of the stomach. Patients who had experienced digestive symptoms for a long time survived longer than those with a short history. It was concluded that the main prognostic factor was resectability and, regardless of any other variables, only patients from the group submitted to gastric resection survived more than 5 years.

[Barrett esophagus following peptic and alkaline esophagitis]. / Esôfago de Barrett pós-esofagite péptica e alcalina.

Eight cases of Barrett's esophagus are presented, six as a result of long-term reflux esophagitis, three of them with ulcer in gastric-like mucosa, two with stenosis. The Congo-Red test in three patients showed non-secretory pattern. They could twice confirm the epithelial change in previous normal esophageal mucosa, once after alkaline reflux esophagitis in a patient with total gastrectomy and esophagus-jejunostomy. Both surgical and medical treatment of reflux could afford relief of the symptoms but they produce no change in the ectopic mucosa.

Secrecao gastrica-acida apos vagotomia gastrica proximal. Estudo comparado. / Gastric acid secretion after proximal gastric vagotomy. Comparative study

Objetivando avaliar o comportamento da secrecao gastrica-acida, basal e estimulada pela histamina, em relacao a vagotomia gastrica proximal, estudou-se pacientes portadores de ulcera duodenal, no pre e no pos-operatorio daquela cirurgia, comparando-os a individuos normais e a pacientes portadores de ulcera duodenal em fase de acalmia ou com lesao cicatrizada. Verificaram que a vagotomia promoveu uma reducao media da acidez basal de 60,76% e da estimulada, de 49,93%. Os niveis secretorios dos pacientes no pos-operatorio foram estatisticamente semelhantes aos dos individuos normais. Tambem foram semelhantes as curvas de acidez, quando se comparou ulcerosos com lesao cicatrizada e em fase de acalmia clinica, com aqueles com ulcera ativa, o que parece indicar que individuos, desde que portadores de ulcera duodenal, tem sempre o mesmo comportamento secretorio, independente da historia natural da doenca ulcerosa

Esofago de Barrett pos-esofagite peptica e alcalina. / Barrett esophagus following peptic and alkaline esophagitis

Sao apresentados oito casos de esofago de Barrett, seis como resultado de esofagite de longa duracao, tres deles com ulcera em mucosa tipo gastrica, dois estenosantes.Teste com o vermelho congo realizado em tres doentes mostrou mucosa nao secretora.Foi possivel acompanhar em duas ocasioes, a modificacao do epitelio esofagico de plano para cilindrico, em uma delas na vigencia de esofagite alcalina de refluxo em um paciente com gastrectomia total e esofagojejunostomia. A correcao cirurgica do refluxo ou seu tratamento clinico promoveram remissao dos sintomas da esofagite mas sem regressao ao normal da mucosa esofagica

Resultados tardios na vagotomia superseletiva. / Late results in superselective vagotomy

No presente trabalho os autores analisam 89 pacientes submetidos a vagotomia superseletiva, para tratamento da ulcera duodenal, entre janeiro de 1976 e julho de 1979. Tais pacientes foram avaliados, ate julho de 1981, pelo criterio de Visick e classificados em: Visick I = 52 pacientes (71,23%);Visick II = 13 pacientes (17,80%) Visick IIIs = 1 paciente (1,36%); Visick IIIi = 2 pacientes (2,73%); Visick IV = 5 pacientes (6,85%). Das 5 recidivas, 3 eram duodenais e 2 gastricas. Esses resultados foram comparados aos observados com a gastrectomia parcial e com a vagotomia troncular e antropilorectomia e mostraram-se sensivelmente melhores na vagotomia supeseletiva.seletiva

Vagotomia troncular e antropiloroduodenectomia no tratamento da ulcera duodenal.Resultados tardios. / Truncal vagotomy and antroduodenectomy in the treatment of duodenal ulcer. Late results

Os autores apresentam os resultados tardios da vagotomia troncular associada a antropiloroduodenectomia parcial anterior en 123 pacientes portadores de ulcera duodenal, operados entre janeiro de 1970 e julho de 1980. Esses pacientes responderam a um questionario dirigido, em que os seguintes itens foram analisados: dor, nauseas e vomitos, fraqueza, sudorese e mal-estar, intolerancia alimentar, plenitude pos-prandial, pirose retroesternal, funcao instestinal, tempo de retorno ao trabalho e opiniao subjetiva do paciente sobre os resultados da cirurgia. Por meio dessa avaliacao, foram classificados segundo o criterio de Visick em: I = 27,64%; II = 56,91%; IIIs = 9,76%; IIIi = 5,69% e IV = zero. Concluem que e um procedimento valido para o tratamento cirurgico da ulcera duodenal, com 84,55% de excelentes e bons resultados tardios

Evaluation of vagotomy by the Hollander-Congo red test.

In the present study, the completeness of vagotomy in patients who underwent truncal and highly selective vagotomy is evaluated, comparing them with control groups of normal persons and patients with a duodenal ulcer. The evaluation was made by the Hollander test, followed by the endoscopic Congo red test, using the same hypoglycemic stimulus. Gastric acid production was higher in the patients with duodenal ulcer, followed by the normal persons. Lower acidity levels were obtained for patients with truncal vagotomy than for patients with highly selective vagotomy. During the Congo red test, we noted that the patients with truncal or highly selective vagotomy had small black spots in the gastric mucosa, except those having a recurrent ulcer, denoting incomplete vagotomy. Nevertheless, when we observed the appearance of the gastric mucosa, we noted a similar aspect for those having had a vagotomy and for normal persons. This appearance was completely different from the patients with a duodenal ulcer. We concluded that truncal vagotomy greatly reduces the level of gastric acid production, while highly selective vagotomy does so to a lesser extent. The endoscopic aspect of these patients during the Congo red test was similar to that for normal persons.

Tratamento cirurgico das neoplasias de intestino grosso. Experiencia do servico de cirurgia. / Surgical treatment of large intestine neoplasms.Experience of the Surgical Service

Os autores apresentam os resultados observados com o tratamento cirurgico instituido em 31 pacientes portadores de tumor maligno de intestino grosso, atendidos essencialmente em carater de urgencia.As lesoes estavam localizadas em 41,9% das vezes no colon sigmoide e no reto. Havia 3 casos de polipose adenomatosa multipla, uma de carater familiar. Pelo criterio de Dukes, 67,86% foram classificados em C (estadios III e IV). A ressecabilidade foi de 77,42%, a mortalidade operatoria de 16, 13% e a sibrevida de 5 anos de 15,38%. Atribuem a baixa de sobrevida ao estadio avancado com que os pacientes se apresentavam por ocasiao do atendimento

Teste do vermelho congo com estimulo pela insulina para avaliacao da integralidade vagal apos vagotomia. / Congo red test with insulin stimulation for evaluation of vagal integrity after vagotomy

Os autores propoem um metodo para a avaliacao da integralidade vagal apos vagotomia, baseado nas propriedades tintoriais do indicador de pH vermelho congo. O metodo consiste na realizacao do teste de Hollander com injecao intravenosa de 0,2-0,3U de insulina por kg de peso (nao ultrapassando 20U). Imediatamente apos completar o teste de Hollander (120 min apos a injecao da insulina), com a glicemia em niveis iguais ou inferiores a 50 mg%, a mucosa gastrica e endoscopicamente tinta com vermelho congo. Nas areas com pH abaixo de 3,4 (niveis estabelecidos para viragem do vermelho congo a 1% de diluicao), a mucosa aparece corada em negro, denotando acao mediada pelo vago em funcao do estimulo hipoglicemico induzido pela insulina, por tanto, fibras vagais gastricas intactas.Esse teste foi empregado em l0 pacientes submetidos a vagotomia troncular e operacao de drenagem, por ulcera duodenal, ha mais de 5 anos. Observamos em 6 pacientes areas tintas em negro, denotando vagotomia incompleta. Comparando com outros metodos para avaliacao da vagotomia, o teste do vermelho congo com estimulo hipoglicemico induzido pela insulina mostrou-se mais sensivel