[A missing name in the history of chagasic megaesophagus: Joseph Cooper Reinhardt (1809/10-1873)]. / Um nome que faltava na história do megaesôfago chagásico: Joseph Cooper Reinhardt (1809/10-1873).

The book entitled "Brazil and the Brasilians", written by the Reverends Kidder and Fletcher and firstly published in the United States in 1857, reports the travels of these two missionaries throughout Brazil and includes a section entitled "A new disease". This section contains data regarding the clinical picture, the natural history and the epidemiology of a commom disease in Brazilian hinterland, which was known as "mal de engasgo". These informations were collected in 1855 by Rev. Fletcher from an anonymous North American physician, who worked in Limeira, State of São Paulo, and is called in the book merely as "Dr.-". The present work reports the results of an investigation carried out aiming at the identification of "Dr.-" and discloses documental evidence that "Dr.-" was actually Dr. Joseph Cooper Reinhardt (1809/10-1883). Dr. Reinhardt worked for many years in the citites of Limeira and Campinas, State of São Paulo, and probably had an extensive knowledge regarding the main features of this particular disease, which would be known, nearly 100 years later, as chagasic megaesophagus. The authors point out that, from now on, any account of the history of chagasic megaesophagus must include the name of Dr. Joseph Cooper Reinhardt.

Microanatomic features of unilateral condylar hyperplasia.

Microanatomic features of unilateral condylar hyperplasia (UCH) are described. The articular surface exhibited clefts with surrounding elevations, and globules varying 0.5-2 microns in diameter. The articular zone presented giant coiled fibers, and the proliferative zone was composed of small round cells. The findings suggest that degenerative changes occur in UCH, both in adult and juvenile forms.

Active unilateral condylar hyperplasia.

Two cases of active unilateral condylar hyperplasia which were treated with condylectomy alone are presented. The first case was an adult form and the other a juvenile form. Both were classified as active by using 99Tc bone scintigraphy. Clinical and radiographic features of both cases conformed to the hemimandibular hypertrophy type. Satisfactory facial symmetry and dental occlusion were achieved. Histopathological data confirmed the activity of the articular cartilage layers.

The effect of indirect trauma on the rat temporomandibular joint.

The effect of indirect trauma to the rat temporomandibular joint (TMJ) is analysed by means of an experimental model. The trauma, applied from an angle-glenoid fossa direction, produced injury of the TMJ. The histological data demonstrated that the impact could produce fractures of the glenoid fossa, but no hemarthrosis was observed. Trauma, both with or without fracture, caused proliferative changes in the TMJ. The glenoid fossa, the articular disk and the articular surface of the condyle were injured. Thickening of the articular surfaces had resulted in reduced joint space. Subsequently, remodelling changes in the condyle were found.

Mucosal alterations in human chronic chagasic esophagopathy.

Patients diagnosed as having chronic chagasic esophagopathy were divided into three groups on the basis of radiologic findings: group I, no dilation; group II, moderate dilation, and group III, extensive dilation. Stasis esophagitis was more frequent in group III, with a significant increase in basal layer thickness when compared with groups I and II. The pathogenesis of basal layer hyperplasia may have been due to stasis of ingested food and to myenteric denervation of the viscera. This hyperplasia may be an intermediate condition explaining the higher frequency of cancer among patients with chagasic megaesophagus.

[Peripheral denervation in the various clinical forms of Chagas' disease]. / Desnervação periférica nas diferentes formas clínicas da doença de Chagas.

EMG examination was performed in 41 patients with Chagas' disease, belonging to the several clinical forms of the disease. Constant and direct relationship between the amount of muscle skeletal denervation and the clinical forms has been shown. In addition light peripheral axonal neuropathy was seen. Both muscular and sensory denervation was intense in the group with cardio-digestive form, moderate in the groups with either cardiac or digestive form and light in the group with the indeterminate form. The severity of the clinical symptoms was not related with the amount of peripheral denervation.

Trypanosoma cruzi: zymodemes associated with acute and chronic Chagas' disease in central Brazil.

The clinical characteristics of acute and chronic Chagas' disease in central Brazil are described (29 acute cases and 111 chronic cases). The geographical distribution of Trypanosoma cruzi zymodemes in this region was mapped. Zymodeme (Z) 1 was identified in 12 acute cases, Z2 in 13 and repeated xenodiagnosis gave the same zymodeme identification. The clinical pictures of the Z1 and Z2 acute phases were similar. Resistance to benznidazole treatment occurred after either Z1 or Z2 acute infections. Only 14 positive xenodiagnosis were obtained from the 111 chronic phase patients examined. For 12 of these 14 patients the zymodeme was identified. All 12 carried Z2, 10 of whom had mega involvement. There were several possible explanations for the failure to detect T. cruzi Z1 in chronic Chagas' disease with mega syndromes: suggestions were made for follow-up investigations.

[Endoscopy in megaesophagus. Prospective study of 600 cases]. / Endoscopia no megaesôfago. Estudo prospectivo de 600 casos.

From 1977 to 1984 six-hundred non selected patients with megaesophagus were prospectively examined through 722 endoscopies. 347 (57.8%) were men and 253 (42.2%) women the age ranged from 11 to 87 years (mean 45.7). 499 (90.2%) out of 553 patients had positive serologic test for Chagas' disease. 480 were non treated patients and 120 were previously treated. The following endoscopic findings were found: stasis esophagitis--15 (2.5%), reflux esophagitis--41 (6.5%), stenosis of esophagus--8 (1.3%), cancer of esophagus--5 (0.8%), hiatal hernia--3 (0.5%), esophageal varices--2 (0.3%), leukoplasia--1 (0.2%), duodeno-gastric biliary reflux--173 (30.4%), chronic gastritis--109 (18.2%), gastric ulcer--10 (1.8%), gastric polyp--2 (0.4%), gastric cancer--1 (0.2%), megabulbus--9 (1.6%), duodenal ulcer--10 (1.8%) and duodenitis--5 (1.9%). The cancer of esophagus and megaesophagus association in our results was lower than those reported by others; this may be due to the inclusion of early cases of megaesophagus in our patients. The high incidence of duodeno-gastric biliary reflux in the chagasic megaesophagus is claimed by the authors to be due to an antrum-pyloric-duodenal dyskinesia secondary to intrinsic denervation caused by Chagas' disease. Finally the authors recommend the endoscopy as a routine procedure in the megaesophagus in order to detect these associated morbid conditions.

[Effects of food temperature on the esophageal motility in Chagas' megaesophagus. Manometric study]. / Efeito da temperatura dos ingesta sobre a motilidade esofagiana no megaesôfago chagásico. Estudo manométrico.

The authors studied the effects of food temperature in esophageal motility by the use of manometry in 26 cases of chagasic megaesophagus of hyperkinetic type. An assembly of three water filled polyvinyl catheters was used. Each catheter had a distal side hole and was connected proximally with a transducer. One catheter was localized at the lower esophageal sphincter and the other two respectively 5 cm and 10 cm above the sphincter. Pressure changes were recorded graphically on a direct writing multichannel recorder. 50 ml of water was introduced into the esophagus at 5 degrees C, 20 degrees C, 35 degrees C, and 50 degrees C. This produced incoordinated contractions at the three levels considered. The motility pressures were quantified by planimetry and transformed in areas of mm2. A statistic analysis showed that more activity accured with extreme temperature, specially with the water at 5 degrees C. This fact permits one to understand the reason of increasing dysphagia in patients with chagasic megaesophagus when very hot food is eaten.

A clinical trial with pre- and post-treatment manometry comparing pneumatic dilation with bouginage for treatment of Chagas' megaesophagus.

The physiologic similarities between the megaesophagus of Chagas' disease and idiopathic achalasia are well documented. Therefore, it would seem reasonable that comparisons of controlled trials of therapy for the more common Chagas' megaesophagus could be applied to idiopathic achalasia, where the paucity of cases makes such a controlled comparison difficult. We had the opportunity to study 18 patients with achalasia secondary to Chagas' disease. All of the patients were from the mid central states of Brazil, all had symptoms of dysphagia and radiographic documentation of dilated esophagus and abnormal peristalsis (Rezende Groups II and III), as well as positive serologic evidence of Chagas' disease. Perfused intraluminal manometric studies were performed on all patients. Resting sphincter pressures ranged from 20-35 mm./Hg., mean of 25 (normal 5-12 mm./Hg.) with aperistalsis. Patients were randomly dilated with either bouginage (44-55 ff catheter) or pneumatic dilator (4-4.5 kg./6.5 cm.2 x 2 min.). Although all patients reported symptomatic improvement several days after either procedure, repeat manometric tracings demonstrated no change in the sphincter pressure in the bouginage group. The pneumatically dilated group, however, demonstrated a decrease in sphincter pressure to normal levels (mean 12 mm./Hg.). Follow-up studies one year after the procedure confirmed the persistence of normal sphincter pressure in the pneumatically dilated group but no change, as well as return of initial symptoms, in the bouginage group.