Lower esophageal sphincter analysis using computerized manometry in patients with chagasic megaesophagus.

Due to the introduction of computer technology into manometry laboratories, three-dimensional manometric images of the lower esophageal sphincter can be constructed based on radially oriented pressures, a method termed 'computerized axial manometry.' Calculation of the sphincter pressure vector volume using this method is superior to standard manometric techniques in assessing lower esophageal sphincter function in patients with gastroesophageal reflux disease and idiopathic achalasia. Despite similarities between idiopathic achalasia and chagasic esophagopathy found using clinical, radiological, and manometric studies, controversy around lower esophageal sphincter pressure persists. The goal of this study was to analyze esophageal motor disorders in Chagas' megaesophagus using computerized axial manometry. Twenty patients with chagasic megaesophagus (5 men, 15 women, and average age 50.1 years, range 17-64) were prospectively studied. For three-dimensional imaging construction of the lower esophageal sphincter, a low-complacency perfusion system and an eight-channel manometry probe with four radial channels placed in the same level were used. For probe traction, the continuous pull-through technique was used. Results showed that the lower esophageal sphincter of patients with chagasic megaesophagus have significantly elevated pressure, length, asymmetry, and vector volumes compared to those of normal volunteers (P < 0.05). Aperistalsis of the esophageal body waves was observed in all patients and contraction amplitude was lower than that in normal patients. We conclude that patients with chagasic megaesophagus have hypertonic lower esophageal sphincter and aperistalsis of the esophageal body.

Ultra-sonografia durante operacoes pancreaticas. / Ultrasonograpy during pancreatic operations

A ultra-sonografia do tipo B-modo "real-time foi utilizada em 64 operacoes pancreaticas, 43 por doenca inflamatoria e 21 por tumor. Em 25 dessas operacoes a ultrasonografia forneceu informacoes adicionais que orientaram no tratamento cirurgico de pseudocistos, abscessos, pancreatites cronicas e tumores pancreaticos.As informacoes consistiam em estabelecer ou excluir o diagnostico de pseudocisto e abscessos pancreatico, localizar pseudocisto e ducto pancreatico principal que nao eram palpaveis, selecionar o melhor local de biopsia pancreatica, avaliar a ressecabilidade do adenocarcinoma de pancreas e localizar tumores pancreaticos endocrinos. A ultra-sonografia per-operatoria e um metodo simples e eficiente para avaliar doenca pancreaticas