Antireflux surgery followed by bipolar electrocoagulation in the treatment of Barrett's esophagus.

BACKGROUND: Management of Barrett's esophagus requires reduction of gastric acid secretion and screening for the development of adenocarcinoma. However, the current therapeutic options are ineffective in reducing the Barrett's mucosa. The aim of this study was to evaluate the effectiveness of endoscopic thermal coagulation of Barrett's mucosa as an alternative therapeutic approach and the recurrence of the disease in the long term. METHODS: Fourteen patients (11 men, 3 women; mean age 45.7 years) with Barrett's esophagus participated in the study. They underwent laparoscopic fundoplication and were symptom free with no defective fundoplication wraps before therapeutic endoscopy. Endoscopic thermocoagulation was performed with a flexible videoendoscope and a bipolar probe. Mucosal areas were treated once a month until the Barrett's mucosa disappeared. Endoscopy was performed 1 and 7 months after completion of the treatments and once a year thereafter. RESULTS: The mean follow-up period was 21.6 months (range 18 to 30 months). The mean length of Barrett's esophagus was 4.8 cm. Successful ablation of the columnar epithelium was achieved in 3.7 sessions, as defined by demonstration of normal squamous epithelium at histologic examination of biopsy samples collected after completion of the treatments and at follow-up evaluations. Three patients experienced short-term (10 days) odynophagia or dysphagia. All patients were symptom free with no evidence of Barrett's esophagus at the end of the study. CONCLUSIONS: Bipolar electrocoagulation after antireflux operations is effective in promoting regression of Barrett's esophagus and has few complications. Endoscopic thermal coagulation might reduce risk for adenocarcinoma among these patients.

Diagnostic value of fecal leukocytes in chronic bowel diseases.

To evaluate the importance of fecal leukocytes, 42 patients who showed signs of fecal leukocytes (++ or +++) were studied. Their endoscopic examinations with biopsy and/or radiology of the colon showed the following diagnoses: 33 had ulcerative colitis, four had colonic adenocarcinoma, two had Crohn's disease, two had amebic colitis and one had eosinophilic colitis. The presence of fecal leukocytes allowed for the diagnosis of colon disease in all the patients, and it might indicate exudative bowel disease. These results suggest that whenever fecal leukocytes are found in the feces, an examination for colon disease should be made.

[Absorption of medium chain triglycerides in patients with blind loop syndrome]. / Absorção de triglicérides de cadeia média em pacientes com síndrome de alça estagnada.

Absorption of medium chain triglycerides (MCT) was estimated in 10 patients with stagnant loop syndrome (SLS). Six patients had steatorrhea due to gastrojejunal anastomosis and 4 due to diabetic neuropathy. The diagnosis of SLS was confirmed by antibiotic therapeutic test after exclusion of other causes of malabsorption syndrome. Each patient was submitted to 2 types of diet during one week each, differing only in the type of added lipid. In the diet with long chain triglycerides (LCT), soy oil and butter were added. In the diet, with medium chain triglycerides, only MCT oil from babaçu was added. The excretion of lipid was determined in the feces in the last 3 days of each diet. The results showed that the medium fecal lipid excretion was 48.6 (sd = 19.8) g/d in the LCT diet and 26.6 (sd = 13.8) g/d in the MCT [d = 22.0; s(d) = 3.10; t = 7.10; p less than 0.001], which indicates that in patients with SLS, MCT diet was better absorbed than LCT diet. It is suggested that MCT oil may be used as a caloric source during nutritional recovery in SLS.

[Qualitative microscopic evaluation of fecal fats. Comparative study]. / Avaliação microscópica qualitativa da gordura fecal. Estudo comparativo.

Microscopical examination of stool fat is an easy laboratory procedure a long ago used as screening for steatorrhea. Quantitative analysis of stool fat is accepted as the best method to diagnose fat malabsorption, but stool collection and the laboratory technique are more difficult and time-consuming. The main objective of this work was performed to compare the accuracy of microscopical qualitative examination in the same fecal sample collected in 500 patients, 299 adults and 201 children, for the three days quantitative method. The diagnosis of steatorrhea was confirmed by chemical determination in 237 adults (stool fat values greater than 5 g) and 131 children (stool fat values greater than 2 g). From these 62 patients adults and 70 children were admitted as controls. The study showed that microscopical qualitative fat evaluation is highly comparable with findings obtained by chemical dosage. However, it is important to consider the use of two microscopic examination for each fecal sample, that must be carefully homogenized.

[Isoniazid acetylation in Gilbert's syndrome]. / A acetilação da isoniazida na síndrome de Gilbert.

Phenotyping of isoniazid acetylators in 19 Caucasoid patients with Gilbert's syndrome was achieved by evaluating the percentual of acetylisoniazid in the urine. The proportion of slow acetylators among the patients with Gilbert's syndrome was similar to those found among Caucasoids of control group. The conclusion was that Gilbert's syndrome doesn't interfere in the hepatic capacity of isoniazid acetylation.

[Gilbert's syndrome in patients with splenomegaly]. / Síndrome de Gilbert em pacientes com esplenomegalia.

Three patients are reported with hyperbilirubinemia and splenomegaly. The diagnosis of Gilbert's syndrome was made by the caloric restriction test and enzymatic induction test. The splenomegaly was attributed to spherocytosis in two patients, while the third case had a probable diagnosis of spherocytosis.

[Electron microscopy of the liver in Gilbert's syndrome]. / Microscopia electrônica do fígado na síndrome de Gilbert.

Hepatic biopsy of five patients with Gilbert's syndrome was examined at the electron microscopy and only one disclosed incharacteristic alterations. The others were considered normal.

Histochemistry of the amyloid substance from familial amyloidotic polyneuropathy.

The histochemical properties of the amyloid substance from familial amyloidotic polyneuropathy (FAP) were studied. The results showed differences among the FAP amyloid and the others amyloid substance. The main difference being that FAP amyloid substance was free of or only contain a small amount of protein. It contains acid and neutral glycidic substances, constituting its major part.