Quality Of Life Of Esophagectomized Patients: Adenocarcinoma Versus Squamous Cell Carcinoma.

To evaluate and compare the quality of life (QOL) of patients undergoing esophagectomy for treatment of adenocarcinoma of the esophagogastric junction and squamous cell carcinoma. We conducted a cross-sectional study in postoperative patients submitted to esophagectomy for adenocarcinoma of the esophagogastric junction (ACA) and squamous cell carcinoma (SCC), using the SF-36 questionnaire applied in 24 patients (10 ACAs and 14 SCCs), from the 5th months postoperatively, including clinical symptoms and weight change. The assessment of QOL showed the best functional capacity (p = 0.018) in the ACA group. There was a correlation between the fields mental health and Role of Emotions (p = 0.003) and between pain and physical aspects limitation (p = 0.003) in both histological types. Weight loss was greater in ACA (45.9 kg), with no significant difference between current BMI (p> 0.66). Dysphagia was reported by 83.3% of patients, anorexia by 58.3%, chewing difficulty by 42%, nausea and vomiting by 41.7% and diarrhea by 29.2%, with no correlation with QOL reported (p> 0.05). The highest score for functional capacity indicates that ACA patients were able to perform all types of physical activity, including the more demanding, at a higher level than patients with SCC. Some symptoms persisted postoperatively, but did not affect the quality of life of patients.403-

Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?

to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were male (60%). Indications were 18 tumors of the distal esophagus and esophagogastric junction (90%) and two with invasion of gastric fundus (10%) in patients with previous gastrectomy. Preoperative colonoscopy to exclude colonic diseases was performed in ten cases. the surgical technique consisted of median laparotomy and left cervicotomy, followed by transhiatal esophagectomy associated with D2 lymphadenectomy. The reconstructions were performed with eight esophagocoloduodenoplasty and the others were Roux-en-Y esophagocolojejunoplasty to prevent the alkaline reflux. Three cases were stage I / II, while 15 cases (85%) were stages III / IV, reflecting late diagnosis of these tumors. The operative mortality was 5 patients (25%): a mediastinitis secondary to necrosis of the transposed colon, abdominal cellulitis secondary to wound infection, severe pneumonia, an irreversible shock and sepsis associated with colojejunal fistula. Four patients died in the first year after surgery: 3 (15%) were due to tumor recurrence and 1 (5%) secondary to bronchopneumonia. The 5-year survival was 15%. the total esophagogastrectomy associated with esophagocoloplasty has high morbidity and mortality, requiring precise indication, and properly selected patients benefit from the surgery, with the risk-benefit acceptable, contributing to increased survival and improved quality of life.To analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were426360365sem informaçãosem informaçã

Futuro dos modelos de linguagem nos cuidados em saúde: o papel do ChatGPT

The field of medicine has always been at the forefront of technological innovation, constantly seeking new strategies to diagnose, treat, and prevent diseases. Guidelines for clinical practice to orientate medical teams regarding diagnosis, treatment, and prevention measures have increased over the years. The purpose is to gather the most medical knowledge to construct an orientation for practice. Evidence-based guidelines follow several of the main characteristics of a systematic review, including systematic and unbiased search, selection, and extraction of the source of evidence. In recent years, the rapid advancement of artificial intelligence (AI) has provided clinicians and patients with access to personalized, data-driven insights, support and new opportunities for healthcare professionals to improve patient outcomes, increase efficiency, and reduce costs. One of the most exciting developments in AI has been the emergence of chatbots. A chatbot is a computer program to simulate conversation with human users. Recently, OpenAI, a research organization focused on machine learning, developed ChatGPT, a large language model that generates human-like text. ChatGPT uses a type of AI known as a deep learning model. ChatGPT can quickly search and select pieces of evidence through numerous databases to provide answers to complex questions, reducing the time and effort required to research a particular topic manually. Consequently, language models can accelerate the creation of clinical practice guidelines. While there is no doubt that ChatGPT has the potential to revolutionize the way healthcare is delivered, it is essential to note that it should not be used as a substitute for human healthcare professionals. Instead, ChatGPT should be seen as a tool that can be used to augment and support the work of healthcare professionals, helping them to provide better care to their patients.A área da medicina sempre esteve na vanguarda da inovação tecnológica, buscando constantemente novas estratégias para diagnosticar, tratar e prevenir doenças. As diretrizes para a prática clínica são para orientar as equipes médicas quanto ao diagnóstico, tratamento e medidas de prevenção aumentaram ao longo dos anos. O objetivo é reunir o máximo de conhecimento médico para construir uma orientação para a prática. As diretrizes baseadas em evidências seguem várias das principais características de uma revisão sistemática, incluindo busca sistemática e imparcial, seleção e extração da fonte de evidência. Nos últimos anos, o rápido avanço da inteligência artificial (IA) forneceu aos médicos e pacientes acesso a informações personalizadas e baseadas em dados, suporte e novas oportunidades para os profissionais de saúde melhorarem os resultados dos pacientes, aumentarem a eficiência e reduzirem custos. Um dos desenvolvimentos mais empolgantes da IA foi o surgimento dos chatbots. Um chatbot é um programa de computador para simular conversas com usuários humanos. Recentemente, a OpenAI, uma organização de pesquisa focada em aprendizado de máquina, desenvolveu o ChatGPT, um grande modelo de linguagem que gera texto semelhante ao humano. O ChatGPT usa um tipo de IA conhecido como modelo de aprendizado profundo. O ChatGPT pode pesquisar e selecionar rapidamente evidências em vários bancos de dados para fornecer respostas a perguntas complexas, reduzindo o tempo e o esforço necessários para pesquisar um tópico específico manualmente. Consequentemente, os modelos de linguagem podem acelerar a criação de diretrizes de prática clínica. Embora não haja dúvida de que o ChatGPT tem potencial para revolucionar a forma como os cuidados de saúde são prestados, é essencial observar que não deve ser usado como substituto de profissionais de saúde humanos. Em vez disso, o ChatGPT deve ser visto como uma ferramenta que pode ser usada para aumentar e apoiar o trabalho dos profissionais de saúde, ajudando-os a prestar melhores cuidados aos seus pacientes

Omeprazol e misoprostol na prevenção de lesões de mucosa gástrica causadas por indometacina e celecoxib em ratos

PURPOSE: To evaluate and to compare macro and microscopically the intense injuries of the gastric mucosa of rats which were caused by NSAIDS celecoxib and indomethacin and the gastric cytoprotection with omeprazole and misoprostol. METHODS: The sample is formed by one hundred and fifty Wistar rats with average weight 200 g, distributed in four groups, such as: Group A, subdivided in groups A1 and A2 - pre-treatment with omeprazole (20 mg/rat) during seven days and on the 8th day - use of NSAIDS, concerning A1 (20 rats) were given celecoxib (1mg/rat) and A2 (20 rats) were given indomethacin. The Group B, subdivided in group B1 and B2 - pre-treatment with misoprostol (20mg/rat) during seven days and on the 8th day use of NSAIDS, concerning B1 (20 rats) were given celecoxib (1 mg/ rat) and B2 (20 rats) were given indomethacin (12.5 mg/rat). The Group C: were not given cytoprotection during seven days, from the 7th to the 8th day - fast of food and water ad libitum, on the 8th day of NSAIDS use, concerning C1 (20 rats) were given celecoxib, C2 (20 rats) were given indomethacin (12.5 mg/ rat), C3 (20 rats) were given celecoxib (200mg/rato), and Group D - control group, concerning 10 rats were observed during seven days ingesting food and water ad libitum. On the 9th day, the stomachs were taken out and were macro and microscopically evaluated for the identification of the gastric injuries. RESULTS: On the macroscopic studies, the groups A2, B2 and C2 presented a remarkable high number of injuries for cm² /animal, respectively 18.55 injuries for cm² /animal, 16.25 injuries for cm² /animal and 13.55 injuries for cm²/animal. On the microscopic studies, the percentage of the injured mucosa, presented expressive difference among the groups A1, B1, C1 when compared to the groups A2, B2, C2 (p<0.0001). The average of the length/injury and the average of the depth of the injuries did not present expressive statistics differences among the groups A2, B2 and C2. The average of the edema presented expressive statistics difference among the groups A2 and D; B2 and C2 and between C2 and D (p < 0.05). CONCLUSIONS: The indomethacin on the applied concentration causes a great number of macroscopic and microscopic injuries to gastric mucosa of rats when compared to celecoxib which does not cause lesions. Omeprazole and misoprostol on the applied concentrations do not present macroscopic and microscopic effectiveness on the gastric cytoprotection when applying indomethacin. Considering the microscopic analysis of the average of the edema, the group of animals, which was given misoprostol as cytoprotection, presented a lower average compared to the group which was given omeprazole.OBJETIVO: Avaliar e comparar macro e microscopicamente as lesões agudas da mucosa gástrica de ratos provocadas pelos AINEs celecoxib e indometacina e a citoproteção gástrica com omeprazol e misoprostol. MÉTODOS: A amostragem consistiu 150 ratos machos da raça Wistar, com peso médio de 200g, divididos em quatro grupos, a saber: grupo A, subdividido em grupos A1 e A2 - pré-tratamento com omeprazol (20 mg/rato) durante sete dias, e no oitavo dia receberam o AINEs, sendo A1 (20 ratos) receberam celecoxib (1mg/rato) e A2 (20 ratos) receberam indometacina (12,5mg/rato). O grupo B, subdividido em grupo B1 e B2 - pré-tratamento com misoprostol (20ìg/rato) durante sete dias e no oitavo dia receberam AINEs, sendo B1 (20 ratos) receberam celecoxib (1mg/rato) e B2 (20 ratos) receberam indometacina (12,5mg/rato). O grupo C não recebeu citoproteção durante sete dias e no oitavo dia recebeu AINEs, sendo C1 (20 ratos) receberam celecoxib (1mg/rato) , C2 (20ratos) receberam indometacina (12,5mg/rato), C3 (20 ratos) receberam celecoxib e grupo D - grupo controle, no qual dez ratos foram observados recebendo ração e água ad libitum. A seguir, no 9º dia (de todos os grupos), os estômagos eram removidos e avaliados macro e microscopicamente para a identificação das lesões gástricas. RESULTADOS: Na análise macroscópica, os grupos A2, B2 e C2 apresentaram número de lesões por cm²/animal significativamente elevados, sendo respectivamente 18,55 lesões por cm²/animal, 16,25 lesões por cm²/animal e 13,55 lesões por cm²/animal. Na análise microscópica, a porcentagem da mucosa com lesão mostrou diferença significativa entre os grupos A1, B1, C1 quando comparados com os grupos A2, B2 e C2 (p<0,0001). Os resultados da média da extensão/lesão e da média da profundidade das lesões não mostraram diferenças estatísticas significativas entre os grupos A2, B2 e C2. A média do edema mostrou diferença estatística significativa entre os grupos A2 e D; B2 e C2 e entre C2 e D (p<0,05). CONCLUSÕES: A indometacina na concentração empregada provoca número significativo de lesões macro e microscópicas na mucosa gástrica de ratos quando comparadas ao celecoxib, que não provocou lesões. O omeprazol e o misoprostol nas concentrações empregadas não mostraram efetividade macro e microscópica na citoproteção gástrica à administração da indometacina. Considerando-se a análise microscópica da média do edema, o grupo de animais que recebeu misoprostol como citoprotetor apresentou menor média em comparação ao grupo que recebeu o omeprazol.16817

Esophageal mucosal resection versus esophagectomy: a comparative study of surgical results in patients with advanced megaesophagus

The surgical treatment of advanced megaesophagus has no consensus, being esophagectomy the more commonly used method. Since it has high morbimortality--inconvenient for benign disease -, in recent years an alternative has been introduced: the esophageal mucosal resection. To compare early and late results of the two techniques evaluating the operative time, length of ICU stay; postoperative hospitalization; total hospitalization; intra- and postoperative complication rates; mortality; and long-term results. Were evaluated retrospectively 40 charts, 23 esophagectomies and 17 mucosectomies. In assessing postoperative results, interviews were conducted by using a specific questionnaire. Comparing the means of esophagectomy and mucosal resection, respectively, the data were: 1) surgical time--310.2 min and 279.7 min (p > 0.05); 2) length of stay in ICU--5 days and 2.53 days (p 0.05); 4) length of hospital stay after surgery--19.05 days and 14.94 days (p> 0.05); 5) presence of intraoperative complications--65% and 18% (p 0.05). In the assessment of late postoperative score (range 0-10) esophagectomy (n = 5) obtained 8.8 points and 8.8 points also got mucosal resection (n = 5). Esophageal mucosal resection proved to be good alternative for surgical treatment of megaesophagus. It was advantageous in the immediate postoperative period by presenting a lower average time in operation, the total hospitalization, ICU staying and complications rate. In the late postoperative period, the result was excellent and good in both operations.The surgical treatment of advanced megaesophagus has no consensus, being esophagectomy the more commonly used method. Since it has high morbimortality--inconvenient for benign disease -, in recent years an alternative has been introduced: the esophageal m2812831sem informaçãosem informaçã

Studies Of Distribution And Recurrence Of Helicobacter Spp. Gastric Mucosa Of Dogs After Triple Therapy [estudos Da Distribuição E Recorrência Do Helicobacter Spp. Na Mucosa Gástrica De Cães Após Terapia Tríplice]

Purpose: To analyze the triple antimicrobial therapy in positive Helicobacter spp. dogs and to investigate recurrence. Methods: A total of 20 dogs underwent endoscopy followed by gastric biopsy using the rapid urease test and histopathology stained with Giemsa. Ten animals were treated with triple therapy recommended for humans and divided into control and experimental group. The control group was kept in isolation while the experimental group was placed in contact with positive animals during 60 days. Results: The prevalence of infection in animals in this experiment was 100%, and more frequent in the fundus and the gastric body. Therapy for 7 days using clarithromycin, amoxicillin and lansoprazole was effective in 100% of the animals. Recurrence of the infection in 80% of dogs in the experimental group, while the control group remained eradicated after 60 days. Conclusion: Crowded environments associated with close contact with dogs infected with helicobacter are a determinant for transmission of Helicobacter spp. between canines.2628287Ladeira, M.S.P., Salvador, D.M.F., Rodrigues, M.A.M., Biopatologia do Helicobacter pylori (2003) J Bras Patol Med Lab, 39 (4), pp. 335-342Marshall, B.J., Warren, J.R., Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration (1984) Lancet, 1, pp. 1311-1315Carvalho, G.D., Pinto, P.S.A., Vilória, M.I.V., Nero, L.A., Aspectos zoonóticos de Helicobacter spp (2008) Biosci J, 24 (4), pp. 121-130Escobar, M.L., Kawakami, E., Evidence of mother child transmission of Helicobacter pylori infection (2004) Arq Gastroenterol, 41 (4), pp. 239-244Parente, J.M.L., Silva, B.B., Palha-Dias, M.P.S., Zaterca, S., Nishimura, N.F., Zeitune, J.M.R., Helicobacter pylori infection in children of low and high socioeconomic status in northeastern Brazil (2006) Am Soc Trop Med Hyg, 75 (3), pp. 509-512Strauss-Ayali, D., Simpson, K.W., Gastric Helicobacter infeccion in dogs (1999) Vet Clin N Am Small Anim Pract, 29 (2), pp. 397-414Neiger, R., Simpson, K.W., Helicobacter infection in dogs and cats: Facts and fiction (2000) J Vet Intern Med, 14 (2), pp. 125-133Happonen, E.U., Saari, S., Castren, L., Tyni, O., Hänninen, M.L., Westermarck, E., Comparison of diagnostic methods for detecting gastric Helicobacter like organisms in dogs and cats (1996) J Comparat Pathol, 115 (2), pp. 117-127Mendall, M.A., Northfeld, T.C., Transmission of Helicobacter pylori infection (1995) Gut, 37, pp. 1-3Fox, J.G., Non-human reservoirs of Helicobacter pylori (1995) Aliment Pharmacol Ther, 9 (2), pp. 93-103Coelho, L.G.V., Mattos, A.A., Francisconi, C.F.M., Castro, L.P., Suraia, A.B., Effcacy of the dosing regimen of pantoprazole 40 mg, amoxicillin 1000 mg and clarithromycin 500 mg, twice daily of 7 days, in the eradication of Helicobacter pylori in patients with peptic ulcer (2004) Arq Gastroenterol, 41 (1), pp. 71-76Coelho, L.G.V., Zaterca, S., Second Brazilian Consensus Conference on Helicobacter pylori infection (2005) Arq Gastroenterol, 42 (2), pp. 128-132Chether, L., Rodrigues, L., Faria, C.M., Recorrência da infecção por H. pylori na Unifesp (2005) GED, 24 (3), pp. 121-130Mesquita, M.A., Lorena, S.L., Zeitune, J.M.R., Montes, C.G., Guerrazzi, F., Carvalho, A.F., Santos, J.O.M., Almeida, J.R.S., Recurrence of Helicobacter pylori infection after eradication therapy in brazilian patients with peptic ulcer (2005) J Clin Gastroenterol, 39 (5), p. 447Moutinho, F.Q., Thomassian, A., Watanabe, M.J., Suzano, S.M.C., Sequeira, J.L., Prevalence of helicobacters and alterations in gastric mucosa of healthy dogs (2007) Arq Bras Med Vet Zootec, 59 (4), pp. 1080-1083Eaton, K.A., Dewhirst, F.E., Paster, B.J., Tzellas, N., Coleman, B.E., Paola, J., Sherding, N., Prevalence and varieties of Helicobacter species in dogs from random sources and pet dogs: Animal and public health implications (1996) J Clin Microbiol, 34, pp. 3165-3170Hänninen, M.L., Happonen, I., Saari, S., Jalava, K., Culture and characteristic of Helicobacter bizzozeronii, a new gastric canine Helicobacter sp (1996) Int J Syst Bacteriol, 46 (1), pp. 160-166Lee, A., Hazell, S.L., O'Rourke, J.L., Kouprach, S., Isolation of a spiral shaped bacterium from the cat stomach (1988) Infect Immunol, 56 (11), pp. 2843-2850Paster, B.L., Lee, A., Fox, J.G., Dewhirst, F.E., Tordoff, L.A., Fraser, G.J., O'Rouke, J.L., Ferrero, R., Phylogeny of Helicobacter felis sp. nov., Helicobacter mustelae, and related bacteria (1991) Int J Syst Bacteriol, 41, pp. 31-38Javala, K., Kaartinen, M., Utriainen, M., Happonen, I., Hänninen, M.L., Helicobacter salomonis sp. nov., a canine gastric Helicobacter sp. Related to H. felis and H. bizzozeronii (1997) Int J Syst Bacteriol, 52, pp. 975-980Takemura, L.S., Camargo, P.L., Alferi, A.A., Bracarense, A.P., Helicobacter spp. in cats: Association between infecting species and epithelial proliferation within the gastric lamina propria (2009) J Comp Pathol, 141 (2-3), pp. 127-134Hernández, C.A., Gallon, G., Restrepo, L.F., Análises de biópsias gástricas endoscópicas em caninos (2007) Rev Colom Cienc Pecua, 20 (3), pp. 250-259Coelho-Neto, J.S., Andreollo, N.A., Lopes, L.R., Nishimura, N.F., Brandalise, N.A., Leonardi, L.S., Late follow-up of gastrectomized patients for peptic ulcer: Clinical, endoscopic and histopathological aspects (2005) Arq Gastroenterol, 42 (3), pp. 146-152Ferreira, L.E.V.V.C., Meirelles, G.S.P., Vieira, R.C., Bragagnolo, M.A., Chebli, J.M.F., Souza, A.F.M., (2001) Changes In Ultra Rapid Urease Test and Histopathological Examination For Helicobacter Pylori By Antisecretory Drugs Arq Gastroenterol, 38 (1), pp. 3-8Happonen, E.U., Linden, J., Westermarck, E., Effect of triple therapy on eradication of canine gastric helicobacters and gastric disease (2008) J Small Anim Pract, 41 (1), pp. 1-6Leib, M.S., Duncan, R.B., Ward, D.L., Triple antimicrobial therapy and acid suppression in dogs with chronic vomiting and gastric Helicobacter spp (2008) J Vet Intern Med, 21 (6), pp. 1185-1192Pereira, G.A.S., Detección de Helicobacter pylori en placa dental y en mucosa gástrica de pacientes sometidos a endoscopia digestiva (2005) Acta Odontol Venez, 43 (2), pp. 113-118Recordati, C., Gualdi, V., Tosi, S., Facchini, R.V., Pengo, G., Luini, M., Simpson, K.W., Scanziania, E., Detection of Helicobacter spp. DNA in the oral cavity of dogs (2007) Vet Microbiol, 119 (24), pp. 346-351Souza, M.L., Kobayasi, S., Rodrigues, M.A.M., Hossne, R.O.G., Naresse, L.E., Prevalence of Helicobacter in canines from animal colony of the State University of Sao Paulo (UNESP)-Botucatu (2004) Acta Cir Bras, 19 (5), pp. 565-570Schütze, K., Hentschel, E., Dragosics, B., Hischl, A.M., Helicobacter pylori reinfection with indentical organisms: Transmission by the patients' spouses (1995) Gut, 36, pp. 831-83

Modelo experimental de tabagismo e simulação de refluxo com ácido e pepsina em ratos

To develop experimental models to evaluate the effects of hydrochloric acid associated with the pepsin instilled in the mucosa of the upper esophagus and the esophagogastric junction of young male rats Wistar, simulating injury caused by gastroesophageal reflux on the mucosa of aero-digestive tract in humans as well as the action of the risk exposure of mucosa to cigarette smoke. Fifty young male Wistar rats divided in 5 groups with 10 animals each one, respectively simulating pharyngo-laryngeal reflux and gastroesophageal reflux, pharyngo-laryngeal reflux and smoking, smoking only, gastroesophageal reflux and control group. The histopathologic studies no recorded neoplasias, only mild changes and no significant alterations. The hemo-oximetry (carboxyhemoglobin and methemoglobim) and CO2 concentration confirm that the animals were submitted to high intensity of exposure to carcinogens in tobacco and its derivatives. The experimental models were highly efficient, practical, easy to use and economical and can be employed in other similar studies to determine the harmful effects by smoking and reflux2711822Desenvolver modelos experimentais para avaliar os efeitos do ácido clorídrico associado a pepsina, instilados na mucosa da parte superior do esôfago e da junção esofagogástrica de jovens ratos Wistar, simulando lesão causada por refluxo gastroesofágico na mucosa do trato aero-digestivo em humanos, bem como a ação da exposição ao risco de mucosa, como a fumaça de cigarro. Cinqüenta jovens ratos Wistar divididos em cinco grupos com 10 animais cada um, respectivamente, simulando o refluxo faringo-laríngeo e refluxo gastroesofágico, refluxo faringo-laríngeo e tabagismo, tabagismo só, refluxo gastroesofágico e grupo controle. Os estudos histopatológicos não registraram neoplasias, apenas leves alterações e não significativas. O hemo-oximetria (carboxiemoglobina e metemoglobina) e concentração de CO2 corroboram que os animais foram submetidos a alta intensidade de exposição a substâncias cancerígenas do tabaco e seus derivados. Os modelos experimentais desenvolvidos foram altamente eficientes, práticos, fáceis de usar e econômicos podendo ser empregados em outros estudos semelhantes para determinar os efeitos prejudiciais causados pelo tabagismo e reflux

Laparoscopic antireflux surgery in patients with extra esophageal symptoms related to asthma

Asthma, laryngitis and chronic cough are atypical symptoms of the gastroesophageal reflux disease. To analyze the efficacy of laparoscopic surgery in the remission of extra-esophageal symptoms in patients with gastroesophageal reflux, related to asthma. Were reviewed the medical records of 400 patients with gastroesophageal reflux disease submitted to laparoscopic Nissen fundoplication from 1994 to 2006, and identified 30 patients with extra-esophageal symptoms related to asthma. The variables considered were: gender, age, gastroesophageal symptoms (heartburn, acid reflux and dysphagia), time of reflux disease, treatment with proton pump inhibitor, use of specific medications, treatment and evolution, number of attacks and degree of esophagitis. Data were subjected to statistical analysis, comparing the pre- and post-surgical findings. The comparative analysis before surgery (T1) and six months after surgery (T2) showed a significant reduction on heartburn and reflux symptoms. Apart from that, there was a significant difference between the patients with daily crises of asthma (T1 versus T2, 45.83% to 16.67%, p=0.0002) and continuous crises (T1, 41.67% versus T2, 8.33%, p=0.0002). Laparoscopic Nissen fundoplication was effective in improving symptoms that are typical of reflux disease and clinical manifestations of asthma.Asthma, laryngitis and chronic cough are atypical symptoms of the gastroesophageal reflux disease. To analyze the efficacy of laparoscopic surgery in the remission of extra-esophageal symptoms in patients with gastroesophageal reflux, related to asthma. W2729295sem informaçãosem informaçã

Lesões proliferativas gástricas induzidas pelo refluxo duodenogástrico em ratos

PURPOSE: To analyze mucosal proliferation and its characteristics, through specific models of duodenogastric reflux, in the stomach of Wistar rats. METHODS: Seventy-five healthy and adult male rats were divided into three groups: group I - control (n = 25 animals), submitted to gastrotomy of the posterior wall of the glandular stomach; group II - DGR (n = 25 animals), submitted to duodenogastric reflux through latero-lateral gastrojejunal anastomosis in the posterior wall of the glandular stomach and group III - DGR-P (n = 25 animals), submitted to duodenogastric reflux through the pylorus following the same procedure of group II, sectioning and closing the afferent loop. The animals were observed during 36 weeks and subsequently the mucosal lesions were analyzed, with macroscopic and microscopic examination of the prepyloric, the gastrojejunostomy and the squamous area of the stomach. RESULTS: Group I did not present any kind of lesion. Macroscopic lesions of the prepyloric area in groups II and III were 0% and 20%, respectively. Macroscopic lesions of the gastrojejunal stoma in groups II and III were 36% and 88%, respectively, and 12% and 28%, respectively, in the squamous area. Microscopically, adenomatous hyperplasia (AH), squamous hyperplasia (SH) and adenocarcinoma (AC) were diagnosed. The occurrence of AH at the prepyloric area in groups II and III was 0% and 40%, respectively, and in the gastrojejunal stoma, 40% and 72%, respectively. The occurrence of SH in the squamous area in groups II and III was 12% and 20%, respectively, without statistical differences between the groups. AC was found only in three animals of groups III (12%). CONCLUSIONS: The duodenogastric reflux in this experimental model caused high frequency of proliferative lesions of the gastrojejunal stoma and in the prepyloric area, while adenocarcinoma was a rare occurrence.OBJETIVO: Avaliar as lesões proliferativas que se desenvolvem na mucosa gástrica de ratos Wistar após modelo específico de refluxo duodeno-gástrico. MÉTODOS: Foram utilizados 75 ratos adultos machos divididos em três grupos experimentais: o grupo I (controle) submetido a gastrotomia na parede posterior do estômago glandular (25 animais); o grupo II (RDG), foi submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular (25 animais) e o grupo III (RDG-P) submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular, com secção e fechamento da alça (25 animais). Os animais foram observados durante 36 semanas, após o que foram realizados estudos macroscópicos e microscópicos da anastomose gastrojejunal, da região pré-pilórica e região escamosa do estômago. RESULTADOS: Os animais do Grupo I não apresentaram nenhum tipo de lesão. No grupo II observou-se 40% de lesões do tipo hiperplasia adenomatosa na anastomose e 12% de hiperplasia escamosa. No grupo III obteve-se 40% de hiperplasia adenomatosa na mucosa pré-pilórica, 72 % de hiperplasia adenomatosa na mucosa da anastomose, 20% de hiperplasia escamosa e 12 % de adenocarcinoma. CONCLUSÕES: O refluxo duodeno-gástrico induz a alta freqüência de lesões proliferativas na mucosa adjacente à anastomose gastrojejunal ou na mucosa pré-pilórica e o adenocarcinoma é um evento raro neste modelo experimental.20721

Dysphagia after antireflux fundoplication: endoscopic, radiological and manometric evaluation

The transient dysphagia after fundoplication is common and most often disappears until six weeks postoperatively. Analyze a group of patients who presented late and persistent dysphagia postoperatively. Forty-one patients after Nissen fundoplication, 14 male and 27 female, mean age 48 year, were evaluated based on medical history, esophagogastroduodenoscopy, contrast radiographic examination and esophageal manometry. The results were compared with another 19 asymptomatic individuals. Contrast radiographic examination of the esophagus revealed in six cases delayed emptying, characterizing that four patients had achalasia and two diffuse spasm of the esophagus. Esophageal manometry showed that maximal expiratory pressure of the lower sphincter ranged from 10 to 38 mmHg and mean respiratory pressure from 14 to 47 mmHg, values similar to controls. Residual pressure ranged from 5 to 31 mmHg, and 17 patients had the same values as the control group. The residual pressure of the lower sphincter was higher and statistically significant in patients with dysphagia compared with those operated without dysphagia. Future studies individualizing and categorizing each motility disorder, employing other techniques of manometry, and the analysis of the residual pressure may contribute to understand of persistent dysphagia in the postoperative fundoplication.The transient dysphagia after fundoplication is common and most often disappears until six weeks postoperatively. Analyze a group of patients who presented late and persistent dysphagia postoperatively. Forty-one patients after Nissen fundoplication, 14 m274251255sem informaçãosem informaçã