Alina Guimarães Quintanilha

Megaesophagus microbiota: a qualitative and quantitative analysis.

Bacterial overgrowth in the esophageal lumen in patients with megaesophagus can be the cause of recurring pulmonary infections, infectious complications due to surgical or endoscopic procedures, and the development of dysplasia of the esophageal mucosa and cancer. Despite this, esophageal microbiota in the megaesophagus have never been studied. The aim of this study was to analyze qualitatively and quantitatively the microbiota in chagasic megaesophagus in comparison to the normal esophagus. Twenty-five patients (10 men and 15 women), ranging in age from 24 to 74 years (mean years), were prospectively studied from March to September 2000. Fifteen patients with chagasic megaesophagus were divided into three subgroups (n = 5 patients in each) according to the grade of esophageal dilation: MG1 = megaesophagus grade I; MG2 = megaesophagus grade II; and MG3 = megaesophagus grade III. Another group of 10 patients without esophageal disease served as a control group. Samples were collected using a method especially developed to avoid contamination with microorganisms ofthe oral cavity and oropharynx. In the control group, 40% of the cultures were positive with the genus Streptococcus predominating and concentrations varying from 101 to 102 colony-forming units/ml. In the megaesophagus group, 93.3% of the cultures were positive, with great variability in the bacteria and a predominance of various aerobic gram-positive bacteria (Streptococcus was most common) and anaerobic bacteria (Veillonella was most frequent) in concentrations that ranged from 101 to 105 colony-forming units/ml. The bacterial concentrations were generally more elevated in MG3 patients in comparison to MG1 and MG2 patients and the control group (P < 0.05). It was concluded that patients with megaesophagus have a variety of microbiota consisting mostly of aerobic gram-positive and anaerobic bacteria, in concentrations that varied according to the degree of esophageal dilation.

Microbiota do megaesôfago e carcinogênese

ABSTRACT – Background – The risk of development of spin cell carcinoma of the esophagus is 33 times higher in patients with chagasicachalasia. It is possible that the production of N-nitroso compounds in the esophageal lumen by of bacterial action in the stasis liquid that reducenitrates from diet into nitrites may play a role in this process. Aim – To analyze qualitatively and quantitatively the microbiota in chagasicmegaesophagus with special attention to bacteria capable of transforming nitto reduction. Patients – Fifteen patients (six men and nine women)were prospectively studied, with ages varying from 28 to 73 years. Patients were divided into three sub-groups according to Rezende et al.classification of esophageal dilation (grade I, grade II and grade III). Method – The sample collection was performed using a method speciallydeveloped to avoid contamination with microorganisms of the oral cavity and oropharynx, using a Levine catheter n o 14 and a 7,5 oro-traquealtube. Results – Ninety three point three percent of the cultures were positive, with great bacterial variability and predominance of a variety ofaerobic Gram-positive and anaerobic bacteria. The bacterial concentrations were generally more elevated in grade III in comparison to grade Iand grade II. Among the microorganisms found,

Intestinal Mucosa-Associated Microflora in Ulcerative Colitis Patients Before and After Restorative Proctocolectomy with an Ileoanal Pouch

PurposeThis study was designed to identify the mucosa-associated microflora in patients with severe ulcerative colitis before and after restorative proctocolectomy with ileoanal pouch construction in comparison with historic controls.MethodsTen patients with a diagnosis of ulcerative colitis were evaluated. Mucus was collected during colonoscopy from all segments of the colon and terminal ileum before surgery, and from the ileal pouch two and eight months after ileostomy closure. The prevalence and mean concentration of the mucosa-associated microflora were compared over time and with historic controls.ResultsVeillonella sp was the most prevalent bacterium in patients and controls. Klebsiella sp was significantly more prevalent in the ileum of controls, was not found in patients with ulcerative colitis, and after proctocolectomy returned to values found in controls. Some bacteria such as Enterobacter sp, Staphylococcus sp (coag-), Bacteroides sp (npg), Lactobacillus sp, and Veillonella sp had higher mean concentrations in the ileal pouch of patients after surgery than in controls.ConclusionNo bacterium was identified that could be exclusively responsible for the maintenance of the inflammatory process. The mucosa-associated microflora of patients with ulcerative colitis underwent significant changes after proctocolectomy with ileal pouch construction and returned to almost normal values for some bacteria.

Single-use trocar: is it possible to reprocess it after the first use?

The aim of this study was to verify and describe the presence of microorganisms in the single-use trocar after its use in surgical procedures, and after this device was submitted to cleaning, conditioning, and sterilization by physicochemical processes (formaldehyde, ethylene oxide, and hydrogen peroxide plasma). Twenty-eight trocars of the Ethicon, Auto-suture, and Aesculap brands, were randomly selected and analyzed after laparoscopic cholecystectomy. The results have shown that cultures grown of the material collected from the trocars, immediately after its use and before its sterilization process, showed the presence of bacteria and fungi in 46.5% (13). In 53.5% (15) of the trocars, the presence of microorganisms was not detected, very likely due to niches scarcity. In the cultures grown of the 28 trocars after being submitted to sterilization processes, the presence of microorganisms was not verified. We can therefore conclude that although trocars possess compartments not easily accessed for cleaning, these devices can be adequately cleaned and effectively sterilized, when well manipulated, in the institution where the study was carried out by the processes of steam sterilization at low temperature and formaldehyde, ethylene oxide, and hydrogen peroxide plasma.

Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis

OBJECTIVE: Many changes in mucosal morphology are observed following ileal pouch construction, including colonic metaplasia and dysplasia. Additionally, one rare but potential complication is the development of adenocarcinoma of the reservoir. The aim of this study was to evaluate the most frequently observed histopathological changes in ileal pouches and to correlate these changes with potential risk factors for complications. METHODS: A total of 41 patients were enrolled in the study and divided into the following three groups: a non-pouchitis group (group 1) (n = 20; 8 males; mean age: 47.5 years) demonstrating optimal outcome; a pouchitis without antibiotics group (group 2) (n = 14; 4 males; mean age: 47 years), containing individuals with pouchitis who did not receive treatment with antibiotics; and a pouchitis plus antibiotics group (group 3) (n = 7; 3 males; mean age: 41 years), containing those patients with pouchitis who were administered antibiotics. Ileal pouch endoscopy was performed, and tissue biopsy samples were collected for histopathological analysis. RESULTS: Colonic metaplasia was found in 15 (36.6%) of the 41 patients evaluated; of these, five (25%) were from group 1, eight (57.1%) were from group 2, and two (28.6%) were from group 3. However, no correlation was established between the presence of metaplasia and pouchitis (p = 0.17). and no differences in mucosal atrophy or the degree of chronic or acute inflammation were observed between groups 1, 2, and 3 (p>0.45). Moreover, no dysplasia or neoplastic changes were detected. However, the degree of mucosal atrophy correlated well with the time of postoperative follow-up (p = 0.05). CONCLUSIONS: The degree of mucosal atrophy, the presence of colonic metaplasia, and the degree of acute or chronic inflammation do not appear to constitute risk factors for the development of pouchitis. Moreover, we observed that longer postoperative follow-up times were associated with greater degrees of mucosal atrophy.

Influence of storage and heating on mother´s milk microbiota

BACKGROUND: There is a consensus among many authors that the newborn (NB) is particularly prone to infections of the gastrointestinal tract for multiple factors, such as the hypoxia and the artificial milk. These factors facilitate the abnormal bacterial colonization and promote a drawback in the destruction of the toxins of such bacterias. AIM: To identify the microorganisms in the breast milk, after its storage in the refrigerator at 4°C, as well as after heating and to relate the eventual clinical NB signs with the microbiologic laboratory results of the breast milk which was offered. METHODS: The samples collected contemplated the three phases of post-natal breast milk. In 16 cases, the colostrum type was obtained as yellowish milky secretion, up to the beginning of the second week after the birth. In 14 cases, the transition type was obtained as intermediate product of the mothers milk, between colostrum and the mature milk, between the 7th and the 15th day after the birth. In 14 cases, the mature type was obtained as a white opaque liquid, of light smell and sweet taste, from the 15th day after birth. The milk types obtained in the three presentations were subdivided according to the period of conservation and heating in the group colostrums, transition and mature. RESULTS: The microorganisms which did not present growth were: Salmonella sp, Molds/leavens and Pseudomonas aeruginosa. The total coliforms and fecal coliforms were observed. There was no significant microorganisms growth. The aerobic mesophiles, Staphilococcus aureus and Bacillus cereus were also observed. These microorganisms presented growth, but the NBs did not present damage in their clinical status. CONCLUSIONS: Under this conditions of collecting and storage, there was no fecal coliforms, Salmonella sp, Molds/leavens and Pseudomonas aeruginosa; the microorganisms which grew up, kept themselves above the limits of detection (aerobic mesophiles, total coliforms, Stapholococcus aureus and Bacillus cereus; microbian rates, even when higher than the ones stablished, did not influence the clinical status of the NB; the breast milk collected, transported and stored under the conditions presented in this study can be safely used up to 24 hours after being stored in a refrigerator at 4°C.