Antonio Carlos Gruber

Mate (chimarrão) é consumido em alta temperatura por população sob risco para o carcinoma epidermóide de esôfago

ABSTRACT – “Mate”, a popular hot infusion of a herb ( Ilex paraguayensis) drunk in large volumes, is a known risk factor for squamous cellcarcinoma of the esophagus and there is a suspicion that high temperature of boiled water used for the infusion may contribute for carcinogenesis. Methods - We measured the temperature of “mate” infusion drank by a sample of the population at risk for this carcinoma in Taquara, so uthernBrazil. We interviewed inhabitants for drinking habits and the temperature of the infusion was measured with high precision thermometers.Temperature of the infusion was asked to consumers and their estimate compared to our measurements. We considered 60 o C or higher as “hot”. Results - In 36 residencies, 107 individuals were drinking “mate”. Most individuals drunk it daily (97,2%), and the medium daily volume was1,265 ml (SD ± 1,132 mL) ranging from 250 to 6,000 mL. The measured temperature was 60 o C or higher in 72% of residencies with mediumof 63.4 o C (51-78 o

3534 High grade dysplasias are present in normal appearing esophageal mucosa in subjects at risk for squamous cell carcinoma in southern brazil.

Objectives: Subjects at risk for squamous cell carcinoma of the esophagus were examined for mucosal abnormalities that could contain high grade dysplasias and/or early cancer with upper gastrointestinal endoscopy. Methods: Individuals found with cytology atypias at a screening program using esophageal balloon were submitted to esophagoscopy and the mucosa examined before and after Lugol spraying and biopsies obtained from unstained and stained areas. Results: 1495 subjects were screened and 122 underwent endoscopy. Their mean age was 57,8 and 75 (61.5%) were males. They were exposed, daily, to known risk factors as hot mate infusion drinking (91%), cigarrette smoking (51.6%) and alcohol drinking (19.7%). Conventional esophagoscopy visualized minute mucosal lesions (focal hyperemia, erosion, ulceration, nodule, depression / elevation, white plaque, red focal area) in 78 (63.9%) subjects but it was normal in 44 (36.1%). After Lugol spraying unstained areas were seen in 82 (67.2 %) individuals, 61 of which localized in mucosa with normal appearance with biopsies disclosing 10 dysplasias ( 5 high and 5 low grade) while 21, coincident with visible abnormalities had adenocarcinoma in one and a low grade dysplasia in another. Stained mucosa were also biopsied randomly in all subjects and 2 dysplasias were found (1 high and 1 low grade). Lugol esophagoscopy unstained areas had sensitivity of 83.3%, specificity of 61.1 %, positive predictive value of 6.09% and negative predictive value of 99.1% to detect high grade dysplasias ( p = 0.03, Fishers exact test). All high grade dysplasias were present in normal appearing esophageal mucosa. Conclusions: High grade dysplasias were occult in normal appearing mucosa and most were detected only after addition of Lugol staining to the esophageal mucosa.