Arnaldo Zanoto

Detection of Helicobacter pylori in gastric cancer

BACKGROUND AND OBJECTIVES Considering the high prevalence of stomach cancer in the northern region of Brazil and the recognized relationship between chronic gastric inflammation caused by Helicobacter pylori, and its carcinogenic potential, the objective we had with this study was to investigate the presence of the microorganism in macro and microscopic presentations of neoplasm in different regions of the stomach, and in non-malignant lesions concomitant to the adenocarcinoma in patients originating from the metropolitan area of Belém (State of Pará, Brazil). METHODS Examinations were made on 172 patients divided into two groups: group I, formed by 75 patients with gastric carcinoma, and group II, formed by 97 patients with mild enanthematic gastritis, considered control group. The diagnosis was obtained during endoscopic examination and the respective biopsy. Gastric neoplasms were classified macroscopically in accordance with Borrmanns classification, and microscopically in accordance with Lauréns classification. In group I, 54 patients were male and 21 female while in group II, 22 patients were male and 75 female. The average age in group I was 61.2 years (range 27 to 86 years), while in group II it was 37.5 years (range 16 to 69 years). Thin sections were prepared and stained using the hematoxylin-eosin method. In the Helicobacter pylori research, the modified Gram stain was utilized. Statistical analysis was done by utilizing the chi-squared (chi 2) test, Mann-Whitney test (U), and Fishers exact test. RESULTS The results showed the detection of Helicobacter pylori were significantly greater in patients with mild enanthematic gastritis than in patients with gastric carcinoma. The presence of Helicobacter pylori in patients with gastric carcinoma and mild enanthematic gastritis was significantly greater in the antral region than in other gastric regions. Helicobacter pylori detection in patients with gastric carcinoma did not present a significant difference in relation to the macroscopic aspect of the tumor either intestinal or diffuse histological types. CONCLUSIONS These data suggest the presence of the bacteria is predominant in the antral region and it does not show relation with the macroscopic types or histological intestinal or diffuse types of gastric carcinoma.

Contribuição da ultrassonografia para o diagnóstico das alterações histopatológicas presentes na hepatite C crônica, com ênfase na esteatose hepática: Parte I

OBJECTIVE: To evaluate the role of ultrasonography in the assessment of histopathological changes in patients with chronic hepatitis C, with emphasis on hepatic steatosis. MATERIALS AND METHODS: Liver ultrasonography results were compared with histopathological findings of liver biopsy of 192 patients with chronic hepatitis C virus infection. All the US examinations followed a single protocol, analyzing the following aspects: echogenicity, echotexture and attenuation. The patients sample was divided into two groups as follows: patients with sonographic changes and patients with no sonographic changes. Sonographic findings of both groups were compared with histopathological findings after liver biopsy. RESULTS: Statistically significant intergroup differences were observed just regarding architectural changes grades 0 and 3 and hepatic steatosis. Attenuation was the sonographic criterion that was best correlated with hepatic steatosis. CONCLUSION: The results of the present study demonstrate that, in patients with chronic hepatitis C, ultrasonography has limitations in the characterization of histopathological changes, with an intermediate rate of agreement with the diagnosis of hepatic steatosis. Considering the specificity of 77.9% and the negative predictive value of 95.5%, the authors highlight the capacity of the method to demonstrate the probability of absence of hepatic steatosis.

Predição da coledocolitíase pela associação de indicadores clínicos e laboratoriais em dois momentos do pré-operatório da colecistectomia

OBJETIVO: O proposito deste estudo foi determinar a probabilidade de ocorrencia de coledocolitiase atraves do estudo da associacao de indicadores clinicos e laboratoriais desta doenca em dois momentos do pre-operatorio de colecistectomia. METODO: Entre marco de 2001 e marco de 2002, 48 pacientes consecutivos com colelitiase foram submetidos a colecistectomia e colangiografia intra-operatoria (CIO). Os pacientes foram divididos em dois grupos, sendo o grupo A constituido por 13 pacientes com coledocolitiase e o grupo B por 35 pacientes sem esta doenca. Os pacientes foram investigados quanto aos indicadores clinicos e laboratoriais da coledocolitiase, analisados em dois periodos, tomando como ponto de corte as 48 horas que precederam a cirurgia. Posteriormente, estes indicadores pre-operatorios foram associados na equacao da regressao logistica em diferentes combinacoes. RESULTADOS: Utilizando a equacao da regressao logistica, constatou-se que a associacao de dois indicadores clinicos em ambos os periodos (ictericia e sinal de Murphy) e dois laboratoriais ( nivel de corte da gama glutamil transpeptidase e bilirrubina direta 48 horas antes da cirurgia) foi a mais adequada para a predicao da coledocolitiase. Os valores obtidos por esta equacao mostraram concordância com os grupos A e B, de 95,6%, e discordância de 4,4% (p= 0,0000007 e k = 0,89). Esta equacao mostrou sensibilidade de 92,3%, especificidade de 97,0%, valor preditivo positivo de 92,3% e valor preditivo negativo de 97%. Estes valores foram proximos aos obtidos pela CIO, que mostrou concordância com os grupos estudados de 95,8%, e discordância de 4,2% (k = 0,90). CONCLUSAO: Considerando os resultados obtidos, recomenda-se a associacao de indicadores da coledocolitiase na equacao da regressao logistica para estabelecer a probabilidade de ocorrer coledocolitiase associada a colelitiase. A utilizacao desta equacao pode orientar melhor a conduta diagnostica e terapeutica nesta doenca.

Tratamento cirúrgico da litíase biliar em idosos experiência em hospital de ensino

Due to high incidence of postoperative complications in elderly people there is some degree of reluctance in the surgical management of the biliar lithiasis in these patients. The main purpose of this study was to verify the real extension of these problem in the Department of Gastroenterologic Surgery of the HSPE-FMO. Over a 6-year period (1990-1995) 185 elderly patients with biliary lithiasis and mean age of 73.0 ± 6,2 years were evaluated. The patients were divided into two groups according to the age: I-118 (63.8%) patients with 60-74 and II- 67 (36.2%) patients with 75-90 years. The number of mate patients was significantly higher at the group II. Symptoms were similar into two groups of patients. The most part of patients was submitted to elective procedures - (163) 88.1% while (22) 1.9% underwent emergency surgery (acute cholecystitis). The number of emergency cases was more than twice in the group II (19.4% versus 7.6%). Cholecystectomy was performed in all patients. Operative cholangiography was performed in 157 (84,8%) patients. Complementary surgery was necessary for 38 (21.6%)patients (choledocholithiasis in 15.1% and papillar stricture in 2.7%) and was higher in the group II. Choledocholithotomy as a component of the primary biliary operation was performed in 28 (15.1%) patients, biliar enteric anastomosis in seven (3.8%) and papillotomy in five (2.7%) patients. Complications occurred in 37 (20%) patients and were similar in both groups. There was no mortality. Retained stones of the common duct was found in 15 (8.1%) patients. Endoscopic sphincterotomy was performed upon all patients, with success. The results of the present study support the use of elective cholecystectomy with low morbidity and without mortality in geriatric patients.

Papel da esofagogastroplastia (Thal-Hatafuku) e da gastrectomia parcial com anastomose gastrojejunal em Y (Holt -Large) na prevenção do refluxo gastroesofágico: estudo experimental em cães

The aim of this study was to evaluate in dogs the effects of two kinds of procedures in the gastroesophageal reflux prevention. Thirty animals divided in three randomized groups of ten were analysed as follow: group I (control) - esophagastrostomy side-to-side ; group II - esophagogastroplasty; group III -esophagogastrostomy side-to-side, partial gastrectomy and gastrojejunoanastomosis with excluded loop on y, The following parameters were used: body weight, endoscopy, radiological study and macro and microscopy data of the inner surface of the esophagus. The animals received daily histamine-in-beeswax parenterally for the posoperative stimulation of the gastric acid output until death or sacrifice. The research was carried out in three phases: preoperative phase, between the 35° and the 40° postoperative day and after histamine application. Group I showed sgnificant weight loss between the 1st and 2nd phase, which was intense on the 3rd phase. Group II showed no significative weight changes in any phase. Group III revealed significant weight changes even without histaminic stimulus. Endoscopy brought out significant more intensive esophagitis in group I than in II, after histaminic stimulus. In III, it was not possible to obtain these results, because of the precocious death of the animals. Fluoroscopic examination showed that 70% of the animals from group I, exhibited significative reflux, while in 30% this complication was not present. In group II, the reflux ocurred in few dogs and was not seen in 70% of the dogs.. Group III, revealed reflux in all animals and of significant manner in 70% of then. The macro and microscopic data did not show a significant difference among the groups, however the group II was the least committed. The results of this experiment demonstrated that the esophagogastrostomy side-to-side as expected produce intense esophageal reflux, the esophagogastroplasty showed minor morbidity and efficacy to impede the action of esophageal reflux and the surgery performed in group III, exhibited raised morbidity and early mortality after histamine stimulus. It is believed that the esophagogastroplasty takes reserved place in the procedures suggested to the treatment of achalasia and of peptique stenosis of the esophagus.

Análise quantitativa das ondas fisiológicas do intestino delgado após plicatura parcial e ordenada do íleo em ratos

The present experimental study analyzed the spontaneous intestinal movements of proximal jejunum and distal ileum in rats, after ordered plication in ileum. Thirty-one albino rats were utilized, distributed into three groups submitted to the same experiment: group A - animals reoperated on 10th day after ordered ileal plication; group B - animals reoperated on 20th day; group C - animals reoperated on 60th day. Ordered plication of the ileum was performed in four intestinal segments, each of length 2 cm. In the reoperation, a sectioning procedure was performed, removing the plicated intestinal segments with the pre-plication jejunal segment and post-plication ileal segment, as a single piece. Two chemographs were utilized for simultaneous recording of the spontaneous intestinal waves. Analysis was done of frequencies of types I, II and III physiological waves in the proximal jejunal and distal ileal segments of groups A, B and C, separately and together. The statistical study was performed using the non-parametric methods of Kruskal-Wallis, Friedman and Wilcoxon. The results of the present experiment concluded that ordered partial ileal plication does not interfere in spontaneous intestinal movements represented by types I, II and III waves in the pre-plication jejunal segment and in the post-plication ileal segment after two months of the operation.