M. Leitão

Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

Background and aim The effects of portal hypertension in the small bowel are largely unknown. The aim of the study was to prospectively assess portal hypertension manifestations in the small bowel. Methods We compared, by performing enteroscopy with capsule endoscopy, the endoscopic findings of 36 patients with portal hypertension, 25 cirrhotic and 11 non-cirrhotic, with 30 controls. Results Varices, defined as distended, tortuous, or saccular veins, and areas of mucosa with a reticulate pattern were significantly more frequent in patients with PTH. These two findings were detected in 26 of the 66 patients (39%), 25 from the group with PTH (69%) and one from the control group (3%) (Pxa0<xa00.0001). Among the 25 patients with PTH exhibiting these patterns, 17 were cirrhotic and 8 were non-cirrhotic (Pxa0=xa00.551). The presence of these endoscopic changes was not related to age, gender, presence of cirrhosis, esophageal or gastric varices, portal hypertensive gastropathy, portal hypertensive colopathy, prior esophageal endoscopic treatment, current administration of beta-blockers, or Child–Pugh Class C. More patients with these endoscopic patterns had a previous history of acute digestive bleeding (72% vs. 36%) (Pxa0=xa00.05). Active bleeding was found in two patients (5.5%). Conclusions The presence of varices or areas of mucosa with a reticulate pattern are manifestations of portal hypertension in the small bowel, found in both cirrhotic and non-cirrhotic patients. The clinical implications of these findings, as regards digestive bleeding, are uncertain, although we documented acute bleeding from the small bowel in two patients (5.5%).

Aberrant crypt foci: endoscopic assessment and cell kinetics characterization.

Background and aimsAberrant crypt foci (ACF) are preneoplastic lesions in animal models of colorectal cancer. The aim of the study is to investigate if ACF are involved in human colorectal carcinogenic process and if they can be helpful in predicting the presence of a colorectal neoplasia.MethodsThe study included, between 2003 and 2005, 182 patients, 62 with adenoma, 55 with colorectal carcinoma, 53 without colorectal lesions, and 12 with nonneoplastic mucosal polyps. The number of rectal ACF was determined by colonoscopy. Proliferation and apoptosis indexes were evaluated by immunohistochemistry in rectal ACF, in normal rectal mucosa, and in carcinomatous tissue.ResultsThe mean number of rectal ACF in patients with rectal neoplasia was 12.64, significantly higher than in patients with neoplastic lesions elsewhere in the colon (pu2009=u20090.01). The apoptosis index in ACF of patients with colorectal carcinoma or adenoma aged 50xa0years or older was significantly lower than in younger patients (1.3% vs 2.7%, pu2009=u20090.01) and, in patients with carcinoma, lower than in normal mucosa (1.1% vs 2.1%, pu2009=u20090.002). The proliferation index was significantly higher in ACF of patients with colorectal neoplasia aged less than 50xa0years than in normal mucosa (10.9% vs 7.7%, pu2009=u20090.02). The apoptosis index in ACF foci of patients with carcinoma (1.1%) was significantly lower than in patients without lesions (2.2%) and than in normal mucosa (2%). The mean number of ACF is significantly higher in patients with polyps larger than 1xa0cm (11.28 vs 6.27, pu2009=u20090.02).ConclusionAberrant crypt foci probably precede the appearance of neoplasia and may be helpful in predicting the presence of a colorectal neoplastic lesion.

Mesenteric arteriovenous fistula causing portal hypertension and bleeding duodenal varices

We report a case of portal hypertension associated with a non-traumatic arteriovenous fistula, presenting with bleeding duodenal varices. The patient was admitted for melaena. Emergency endoscopy showed oesophageal varices with no signs of recent bleeding and with no blood in the upper gastrointestinal tract. Arteriography of the coeliac axis and superior mesenteric artery failed to detect any bleeding source. Endoscopy was repeated because of persistent bleeding and revealed active bleeding from varices in the distal duodenum. The patient underwent surgery and a large paraduodenal varicose vein associated with an arteriovenous fistula was found. Resection of the paramural varix and surgical occlusion of the arteriovenous fistula were effective in the control of bleeding. Liver biopsy revealed mild portal fibrosis without cirrhosis. Three years after surgery the patient still has oesophageal varices but has not had recurrent bleeding. There was regression of intraduodenal varices.

The Megalithic Tomb Of Pedra Branaca, Portugal: Preliminary Report

The megalithic tomb of Pedra Branca lies at Montum, on the west coast of Portugal about 140 kilometers south of Lisbon by road (fig. 1). The tomb is the first in Portugal to have yielded Beaker graves overlying earlier burials; prior to its discovery, no Beaker remains had ever been noted further south than Palmela, in the estuary of the Sado river, approximately 40 kilometers from Lisbon. The tomb is situated on the top of a small hillock 100 m above sea level, separated from the Atlantic Ocean by a fertile undulating plain about 5 km in width. The Lake of Melides lies to the north and, to the east, the hills of Grandola rise steeply to an altitude of 300 m; an expanse of rough terrain stretches to the south, ravined by various small streams which flow into the Lake of Santo Andre on the coast. When the tomb was discovered by surveyors of the Geological Services of Portugal, it was already very badly damaged; all the orthostats had been broken for use in local construction and part of the circular covering mound had already been ploughed under. The Services therefore, decided that a salvage campaign was called for, and a team made up of the authors, was invited to carry it out with funds granted by the Calouste Gulbenkian Foundation.