The role of stress-related physical confinement in the pathogenesis of acute gastric hemorrhage after alcohol instillation in rats.

The combination of alcohol and stress have been considered producers of gastric hemorrhage both experimentally and in clinical observations. Since excessive alcohol intake often occurs in situations of severe emotional conflict and stress, it was decided to study the possible role of the latter in the etiology of gastric hemorrhage, up to now thought to be dependent only on alcohol. The study consists of 75 male Wistar rats divided into eight groups with seven to 14 animals each. They were submitted to fasting only, or to additional prolonged fasting, restraint-stress (physical confinement) for 17 hours and the oral administration of a single dose of 40% alcohol (1 ml/150 g of body weight). The stomachs were analyzed macroscopically and microscopically for the presence of gastric hemorrhage, and the following was observed; 1) only 10% of the rats submitted to a 25 hour fast either isolated or associated with 17 hours of physical confinement, demonstrated gastric hemorrhage; 2) after an eight hour fast, the administration of alcohol to the rats either sacrificed immediately or maintained for 17 hours, revealed gastric lesions in only 33.3% and 28.5% respectively, without significant statistical difference between the two groups (P > 0.05); 3) administration of alcohol prior to the 17 hour physical confinement revealed lesions in only 12.5% of the animals; 4) administration of alcohol to rats previously submitted to a 25 hour fast plus physical confinement for 17 hours, resulted in a significant number of hemorrhagic lesions (88.8%). This caused a statistical difference in the group compared to the others (P < 0.01). The results of this study led to the conclusion that stress (by prolonged physical confinement) was an important conditioning factor to the appearance of gastric hemorrhage when 40% alcohol was administered. It is possible that if the alcohol had been administered prior to the prolonged physical confinement its cytotoxic effect on the gastric mucosa might have been reduced.

Electromanometry of the rectosigmoid in colonic diverticulosis.

In order to better understand the rectosigmoid motor activity in diverticular disease of the colon, we studied 186 patients, grouped according to their intestinal habit, the presence of diverticular disease and previous crisis of sigmoid diverticulitis. The intestinal habit was classified as: normal habit, irritable colon syndrome, diarrhea and constipation. The group of diverticulosis was classified by their intestinal habit and by diverticula localization (localized or generalized). The presence of systemic diseases or drug ingestion that could modify intestinal motility, were considered criteria for exclusion. The manometric study was preceded by food stimulus, with 650 kcal meal, by mechanic intestinal cleansing, with 500 ml of saline solution enema and by one hour resting period. A manometric catheter, was introduced by rectosigmoidoscopy, with open ended orifices situated at the sigmoid and upper rectum, respectively. The catheter was perfused by a capillary infusion system and the bowel pressures were registered for 30 minutes, in a thermal paper physiograph. We analyzed the % of activity, mean amplitude and motility index, by non parametric tests. No significant difference was observed between sexes. Difference or close to it were found for the groups with constipation, with or without diverticulosis, and for the latter in its subdivisions (localized, generalized and sigmoid diverticulitis). The rectal motor activity was similar in all groups. There was no difference for diverticulosis and its subdivision, when we take into account the several kinds of intestinal habits and the diverticula localization. The motility index averages showed low values for the sigmoid diverticulitis fact that suggests some dysfunction of this segment (hypocontractility). The key factor differentiating the groups was the presence of constipation and no influence was noted regarding the localization of diverticula or previous inflammatory process on intraluminal pressures. The fact that no difference was found in the mean amplitude or % of activity among patients with or without diverticulosis, suggests that the high pressures in a colonic segment, may not be responsible for the diverticular disease, and there must be other factors, besides motility, accounting for the development of the different forms of this disease.

[Single nocturnal dose of ranitidine in the treatment of duodenal ulcer: results of an open multicenter, comparative trial]. / Ranitidina em dose única noturna no tratamento da úlcera duodenal. Resultado de um estudo aberto, multicêntrico, comparativo.

This prospective multicentric randomized open trial was designed to evaluate the efficacy of ranitidine 150 mg bid vs 300 mg nocte in the short-term (4 weeks) treatment of duodenal ulcer in 15 Brazilian centers. On the basis of a randomization table 190 patients with endoscopically confirmed duodenal ulcer were allocated to receive either ranitidine 150 mg bid (94 pts) or 300 mg nocte (96 pts). The 2 treatment groups were well matched for age, sex, duration of ulcer disease, number and size of ulcers, duration of current episode, intensity of ulcer pain, alcohol and coffee intake and smoking habits. They were endoscopically controlled at the end of the 4 weeks. At 4 weeks 78 of 94 patients (83.0%) had their ulcers healed with the 150 mg bid regimen as opposed to 79 of 96 patients (82.3%) allocated to the 300 mg nocte dosage. This difference was not statistically significant. Ulcer symptoms diminished with treatment in both groups. The tolerability and compliance was excellent in both groups. The results show that ranitidine 300 mg nocte is as effective in the short-term treatment of duodenal ulcer as ranitidine 150 mg bid. Considering the greater simplicity of administration enhancing patient compliance, the treatment with 300 mg nocte is preferable.

Teaching psychosomatic medicine.

The authors want to present their experience over the last 20 years in teaching the psychosomatic approach to health professionals and students in their last years, i.e. medical doctors, psychologists, social workers, nurses and dentists. The teaching classes take up 2 years and their main function is to teach students psychosomatics as an approach, a proposal for an integral assistance in health care. They are aimed at emphasizing the human comprehension of pathology, trying to understand it within the scope of a historical and related process, without denying the organic reality of disease.

Deficient release of prostacyclin-like activity by rat stomach under stress.

It is known that a confinement procedure will promote histological alterations in the gastric mucosa of rats. It is our hypothesis that, under these conditions, there should be an alteration in prostacyclin metabolism. Our findings corroborate this idea, which makes us suppose that the deficient release of prostacyclin-like activity by the rat's stomach may play an important role in gastric mucosa vitality and in its consequent damage.

Gastrointestinal motility in constipation.

This study included ten subjects with normal intestinal habits and 25 with constipation. Data were collected from X-rays of gastrointestinal transit times and from intraluminal pressures in the sigmoid and rectum using electromanometry. A comparison of the results led to the following conclusions: a) transit times to the cecum were essentially similar in both the control group and patients with constipation; b) the barium contrast arrived faster in the proximal sigmoid of patients with constipation compared to the control group; c) the mean of the total time of gastrointestinal emptying was slower in constipation; d) under unstimulated conditions, the electromanometry study of the sigmoid and rectum showed a higher motility index in constipation than in the control group; e) the high values of the percent activity was the most important element in the elevation of the motility index in constipation; f) the propulsion and retention activities of the colon were higher in constipation than in normals, as was demonstrated by radiologic and electromanometric studies.

[Emergencies in peptic gastroduodenal ulcers]. / Urgências na ulcera péptica gástrica e duodenal.

The authors present an objective review of the main emergencies regarding peptic ulcer disease, gastric and duodenal. The complications, perforation, bleeding and pyloric stenosis, are dealt with in detail, regarding diagnosis and best therapeutic orientation, either clinical or surgical.

Misoprostol in the treatment of duodenal ulcer. A multicenter double-blind placebo-controlled study.

Patients with endoscopically documented duodenal ulcer participated in a double-blind, multicenter trial comparing placebo with misoprostol 100 micrograms administered q.i.d. for up to four weeks in the treatment of duodenal ulcer. Ulcers were examined endoscopically at two weeks and, if not healed, again at four weeks. Acetaminophen was permitted for pain relief. At four weeks, of 286 patients admitted to the study, the cumulative healing rate for the 227 evaluable patients was 64.9% for misoprostol and 47.4% for placebo (P = 0.008). Misoprostol was also significantly superior to placebo in promoting ulcer healing when all patients entering the study (intent-to-treat cohort) were compared (P = 0.018), and in a modified intent-to-treat cohort consisting of all patients whose final endoscopic results were known (P = 0.005). Ulcer symptoms were similar in both treatment groups, and most patients in both groups were pain free at the end of the first two weeks of treatment. Diarrhea was the most frequently reported adverse experience (8.5% for misoprostol and 3.5% for placebo). This symptom was mild and self-limiting in spite of continued use of misoprostol. We conclude that misoprostol 100 micrograms q.i.d. for four weeks is safe and effective in the healing of duodenal ulcers.

Gastrointestinal motility in normal subjects and patients with diverticulosis of the colon.

Our study included 25 subjects, ten with normal intestinal habits and 15 with colonic diverticulosis. Data was collected from X-rays of gastrointestinal transit times and from intraluminal pressures in the sigmoid and rectum, using electromanometry. A comparison of the results led to the following conclusions: 1) transit times to the cecum were essentially similar in both the control subjects and patients with diverticulosis; 2) the barium contrast arrived twice as fast in the proximal sigmoid of patients with diverticulosis compared to the control group. Therefore, there is an increase in the transit between the cecum and sigmoid in individuals with diverticulosis of the colon; 3) the mean of the total time of gastrointestinal emptying is similar in both groups; 4) under unstimulated conditions, the electromanometric study of the sigmoid and rectum was similar in both groups; 5) the sigmoid region in patients with diverticulosis has a modulating transit capacity delaying it. This modulation was not reflected in the electromanometric study as an increase in motor activity.

Gastrointestinal motility in normal subjects and patients with diverticulosis of the colon.

Foram estudados 25 individuos, dez com habito intestinal normal e 15 com diverticulose colonica. Os parametros analisados foram o tempo de transito em radiografias gastrointestinais e a analise das pressoes intraluminais do reto sigmoide por eletromanometria. A comparacao dos resultados em ambos os grupos permitiu as seguintes conclusoes: 1) o tempo de transito ate o ceco foi semelhante nos dois grupos; 2) nos pacientes com diverticulose, o contraste baritado chegou ao sigmoide proximal na metade do tempo dos normais; 3) a media do tempo total de esvaziamento gastrointestinal foi similar nos dois grupos; 4) o estudo eletromanometrico do reto sigmoide foi similar nos dois grupos, em condicoes sem estimulacao; 5) a regiao do sigmoide, em pacientes com diverticulose, tem um retardo na capacidade moduladora do transito Entretanto, no estudo eletromanometrico nao se detectou aumento da atividade motora

[Crohn's disease of the duodenum associated with acute acalculous cholecystopathy]. / Doenca de Crohn do duodeno associada à colecistopatia aguda alitiásica.

Since the initial description of Crohn's disease (CD) located in the distal ileum, great number of cases has been observed, and we know that this disease can occur in any part of the digestive tube, from mouth to anus. The duodenal involvement is rare and no more than two hundred cases have been observed. A case of Crohn's disease located in the duodenum, with a severe acalculus cholecystitis, without intestinal involvement is presented. Radiological study showed a stenotic process in the first, second and third duodenal portion, later on confirmed by endoscopy. This was confirmed at surgery, when a gastrojejunostomy with truncal vagotomy, cholecystectomy, besides duodenum and liver biopsies were performed. The patient is asymptomatic four years after surgery. It is considered that bile reflux, resulting from involvement of Vater papilla by CD, is responsible factor of the biliary pathology.

Doenca de Crohn do duodeno associada a colecistopatia aguda alitiasica. / Crohn's disease of the duodenum associated with acute acalculous cholecystopathy

Desde a descricao inicial da doenca de Crohn (DC) com localizacao no ileo distal, um grande numero de casos tem sido relatado, sabendo-se que atualmente esta afeccao pode comprometer qualquer segmento do tubo digestivo, desde a boca ate o anus. O envolvimento duodenal no entanto, e mais raro sendo relatados nao mais do que duas centenas de casos. E apresentado um caso da DC localizada no duodeno, acompanhada de colecistite aguda alitiasica sem contudo apresentar envolvimento intestinal. O aspecto radiologico era de um processo estenotico envolvendo a primeira e segunda porcoes do duodeno, que foi posteriormente confirmado pela endoscopia.A operacao confirmou-se a existencia destes achados tendo sido praticado a gastrojejunostomia com vagotomia troncular, colecistectomia, coledoscotomia, alem de biopsia duodenal e hepatica. O decurso pos-operatorio foi sem intercorrencia, encontrando-se o paciente assintomatico num periodo de seguimento de quatro anos. Considera-se o refluxo duodeno-biliar, consequente ao comprometimento da papila de Vater pela DC, como o fator desencadeante da patologia biliar

[Hamartomatosis and adenomatosis of the colon]. / Hamartomatose e adenomatose dos colos.

The authors report five members of a family, having colonic polyposis, whose parents had adenomas that posteriorly degenerated to carcinoma, while sons had juvenile polyposis. Such aspects were considered as familial, evolutive and genetic. In contrast to adenomas, juvenile polyposis or hamartomas were always considered as benign lesions, with no susceptibility to malignancy. Nevertheless, these lesions must be considered as having degenerative potential at least similar to the originating tissue and, perhaps, even higher, once the sick tissue shows abnormal growth rate. These observations raise an important problem, namely, evaluating an eventual existence of malignancy among patients with juvenile polyposis which, if actually confirmed, could result in changes of its concepts and of its therapeutic approaches. The acknowledgement of the association between malignant potenial with genetics, could also result in better prevention for colonic cancer, once known its hereditary predisposition. The expectation of new cases among members of a same family should promote prevention before cancer appears. Thus, with this approach, the transcolonoscopic removal of polyps, mostly among families presenting high cancer potential, should avoid the sequence "adenoma-carcinoma".