Nutritional assessment in patients with squamous cell carcinoma of the esophagus.

BACKGROUND/AIMS: Protein-calorie malnutrition that occurs in patients with squamous cell carcinoma of the esophagus presents defined implications in surgical results. The present study aims to establish a nutritional score for malnutrition to measure the prevalence of protein-calorie malnutrition and to determine parameters with higher discriminatory power for protein-calorie malnutrition diagnosis. METHODOLOGY: Forty-five (45) patients with squamous cell carcinoma of the esophagus (cases) and 90 surgical patients (controls) were analyzed using twelve parameters: percentage of body weight loss, triceps and subscapular skin fold, mid arm circumference and arm muscle circumference, serum total proteins, albumin, transferin, pre-albumin, hematocrit, total lymphocyte count and late hypersensitivity skin tests. Prognostic Nutritional Index was calculated for all patients. RESULTS: There was a statistically significant difference between the two groups (p < 0.05) regarding all evaluated parameters except late hypersensitivity skin tests. Patients were classified as malnourished when presented with six or more altered parameters. Through the proposed score, the prevalence of protein-calorie malnutrition was defined in cases (57.8%) and in controls (7.8%) groups with statistic significant difference (p = 0.001). CONCLUSIONS: The proposed score allowed the diagnosis of malnourished patients, defined the malnutrition prevalence in both groups and established parameters with a greater discriminatory power for the protein-calorie malnutrition diagnosis.

CYP2A6/2A7 and CYP2E1 expression in human oesophageal mucosa: regional and inter-individual variation in expression and relevance to nitrosamine metabolism.

Oesophageal cancer is one of the most common and lethal malignancies in the world. Despite many efforts, treatment is still ineffective for most cases; thus, the development of preventive strategies is crucial for decreasing the burden presented by this disease. Environmental factors, particularly nitrosamines, are thought to be involved in the genesis of oesophageal tumours, and knowledge about the expression of enzymes capable of activating pre-carcinogens in human oesophagus is very important for the development of preventive measures. We analysed the expression of CYP1A1, CYP1A2, CYP2A6/2A7, CYP2E1 and CYP3A4 mRNA in oesophageal mucosa of 50 patients by semi-quantitative RT-PCR. In five patients, who suffered from squamous cell carcinoma, we measured Nnitrosodimethylamine and N-nitrosodiethylamine metabolism in normal and tumorous tissue. CYP2A6/2A7 mRNA was expressed in 61% and CYP2E1 mRNA in 96% of the patients, but in the latter a lower degree of inter-individual variation was observed. These enzymes were expressed either in the distal or middle portions of the oesophagus of 90% of the patients. CYP1A1, CYP1A2 and CYP3A4 mRNA expression was not detected in any portion of the oesophagus. Oesophageal microsomes activated N-nitrosodimethylamine with a low degree of inter-individual variation and microsomes prepared from the tumour of a patient who strongly expressed CYP2A6/2A7 mRNA activated N-nitrosodiethylamine. We conclude that the human oesophagus expresses CYP2A6/2A7 and CYP2E1 and can activate nitrosamines. Notably, the expression of these enzymes is preferentially localized to the most common sites where tumours arise.

Induction of intrabdominal adhesion formation by a polypropylene mesh prosthesis: an experimental study in rats

A correção de hernias na virilha através de método videolaparoscópico está se tornando procedimento comum que pode, entretanto, levar ao aumento da incidência de aderências...

Cervical anastomosis of the esophagus for esophageal carcinoma: an alternative approach

OBJETIVO: Avaliar o papel da técnica de anastomose esofagovisceral cervical retardada em relaçäo à incidência de complicaçöes anastomóticas. MATERIAIS E MÉTODOS: Oito pacientes (grupo 1) e 12 pacientes (grupo 2) submetidos a cirurgias em uma ou duas etapas, respectivamente, foram selecionados com base em avaliaçäo intra-operatória por um cirurgiäo. A avaliaçäo levou em conta, principalmente, o fluxo sanguíneo do tecido do órgÝo recolocado, depois da sua colocaçäo na regiäo cervical. RESULTADOS: No Grupo 1 foi observada deiscência anastomótica em 37,5 por cento dos pacientes, enquanto no Grupo 2 näo ocorreu nenhum caso de deiscência (p=0,049). No entanto, a taxa de mortalidade pós-operatória näo foi diferente para os dois grupos (12,5 por cento versus 0 por cento, näo significativo). CONCLUSÄO: Quando a viabilidade do órgäo é incerta, a anastomose esofagovisceral é melhor realizada em duas etapas, uma vez que dessa forma, diminuiu a incidência de vazamento anastomótico