P064 Association Between Crohn's Disease (CD) and Transient IgM and IgG Immunodeficiency-Diagnostic and Management Challenges.

CASE: Background: CD is an inflammatory disease that predominantly affects the gastrointestinal tract and has a progressive course. Immunodeficiencies can occur by altering different components of innate or adaptive immune responses. Such changes put the patient at greater risk for infectious diseases or non-infectious complications. Among the non-infectious complications are cancer, autoimmune diseases and gastrointestinal diseases, which should be suspected in patients with recurrent infections, with clinical, radiological or histological features of the disease are atypical or in the occurrence of an unsatisfactory response to conventional therapy. OBJECTIVE: To describe a case report of a CD patient complicated with enteric alterations related to immunodeficiency. RESULTS: A 31-year-old male patient started presenting abdominal pain, diarrhea, and weight loss in October 2020. He underwent a colonoscopy that showed diffuse involvement of the colon suggestive of CD. He didn`t respond to therapy with prednisone and azathioprine and lost 40kg until January 2021, when he was referred to an IBD center. He had signs of malnutrition (eg, BMI = 15.4, Albumin = 1.8g/dL). The MRI showed diffuse thickening of the walls of the entire length of the ileum, colon and rectum, associated with submucosal edema and more intense enhancement in the inner layer. Findings compatible with nonspecific diffuse ileocolitis. After negative infectious screening, hydrocortisone, azathioprine and infliximab were prescribed, but the patient remained clinical worsening. During the 6 weeks of therapy use, the patient presented oral candidiasis, septic pyoarthritis, DNA testing for Clostridium difficile and PCR for Cytomegalovius were positive. Despite the treatment of infectious diseases, the patient continued to worsen and was considered a primary non-response to anti-TNF, opting for the initiation of Ustekinumab. There was improvement in endoscopic and fecal calprotectin, but continued progression of ileal disease and diarrhea, with no response to enteral or parenteral nutritional therapies. An investigation for immunodeficiencies was carried out and IgM/IgG deficiency was noted, and parenteral immunoglobulin was started. He presented an intestinal subocclusion, requiring a loop ileostomy. In this surgery, it was decided to send a sample of ileal tissue for diagnostic differentiation, where ileitis was observed with intense plasma cell reaction and lymphoid nodular hyperplasia, uncharacteristic of DC, which may correspond to enteropathy secondary to immunodeficiency. Despite the treatment, the patient presented fungal endocarditis, esophageal moniliasis and septic condition of undetermined origin. He remained in hospital for 120 days until complete improvement of the infectious complications. With the slow improvement in nutritional parameters, there was a reduction in the incidence of infections as well as an increase in immunoglobulins. After five months of combined nutrition and anti-interleukin therapy, the patient presented clinical improvement, weight gain and complete normalization of IgG and IgM. Ileal disease is in regression and in the colon, in endoscopic remission. CONCLUSION: We present a case report of the initial presentation of DC complicated with severe malnutrition where there was depletion of part of immunoglobulins, resulting in infectious and non-infectious complications, where ileal involvement intensified the manifestation of colonic DC.

Rebamipide does not protect against naproxen-induced gastric damage: a randomized double-blind controlled trial.

BACKGROUND: Rebamipide is a gastroprotective agent with promising results against gastric damage induced by non-steroidal anti-inflammatory drugs. The present study evaluated if rebamipide protects against naproxen-induced gastric damage in healthy volunteers. Changes in gastric PGE2 tissue concentration were also evaluated. METHODS: After a preliminary endoscopy to rule out previous gastric macroscopic damage, twenty-four healthy volunteers of both sexes were divided into 2 groups. One group received sodium naproxen 550 mg b.i.d. plus placebo for 7 days, while the other group received sodium naproxen 550 mg b.i.d. plus rebamipide 100 mg b.i.d. At the end of treatment, a new endoscopy was performed. Gastric macroscopic damage was evaluated by the Cryer score and by the modified Lanza score. The primary outcome measure of the trial was the macroscopic damage observed in each treatment group at the end of treatment. Biopsies were collected at both endoscopies for PGE2 quantification and histopathological analysis (secondary outcomes). Tissue PGE2 was quantified by ELISA. The randomization sequence was generated using 3 blocks of 8 subjects each. Volunteers and endoscopists were blind to whether they were receiving rebamipide or placebo. RESULTS: All recruited volunteers completed the trial. Sodium naproxen induced gastric damage in both groups. At the end of the study, median Cryer score was 4 in both groups (Difference = 0; 95%CI = -1 to 0; p = 0.728). In the placebo group, the mean tissue PGE2 concentration was 1005 ± 129 pg/mL before treatment and 241 ± 41 pg/mL after treatment (p < 0.001). In the rebamipide group, the mean tissue PGE2 concentration was 999 ± 109 pg/mL before treatment, and 168 ± 13 pg/mL after treatment (p < 0.001). There was no difference in mean tissue PGE2 between the two groups (difference = 5; 95%CI from -334.870 to 345.650; p = 0.975). No significant change was observed at the histopathological evaluation, despite the evident macroscopic damage induced by naproxen. CONCLUSION: Rebamipide does not protect against naproxen-induced gastric damage in healthy volunteers. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02632812 . Registered 14 December 2015.

Acetylsalicylic Acid Daily vs Acetylsalicylic Acid Every 3 Days in Healthy Volunteers: Effect on Platelet Aggregation, Gastric Mucosa, and Prostaglandin E2 Synthesis.

Substantial platelet inhibition was observed 3 days after a single administration of acetylsalicylic acid 81 mg to healthy volunteers. Here we investigate prostaglandin E2 (PGE2 ) antrum concentrations and gastrointestinal symptoms in two treatment groups: one receiving losartan and acetylsalicylic acid every day and the other receiving losartan every day and acetylsalicylic acid every 3 days. Twenty-eight healthy volunteers from both sexes received either 50 mg losartan and acetylsalicylic acid 81 mg daily or 50 mg losartan and acetylsalicylic acid 81 every 3 days with placebo on the other days. Therapy was delivered for 30 days for both groups. Gastric endoscopy was performed before and after treatment period. Biopsies were collected for PGE2 quantification. Platelet function tests were carried out before and during treatment and TXB2 release on platelet rich plasma was measured. The every 3 day low-dose acetylsalicylic acid regimen produced complete inhibition of platelet aggregation compared to the daily treatment. Thromboxane B2 release was substantially abolished for both groups during treatment. There was no significant difference on the endoscopic score of both treatment groups after the 30-day treatment (P = .215). There was over 50% suppression of antrum PGE2 content on volunteers receiving acetylsalicylic acid daily (P = .0016), while for the every 3 day dose regimen there was no significant difference between pre and post-treatment antrum PGE2 dosages (P = .4193). Since PGE2 is involved in gastric healing, we understand that this new approach could be safer and as efficient as the standard daily therapy on a long-term basis.

Immunohistochemical analysis of vascular density and area in colorectal carcinoma using different markers and comparison with clinicopathologic prognostic factors.

Analysis of blood and lymphatic vessel in colorectal cancer is controversial in the literature, possibly due to variations in the methods of analysis. In this study, it was aimed to search for a reliable approach in the quantification of angio- and lymphangiovascular density and area as a prognostic factor and to compare such vessel counts in normal mucosa, adenomas and cancer. A retrospective study was performed on 60 sporadic colorectal cancer, 30 colorectal adenomas, and 10 colorectal non-neoplastic lesions. Archival tissues were submitted to immunohistochemical evaluation using antibodies to CD31, CD34, CD105, VEGF-A, VEGF-C, and D2-40. Microvessel density and total vascular area were determined by computer image analysis and values were compared in the three groups of lesions; the prognostic value of these parameters was evaluated in the group of colorectal cancer. Most markers showed progressive vessel counts from non-neoplastic tissue to carcinoma, both for microvessel density and total vascular area. Only microvessel density determined by CD34 in the central areas of the cancer correlated with recurrence/metastasis (p = 0.04) and survival (p = 0.02). Different methods of quantification (microvessel counting versus estimation of total vascular area), immunohistochemical markers (pan-endothelial marker versus neovessels and lymphatic markers), and areas of analysis (periphery versus inner portions of the lesion) were assessed using image analysis. The results corroborate the increase in vascularization of carcinoma and suggest that microvessel density determined by immunostaining for CD34 in the inner portion of the tumor might represent a prognostically relevant parameter in colorectal cancer.

The immunosuppressant drug, thalidomide, improves hepatic alterations induced by a high-fat diet in mice.

BACKGROUND: Pro-inflammatory cytokines, such as tumour necrosis factor (TNF)-alpha, are known to be involved in the establishment of insulin resistance. Insulin resistance plays a key role in the development of obesity-related pathologies, such as type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). The state of chronic inflammation associated with obesity led us to hypothesize that TNF-alpha blockade may have an effect on experimentally obese animals. AIMS: We studied the effects of thalidomide, an immunosuppressant and anti-TNF-alpha drug, on hepatic alterations that were induced by a high-fat diet (HFD) in mice. METHODS: Obesity was induced in Swiss mice using a HFD for 12 weeks. Thalidomide-treated animals received thalidomide i.p. (100 mg/kg/day, 10 days). Glucose, aspartate aminotransferases and alanine aminotransferases levels were assessed in the blood. Insulin and glucose tolerance tests were performed. The liver was excised for histological, triglyceride, gene and protein expression analyses. RESULTS: We found improvements in both the basal glucose blood levels and the response to insulin administration in the treated animals. The molecular analysis of insulin signalling revealed a restoration of the hepatic insulin receptor substrate (IRS)-1 and AKT phosphorylation. The hepatic expression of TNF-alpha was inhibited and the levels correlated with a significant reduction in the steatosis area. Other hepatic inflammatory markers, such as iNOS and suppressor of cytokine signalling (SOCS-3), were also reduced. CONCLUSIONS: We suggest that immunosuppressant drugs that target TNF-alpha and that may also contribute to reductions in the inflammatory markers that are associated with obesity could be a therapeutic option in NAFLD and type 2 diabetes.

Effects of Helicobacter pylori infection on the expressions of Bax and Bcl-2 in patients with chronic gastritis and gastric cancer.

The aim of the present study is to evaluate the influence of Helicobacter pylori on Bax and Bcl-2 mRNA and protein levels in patients with chronic gastritis and gastric cancer. The study included 217 patients, of which 26 were uninfected; 127 had chronic gastritis and were H. pylori-positive, and 64 had gastric cancer. Bacterial genotypes were evaluated by PCR, and the expression values were determined by quantitative real-time PCR and immunohistochemistry. Our data showed that the up-regulationary effects of H. pylori infection on the pro-apoptotic gene, Bax, were stronger than its induction of Bcl-2; this effect may increase apoptosis in patients with chronic gastritis. In patients with gastric cancer, the up-regulation of the anti-apoptotic gene, Bcl-2, counteracted the pro-apoptotic effects of Bax, leading to a deregulation of apoptosis-associated gene expression, favoring cell proliferation. Thus, the disturbance in Bax and Bcl-2 balance, induced by H. pylori, might be important in gastric cancer development.

Correlation between thymidylate synthase protein expression and gene polymorphism with clinicopathological parameters in colorectal carcinoma.

5-Fluorouracil (5-FU) represents the basis of chemotherapy for colorectal carcinoma, inhibiting thymidylate synthase (TS), an essential enzyme for DNA replication. Previous studies have associated high TS protein expression by tumor cells with poor outcome of patients with colorectal carcinoma, but others have refuted these findings. In view of the potential role of TS as predictive parameter and the lack of consensus in the literature, the present study compared 2 methods: protein expression and gene polymorphism, correlating them with clinicopathological findings. Immunohistochemical detection of TS in tumor cells and detection of gene polymorphism in the blood were performed in 32 patients with colorectal carcinoma treated with 5-FU. No correlation was found between TS protein expression and gene polymorphism. Neither method correlated with survival, tumor staging, and tumor histological grading. This result possibly reflects a complex tumor response to 5-FU therapy, where TS is just one of the involved proteins.

Effect of Helicobacter pylori infection on IL-8, IL-1beta and COX-2 expression in patients with chronic gastritis and gastric cancer.

OBJECTIVE: Helicobacter pylori infection is related to gastric cancer development, and chronic inflammation is presumed to be the main cause. The aim of the present study was to evaluate the influence of H. pylori cagA, vacA, iceA, and babA genotypes on COX-2, IL-1beta, and IL-8 expression. MATERIAL AND METHODS: Of the 217 patients included in the study, 26 were uninfected, 127 had chronic gastritis and were H. pylori-positive, and 64 had gastric cancer. Bacterial genotypes were evaluated by polymerase chain reaction (PCR), and the expression values were determined by quantitative real-time PCR and immunohistochemistry. RESULTS: An association was found between the infection with cagA, vacA s1m1 strains and gastric cancer development. Regarding the 3' region of the cagA gene, we also found an association between the infection with cagA EPIYA-ABCCC strains and clinical outcome. Higher levels of IL-8, IL-1beta, and COX-2 were detected in gastric mucosa from infected patients with chronic gastritis, and they were also associated with the infection by cagA, vacA s1m1 strains. The IL-8 and IL-1beta levels decrease significantly from chronic gastritis to gastric cancer, while the relative expression remained unaltered when COX-2 expression was analyzed among patients with gastritis and cancer. CONCLUSIONS: Since inflammatory response to H. pylori infection plays an important role in cellular proliferation and gastric mucosal damage, the up-regulation of IL-1beta, IL-8, and COX-2 in patients with chronic gastritis has an important clinical implication in gastric carcinogenesis.

Effects of a one-week treatment with acid gastric inhibitors on Helicobacter pylori-infected mice.

OBJECTIVE: Antiacid drugs, including omeprazole and ranitidine, were prescribed to Helicobacter pylori-infected subjects in combination with antibiotics during eradication treatment. Several reports suggest that these drugs have additional pharmacological properties, such as antineutrophil, antiapoptotic and antioxidant characteristics. The aim of this work was to study the effects of acid suppressive medication treatment in the H. pylori infection experimental model, focusing on possible additional pharmacological properties. MATERIAL AND METHODS: The ability of gastric acid suppression was assessed in pylorus-ligated animals. Gastric H. pylori colonization levels, myeloperoxidase (MPO) acitivity, macroscopic damage, Bax and Bcl-2 expression and DNA damage levels were assessed in C57BL/6-infected mice after treatment for one week with omeprazole (100 mg kg(-1)) or ranitidine (100 mg kg(-1)). RESULTS: Omeprazole treatment increased bacteria colonization and MPO activity in mice stomachs. Both antiacid drugs efficiently improved macroscopic damage, although only omeprazole restored the expression of the antiapoptotic Bcl-2 protein in gastric mucosa of infected animals. CONCLUSIONS: Some additional omeprazole-related properties, such as antineutrophil properties, were not observed in H. pylori-infected mice after one week of treatment, suggesting that this property is restricted to in vitro approaches. However, the antiapoptotic activity of omeprazole could be attributed to an ability to modify the protein expression of Bcl-2, decreased by H. pylori infection.

[Relationship of the sialomucins (Tn and Stn antigens) with adenocarcinoma in Barrett's esophagus]. / A inter-relação das sialomucinas (antígenos Tn e Stn) com o adenocarcinoma no esôfago de Barrett.

OBJECTIVE: Barrett's esophagus (BE) is a consequence of chronic gastroesophageal reflux and is considered a risk factor for adenocarcinoma. The study of the mucus, especially acid mucins, such as the sialomucins in the goblet cells which characterize BE, showed that in intestinal metaplasia, frequent in the digestive tract, the organ's original epithelium could express Tn and Stn antigens. These antigens have already been detected in gastric and colonic tumors, however references in BE were not found. This research aimed to analyze these antigens in patients with BE and in adenocarcinoma associated with BE. METHODS: Utilizing immunohistochemistry tests, Tn and Stn antigens were studied in the endoscopic biopsies of 29 patients with BE and seven with adenocarcinoma in BE, as well as eight individuals with normal esophageal epithelium at upper digestive endoscopy. RESULTS: The Stn antigen was positive in the goblet cells of patients with BE in 100% of the cases and the Tn was positive in 48%. In the columnar cells, Stn was always negative, while Tn was positive in 100% of the cases. However, in adenocarcinoma in BE, both antigens were 100% positive. In normal individuals, the Tn antigen was positive and the antigen Stn negative in all cases. CONCLUSION: It is probable that the BE group in which the Tn antigens in the goblet cells are positive, similarly to the same antigen in the adenocarcinoma group, might indicate a higher susceptibility for potential occurrence of cancer. In the future, trials with sialomucins could be used routinely, thereby contributing as a prognostic factor of adenocarcinoma in BE.

A inter-relação das sialomucinas (antígenos Tn e Stn) com o adenocarcinoma no esôfago de Barrett / Relationship of the sialomucins (Tn and Stn antigens) with adenocarcinoma in Barrett's esophagus

OBJETIVO: O esôfago de Barrett (EB) é conseqüência do refluxo gastroesofágico crônico e considerado fator de risco para o desenvolvimento de adenocarcinoma. Estudos do muco, em especial das mucinas ácidas representadas pelas sialomucinas presentes nas células caliciformes, mostraram que na metaplasia do tipo intestinal, o epitélio do órgão pode expressar antígenos denominados Tn e Stn. Estes antígenos já foram analisados em tumores gástricos e colônicos, porém não foram encontradas referências à sua utilização no EB. Este trabalho objetivou analisar estes antígenos em doentes com EB e em adenocarcinoma associado ao EB. MÉTODOS: Foram estudados, utilizando testes imunohistoquímicos, os antígenos Tn e Stn, nas biópsias endoscópicas de 29 doentes com EB, sete com adenocarcinoma no EB, além de oito indivíduos com epitélio esofágico normal. RESULTADOS: Nas células caliciformes, foi observada positividade para Stn em 100 por cento dos casos e para Tn em 48 por cento dos casos. Nas células colunares, o Stn foi sempre negativo, enquanto o Tn foi positivo em 100 por cento dos casos. Entretanto, nos doentes com adenocarcinoma no EB, a positividade para ambos os antígenos foi de 100 por cento. Nos indivíduos normais, houve positividade para o antígeno Tn e negatividade para Stn em todos os casos (100 por cento). CONCLUSÃO: É provável que nos doentes com EB a positividade para o Tn, à semelhança do ocorrido quanto à positividade do mesmo antígeno nos portadores de adenocarcinoma, possa significar maior suscetibilidade para ocorrência futura de câncer. Assim, a pesquisa das sialomucinas poderá ser rotineiramente utilizada, contribuindo como fator prognóstico para desenvolvimento de adenocarcinoma no EB.

OBJECIVE: Barrett's esophagus (BE) is a consequence of chronic gastroesophageal reflux and is considered a risk factor for adenocarcinoma. The study of the mucus, especially acid mucins, such as the sialomucins in the goblet cells which characterize BE, showed that in intestinal metaplasia, frequent in the digestive tract, the organ's original epithelium could express Tn and Stn antigens. These antigens have already been detected in gastric and colonic tumors, however references in BE were not found. This research aimed to analyze these antigens in patients with BE and in adenocarcinoma associated with BE. METHODS: Utilizing immunohistochemistry tests, Tn and Stn antigens were studied in the endoscopic biopsies of 29 patients with BE and seven with adenocarcinoma in BE, as well as eight individuals with normal esophageal epithelium at upper digestive endoscopy.. RESULTS: The Stn antigen was positive in the goblet cells of patients with BE in 100 percent of the cases and the Tn was positive in 48 percent. In the columnar cells, Stn was always negative, while Tn was positive in 100 percent of the cases. However, in adenocarcinoma in BE, both antigens were 100 percent positive. In normal individuals, the Tn antigen was positive and the antigen Stn negative in all cases. CONCLUSION: It is probable that the BE group in which the Tn antigens in the goblet cells are positive, similarly to the same antigen in the adenocarcinoma group, might indicate a higher susceptibility for potential occurrence of cancer. In the future, trials with sialomucins could be used routinely, thereby contributing as a prognostic factor of adenocarcinoma in BE.

Autoimmune and non-autoimmune thyroid diseases have different patterns of cellular HLA class II expression

CONTEXT: Surface HLA-DR antigen is usually only expressed by antigen-presenting cells (APC). In autoimmune thyroid disease, follicle cells function as APC, thus expressing HLA-DR. However, non-autoimmune thyroid diseases may also express surface class II antigens. OBJECTIVE: To evaluate the presence and pattern of HLA class II expression in autoimmune and non-autoimmune thyroid disorders. DESIGN: Retrospective: histopathological and immunohistochemical analysis. LOCATION: Referral center, university hospital. SAMPLE: Ten histologically normal thyroids, 11 GravesÆ disease, 7 HashimotoÆs thyroiditis, 10 atoxic multinodular goiter and 3 toxic adenomas were analyzed by immunohistochemistry, using a monoclonal antibody anti-HLA-DR. MAIN MEASUREMENTS: The presence of these antigens in thyroid follicular cells and their relation to inflammatory infiltrate was evaluated. The pattern of HLA-DR expression in thyroid follicular cells was analyzed: membrane, cytoplasmic or both. RESULTS: Although HLA-DR antigens were sparsely present in one of the 8 normal thyroids, in 6 of the 9 atoxic multinodular goiter and in 2 of the 3 toxic adenomas a net positivity could be seen in large areas. In all 5 HashimotoÆs thyroiditis and in 7 of the 10 GravesÆ disease cases. This expression occurred in follicle cells either in contact with inflammatory cells or not. In non-autoimmune thyroid disease, HLA-DR positivity was essentially cytoplasmic, whereas in GravesÆ disease and Hashimoto thyroiditis it was mainly in cell membranes. CONCLUSIONS: It is suggested that the HLA class II expression on the surface of follicle cells could be related to auto-antigen presentation to the immune system by these cells, leading to inflammation

Ultra-sonografia do esôfago intra-abdominal em crianças portadoras de refluxo gastroesofágico: correlaçäo com achados endoscópicos e histopastológicos / Esophageal intra-abdominal ultrasonographic in in children with gastroesophageal reflux: correlation between endoscopical an histophatological data

A esofagite péptica é uma das mais importantes complicaçoes da doença do refluxo gastroesofágico e seu diagnóstico é baseado em achados endoscópicos e histopatológicos. Um dos fatores envolvidos na patogênese da esofagite é a diminuiçao da pressao do esfíncter inferior do esôfago que está relacionada com o comprimento da porçao intra-abdominal deste órgao que pode ser mensurada por meio de ultra-sonografia. Este trabalho relaciona as medias ultra-sonográficas do esôfago intra-abdominal de crianças portadoras da doença de refluxo gastroesofágico com os achados endoscópicos e os de biopsias esofágicas das mesmas crianças. Foram avaliadas 16 crianças com idades entre 10 e 156 meses (mediana 63,5 meses) portadoras de doença do refluxo gastroesofágico e submetidas a endoscopia digestiva e biopsia esofágica para pesquisa de esofagite. Dos 16 pacientes, seis apresentaram diagnóstico de esofagite péptica à endoscopia digestiva alta, confirmado pela biopsia em cinco pacientes. Os restantes 10 pacientes tinham endoscopia normal e em apenas quatro destes foram encontradas alteraçoes compatíveis com esofagite na biopsia esofágica. Nao se observou correlaçao estatística entre a endoscopia e a biopsia esofágica se considerados todos os graus de alteraçoes histopatológicas compatíveis o diagnóstico de esofagite, mas se observa correlaçao quando se considera o grau histopatológico mais discreto como secundário apenas ao refluxo e nao como diagnóstico de esofagite. Ao ultra-som dos seis pacientes portadores de esofagite à endoscopia digestiva alta, cinco apresentaram esôfago intra-abdominal diminuído e nos pacientes portadores de esofagite através de biopsia, considerando o grau histológico discreto como secundário apenas ao refluxo, todos tinham esôfago intra-abdominal diminuído. Em conclusao, encontrou-se relaçao entre as alteraçoes endoscópicas e achados histopatológicos para o diagnóstico de esofagite e a dimensao do esôfago intra-abdominal medido por ultra-som.

A técnica Ag-NOR auxiliando no diagnóstico do câncer colorretal / The diagnostic value of Ag-NOR technique in colorectal cancer

A técnica Ag-NOR coloca em evidência as regioes organizadoras do nucléolo (NORs) e tem sido aplicada a muitos tecidos para avaliar lesoes proliferativas. Isto é feito, em geral, através da contagem dos pontos prata-positivos que representam as NORs, presentes em todas as células. Em mucosa colorretal a contagem de pontos mostra superposiçao de valores entre os grupos, mas uma análise de sua morfologia pode ser útil para diagnóstico. Seteneta e um esfregaço de mucosa colorretal, agrupados de acordo com o diagnóstico histopatológico da biopsia correspondente, foram corados pela técnica Ag-NOR. No grupo de mucosa normal/reacional (20 casos) e no de mucosa displásica de baixo grau/adenoma (seis casos), as NORs foram observadas como pontos pequenos ou médios, bem delineados, isolados ou interligados, mas com um aspecto homogêneo entre eles. Nos adenocarcinomas (45 casos) houve uma grande variaçao, com elementos maiores, angulados e grosseiramente interligados, formas bizarras, resultando num padrao morfológico muito heterogêneo de NORs. Devido à ampla e característica variaçao no tamanho e forma das NORs em células carcinomatosas da mucosa colorretal, elas podem ser utilizadas como "marcadoras de malignidade", sendo um auxílio na prática diária para os casos de difícil interpretaçao.

Incidência e epidemiologia do epitélio de Barrett no Gastrocentro - UNICAMP / Incidence and epidemiology of Barrett's epithelium at the Gastrocentro - UNICAMP

É de fundamental importância para a prática médica o conhecimento de portadores de esôfago de Barrett, pois existe o risco de aparecimento de adenocarcinoma sobre o epitélio colunar pré-existente. Assim, com o objetivo de verificar a real incidência deste epitélio no Gastrocentro-Unicamp, Campinas-SP, foram revistos os resultados de 15.976 endoscopias realizadas no período de julho de 1992 a dezembro de 1995. Dentre o total de exames realizados no período, foram identificados 2.381 exames (14,9 por cento) com diagnóstico de esofagite de refluxo em variados graus (Savary-Miller). Deste total, em 110 casos (4,6 por cento) o endoscopista suspeitou de esôfago de Barrett, realizando múltiplas biopsias. Porém, do total anterior, em somente 85 casos (77,3 por cento) o exame histopatológico confirmou tratar-se de epitélio de Barrett. Analisando somente os portadores de esôfago de Barrett, eram 53 do sexo masculino (62,3 por cento), tinham média de idade de 52,2 anos e apresentavam os seguintes graus de esofagite: grau I - 33 casos (38,8 por cento); grau II - 15 casos (17,7 por cento); grau III - 15 casos (17,7 por cento); grau IV - 12 casos (14,1 por cento) e sem esofagite associada - 10 casos (11,7 por cento). Concluindo, a incidência de esôfago de Barrett entre os portadores de esofagite foi de 3,57 por cento e de 0,53 por cento dentre o total de endoscopias realizadas neste Serviço no período de estudo, totalizando 22,4 casos por 100.000 habitantes. Estes dados refletem as mesmas taxas de incidência da literatura mundial e, embora näo muito elevadas quando comparadas aos de outras doenças existentes em nosso meio, há necessidade de acompanhamento insistente destes doentes pela possibilidade de transformaçäo em neoplasia maligna.

Exame citopatológico realizado durante colonoscopia no diagnóstico das estenoses colorretais / Cytopathological test performed during colonoscopy in diagnosis of colorectal stenosis

As estenoses colorretais podem apresentar dificuldades para um diagnóstico etiológico. Com a colonoscopia e a coleta de material diretamente da lesäo, a citopatologia passou a revelar uma eficácia diagnóstica semelhante à histopatologia. Neste estudo (107 pacientes), empregou-se citopatologia durante colonoscopia, de material de estenose, esfregado em lâmina, fixado em álcool etílico a 95% e corado pela HE, com conclusöes obtidas durante a endoscopia. Os resultados foram comparados com a histopatologia e ambos cotejados com o anatomopatológico do espécime cirúrgico. Nos näo operados, comparou-se com a evoluçäo tardia. Observaçäo elevado grau de correlaçäo entre os exames. O citopatológico näo apresentou resultado inconclusivo, falso-negativos foram menos freqüentes do que com a histopatologia e falso-positivo foi observado em apenas um paciente (adenoma viloso do reto). Correlacionados quanto ao tipo, localizaçäo e permeabilidade da lesäo, conclusöes semelhantes puderam ser tiradas e estas condiçöes näo afetaram a efetividade dos exames, exceto que existiram mais resultados falso-negativos para o cito e histopatologia, quando as lesöes eram impérvias. Tanto a cito como a histopatologia se mostraram sensíveis e específicos para o diagnóstico do carcinoma colorretal. Como conclusäo, pode-se afirmar ser a citopatologia realizada durante a colonoscopia, um exame seguro e eficiente para o estudo de lesöes com estenose em cólon e reto, contribuindo na orientaçäo desses pacientes

A mucosa gastroduodenal em doentes com hipertensäo portal: correlaçäo com a gastrinemia / The gastroduodenal mucosa in patient with portal hypertension: correlation with blood gastrin

objetivo do estudo: estudar as alteraçöes da mucosa gastroduodenal em dois grupos de doentes hepatopatas com hipertensäo portal: um esquistossomótico (HNE), correlacionando os achados endoscópicos e histopatológicos com a gastrinemia de jejum. Tipo de estudo: prospectivo. Local: Hospital das Clínicas, Unicamp. Pacientes: 24 pacientes foram incluídos na pesquisa, do total de 26 estudados. Eram 12 pacientes com HE e 12 com HNE. Intervençöes: esofagogastroduodenoscopias e colheita de biópsias do antro gástrico e duodeno. Medidas e resultados: as dosagens de gastrinemia verificadas encontravam-se dentro da normalidade nos dois grupos. O teste "t" de Student näo mostrou diferença estatística significante entre os dois grupos, em nível de 5%. Entretanto, os doentes com HNE apresentaram achados endoscópicos, bem como processo inflamatório da mucosa gastroduodenal, bem mais significativos que os HE. Conclusöes: os doentes portadores de hepatopatia de etiologia näo esquistossomótica, principalmente pelo risco mais elevado de hemorragia digestiva, devem ser mantidos sob vigilância, orientaçäo alimentar adequada e até mesmo uso continuado de medicamentos, se for o caso. Além disso, outras pesquisas devem ser feitas para elucidar a etiologia destas alteraçöes da mucosa nestes doentes, já que os níveis de gastrinemia registrados foram semelhantes nos dois grupos

A mucosa gastroduodenal em doentes com hipertensäo portal: correlaçäo com a gastrinemia / The gastroduodenal mucosa in patients with portal hypertension: correlation with gastrinemia

Tem sido registrada elevada incidência de alteraçöes da mucosa gastroduodenal em hepatopatas crônicos, inclusive causando hemorragias digestivas. Com o objetivo de verificar esta associaçäo com a gastrinemia, foram estudados 24 doentes portadores de hipertensäo portal, sendo 12 de etiologia esquistossomótica (HE) e 12 näo esquistossomótica (HNE). Foram realizados dosagem de gastrinemia de jejum, endoscopia digestiva com bópsias de estômago e duodeno, além de exames laboratoriais que avaliam a funçäo hepática. Os doentes com HNE apresentavam achados endoscópicos, assim como processo inflamatório crônico da mucosa gastroduodenal, bem mais significativos que os doentes HE. As dosagens de gastrinemia encontradas estiveram dentro da normalidade nos dois grupos, a exceçäo de dois doentes no grupo de HNE. Assim, conclem os autores que os HNE, principalmente pelo risco mais elevado de hemorragia digestiva, devem ser mantidos sob vigilância, orientaçäo alimentar adequada e eaté mesmo uso continuado de medicamentos, se for o caso. Além disso, outras pesquisas devem ser feitas para elucidar a etiologia destas alteraçöes da mucosa nestes doentes

Adenocarcinoma no esôfago de Barret em portador de esclerodermia / Adenocarcinoma in Barrett's esophagus in a patient with scleroderma

A esclerodermia acomete o esclerodermia acomete o esôfago e favorece o refluxo gastroesofágico, que, por sua vez, predispöe ao aparecimento do esôfago de Barrett, no qual a incidência de adenocarcinoma está por volta de 20%. Os autores registram o caso de um paciente com esclerodermia e esofagite de refluxo com esôfago de Barrett que desenvolveu adenocarcinoma que foi tratado através de esofagectomia transmediastinal. Trata-se de complicaçäo rara e somente cinco outros casos foram descritos na literatura até o momento. Assim, tendo em vista essa possibilidade, recomendam que portadores de esclerodermia e sintomas de refluxo sejam periodicamente submetidos a endoscopias digestivas de controle, para detectar o esôfago de Barrett

Pesquisa de eosinófilos no muco nasal: valor no diagnóstico diferencial de rinites / Eosinophils search in the nasal mucus: value in the differential diagnosis of rhinitis

O exame citológico do muco nasal para pesquisa de eosinófilos foi avaliado criticamente em 75 pacientes portadores de sintomas e comprovadamente alérgicos e em 29 pessoas sem quadro clínico de ritine e sem qualquer síntoma sugestivo de atopia. A pesquisa dos eosinófilos foi feita avaliando-se a percentuagem dos mesmos em relaçäo aos leucócitos e fazendo-se a contagem seqüencial das células em estudo. Os autores concluem que a determinaçäo do número absoluto de eosinófilos é a forma mais objetiva e correta de se fornecer o resultado.É também uma forma prática de se examinar a lâmina, pois, ao ser atingido o número crítico indicativo de processo alérgico, o exame pode ser dado por terminado. Consideram significativo o encontro de mais de 20 eosinófilos por lâmina. É importante salientar que as lâminas devem ser examinadas minuciosamente em toda a sua extensäo,exeto nos casos em que há abundantes eosinófilos ou que logo de início é atingida a contagem de 20 eosinófilos. Os casos negativos näo têm valor diagnóstico