[Ultrasonography aspects of primary gallbladder neoplasms]. / Aspectos ultra-sonográficos do câncer primário da vesícula biliar.

Sixty six patients with primary gallbladder cancer were seen at the Hospital A. C. Camargo, São Paulo, Brazil, from January 1980 to December 1988 and who represent 0.14% of the total of 46,519 patients registered in the same period. Out of the 66 cases, 41 were submitted to an ultrasonographic exam. As to the other 25 patients, 20 had been submitted to a cholecystectomy at another hospital. This exam was not done in the other 5 patients for several reasons. The gallbladder cancer diagnosis was based on data obtained from surgery and confirmed by anatomopathological exam. Regarding the 20 cases operated on at another hospital there was a slide review performed at the Department of Pathologic Anatomy at the Hospital A. C. Camargo. The main ultrasonographic aspects in the 30 cases in which there was a correct diagnosis, were the following: solid mass in the gallbladder lumen in 13 cases (43.33%); solid tumour in the gallbladder area in 7 cases (23.33%); a tumour contiguous to the gallbladder reaching other organs in 6 cases (20.00%); an alteration of the gallbladder shape in 3 cases (10.00%) and an accentuated thickening of the gallbladder wall with inaccurate limits in one case (3.33%). In the sub-group in which the ultrasonographic exam was performed, cholelithiasis was observed in 31 (75.60%) of the 41 cases. There was a correct diagnosis in 18 (58.06%) of the 31 cases with cholelithiasis and in 8 (80.00%) of the 10 without cholelithiasis; not a significant difference. As to the ultrasonographic aspects of the false negative cases, in 9 (81.81%) of the 11 cases the images suggested cholelithiasis. Among these 9 cases there were 2 with an enlarged gallbladder, one case of escleroatrophic gallbladder and one case with thickened walls. The diagnosis of the other 2 cases were biliary mud in one and a probable cholelithiasis in another.

[Ethanol and the gastrointestinal tract]. / Etanol e o trato gastrointestinal.

The effects of ethanol upon the gastrointestinal tract (mouth, pharynx, esophagus, stomach, duodenum, Oddi's sphincter, small bowel, colon and rectum) were reviewed. Several studies showed that the incidence of cancer in the mouth and pharynx is increased in alcoholics as a consequence of ethanol effects and probably those of other compounds found in liquors. The gastroesophageal reflux disease may be induced by alcohol since it reduces the pressure in the lower and the upper esophageal sphincter, as well as the extent of primary peristalsis. Several studies showed a strong correlation between esophageal cancer and alcohol abuse. The risk for developing this kind of tumour is significantly increased when alcohol abuse and smoking coexist. Alcoholism predisposes patients to Mallory-Weiss syndrome as well as to bleeding of esophageal varices Ethanol may affect gastric secretion, motility, and permeability. Some drugs acting upon the gastric alcohol-dehydrogenase are able to affect gastric absorption of ethanol. Eradication of Helicobacter pylori increases the activity of alcohol-dehydrogenase in the pyloric antrum. The effects of alcohol upon the gastric mucosa include caustic damage, retrograde diffusion of H+, and cytoprotection. This agent may cause an acute gastritis but it is probably not involved in chronic gastritis. Whether alcohol is a risk factor for ulcer or not is unknown. Some studies found an increased incidence of gastric cancer associated with consumption of beer, wine and vodka. Some authors reported a decreased pressure in Oddi's sphincter while others found it increased in association with the consumption of ethanol. The acute and the chronic consumption of alcohol may affect the structure of small bowel as well as the absorption of nutrients. Several studies reported a significant correlation between colorectal cancer and the chronic consumption of ethanol.