[Prospective comparative study of ERCP brush cytology and EUS-FNA for the differential diagnosis of biliary strictures]. / Estudo prospectivo e comparativo do escovado obtido pela CPER à ecoendoscopia associada à punção aspirativa com agulha fina (EE-PAAF) no diagnóstico diferencial das estenoses biliares.

OBJECTIVE: To evaluate and to compare the diagnostic yield of ERCP brush cytology (ERCP) and EUS-FNA in patients with biliary strictures and evaluates the agreement between general pathologists (GP) and expert GI pathologists (GIP) in the final diagnosis of biliary strictures. METHODS: Patients with biliary strictures documented by ERCP were included. Brush cytology was performed and during EUS, only visible mass lesions or localized bile duct wall thickening were aspirated. The gold standard method for diagnosis was surgical histology and/or follow-up. Tissue sampling results were: malignant, suspicious, atypical, insufficiently or benign. Specimens were interpreted by GP and GIP, blinded for prior tests results. RESULTS: 46 patients were included. Final diagnosis was malignancy in 37 (26 pancreatic--11 biliary) and benign in 9 (8 chronic pancreatitis--1 common bile duct inflammatory stricture). Sensitivity and accuracy for ERCP brush cytology were 43.2% and 52.2% for GP and 51.4% and 58.7% for GIP. Sensitivity and accuracy for EUS-FNA were 52.8% and 58.5%, respectively for GP and 69.4% e 73.2% for GIP. In comparison, the combination of brush cytology and EUS-FNA demonstrated higher sensitivity and accuracy for both GP (64.9% and 69.6%, respectively) and GIP (83.8% and 84.8%, respectively) and improved agreement with final diagnosis for both (mostly for GIP). CONCLUSION: Both, ERCP brush cytology and EUS-FNA has a similar yield for the diagnosis of biliary strictures. However, the combination of these methods results in an improved diagnostic accuracy. In addition, GIP might be expected to interpret specimens with greater accuracy than GP.

Estudo prospectivo e comparativo do escovado obtido pela CPER à ecoendoscopia associada à punção aspirativa com agulha fina (EE-PAAF) no diagnóstico diferencial das estenoses biliares / Prospective comparative study of ERCP brush cytology and EUS-FNA for the diferential diagnosis of biliary strictures

OBJETIVO: Avaliar o desempenho diagnóstico da citologia obtida pela CPER, aquele obtido pela EE-PAAF e a concordância entre patologistas gerais (PG) e especialistas (PE) em pacientes com estenose biliar. MÉTODOS: Incluímos pacientes com estenose biliar identificados pela CPER. A EE-PAAF foi realizada apenas em áreas com efeito de massa ou da parede espessada do ducto biliar. O padrão-ouro foi a cirurgia, histologia e/ou o seguimento. As amostras teciduais foram consideradas: malignas, suspeitas, atípicas, insuficientes ou benignas. Os espécimes obtidos por cada método foi interpretado (cego) por um PG e outro PE. RESULTADO: 46 pacientes foram incluídos (37 malignos e 9 benignos). O diagnóstico final foi de tumor pancreático (26), biliar (11), pancreatite crônica (8) e estenose inflamatória do ducto biliar (1). Sensibilidade e acurácia da CPER foram 43,2 por cento e 52,2 por cento para o PG e 51,4 por cento e 58,7 por cento para o PE. Sensibilidade e acurácia da EE-PAAF foi 52,8 por cento e 58,5 por cento para o PG e 69,4 por cento e 73,2 por cento para o PE. A combinação entre a CPER e EE-PAAF demonstrou maior sensibilidade e acurácia para ambos PG (64,9 por cento e 69,6 por cento) e PE (83,8 por cento e 84,8 por cento), respectivamente. CONCLUSÃO: A citologia obtida pelo escovado da via biliar durante a CPER e as amostras teciduais colhidas pela EE-PAAF tem rendimento semelhante para o diagnóstico das estenoses biliares. No entanto, a combinação dos métodos resulta em uma maior acurácia. Além disso, espera-se que a interpretação das amostras ocorra com maior precisão pelo PE se comparado ao PG.

OBJECTIVE: To evaluate and to compare the diagnostic yield of ERCP brush cytology (ERCP) and EUS-FNA in patients with biliary strictures and evaluates the agreement between general pathologists (GP) and expert GI pathologists (GIP) in the final diagnosis of biliary strictures. METHODS: Patients with biliary strictures documented by ERCP were included. Brush cytology was performed and during EUS, only visible mass lesions or localized bile duct wall thickening were aspirated. The gold standard method for diagnosis was surgical histology and/or follow-up. Tissue sampling results were: malignant, suspicious, atypical, insufficiently or benign. Specimens were interpreted by GP and GIP, blinded for prior tests results. RESULTS: 46 patients were included. Final diagnosis was malignancy in 37 (26 pancreatic - 11 biliary) and benign in 9 (8 chronic pancreatitis - 1 common bile duct inflammatory stricture). Sensitivity and accuracy for ERCP brush cytology were 43.2 percent and 52.2 percent for GP and 51.4 percent and 58.7 percent for GIP. Sensitivity and accuracy for EUS-FNA were 52.8 percent and 58.5 percent, respectively for GP and 69.4 percent e 73.2 percent for GIP. In comparison, the combination of brush cytology and EUS-FNA demonstrated higher sensitivity and accuracy for both GP (64.9 percent and 69.6 percent, respectively) and GIP (83.8 percent and 84.8 percent, respectively) and improved agreement with final diagnosis for both (mostly for GIP). CONCLUSION: Both, ERCP brush cytology and EUS-FNA has a similar yield for the diagnosis of biliary strictures. However, the combination of these methods results in an improved diagnostic accuracy. In addition, GIP might be expected to interpret specimens with greater accuracy than GP.

Endoscopic ultrasound guided fine-needle aspiration core biopsy: comparison between an automatic biopsy device and two conventional needle systems.

BACKGROUND: endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) allows cytologic and/or histologic diagnosis of lesions within or adjacent to the gastrointestinal tract. However, the amount of tissue obtained with a regular 22 gauge needle is not always satisfactory. With the development of a needle XNA-10J-KB (Shot-Gun) that resembles the automatic liver biopsy needle, it is expected that significant samples be obtained more frequently (core biopsy), optimizing histological analysis. OBJECTIVE: to compare samples obtained with EUS-FNA using 3 different needle systems: GIP, NA-10J-1 and Shot-Gun. METHODS: 19 patients underwent EUS-FNA for diagnosis (5) or tumor staging (14). Mean age was 58.9 years (range 27-82), being 50% men. All patients were submitted to EUS-FNA with the 3 needle models. The Shot-Gun model was "shot" when its tip was near the target inside the lesion, followed by aspiration. Samples were submitted for cytologic and histologic examination. RESULTS: mean lesion size was 3.0 cm (range 0.8-5.5 cm). Final diagnoses were made after surgery or intra-operative biopsy: 13 pancreatic tumors (12 adenocarcinomas and 1 neuroendocrine tumor), 4 chronic pancreatitis, 1 acute pancreatitis, and 1 cholangiocarcinoma. Specimens adequate for cytologic diagnosis were obtained in 13/19 (68. 4%) patients using GIP model, in 14/19 (73.7%) with NA10J-1 model, and in 17/19 (89.5%) with ShotGun, model (p=0.039). Histologic analysis was possible in 10/19 (52.6%) patients using the GIP model, in 14/19 (73.7%) with NA10J-1, and in 17/19 (89.5%) with Shot-Gun, model (p=0.005). Adequate samples for cytologic or histologic assessment in 16/19 (84.2%) patients using the GIP model, in 17/19 (89.5%) with NA10J-1, and in 18/19 (94.7%) with Shot-Gun, model (p=0.223). In two cases biopsies were negative due to very hard tumors. CONCLUSION: the Shot-Gun needle obtained better samples for histological diagnosis than NA10J-1 needle and GIP.

Endoscopic ultrasound guided fine-needle aspiration core biopsy: comparison between an automatic biopsy device and two conventional needle systems / Biopsia tecidual con aguja fina guiada por ultrasonido endoscópico: comparación entre un dispositivo automático de la biopsia y dos sistemas de agujas convencionales

BACKGROUND: endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) allows cytologic and/or histologic diagnosis of lesions within or adjacent to the gastrointestinal tract. However, the amount of tissue obtained with a regular 22 gauge needle is not always satisfactory. With the development of a needle XNA-10J-KB (Shot-Gun) that resembles the automatic liver biopsy needle, it is expected that significant samples be obtained more frequently (core biopsy), optimizing histological analysis. OBJECTIVE: to compare samples obtained with EUS-FNA using 3 different needle systems: GIP, NA-10J-1 and Shot-Gun. METHODS: 19 patients underwent EUS-FNA for diagnosis (5) or tumor staging (14). Mean age was 58.9 years (range 27-82), being 50% men. All patients were submitted to EUS-FNA with the 3 needle models. The Shot-Gun model was "shot" when its tip was near the target inside the lesion, followed by aspiration. Samples were submitted for cytologic and histologic examination. RESULTS: mean lesion size was 3.0 cm (range 0.8-5.5 cm). Final diagnoses were made after surgery or intra-operative biopsy: 13 pancreatic tumors (12 adenocarcinomas and 1 neuroendocrine tumor), 4 chronic pancreatitis, 1 acute pancreatitis, and 1 cholangiocarcinoma. Specimens adequate for cytologic diagnosis were obtained in 13/19 (68. 4%) patients using GIP model, in 14/19 (73.7%) with NA10J-1 model, and in 17/19 (89.5%) with ShotGun, model (p=0.039). Histologic analysis was possible in 10/19 (52.6%) patients using the GIP model, in 14/19 (73.7%) with NA10J-1, and in 17/19 (89.5%) with Shot-Gun, model (p=0.005). Adequate samples for cytologic or histologic assessment in 16/19 (84.2%) patients using the GIP model, in 17/19 (89.5%) with NA10J-1, and in 18/19 (94.7%) with Shot-Gun, model (p=0.223). In two cases biopsies were negative due to very hard tumors. CONCLUSION: the Shot-Gun needle obtained better samples for histological diagnosis than NA10J-1 needle and GIP.

Introducción: la ecografía endoscópica asociada a la punción guiada con aguja fina (EUS-FNA) permite el examen citológico y/o diagnóstico histológico de las lesiones dentro o junto al tracto gastrointestinal. Sin embargo, la cantidad de tejido obtenido con una aguja de calibre 22 G no es siempre satisfactoria. Con el desarrollo de una aguja XNA-10J-KB (Shot-Gun®) que seasemeja a la biopsia hepática automática como una aguja especial, se espera que se obtengan muestras importantes con más frecuencia permitindo optimizar el mejor análisis histopatológico. Objetivo: comparar lasmuestras obtenidas con EUS-FNA con 3 diferentes sistemas de aguja: GIP ®, NA-10J-1 ® y Shot-Gun ®. Métodos: 19 pacientes fueron sometidos a EUS-FNApara el diagnóstico (5) para el análisis de las etapas del tumor (14). La edad media fue de 58,9 años (rango 27-82), siendo el 50% hombres. Todos los pacientes fueron sometidos a EUS-FNA con los 3 modelos de aguja. Del Shot-Gun ® fue "disparada" su punta cuandoestaba cerca de la meta en el interior de la lesión, seguida de aspiración. Las muestras se sometieron a examencitológico e histológico. Resultados: el promedio de tamaño de la lesión fue de 3,0 cm (rango 0,8-5,5 cm). Los diagnósticos definitivos fueron hechos después de la cirugía o la biopsia intra-operatoria: 13 tumores de páncreas (12 adenocarcinomas y 1 tumor neuroendócrino), 4 de pancreatitis crónica, 1 de pancreatitis aguda, y 1 de colangiocarcinoma. Las muestras adecuadas para el diagnóstico citológico se obtuvieron en 13/19 (68,4%) pacientes que utilizan GIP ®, en 14/19 (73,7%) con NA10J-1 ®, y en 17/19 (89,5%) con Shot-Gun® (p = 0,039). El análisis histológico fue posible en 10/19 (52,6%) pacientes que utilizan elGIP®, en 14/19 (73,7%) con NA10J-1 ®, y en 17/19 (89,5%) con Shot-Gun® (p = 0,005). Suficientes muestras para citológico o histológico de evaluación en16/19 (84,2%) pacientes que utilizan el modelo GIP ®, en 17/19 (89,5%) con NA10J-1 ®...

[Endoscopic ultrasound in the preoperative staging of gastric cancer: correlation with the surgical and/or pathological findings]. / Ecoendoscopia na avaliação pré-operatória do estádio em doentes com câncer gástrico: correlação com os achados cirúrgicos e/ou histopatológicos.

BACKGROUND: Gastric adenocarcinoma is the major cause of death by cancer in Brazil. For the planning of the treatment and evaluation of the prognosis, the preoperative staging according to the TNM classification is very important. AIM: To evaluate the results of endoscopic ultrasound for the T and N categories. METHODS: We examined 30 patients with gastric adenocarcinoma in the period of 1 year. We used a Olympus GIF UM-20. After positioning in the third portion of the duodenum, we started to evaluate the lymph node stations 16, 13, 12, 6, 5, 4, 3, 8, 7, 9, 10, 11, 1 and 2, using the frequency of 7.5 MHz. The depth of the tumor in the gastric wall was evaluated with the frequencies of 7.5 and 12 MHz. The results T and N were compared with the conclusive findings. In the unresectable cases, the correlation was made by the macroscopic findings. RESULTS: We performed 16 total gastrectomies, 7 subtotal gastrectomies, 5 exploratory laparotomies and 2 laparoscopies. For T category, endoscopic ultrasound results were correct in 25/30 cases (83.3%). All the other 16.7% were overestimated. The accuracy varied from 90% to 96.7% according to the subcategories T1 to T4. For the N category, endoscopic ultrasound results were correct in 23/30 cases (76.7%). Sixteen point six percent were underestimated and 6.7% overestimated. The accuracy varied from 76.7% to 90%, in agreement with the subcategories N1 to N3. CONCLUSION: There was a clear correlation between endoscopic ultrasound and the surgical and pathological findings in the evaluation of T and N categories in patients with gastric adenocarcinoma.

Ecoendoscopia na avaliação pré-operatória do estádio em doentes com câncer gástrico: correlação com os achados cirúrgicos e/ou histopatológicos / Endoscopic ultrasound in the preoperative staging of gastric cancer: correlation with the surgical and/or pathological findings

RACIONAL: O câncer gástrico é a maior causa de morte por câncer no Brasil. Na avaliação do prognóstico e no planejamento da terapêutica, é importante determinar o estádio e classificá-lo em TNM. OBJETIVO: Estudar os resultados da ecoendoscopia na determinação pré-operatória das categorias T e N. MÉTODOS: Foram examinados prospectivamente e de forma consecutiva 30 pacientes com adenocarcinoma gástrico no período de 1 ano. Utilizou-se o aparelho Olympus GIF-UM-20. Após seu posicionamento na terceira porção duodenal, estudaram-se as estações linfonodais 16, 13, 12, 6, 5, 4, 3, 8, 7, 9, 10, 11, 1 e 2, usando a freqüência de 7,5 MHz. Os resultados T e N foram comparados com os achados cirúrgicos e/ou histopatológicos. Nos casos irressecáveis, a correlação foi feita com os achados macroscópicos. Para a análise estatística utilizou-se o teste de correlação coeficiente kappa. RESULTADOS: Foram realizadas 16 gastrectomias totais, 7 subtotais, 5 laparotomias exploradoras e 2 videolaparoscopias. Para a categoria T a ecoendoscopia acertou em 25/30 casos (83,3 por cento). Todos os restantes 16,7 por cento foram superestimados. A precisão variou de 90 por cento a 96,7 por cento, de acordo com as subdivisões T1 a T4. Para a categoria N, a ecoendoscopia foi correta em 23/30 casos (76,7 por cento), sendo 16,6 por cento subestimados e 6,7 por cento superestimados. A precisão variou de 76,7 por cento a 90 por cento, de acordo com as subdivisões N0 a N2. CONCLUSÃO: Houve nítida correlação entre a ecoendoscopia pré-operatória e os achados cirúrgicos e/ou histopatológicos em pacientes com adenocarcinoma gástrico.

BACKGROUND: Gastric adenocarcinoma is the major cause of death by cancer in Brazil. For the planning of the treatment and evaluation of the prognosis, the preoperative staging according to the TNM classification is very important. AIM: To evaluate the results of endoscopic ultrasound for the T and N categories. METHODS: We examined 30 patients with gastric adenocarcinoma in the period of 1 year. We used a Olympus GIF UM-20Ô. After positioning in the third portion of the duodenum, we started to evaluate the lymph node stations 16, 13, 12, 6, 5, 4, 3, 8, 7, 9, 10, 11, 1 and 2, using the frequency of 7.5 MHz. The depth of the tumor in the gastric wall was evaluated with the frequencies of 7.5 and 12 MHz. The results T and N were compared with the conclusive findings. In the unresectable cases, the correlation was made by the macroscopic findings. RESULTS: We performed 16 total gastrectomies, 7 subtotal gastrectomies, 5 exploratory laparotomies and 2 laparoscopies. For T category, endoscopic ultrasound results were correct in 25/30 cases (83.3 percent). All the other 16.7 percent were overestimated. The accuracy varied from 90 percent to 96.7 percent according to the subcategories T1 to T4. For the N category, endoscopic ultrasound results were correct in 23/30 cases (76.7 percent). Sixteen point six percent were underestimated and 6.7 percent overestimated. The accuracy varied from 76.7 percent to 90 percent, in agreement with the subcategories N1 to N3. CONCLUSION: There was a clear correlation between endoscopic ultrasound and the surgical and pathological findings in the evaluation of T and N categories in patients with gastric adenocarcinoma.

Cell block technique and cytological smears for the differential diagnosis of pancreatic neoplasms after endosonography-guided fine-needle aspiration.

Cytological smear is widely employed to analyse specimens obtained from endosonography-guided fine-needle aspiration (EUS-FNA), but false-negative or inconclusive results may occur. A better diagnostic yield can be obtained from processing cell blocks. We compared the effectiveness of the cell block technique and cytological smear in the diagnosis of pancreatic neoplasms. From January 1997 to December 2006, 611 patients with pancreatic tumors were evaluated by EUS-FNA. Surgery was performed in 356 cases, and the other 255 patients were followed clinically for an average of 12.8 months. In total, 282 (46.2%) patients were evaluated with cytological smears, and 329 (53.8%) were evaluated using only cell blocks. Malignant disease was detected in 352 (57.6%) cases, in which adenocarcinoma accounted for 236 (67%) cases. A benign disease was found in the other 259 cases, including 35.1% focal chronic pancreatitis and 32.4% pseudocysts. Aspiration samples were satisfactory in 595 (97.4%) patients after an average of 2.2 (1-4) passes of the needle. Regardless of the cytopathological examination technique, EUS-FNA confirmed malignancy in 269 of 352 (76.4%) cases, and a benign disease in 257 of 259 (99.2%) cases. For patients who received surgery with histologically confirmed lesions, the sensitivity specificity, positive and negative predictive values, and accuracy of the smears versus cell blocks in diagnosing pancreatic tumors were 61% versus 85.2% (P<0.001), 100% versus 93.1%, 100% versus 98.4%, 36% versus 55.1% (P=0.046) and 68% versus 86.5% (P<0.001), respectively The cell block technique demonstrated a hig her sensitivity, negative predictive value and accuracy than cytological smears.

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration.

AIM: To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions. METHODS: From January/1997 to December/2006, 611 patients with pancreatic tumors were subjected to EUS-FNA. The final diagnosis was obtained either by surgery (356 cases) or after a mean clinical follow-up of 11.8 mo in the remaining patients. RESULTS: There were 405 solid tumors, 189 cystic lesions and 17 mixed. Pancreatic specimens for cytological assessment were successfully obtained by EUS-FNA in 595 (97.4%) cases. There were 352 (57.6%) malignancies and 259 (42.4%) benign tumors. Among the malignancies, pancreatic adenocarcinomas accounted for 67% of the lesions. Overall, the sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA were, respectively, 78.4%, 99.2%, 99.3%, 77.2% and 87.2%. Specifically for solid tumors, the same parameters for neoplasms larger and smaller than 3 cm were, respectively, 78.8% vs 82.4%, 100% vs 98.4%, 100% vs 99%, 54.8% vs 74.1% and 83.1% vs 87.8%. For cystic lesions, the values were, respectively, 72.2%, 99.3%, 97.5%, 91% and 92.2%. CONCLUSION: EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions can reveal the best negative predictive value and diagnostic accuracy, both higher than 90%.

Eficácia da solução reveladora de linfonodos em peças de gastrectomia com linfadenectomia por adenocarcinoma gástrico / Efficacy of lymph nodes revealing solution in gastrectomy with lymphadenectomy specimens from gastric carcinoma

Com o intuito de identificar um número maior de linfonodos nas peças cirúrgicas de gastrectomia com linfadenectomia por adenocarcinoma gástrico, utilizamos a solução reveladora de linfonodos (SRL), após a retirada dos linfonodos identificados pelo método tradicional de visualização e palpação, em 13 doentes. Encontramos 222 nódulos linfáticos (17,1 por doente) pela maneira habitual e, depois, aplicando a SRL, retiramos mais 123, ou seja, 9,5 (55,5%) de linfonodos a mais por doente. A histologia mostrou 39 linfonodos com invasão neoplásica entre os encontrados com o método tradicional e oito com a SRL. O diâmetro dos nódulos identificados com a SRL foi menor que o dos detectados com o outro método. O estádio da doença não se modificou apósa análise dos linfonodos encontrados com a SRL. Concluímos, pela análise estatística dos dados, que a SRL éeficaz para identificar linfonodos não detectados pelo método tradicional.

In spite of it’s decreasing incidence in the last years, gastric cancer remains the most frequent cause of death by malignant. Prognosis depends on gastric wall tumor invasion, lymph node involvement and distant metastasis. Small lymph nodes (less than 1 mm) are rarely identified, and, disease status and prognosis could change if some are metastatic. To identify lymph nodes in gastrectomy and lymphadenectomy specimens from gastric cancer, we have used a lymph node revealing solution (LNRS) after having taken the visible and palpable lympg nodes off. We have found 222 nodes with this technique (17.1 per patient) and more 123 nodes with LNRS (9.5 per patient), 55.5% additional nodes. Biopsies have shown 39 metastatic nodes revealed by the traditional method and eight with LNRS. Statistics showed that LNRS was effective in lymph nodes detection. LNRS revealed nodes were smaller. Disease status did not change after addiction of LNRS detected nodes. We concluded LNRS was effective in lymph nodes searching from the studied specimens.

Colangite esclerosante promária em criança e adolescentes / Primary sclerosing cholangitis in children and adolescents

Colangite esclerosante primária é uma doença em geral associada a prognóstico pobre, com sobrevida média de 10-12 anos a partir do diagnóstico. Pacientes do sexo masculino predominam nas diferentes populaçoes estudadas, na proporçao de 2:1, com idades variando, na maioria das casuísticas, entre 20-78 e média de 42 anos. Sao descritos quatro pacientes, uma criança (8 anos) e três adolescentes com 13 e 14 anos, que cursaram com esta síndrome que se caracteriza pela instalaçao de estenose, dilataçao e fibrose, envolvendo árvore biliar intra e extra-hepática, possivelmente de etiologia auto-imune. Deteve-se na análise dos aspectos clínicos, imunológicos, laboratoriais, histológicos e colangiográficos deles. Conclui-se que nesta faixa, talvez pela pequena populaçao estudada, nao houve predileçao pelo sexo, sendo que 50 por cento evoluíam anictéricos e sem hepatomegalia, sendo mais acentuados os níveis séricos de gamaglutamiltransferases e, sobretudo, de fosfatase alcalina, em relaçao aos de aminotransferases, sem expressao dos auto-anticorpos séricos. Apenas um exibia os aspectos histológicos típicos de colangite esclerosante primária, diagnóstico confirmado em todos, através dos sinais colangiográficos típicos, restritos apenas à árvore biliar intra-hepática, identificados em todos incluídos neste trabalho.

Mesotelioma maligno primário difuso em cavidade abdominal / Diffuse primary malignant mesothelioma in abdominal cavity

Säo analisados dois casos de mesotelioma maligno difuso presentes na cavidade abdominal. Este tumor primário origina-se do mesotélio peritoneal, da pleura visceral e parietal, pericárdio e túnica vaginal. Todos eles, infra ou supra-diafragmáticos, associam-se com exposiçäo a asbestos em pelo menos 80 por cento dos casos. Dificuldade existe, no entanto, em explicar como asbestos inalados induzem ao aparecimento da neoplasia peritoneal. Estes aspectos säo importantes para realizaçäo do diagnóstico predominantemente definido por laparotomia ou laparoscopia e biopsias das lesöes e, ocasionalmente, pela identificaçäo de células mesoteliais malignas no líquido ascítico. Säo, também, estabelecidas consideraçöes sobre diagnóstico realizado na maioria dos casos em fases avançadas, apresentando grave evoluçäo e opçöes terapêuticas baseadas em ressecçäo cirúrgica radical das lesöes, radio ou quimioterapia isoladas ou combinadas.

Tumor de Frantz: relato de dois casos: medidas terapêuticas e prognóstico / Frantz tumor: report of 2 cases: therapeutic measures and prognosis

Säo apresentados dois casos de um tumor pancreático raro (tumor de Frantz), que se encontravam em estágios evolutivos distintos, enfatizando a complexidade no estabelecimento de um diagnóstico anatomopatológico preciso. Exige-se abordagem cirúrgica agressiva, sempre que possível, devido ao excelente prognóstico. Discutem-se, ainda, a apresentaçäo clínica e origem histológica, bem como os fatores prognósticos e uma nova abordagem terapêutica, visando a conduçäo das metástases hepáticas que eventualmente apresentam.

Tipos histológicos e mortalidade por câncer gástrico em Säo Paulo / Hystological types and mortality for gastric cancer in Säo Paulo, Brazil

Verifica qual tipo histológico prevalece, se o intestinal ou difuso, segundo a classificaçäo de Lauren. Os preparados histopatológicos de 650 casos de um hospital da cidade de Säo Paulo, cobrindo um período de trinta anos, foram revistos, aplicando-se as definiçöes da classificaçäo acima mencionada. Os resultados mostraram que o tipo intestinal tornou-se prevalente após a década de 50, atingindo a cifra de 62,74 por cento entre os casos de carcinoma na década de 80, sendo de 1,71 a razäo intestinal/difuso. Outras séries de casos cujos diagnósticos seguiram a nomenclatura da Classificaçäo Histológica da WHO näo se mostraram adequadas para este tipo de estudo. A prevalência do tipo intestinal contrasta, aparentemente, com o decréscimo das taxas de mortalidade por esta doença no Estado de Säo Paulo no mesmo período. Säo necessários estudos futuros, incluindo análises de taxas de incidência e prevalência do Helicobacter pylori, entre outros, para melhor interpretaçäo desses dados.

Biopsia percutânea guiada por ultra-som em lesöes nodulares sólidas focais malignas do fígado / Ultrasonically guided needle in focal nodular solids malignant lesions of the liver

Na maioria das vezes o diagnóstico das lesoes nodulares sólidas focais do fígado, realiza-se através dos métodos de imagens como ultra-som, tomografia computadorizada, ressonância magnética e angiografia de artéria hepática. No entanto, a diferenciaçao entre neoplasias benignas ou malignas ocorre, às vezes, apenas após realizaçao da biopsia hepática. Estabelece-se consideraçoes sobre 32 lesoes nodulares sólidas focais malignas, diagnosticadas a partir da realizaçao de biopsia hepática guiada por ultra-som. Define-se a eficácia deste método propedêutico pouco invasivo, o qual nao determina mortalidade e exibe discreto índice de morbidade.

Cholelithiasis in cirrhotic patients (analysis of cholelithiasis among patients with liver cirrhosis in Säo Paulo, Brazil)

During the past 20 years, several authors have reported increased prevalence of cholelithiasis in liver cirrhosis. This biliary disease has been implicated with the deterioration of liver function, liver disease of alcoholic origin or even the presence of hypersplenism in this patient population. This study analyzes the incidence and possible factors which are responsible for promoting cholelithiasis in cirrhosis. The study included 110 cirrhotic patients of a private center specialized in treating liver diseases. The incidence of cholelithiasis was 27.3 per cent (25.3 per cent in males and 33.3 per cent in females). There was no correlation between liver function defined by Child's classification or through the laboratory examinations (AST, ALT, AP, GGT, PT, Alb, TB, DB, PA) and the presence of gallstones. No evidence was found that the etiology of cirrhosis or the presence/absence of hypersplenism affected the prevalence of cholelithiasis in this population. In conclusion, an increased prevalence of cholelithiasis was verified in this population of cirrhotics but the pathogenesis is still obscure.

Eficácia do interferon no tratamento das hepatites crônicas virais / Interferon efficaccy in the treatment of chronic viral hepatitis

A terapêutica com interferon para infecçao pelos vírus das hepatites B(VHB) ou C (VHC), tem sido intensamente estudada nestes últimos anos. As indicaçoes, limitaçoes à administraçao, contra-indicaçoes, fatores influenciadores da resposta, efeitos colaterais e esquemas terapêuticos adotados, têm sido revistos neste artigo

Mecanismos patogenéticos da doença hepática alcoólica: aspectos atuais / Pathogenetics mechanisms of alcoholic liver disease: a present view

Abuso e dependência alcoólica constituem-se nos mais graves problemas de saúde pública, do mundo industrializado. O papel do etanol em provocar doença hepática ou perpetuaçao da lesao dos hepatócitos, encontra-se ainda precariamente definido. Mecanismos patogenéticos essenciais responsáveis pela evoluçao das lesões, sao expostos neste artigo e incluem etanos e metabólitos, fatores nutricionais, genéticos e imunológicos, alteraçoes das membranas biológicas e participação dos virus das hepatites B e C

Manifestaçoes extra-hepáticas das hepatites virais / Extrahepatic manifestations of viral hepatitis

Manifestaçoes extra-hepáticas das hepatites virais, sao raras e causadas por vírus A,B,C,D,ou E. As mais comumentes observadas sao vasculites sistêmicas, crioglobulinemias essenciais, polimialgias reumáticas, anemia aplástica, glomerulonefrites membranosas e membranoproliferativas, síndrome de Sjogren, encefalite aguda e urticária. Algumas destas sao graves, inclusive com índices elevados de mortalidade. A maioria porém, assume curso clínico leve. Serao comentadas neste artigo

Importância dos níveis de colesterol, triglicérides e lípides totais na diferenciaçäo entre ascite de etiologia benigna e maligna / Value of cholesterol, triglycerides, and total lipids in the differentiation between benign and malignant ascites

Na maioria das vezes, a ascite é causada por doença crônica do fígado, neoplasias malignas ou insuficiência cardíaca congestiva. Comumente o diagnóstico diferencial baseia-se na avaliaçao de alguns parâmetros bioquímicos. Com esse objetivo, analisamos a importância dos níveis de colesterol, triglicérides e lípides totais no sangue e líquido ascítico de 47 pacientes, dos quais 23 eram cirróticos, 17 portadores de carcinomatose peritoneal e sete com insuficiência cardíaca congestiva. Comprovamos que: a) colesterol é o parâmetro mais indicado na diferenciaçao entre ascite secundária à carcinomatose e cirrose; b) isoladamente, nenhum destes parâmetros bioquímicos é decisivo para o diagnóstico de etiologia do processo patológico; e c) níveis de lípides totais no líquido ascítico encontram-se aumentados na carcinomatose peritoneal.

Gradiente de albumina (soro-ascite) na diferenciaçäo diagnóstica da ascite / The serum ascites albumin gradient concept in the diffential diagnosis of ascites

O objetivo do trabalho resume-se ao estudo no sangue e líquido ascítico dos níveis de proteína total, albumina e gradiente de albumina (soro-ascite), em portadores de ascite. realizou-se prospectiva e sequencialmente coleta de sangue e ascite em 47 pacientes: carcinomatose peritoneal (n = 17), cirrose hepática(n = 23) e insuficiência cardíaca congestiva (n = 7). definiu-se que gradiente de albumina soro-ascite, juntamente com concentraçÝo de proteína, funcionam como excelentes marcadores de pacientes com ascite de etiologia maligna. Por outro lado, o primeiro parâmetro permite: 1) definir com maior sensibilidade e especificidade os processos patológicos estudados; 2) por permitir diagnosticar com grande precisÝo as ascites de etiologia neoplásica das resultantes de outras causas, sugerimos que a classificaçÝo do líquido ascítico em transudato e exsudato seja substituído por ascite de alto e baixo gradiente de albumina