Hiatal hernia and gastroesophageal reflux: Study of collagen in the phrenoesophageal ligament.

BACKGROUND: Gastroesophageal reflux disease (GERD) is defined by the intensity and/or quality of the reflux of gastric or duodenal contents into the esophagus. Surgical treatment of GERD has shown conflicting results and unacceptable recurrence rates, mainly due to herniation of the antireflux valve into the chest. A variety of techniques has been proposed to reduce GERD recurrence, including routine use of prosthesis in cruroplasty. The prevalence of GERD in patients with hiatal hernia (HH) can reach 94 %. It is possible that the phrenoesophageal ligament (POL) engaged in the stabilization of the gastroesophageal junction in the abdomen may be an etiological factor of HH. We conducted a study to evaluate collagen in the constitution of the POL in patients with HH and cadavers without HH. METHODS: POL samples were collected from 29 patients with HH and GERD (cases) and 32 samples from cadavers without HH (controls). Total collagen was quantified through the Picrosirius red histochemical technique, and type-I and type-III collagens were quantified immunohistochemically using a monoclonal antibody. The stained slides were photographed, and images were quantified by computer software (Image Pro Plus) to count the pixels per field. RESULTS: The mean age was 49.5 (±11.5) years for the cases and 38.5 (±13) years for the controls (p < 0.01). Seventeen cases (58.6 %) and six controls (18.75 %) were female (p < 0.01). The quantity of total (p < 0.01), type-I (p < 0.01), and type-III (p < 0.05) collagens was significantly lower by about 60 % in patients with HH compared with controls. CONCLUSION: Our data indicate that the composition of POL for patients with GERD and HH includes less total, type-I, and type-III collagens than that of the POL of cadavers without HH. The quality of the POL may be an etiological factor in the development of HH.

Acute gastric dilatation and necrosis: a case report.

Massive gastric dilatation with necrosis and rupture is a very rare event. Here we describe the case of a 13-year-old girl with acute gastric dilatation, infarction, necrosis and perforation. It began with acute abdominal pain, but an absence of vomiting after eating a heavy meal. Laparotomy showed massive gastric dilatation with infarction and perforation. Early diagnosis is essential to reduce morbidity and mortality, and therefore treatment must be started promptly.

Laparoscopic excision of a retroperitoneal cystic lymphangioma in an elderly patient.

A 68-year-old male patient was referred to our hospital due to protrusion and pain in the right iliac fossa. On physical examination a palpable oval tumor was found. Ultrasonography and computed tomography revealed a cystic mass in right iliac fossa. The tumor was successfully excised laparoscopically and histologically diagnosed as cystic lymphangioma. Retroperitoneal cystic lymphangiomas are rare lesions, most often seen in pediatric patients. Surgical excision is the treatment of choice because of its potential to grow and develop complications, especially due to mass effect. The laparoscopic approach is a safe and effective alternative for treatment of retroperitoneal cystic lymphangioma in the elderly.

Atividade física e as lipoproteinas plasmáticas / Physical activity and plasmatic lipoproteins

Os níveis séricos das lipoproteinas plasmáticas têm sido, já há alguns anos, o foco das pesquisas que preocupam-se em estabelecer os fatores de risco para patologias ateroescleróticas. Com esse propósito, verificou-se que a atividade física é capaz de promover alterações metabólicas que causam um aumento da concentraçäo de lipoproteínas de alta densidade (HDL) e de suas subfraçöes. Além disso, ocorre diminuiçäo de lipoproteínas de baixa densidade (LDL) e lipoproteínas de muito baixa densidade (VLDL). Essas alteraçöes estäo profundamente relacionadas com a diminuiçäo dos acidentes vasculares por diminuiçäo dos níveis de coleterol e triglicerídeos. Os autores procuraram mostrar as alteraçöes ocorridas com as lipoproteínas plasmáticas em decorrência de mudanças na atividade das enzimas lipase lipoprotéica (LPL), lecitina: colesterol acil transferase (LCAT), lipase triglicerídeo hepática (HTGLA) e proteína transferidora de ésteres de colesterila (CETP)