The Comparative Anatomy of the Upper Digestive System in 26 Species of Zoophagous-Polyphagous Palearctic Birds / Anatomía Comparada del Sistema Digestivo Superior en 26 Especies de Aves Paleárticas Zoófagas-Polífagas

SUMMARY: Birds are the most diversified organisms on Earth, with species covering various niches in each major biome, being essential to understand the modern ecosystem. This study concentrates on the diversification of the anatomical structure of the upper digestive tract for 26 species of zoophage-polyphagous birds and the anatomical differences in the digestive system to reveal aspects related to their evolution and diversification. The trophic spectrum of the selected birds includes several categories of food, or, as in the case of strictly carnivorous birds, to a single food category. After performing the dissections, the digestive tract was separated from the carcass and each digestive segment was measured and analysed. In this study, it was demonstrated that the birds' feeding behaviour influence the macroscopic particularities of the digestive system, more visible in the cranial portion (oropharyngeal cavity, esophagus, proventriculus and gizzard), with little descriptive information in the literature. The tongue is poorly developed and immobile in piscivorous birds, while the tongue of insectivorous birds is long and moves considerably away from the tip of the bill. The esophagus was stretchable and presents longitudinal folds on its entire surface in piscivorous species and not extensible in insectivorous birds.

Las aves son los organismos más diversificados de la Tierra, con especies que cubren varios nichos en cada bioma principal, siendo esenciales para comprender el ecosistema moderno. Este estudio se concentra en la diversificación de la estructura anatómica del tracto digestivo superior para 26 especies de aves zoófago-polífagas y las diferencias anatómicas en el sistema digestivo para revelar aspectos relacionados con su evolución y diversificación. El espectro trófico de las aves seleccionadas incluye varias categorías de alimentos o, como en el caso de las aves estrictamente carnívoras, una sola categoría de alimentos. Después de realizar las disecciones, se separó el tracto digestivo de la canal y se midió y analizó cada segmento digestivo. En este estudio se demostró que el comportamiento alimentario de las aves influye en las particularidades macroscópicas del sistema digestivo, más visibles en la porción craneal (cavidad orofaríngea, esófago, proventrículo y molleja), con poca información descriptiva en la literatura. En las aves piscívoras, la lengua está poco desarrollada e inmóvil, mientras que la lengua de las aves insectívoras es larga y se aleja considerablemente de la punta del pico. El esófago era estirable y presentaba pliegues longitudinales en toda su superficie en especies piscívoras y no extensible en aves insectívoras.

Esófago porcino: modelo ex vivo de entrenamiento laparoscópico para la miotomía de Heller y funduplicatura de Dor / Porcine esophagus: ex vivo laparoscopic training model for Heller's myotomy and Dor's funduplication

El dominio de procedimientos avanzados en laparoscopia es fundamental para los cirujanos, por ello el entrenamiento es imprescindible. La miotomía de Heller y funduplicatura de Dor requieren el desarrollo de habilidades y destrezas para realizar la cirugía de forma segura y eficaz, superar la curva de aprendizaje es un reto para el cirujano en formación, por lo que se propone el esófago porcino como modelo ex vivo de entrenamiento laparoscópico, con el fin de permitir desarrollar las habilidades necesarias y así llevar a cabo con éxito el procedimiento quirúrgico.Objetivo : Aplicar el esófago porcino como modelo ex vivo para el entrenamiento laparoscópico de la miotomía de Heller y funduplicatura de Dor.Métodos : Se realizó un estudio prospectivo, experimental y longitudinal, aplicado en un período de 17 semanas, en sesiones de 1 hora cada una, una sesión por semana.Resultados : Se llevaron a cabo 17 prácticas realizadas por el autor, evaluadas por cirujanos expertos, observando un aumento de la puntuación obtenida en la escala GOALS y disminución del tiempo de ejecución a medida que aumentaba el número de prácticas con una correlación altamente significativa, según la tau-B de Kendall (p=0,000).Conclusión : El modelo ex vivo permitió recrear la mayoría de los pasos quirúrgicos y demostró ser una herramienta útil y valiosa, disminuyendo el tiempo de ejecución del procedimiento y aumentando significativamente las habilidades laparoscópicas(AU)

Mastery of advanced procedures in laparoscopy is important for surgeons, therefore training is essential. Heller's myotomy and Dor's fundoplication require the development of abilities and skills to perform the surgery safely and effectively, overcoming the learning curve is a challenge for the surgeon in training, so the porcine esophagus is proposed as an ex vivo model of laparoscopic training in order to develop the necessary skills to successfully carry out the surgical procedure. Objective: To apply the porcine esophagus as an ex vivo model for laparoscopic training of Heller's myotomy and Dor's fundoplication. Methods: A prospective, experimental and longitudinal study was carried out, applied by the authors in a period of 17 weeks, in sessions of 1 hour each, one session per week. Results: 17 practices carried out by the author were carried out, evaluated by expert surgeons, observing an increase in the score obtained on the GOALS scale and a decrease in execution time as the number of practices with a high significant influence increase, according to Kendall's tau-B (p=0.000). Conclusion: The ex vivo model allowed recreating most of the surgical steps and stood out as a useful and valuable tool, decreasing the execution time of the procedure and significantly increasing laparoscopic skills(AU)

Micromorphological study of the upper digestive tract of the Argentine tegu (Salvator merianae).

Argentine black and white tegus (Salvator merianae) are omnivorous lizards native to southeastern Brazil, Uruguay, eastern Paraguay and northern Argentina, and are invasive species in Florida and Georgia, USA. They are opportunistic feeders, which is what allow them to have such a diverse variety of foods. Tegus raised a particular concern due to their adaptive capability to different environments. Our goal was to provide a micromorphology baseline of oesophagus and stomach and correlate findings with their dietary and invasive capabilities. Four Argentine black and white tegus were used for this study. We collected and processed specimens from oesophagus and stomach using standard histological techniques and stained tissue sections using Haematoxylin and Eosin (H&E), Periodic Acid Schiff (PAS), Alcian Blue (AB) and Verhoef's elastic stains. The oesophagus was lined with ciliated pseudostratified columnar epithelium (PSCE) with goblet cells. Gut-associated lymphoid tissues (GALT) were present occasionally in the oesophagus and more frequently in the stomach. Tunica muscularis (Tm) of the oesophageal-gastric junction had distinct smooth muscle which could function as a sphincter. The mucosa of the stomach was lined with simple columnar epithelium (SC). The glands had neck and dark oxyntico-peptic cells. The pyloric sphincter had more GALT and mucus cells than other regions. The Tm outer layer is thinner than the inner. Presence of large number of goblet cells would support faster transit of the bolus. The short digestive tract and the histological features observed are consistent with the ability of tegus consumption of large amount of food.

Revisión anatómica de la cavidad oral, glándulas salivares y esófago de dos ejemplares de pudú (Pudu puda) / Anatomical review of the oral cavity, salivary glands and esophagus of two specimens of pudú (Pudu puda)

RESUMEN: El pudú (Pudu puda), pertenece al orden Artiodactyla y a la familia Cervidae, corresponde al segundo cérvido más pequeño del mundo y es endémico de Chile y Argentina. Son herbívoros que se alimentan de hojas jóvenes y brotes de algunos árboles, arbustos, hierbas, frutos y flores. Esta especie está catalogada en estado Vulnerable, por lo que se prohíbe su caza y captura, esto debido a que su población ha disminuido sustancialmente a causa de la pérdida y fragmentación de la vegetación nativa, los incendios forestales, ataques de perros asilvestrados y caza furtiva. Existe escasa información científica anatómica de esta especie, y más aún referente a su morfología digestiva, por lo que se requieren estudios que aporten información específica de este cérvido. Se utilizaron dos cadáveres de pudú hembras adultas, los cuales fueron donados por el Servicio Agrícola y Ganadero (SAG) de Talca, Región del Maule, Chile. Dentro de los resultados, podemos indicar que la cavidad oral, glándulas salivares y esófago se asemejan a otros rumiantes domésticos, como también existen semejanzas con el venado de campo, sin embargo, existen diferencias como la forma y desarrollo de la glándula parótida; el conducto parotídeo pasa ventral al músculo masetero y se abre en una papila a nivel del tercer premolar superior; la glándula mandibular se divide en tres lobos; la glándula sublingual solo posee porción polistomática, las glándulas bucales dorsales poseen un menor tamaño que las bucales ventrales, la glándula bucal ventral es alargada y de forma compacta y se observa la presencia de una redondeada glándula bucal intermedia, poseen 11 crestas palatinas por lado en el paladar duro y además la papila incisiva se encuentra rodeando al pulvino dental. Esta información es relevante y corresponde a un aporte al conocimiento específico de esta especie, la cual es endémica, vulnerable y protegida.

SUMMARY: The pudu (Pudu puda), belongs to the Artiodactyla order and the Cervidae family, corresponding to the second smallest deer in the world and is endemic to Chile and Argentina. They are herbivores that feed on young leaves and shoots of certain trees, shrubs, herbs, fruits, and flowers. The status of is species is classified as Vulnerable; therefore, its hunting and capture is prohibited, this because its population has decreased substantially due to the loss and fragmentation of native vegetation, forest fires, attacks by feral dogs and poaching. There is little scientific anatomical information available on this species, and even more so regarding its digestive morphology, which is why studies are required to provide specific information on this deer. Two adult female pudu specimens were used, which were donated by the Agricultural and Livestock Service (SAG) of Talca, Maule Region, Chile. Among the results, we can indicate that the oral cavity, salivary glands and esophagus resemble other domestic ruminants; there are also similarities with the field deer, however, there are differences such as the shape and development of the parotid gland; the parotid duct passes ventral to the masseter muscle and opens into a papilla at the level of the upper third premolar; the mandibular gland is divided into three wolves; the sublingual gland only has a polystomatic portion, the dorsal buccal glands are smaller than the ventral buccal glands, the ventral buccal gland is elongated and compact and the presence of a rounded intermediate buccal gland is observed, it has 11 palatal ridges per side in the hard palate and also the incisive papilla is found surrounding the dental pulvino. This information is relevant and corresponds to a report on the specific knowledge of this species, which is endemic, vulnerable, and protected.

Diseño y fabricación de modelos impresos en 3D como complemento para las clases prácticas de histología médica / Design and manufacturing of 3D printed models as a complement for medical histology practical classes

RESUMEN: Tradicionalmente, la Histología se ha apoyado del análisis de preparaciones histológicas a través del microscopio para su enseñanza. En este sentido, uno de los principales obstáculos que enfrentan los estudiantes al analizar los tejidos, es extrapolar una imagen bidimensional a una estructura tridimensional (3D). La impresión 3D permite subsanar esta limitación, haciendo posible fabricar material docente, con las características requeridas con un alto grado de detalle y bajo costo. El objetivo de este trabajo fue diseñar y fabricar modelos impresos en 3D como complemento para las clases prácticas de Histología Médica. Se fabricaron modelos impresos en 3D de la ultraestructura de la barrera de filtración glomerular (BFG) en su estado normal y síndrome nefrótico. Además, se fabricó un modelo de la capa muscular del esófago humano dando énfasis a la disposición helicoidal de sus fibras musculares. Los modelos de epidermis permitieron identificar sus distintos estratos: estrato córneo, estrato granuloso, estrato espinoso, y estrato basal. Dentro los beneficios derivados de la impresión de modelos en 3D podemos destacar el bajo costo económico de su fabricación, alta reproducibilidad, bioseguridad, y potencial para favorecer el aprendizaje y la enseñanza de la Histología. No obstante, es necesario analizar la percepción y beneficio sobre el aprendizaje de los estudiantes derivados de la aplicación de los modelos mediante técnicas de evaluación cuantitativas y cualitativas.

SUMMARY: Traditionally, Histology has relied on the analysis of histological slides through the microscope for its teaching. In this sense, one of the main obstacles faced by students when analyzing tissues is to extrapolate a two-dimensional image to a three-dimensional (3D) structure. 3D printing makes it possible to overcome this limitation, making it possible to manufacture teaching material with the required characteristics with a high degree of detail and low cost. The objective of this work was to design and manufacture 3D printed models as a complement for the practical classes of Medical Histology. 3D printed models of the ultrastructure of the glomerular filtration barrier (GFB) in its normal state and nephrotic syndrome were fabricated. In addition, a model of the muscular layer of the human esophagus was fabricated emphasizing the helical arrangement of its muscle fibers. The epidermis models allowed the identification of its different layers: stratum corneum, stratum granulosum, stratum spinosum, and stratum basale. Among the benefits derived from 3D printing of models, we can highlight the low economic cost of manufacturing, biosafety and potential to favor the learning and teaching of Histology. However, it is necessary to analyze the perception and benefit on student learning derived from the application of the models by means of quantitative and qualitative evaluation techniques.

Anatomia e histologia do esôfago e vasos sanguíneos em Cães ­ Revisão de literatura / Anatomy and histology of the esophagus and blood vessels in dogs ­ Literature review

O sistema digestório é composto por órgãos de morfologia tubular, e glândulas associadas; tendo como principal função o processamento de alimentos e a absorção de nutrientes dos mesmos. Há um padrão estrutural comum entre órgãos tubulares deste sistema, o conhecimento desse padrão, facilita a compreensão das particularidades de cada órgão. Já os vasos sanguíneos são caracterizados e definidos por sua posição dentro do circuito vascular, pela estrutura individual, e mecanismos de controle da função vascular. Dessa forma, o objetivo do presente trabalho é aprofundar conhecimentos a respeito de anatomia e histologia do esôfago e vasos sanguíneos em cães.(AU)

The digestive system is composed of tubular morphology organs and associated glands; with the main function of food processing and nutrient absorption. There is a common structural pattern among tubular organs of this system, knowledge of this pattern facilitates the understanding of the particularities of each organ. Blood vessels are characterized and defined by their position within the vascular circuit, their individual structure, and the mechanisms that control vascular function. Thus, the objective of the present work is to deepen knowledge about the anatomy and histology of the esophagus and blood vessels.(AU)

Laparoscopic Collis-Nissen approach for shortened esophagus treatment in children.

BACKGROUND: Short esophagus is a disability to obtain a proper portion of abdominal esophagus, thus a lengthening technique is required. Collis approach is the best option. OBJECTIVE: To demonstrate effectiveness of laparoscopic Collis-Nissen approach in children. METHOD: Retrospective and descriptive case series performed in children with reflux and short esophagus, Collis esophagoplasty was carried out with stapler, together with fundoplication. Age, symptomatology, surgical background, oral nutrition beginning, hospital stay, complications and reflux control were recorded. RESULTS: Eight children, 4-15 years old were treated from 2005 to 2017. Three of them with slipped fundoplication background and two with esophageal atresia. The rest of the children had no background, two of them with stenosis. Symptoms; cough 8/8, abdominal pain 5/8, dysphagia 3/8. Without complications. Oral nutrition beginning at the 5th day. Up to 10 years follow-up, with complete remission of the symptomatology in 6 years. DISCUSSION: Since a true short esophagus diagnosis depends on transurgical findings, pediatric surgeons should notice this entity when practicing any antireflux procedure. Laparoscopic Collis-Nissen approach is safe and efficient in these patients.

ANTECEDENTES: El esófago corto es la imposibilidad de obtener una porción adecuada de esófago abdominal, por lo que se requiere alguna técnica de alargamiento. La mejor opción es el procedimiento de Collis. OBJETIVO: Demostrar la eficacia del procedimiento de Collis-Nissen por laparoscopía en niños. MÉTODO: Estudio retrospectivo, descriptivo, serie de casos, niños con reflujo y esófago corto, esofagoplastía de Collis con engrapadora y funduplicatura. Se analizaron edad, sintomatología, antecedentes quirúrgicos, tiempo quirúrgico, inicio de vía oral, tiempo de hospitalización, complicaciones y control del reflujo. RESULTADOS: De 2005 a 2017 se trataron ocho niños de 4 a 15 años. De ellos, tres con antecedente de funduplicatura deslizada y dos con antecedente de atresia esofágica. El resto sin antecedentes, dos con estenosis. Síntomas; tos 8/8, dolor abdominal 5/8, disfagia 3/8. Sin complicaciones. Inició de vía oral al quinto día. Seguimiento de hasta 10 años, con remisión total de la sintomatología en seis casos. DISCUSIÓN: Debido a que el diagnóstico de esófago corto verdadero depende de los hallazgos transoperatorios, los cirujanos pediatras deben reconocer esta condición al momento de practicar cualquier procedimiento antirreflujo. El procedimiento de Collis-Nissen laparoscópico es una opción segura y eficaz en estos pacientes.

Morphological study of the gastrointestinal tract of the snow trout, Schizothorax esocinus (Actinopterygii: Cypriniformes)

The present study aimed to investigate the macroscopic structure of the gastrointestinal tract (GIT) of Schizothorax esocinus Heckel, 1838. The surface architecture of the buccopharynx, oesophagus and the entire intestinal tract of S. esocinus has been examined under scanning electron microscope (SEM) after fixing in 2.5% glutaraldehyde buffered with 0.1 M sodium cacodylate at pH 7.3 for 18-48 hours and post-fixation for two hours at room temperature in 1% osmium tetra oxide buffered at pH 7.3 with 0.1 M cacodylate. The mucosal surface of buccopharynx, esophagus, intestinal bulb, and intestine reveal prominent longitudinal major or primary mucosal folds which are further subdivided into the series of irregular and well-circumscribed folds called minor or secondary folds. However, in the intestinal bulb and intestine, the longitudinal major or primary folds themselves form wavy or zigzagging patterns along the mucosal surface. The fine structure of the surface epithelium further shows that the apical surfaces of the epithelial cells are ped with finger-print like microridges, arranged in various patterns and regularly spaced. The rectal mucosa, on the other hand, displays a highly irregular type of major mucosal folds. The separation cant be seen between major mucosal folds. A thin film of mucous spread over the mucosal folds and the numerous pores through which mucous cells release their content has also been noted along the rectal mucosa. This investigation suggests the possible role of different digestive organs in relation to feeding, digestion, storage, absorption, and various other physiological processes, thereby providing a knowledge necessary to the understanding of pathological or physiological alterations in both aquaculture and natural environment.(AU)

Morphological study of the gastrointestinal tract of the snow trout, Schizothorax esocinus (Actinopterygii: Cypriniformes)

The present study aimed to investigate the macroscopic structure of the gastrointestinal tract (GIT) of Schizothorax esocinus Heckel, 1838. The surface architecture of the buccopharynx, oesophagus and the entire intestinal tract of S. esocinus has been examined under scanning electron microscope (SEM) after fixing in 2.5% glutaraldehyde buffered with 0.1 M sodium cacodylate at pH 7.3 for 18-48 hours and post-fixation for two hours at room temperature in 1% osmium tetra oxide buffered at pH 7.3 with 0.1 M cacodylate. The mucosal surface of buccopharynx, esophagus, intestinal bulb, and intestine reveal prominent longitudinal major or primary mucosal folds which are further subdivided into the series of irregular and well-circumscribed folds called minor or secondary folds. However, in the intestinal bulb and intestine, the longitudinal major or primary folds themselves form wavy or zigzagging patterns along the mucosal surface. The fine structure of the surface epithelium further shows that the apical surfaces of the epithelial cells are ped with finger-print like microridges, arranged in various patterns and regularly spaced. The rectal mucosa, on the other hand, displays a highly irregular type of major mucosal folds. The separation can’t be seen between major mucosal folds. A thin film of mucous spread over the mucosal folds and the numerous pores through which mucous cells release their content has also been noted along the rectal mucosa. This investigation suggests the possible role of different digestive organs in relation to feeding, digestion, storage, absorption, and various other physiological processes, thereby providing a knowledge necessary to the understanding of pathological or physiological alterations in both aquaculture and natural environment.

The digestive tube of Piaractus brachypomus: gross morphology, histology/histochemistry of the mucosal layer and the effects of parasitism by Neoechinorhynchus sp.

The objective of the present study was to describe the histology and histochemistry of the mucosal layer of the digestive tube of Piaractus brachypomus, and the histopathology associated with parasitism by Neoechinorhynchus sp. The digestive tube of P. brachypomus consists of three macroscopically distinct portions: short, rectilinear and elastic-walled ooesophagus, J-shaped siphon stomach and a long intestine with rectilinear and curved portions, defined by patterns of villi as foregut, midgut, and hindgut. Histological and histochemical differences were observed in the mucosal layers of the different digestive tube regions, such as intense production of neutral and acidic mucous substances in the pseudostratified mucosal epithelium of the oesophagus; positive periodic acid Schiff reagent (PAS)reactions at the apex of the columnar epithelial cells of the stomach and increased intensity of histochemical reactions in the hindgut region. Neoechinorhynchus sp. was present in 85.7% of specimens examined, with a mean intensity of 7.4 ± 6.2 (±) and abundance of 6.33. Good health of the fish indicated by high relative condition factor values ( Kn ) and occurrence of only mild to moderate alteration in the mucosal layer indicated that Neoechinorhynchus sp. exhibits low pathogenicity towards P. brachypomus hosts in farming environments, with low levels of infection.

Endoscopic identification of endoluminal esophageal landmarks for radial and longitudinal orientation and lesion location.

AIM: To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location. METHODS: Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound (EUS) in 25 consecutive patients to confirm the findings. The scope orientation throughout the exam was maintained at the natural axis, where the left esophageal quadrant corresponds to the area between 6 and 9 o'clock. When an anatomical landmark was identified, it was recorded with a photograph and its quadrant orientation and distance from the incisors were determined. The reference points to obtain the distances and radial orientation were as follows: the midpoint of the left main bronchus and the most intense pulsatile zone of the left atrium. With the video processor system set to moderate insufflation, measurements were obtained at the end of the patients' air expiration. RESULTS: The left main bronchus and left atrium esophageal landmarks were identified using white light in 99% and 100% of subjects at a mean distance of 25.8 cm (SD 2.3), and 31.4 cm (SD 2.4) from the incisors, respectively. The left main bronchus landmark was found to be a tubular, concave, non-pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. The left atrium landmark was identified as a round, convex, pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. Both landmarks were identified using white light on the anterior esophageal quadrant. In the sub-study, the left main bronchus was identified in 24 (92%) patients at 25.4 cm (SD 2.1) and 26.7 cm (SD 1.9) from the incisors, by white light and EUS, respectively. The left atrium was recognized in all patients at 30.5 cm (SD 1.9), and 31.6 cm (SD 2.3) from the incisors, by both white light and EUS, respectively. EUS confirmed that the landmarks corresponded to these two structures, respectively, and that they were located on the anterior esophageal wall. The Bland-Altman plot demonstrated high agreement between the white light and EUS measurements. CONCLUSION: This study provides an endoscopic characterization of esophageal landmarks corresponding to the left main bronchus and left atrium, to permit radial and longitudinal orientation and accurate lesion location.

Eosinophilic Esophagitis Through the Flexible Endoscope and the Lens of a Photographer in the Amazon.

Eosinophilic esophagitis (EoE) is a disorder that has been identified recently, thus knowledge about it, its pathogenesis, and potential etiologies has spread in an era where the medical community and the public are receiving the information and discussing it as it appears in the medical literature. Because physiology, pathology, and pathophysiology are difficult to explain in layman terms, the author has used photographs taken in remote areas of the Amazon to create visual similes within a narrative that brings the scientific and medical concepts of the knowledge on EoE to a level that allows both medical and non-medical persons to grasp and discuss their significance. This set of photographs when presented to audiences has generated interest in the disorder as well as in the Amazon and its natural flora and fauna. The author hopes that this pictorial introduction sets the stage for the multiple novel topics reviewed and presented in this issue.

Building a three-dimensional model of the upper gastrointestinal tract for computer simulations of swallowing.

We aimed to provide realistic three-dimensional (3D) models to be used in numerical simulations of peristaltic flow in patients exhibiting difficulty in swallowing, also known as dysphagia. To this end, a 3D model of the upper gastrointestinal tract was built from the color cryosection images of the Visible Human Project dataset. Regional color heterogeneities were corrected by centering local histograms of the image difference between slices. A voxel-based model was generated by stacking contours from the color images. A triangle mesh was built, smoothed and simplified. Visualization tools were developed for browsing the model at different stages and for virtual endoscopy navigation. As result, a computer model of the esophagus and the stomach was obtained, mainly for modeling swallowing disorders. A central-axis curve was also obtained for virtual navigation and to replicate conditions relevant to swallowing disorders modeling. We show renderings of the model and discuss its use for simulating swallowing as a function of bolus rheological properties. The information obtained from simulation studies with our model could be useful for physicians in selecting the correct nutritional emulsions for patients with dysphagia.

Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation--prospective study of 704 cases.

INTRODUCTION: Although rare, the atrioesophageal fistula is one of the most feared complications in radiofrequency catheter ablation of atrial fibrillation due to the high risk of mortality. OBJECTIVE: This is a prospective controlled study, performed during regular radiofrequency catheter ablation of atrial fibrillation, to test whether esophageal displacement by handling the transesophageal echocardiography transducer could be used for esophageal protection. METHODS: Seven hundred and four patients (158 F/546M [22.4%/77.6%]; 52.8 ± 14 [17-84] years old), with mean EF of 0.66 ± 0.8 and drug-refractory atrial fibrillation were submitted to hybrid radiofrequency catheter ablation (conventional pulmonary vein isolation plus AF-Nests and background tachycardia ablation) with displacement of the esophagus as far as possible from the radiofrequency target by transesophageal echocardiography transducer handling. The esophageal luminal temperature was monitored without and with displacement in 25 patients. RESULTS: The mean esophageal displacement was 4 to 9.1cm (5.9 ± 0.8 cm). In 680 of the 704 patients (96.6%), it was enough to allow complete and safe radiofrequency delivery (30W/40ºC/irrigated catheter or 50W/60ºC/8 mm catheter) without esophagus overlapping. The mean esophageal luminal temperature changes with versus without esophageal displacement were 0.11 ± 0.13ºC versus 1.1 ± 0.4ºC respectively, P<0.01. The radiofrequency had to be halted in 68% of the patients without esophageal displacement because of esophageal luminal temperature increase. There was no incidence of atrioesophageal fistula suspected or confirmed. Only two superficial bleeding caused by transesophageal echocardiography transducer insertion were observed. CONCLUSION: Mechanical esophageal displacement by transesophageal echocardiography transducer during radiofrequency catheter ablation was able to prevent a rise in esophageal luminal temperature, helping to avoid esophageal thermal lesion. In most cases, the esophageal displacement was sufficient to allow safe radiofrequency application without esophagus overlapping, being a convenient alternative in reducing the risk of atrioesophageal fistula.

Histological study of the oesophagus and stomach in grey-backed shrike (Lanius tephronotus) / Estudio histológico de esófago y estómago del alcaudón (Lanius tephronotus)

The microstructure of oesophagus and stomach in grey-backed shrike were examined by means of light microscopy. The results showed that the oesophagus glands were mucous glands, the shedding glandular cells and the mucin from the oesophagus glands secreted to the lumen. The number of the glands in the thoracic part was less than that of in the cervical part. The lumens of the glands showed an intense positive periodic acid-Schiff and Alcian blue reaction. There were two types of glands in the lamina propria. The simple tubular glands were located in the superficial lamella of the lamina propria, while compound tubular glands were located in the deep lamella. The epithelium was lined by a layer of cuticle in the intermediate zone between the proventriculus and gizzard. The surface of gizzard possessed a rough thick cuticle, which was made up of the Alcian blue-positive horizontal matrix and the periodic acid-Schiff-positive vertical rods.

La microestructura del esófago y el estómago del alcaudón gris fueron examinados mediante microscopía de luz. Los resultados mostraron que las glándulas del esófago eran glándulas mucosas, y que las células glandulares de descamación y la mucina de las glándulas del esófago eran secretadas al lumen. El número de glándulas en la porción torácica del esófago fue menor que en la porción cervical. Las aberturas de las glándulas mostraron una reacción positiva intensa al PAS y azul de Alcián. Se encontraron dos tipos de glándulas en la lámina propia. Las glándulas tubulares simples se localizaron en la lámina superficial de la lámina propia, mientras que las glándulas tubulares compuestas se hallaron en la lámina de profundidad. El epitelio se encontró revestido por una capa cuticular en la zona intermedia entre el proventrículo y la molleja. La superficie de la molleja presentó una cutícula gruesa, demostrada por una matriz horizontal positivo para azul de Alcian y varillas verticales positivas para el PAS.

Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation - prospective study of 704 cases / Método simplificado para proteção do esôfago durante a ablação por radiofrequência da fibrilação atrial - estudo prospectivo de 704 casos

Abstract Introduction: Although rare, the atrioesophageal fistula is one of the most feared complications in radiofrequency catheter ablation of atrial fibrillation due to the high risk of mortality. Objective: This is a prospective controlled study, performed during regular radiofrequency catheter ablation of atrial fibrillation, to test whether esophageal displacement by handling the transesophageal echocardiography transducer could be used for esophageal protection. Methods: Seven hundred and four patients (158 F/546M [22.4%/77.6%]; 52.8±14 [17-84] years old), with mean EF of 0.66±0.8 and drug-refractory atrial fibrillation were submitted to hybrid radiofrequency catheter ablation (conventional pulmonary vein isolation plus AF-Nests and background tachycardia ablation) with displacement of the esophagus as far as possible from the radiofrequency target by transesophageal echocardiography transducer handling. The esophageal luminal temperature was monitored without and with displacement in 25 patients. Results: The mean esophageal displacement was 4 to 9.1cm (5.9±0.8 cm). In 680 of the 704 patients (96.6%), it was enough to allow complete and safe radiofrequency delivery (30W/40ºC/irrigated catheter or 50W/60ºC/8 mm catheter) without esophagus overlapping. The mean esophageal luminal temperature changes with versus without esophageal displacement were 0.11±0.13ºC versus 1.1±0.4ºC respectively, P<0.01. The radiofrequency had to be halted in 68% of the patients without esophageal displacement because of esophageal luminal temperature increase. There was no incidence of atrioesophageal fistula suspected or confirmed. Only two superficial bleeding caused by transesophageal echocardiography transducer insertion were observed. Conclusion: Mechanical esophageal displacement by transesophageal echocardiography transducer during radiofrequency catheter ablation was able to prevent a rise in esophageal luminal temperature, helping to avoid ...

Resumo Introdução: Apesar de rara, a fístula átrio-esofágica é uma das complicações mais temidas na ablação por radiofrequência da fibrilação atrial pelo alto risco de mortalidade. Objetivo: Este é um estudo prospectivo controlado, realizado durante a ablação por radiofrequência da fibrilação atrial regular, para testar se o deslocamento do esôfago ao manipular o transdutor de ecocardiografia transesofágica poderia ser usado para a proteção de esôfago. Métodos: Setecentos e quatro pacientes (158 mulheres e 546 homens [22,4%/77,6%]; 52,8±14 [17-84] anos), com EF média igual a 0,66±0,8 e com fibrilação atrial refratária ao tratamento medicamentoso, foram submetidos à terapia híbrida com ablação por radiofrequência (isolamento convencional das veias pulmonares e ninhos de fibrilação atrial e ablação de taquicardia de background) com deslocamento do esôfago o mais longe possível do alvo da radiofrequência por manuseio do transdutor de ecocardiografia transesofágica. A temperatura luminal esofágica foi monitorada com e sem deslocamento em 25 pacientes. Resultados: O deslocamento esofágico significativo foi de 4 a 9,1 centímetros (5,9±0,8 cm). Em 680 dos 704 pacientes (96,6%), isso foi o suficiente para permitir a entrega completa e segura de radiofrequência (30W/40ºC/cateter irrigado ou 50W/60ºC/cateter de 8 milímetros) sem sobreposição do esôfago. As alterações médias de temperatura luminal esofágica com e sem deslocamento de esôfago foram de 0,11±0,13ºC versus 1,1±0,4ºC, respectivamente, P<0,01. A radiofrequência teve que ser interrompida em 68% dos pacientes sem deslocamento de esôfago devido ao aumento da temperatura luminal esofágica. Não houve nenhum caso, suspeito ou confirmado, de fístula átrio-esofágica. Foram observados apenas dois sangramentos superficiais causados por inserção do transdutor de ecocardiografia transesofágica. Conclusão: O deslocamento mecânico do esôfago pelo transdutor de ecocardiografia transesofágico durante ...

Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma

To analyze the epidemiological features of patients with esophageal cancer according to the histopathological types: squamous cell carcinoma or adenocarcinoma. METHODS: A total of 100 patients with esophageal cancer, being 50 squamous cell carcinomas and 50 adenocarcinomas were analyzed for demographics, nutritional factors, lifestyle habits, benign pathological conditions associated, like Barrett's esophagus and megaesophagus, tumor stage and survival rates. The nutritional factors evaluated included body mass index, percent weight loss, hemoglobin and albumin serum levels. Esophageal cancer occurred more often in men over 50 years-old in both histological groups. No significant differences on age and gender were found between the histological groups. Squamous cell carcinoma was significantly more frequent in blacks than adenocarcinoma. Alcohol consumption and smoking were significantly associated with squamous cell carcinoma. Higher values of body mass index were seen in patients with adenocarcinoma. Barrett's esophagus was found in nine patients (18%) with adenocarcinoma, and megaesophagus in two patients (4%) with squamous cell carcinoma. The majority of patients were on stages III and IV in both histological groups. The mean survival rates were 7.7 ± 9.5 months for patients with squamous cell carcinoma and 8.0 ± 10.9 months for patients with adenocarcinoma. No significant differences on tumor stage and survival rates were detected between the histological groups. Epidemiological features are distinct for the histopathological types of esophageal cancer. Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus.(AU)

Histologia e histoquímica do tubo digestório de Phrynops geoffroanus (Testudines, Chelidae) / Histology and histochemistry of the digestive tract of Phrynops geoffroanus (Testudines, Chelidae)

Phrynops geoffroanus is the omnivorous chelonian with widest geographical distribution in South America. This work describes the histology and histochemistry of the digestive tube of this species, to relate the characteristics of these organs to the species' eating habit. The esophagus, stomach and intestine of four specimens were fixed in 10% formal and embedded in paraffin by routine histological techniques. Afterwards, 5-µm sections were stained with hematoxylin-eosin (HE), periodic acid-Schiff (PAS) and alcian blue (AB) pH 0.4 and 2.5. The tube is formed by the mucosa, submucosa, muscular and adventitia or serosa layers. The mucosa layer of the esophagus and stomach is lined with a simple cylindrical epithelium with mucus-secreting cells, where are intraepithelial glands inserted in the portion of the esophagus and gastric fossettes emptying into glands in the stomach. The stomach is divided into an anterior, middle and posterior region, according to the depth of the fossettes and the concentration of gastric glands. The intestine is lined by a simple cylindrical epithelium with striated boundaries and goblet cells and is divided into an anterior and posterior regions, according to the pattern of folds of the mucosa layer and the number of goblet cells. Reactivity to PAS and AB is observed in the entire tube. Smooth muscle fibers are present in mucosa layer of all the segments. The muscular layer is formed by two sub-layers of smooth muscle, except for the posterior stomach. This study will help understanding of the digestive physiology of P. geoffroanus and provide data for comparative analyzes with other turtles.(AU)

Phrynops geoffroanus é o quelônio onívoro com mais ampla distribuição geográfica na América do Sul. Este trabalho descreve a histologia e histoquímica do tubo digestório desta espécie, relacionando as características dos órgãos com seu hábito alimentar. O esôfago, estômago e intestino de quatro espécimes foram fixados em formol 10% e incluídos em parafina por técnica histológica de rotina. Depois, cortes de 5 µm de espessura foram corados com hematoxilina-eosina (HE), ácido periódico de Schiff (PAS) e alcian blue (AB) pH 0.4 e 2.5. O tubo é formado pelas camadas mucosa, submucosa, muscular e adventícia ou serosa. A mucosa do esôfago e do estômago é revestida pelo epitélio simples cilíndrico com células mucossecretoras, onde estão inseridas glândulas intraepiteliais na porção do esôfago e fossetas gástricas desembocando em glândulas no estômago. O estômago divide-se em anterior, médio e posterior, de acordo com a profundidade das fossetas e a concentração de glândulas gástricas. O intestino é revestido pelo epitélio simples cilíndrico com borda estriada e células caliciformes e divide-se em anterior e posterior, de acordo com o padrão de dobramentos da mucosa e o número de células caliciformes. Reatividade ao PAS e AB é observada em todo o tubo. Fibras musculares lisas estão presentes na camada mucosa de todos os segmentos. A camada muscular é formada por duas subcamadas de músculo liso, exceto na porção posterior do estômago. Este estudo ajudará no entendimento da fisiologia digestiva da espécie investigada e fornecerá dados para análises comparativas com outros quelônios.(AU)

Histologia e histoquímica do tubo digestório de Phrynops geoffroanus (Testudines, Chelidae) / Histology and histochemistry of the digestive tract of Phrynops geoffroanus (Testudines, Chelidae)

Phrynops geoffroanus is the omnivorous chelonian with widest geographical distribution in South America. This work describes the histology and histochemistry of the digestive tube of this species, to relate the characteristics of these organs to the species' eating habit. The esophagus, stomach and intestine of four specimens were fixed in 10% formal and embedded in paraffin by routine histological techniques. Afterwards, 5-µm sections were stained with hematoxylin-eosin (HE), periodic acid-Schiff (PAS) and alcian blue (AB) pH 0.4 and 2.5. The tube is formed by the mucosa, submucosa, muscular and adventitia or serosa layers. The mucosa layer of the esophagus and stomach is lined with a simple cylindrical epithelium with mucus-secreting cells, where are intraepithelial glands inserted in the portion of the esophagus and gastric fossettes emptying into glands in the stomach. The stomach is divided into an anterior, middle and posterior region, according to the depth of the fossettes and the concentration of gastric glands. The intestine is lined by a simple cylindrical epithelium with striated boundaries and goblet cells and is divided into an anterior and posterior regions, according to the pattern of folds of the mucosa layer and the number of goblet cells. Reactivity to PAS and AB is observed in the entire tube. Smooth muscle fibers are present in mucosa layer of all the segments. The muscular layer is formed by two sub-layers of smooth muscle, except for the posterior stomach. This study will help understanding of the digestive physiology of P. geoffroanus and provide data for comparative analyzes with other turtles.

Phrynops geoffroanus é o quelônio onívoro com mais ampla distribuição geográfica na América do Sul. Este trabalho descreve a histologia e histoquímica do tubo digestório desta espécie, relacionando as características dos órgãos com seu hábito alimentar. O esôfago, estômago e intestino de quatro espécimes foram fixados em formol 10% e incluídos em parafina por técnica histológica de rotina. Depois, cortes de 5 µm de espessura foram corados com hematoxilina-eosina (HE), ácido periódico de Schiff (PAS) e alcian blue (AB) pH 0.4 e 2.5. O tubo é formado pelas camadas mucosa, submucosa, muscular e adventícia ou serosa. A mucosa do esôfago e do estômago é revestida pelo epitélio simples cilíndrico com células mucossecretoras, onde estão inseridas glândulas intraepiteliais na porção do esôfago e fossetas gástricas desembocando em glândulas no estômago. O estômago divide-se em anterior, médio e posterior, de acordo com a profundidade das fossetas e a concentração de glândulas gástricas. O intestino é revestido pelo epitélio simples cilíndrico com borda estriada e células caliciformes e divide-se em anterior e posterior, de acordo com o padrão de dobramentos da mucosa e o número de células caliciformes. Reatividade ao PAS e AB é observada em todo o tubo. Fibras musculares lisas estão presentes na camada mucosa de todos os segmentos. A camada muscular é formada por duas subcamadas de músculo liso, exceto na porção posterior do estômago. Este estudo ajudará no entendimento da fisiologia digestiva da espécie investigada e fornecerá dados para análises comparativas com outros quelônios.