Lugol dye endoscopy for analysis of esophageal mucosa in achalasia.

BACKGROUND/AIMS: Esophageal cancer in achalasia is often diagnosed in the advanced stage, which makes for a poor prognosis. Therefore, the aim of this report is to analyze the macroscopic features of the esophageal mucosa, employing lugol's solution in order to improve the early detection of carcinoma. METHODOLOGY: From April 1994 to January 1996, the macroscopic features of esophageal mucosa were studied in 64 patients with chagasic or idiopathic achalasia. Conventional endoscopy was employed using lugol's solution for staining. RESULTS: Macroscopically, the mucosa was classed as normal (22 cases), with opacification (22 cases) or with opacification and surface irregularities (20 cases). Conventional endoscopic examination failed to identify any neoplastic lesion in this series. However, upon staining, unstained or poorly stained areas were observed in 11 patients, and in one of these, at the opacified mucosa with irregularities, the poorly stained area was diagnosed as intraepithelial neoplasia. CONCLUSIONS: Slight macroscopic changes that are characteristic of intramucous carcinoma may not be noticeable in the altered mucosa of achalasia found in about two-thirds of patients. By using lugol, the outline of unstained or poorly stained areas permits directed biopsies. This procedure was important in the detection of histological changes, especially the early diagnosis of esophageal carcinoma, which could not be diagnosed by conventional endoscopic examination.

Effect of total parenteral nutrition with different lipid emulsions of human monocyte and neutrophil functions.

Parenteral nutrition (TPN) with lipid emulsions is claimed to be associated with impaired monocyte (M) and neutrophil (N) functions. Long-chain triglycerides (LCT) and a mixture containing 50% medium-chain triglycerides (MCT) and 50% LCT, currently used in nutritional therapy with TPN, were evaluated for their ex vivo effects on human N and M chemotaxis, phagocytosis, bacterial killing, and oxidative metabolism by nitroblue tetrazolium reduction test. Cell functions were examined in a randomized, crossover, blind trial in 10 malnourished patients with gastric cancer. Prior to the operation (2 wk), central TPN (40 kcal/kg) with 25% of caloric energy provided as LCT or MCT/LCT emulsion was infused over 48 h. After the crossover period fat-free TPN was given over 48 h. Function tests were done for N and M before and after each lipid emulsion infusion. Every cell function test performed for each patient was controlled by another test done in healthy adult volunteers and the results were compared with the normal range of values previously established for a healthy adult population. All the patients completed the studies without complications. Crossover validity was statistically established. Bacterial killing was the only function reduced in neutrophils after LCT emulsion (% killed bacteria = 79.0 +/- 8.5 versus 67.4 +/- 19.2; P < 0.05), although this function remained within the normal range values in 80% of the patients. In conclusion, the lipid emulsions did not affect any monocyte functions and only moderately decreased neutrophil bacterial killing.