Budd-Chiari syndrome in association with Behçet's disease: review of the literature.

The risk that patients with Behçet's disease may develop various thrombotic complications has been previously described. Although vascular complications from Budd-Chiari syndrome associated with Behçet's disease have been described, the pathogenic mechanisms are still unknown. Severe vascular complications present in Budd-Chiari syndrome associated with Behçet's disease are very common among young male adults. The objective of this study was to review the literature and present the association of Budd-Chiari syndrome with Behçet's disease.

Budd-Chiari syndrome in association with Behçet's disease: review of the literature / Síndrome de Budd-Chiari em associação com a doença de Behçet: revisão de literatura

The risk that patients with Behçet's disease may develop various thrombotic complications has been previously described. Although vascular complications from Budd-Chiari syndrome associated with Behçet's disease have been described, the pathogenic mechanisms are still unknown. Severe vascular complications present in Budd-Chiari syndrome associated with Behçet's disease are very common among young male adults. The objective of this study was to review the literature and present the association of Budd-Chiari syndrome with Behçet's disease.

O risco de pacientes com doença de Behçet desenvolverem várias complicações trombóticas já foi descrito. Apesar de complicações vasculares na síndrome de Budd-Chiari associada à doença de Behçet terem sido descritas, os mecanismos patogenéticos ainda são desconhecidos. Complicações vasculares graves presentes na síndrome de Budd-Chiari associada à doença de Behçet são muito mais comuns no adulto jovem do sexo masculino. O objetivo deste trabalho é o de revisar a literatura e apresentar a associação da síndrome de Budd-Chiari com a doença de Behçet.

Histoplasmosis in the nasal septum without pulmonary involvement in a patient with acquired immunodeficiency syndrome: case report and literature review.

CONTEXT: Histoplasmosis is a fungal disease caused by inhaling spores of the fungus Histoplasma capsulatum. The spores can be found in soil contaminated with bird, bat or chicken feces. Histoplasmosis occurs worldwide and is one of the most common pulmonary and systemic mycoses. CASE REPORT: We report here the case of a 37-year-old man with acquired immune deficiency syndrome and histoplasmosis in the nasal septum, without pulmonary involvement, that evolved rapidly to disseminated infection, multiple organ failure and death.

Dispepsia funcional: revisão de diagnóstico e fisiopatologia / Functional dyspepsia: review of diagnosis and pathophysiology

Dispepsia funcional é definida como um distúrbio da digestão caracterizado por um conjunto de sintomas relacionados ao trato gastrointestinal superior. É um distúrbio gastrointestinal comum observado na população geral.Sintomas observados: saciedade precoce, empachamento pós-prandial, náuseas, vômitos, timpanismo, distensão abdominal.Vários medicamentos, associados ou não, podem ser empregados.Corresponde a mais de 25% do atendimento no ambulatório de especialidade.

Histoplasmosis in the nasal septum without pulmonary involvement in a patient with acquired immunodeficiency syndrome: case report and literature review / Histoplasmose no septo nasal sem envolvimento pulmonar em um paciente com síndrome da imunodeficiência adquirida: relato de caso clínico e revisão de literatura

CONTEXT: Histoplasmosis is a fungal disease caused by inhaling spores of the fungus Histoplasma capsulatum. The spores can be found in soil contaminated with bird, bat or chicken feces. Histoplasmosis occurs worldwide and is one of the most common pulmonary and systemic mycoses. CASE REPORT: We report here the case of a 37-year-old man with acquired immune deficiency syndrome and histoplasmosis in the nasal septum, without pulmonary involvement, that evolved rapidly to disseminated infection, multiple organ failure and death.

CONTEXTO: Histoplasmose é uma doença fúngica causada pela inalação de esporos do fungo Histoplasma capsulatum. Os esporos podem ser encontrados no solo contaminado com fezes de aves, morcegos ou galinhas. Histoplasmose ocorre em todo o mundo e é uma das mais comuns micoses pulmonares e sistêmicas. RELATO DE CASO: Relatamos aqui o caso de um homem de 37 anos com síndrome da imunodeficiência adquirida e histoplasmose no septo nasal sem envolvimento pulmonar que evoluiu rapidamente para infecção disseminada, falência de múltiplos órgãos e morte.

Heme-oxygenase-2 immunolabelling in pig jejunum.

Heme-oxygenase-2 generates carbon monoxide in the enteric nervous system and in interstitial cells of Cajal in the canine, mouse and human jejunum. Carbon monoxide is considered a non-adrenergic and non-cholinergic inhibitory neurotransmitter and it establishes and maintains the resting membrane potential in the stomach and small intestine. The aim of this study was to determine the distribution of heme-oxygenase-2 in the enteric nervous system of the pig jejunum. Heme-oxygenase-2 immunoreactivity was found in neurons of myenteric ganglia and in nerve fibers in the circular and longitudinal muscle layers. These results suggest that carbon monoxide is produced in the enteric nervous system of the pig jejunum and might mediate inhibitory neural activity in myenteric ganglia and inhibitory neural input to smooth muscle cells in the circular and longitudinal muscle layers.

Non-adrenergic non-cholinergic inhibition of gastrointestinal smooth muscle and its intracellular mechanism(s).

Relaxation of gastrointestinal smooth muscle caused by release of non-adrenergic non-cholinergic (NANC) transmitters from enteric nerves occurs in several physiologic digestive reflexes. Likely candidate NANC inhibitory agents include nitric oxide (NO), adenosine triphosphate (ATP), vasoactive intestinal peptide (VIP), pituitary adenylate cyclase-activating peptide (PACAP), carbon monoxide (CO), protease-activated receptors (PARs), hydrogen sulfide (H2S), neurotensin (NT) and beta-nicotinamide adenine dinucleotide (beta-NAD). Multiple NANC transmitters work in concert, are pharmacologically coupled and are closely coordinated. Individual contribution varies regionally in the gastrointestinal tract and between species. NANC inhibition of gastrointestinal smooth muscle involves several intracellular mechanisms, including increase of cyclic guanosine monophosphate (cGMP), increase of cyclic adenosine monophosphate (cAMP) and hyperpolarization of the cell membrane via direct or indirect activation of potassium ion (K+) channels.

Revisão de dispepsia funcional: diagnóstico, mecanismos fisiopatológicos e tratamento / Review of functional dyspepsia: diagnosis, pathophysiological mechanisms and treatment

A dispepsia funcional ou dispepsia não ulcerosa ou síndrome dispéptica é uma desordem heterogênea caracterizada por períodos de abrandamento e de exacerbação, e o diagnóstico é feito quando nenhuma causa é detectada. Embora várias definições sejam usadas, a mais empregada de acordo com o consenso de Roma II e III inclui dor, queimação, desconforto crônico ou recorrente com sensação subjetiva e desagradável de saciedade precoce, empachamento pósprandial, náuseas, vômitos, timpanismo e distensão abdominal. Não há evidências de nenhuma doença orgânica que justifique os sintomas e nem evidências de que os sintomas foram abrandados ou estão associados com as evacuações.Os sintomas duram pelo menos três meses, contínuos ou intermitentes, com duração mínima de seis a doze meses de acordo com o consenso de Roma III e II respectivamente. É uma desordem gastrointestinal comum observada na população em geral, em ambulatórios de clínica geral e de especialidade, associada a vários tratamentos, uso de váriosmedicamentos, internações, automedicação, absenteísmo e perda de produtividade.

Functional dyspepsia or non-ulcerous dyspepsia or dyspeptic syndrome, is a heterogeneous disorder characterized by periods of mild or exacerbated condition, usually being the diagnosis of choice when a patient with dyspepsia and no cause for the symptoms is identified. Although several definitions are used to describe functional dyspepsia, themost commonly applied definition according to Rome Committee II and III consensus includes pain, burning, or chronic or recurrent discomfort with an unpleasant subjective feeling that is frequently associated with early satiety, postprandial fullness, nausea, vomit, timpanism, bloating, located in the upper abdomen. There is no organic disease capable tojustify the symptoms and no evidence that symptoms improve or are associated with pattern and frequency of bowel movements. The symptoms last for at least three months, continuous or intermittent, with a minimum of six to twelve months duration according to Rome III and II respectively. It is a very common gastrointestinal disorder observed inthe general population, in the general outpatient clinic and gastroenterology clinic, and is associated with several treatments, hospitalization, self-medication, absenteeism and loss of productivity.

The chronic gastrointestinal manifestations of Chagas disease.

Chagas disease is an infectious disease caused by the protozoan Trypanosoma cruzi. The disease mainly affects the nervous system, digestive system and heart. The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease. The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system impairment caused by T. cruzi infection. The anatomical locations most commonly described to be affected by Chagas disease are salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree. Chagas disease has also been studied in association with Helicobacter pylori infection, interstitial cells of Cajal and the incidence of gastrointestinal cancer.

Effect of the effluent released from the canine internal mammary artery after intraluminal and extraluminal perfusion of acetylcholine and adenosine diphosphate.

Segments of the canine internal mammary artery (35 mm in length) were suspended in vitro in an organ chamber containing physiological salt solution (95% O2/5% CO2, pH = 7.4, 37 degrees C). Segments were individually cannulated and perfused at 5 ml/minute using a roller pump. Vasorelaxant activity of the effluent from the perfused internal mammary arteries was bioassayed by measuring the decrease in tension induced by the effluent of the coronary artery endothelium-free ring which had been contracted with prostaglandin F2alpha (2 x 10(-6) M). Intraluminal perfusion of adenosine diphosphate (10(-5) M) induced significant increase in relaxant activity in the effluent from the perfused blood vessel. However, when adenosine diphosphate (10(-5) M) was added extraluminally to the internal mammary artery, no change in relaxant activity in the effluent was noted. In contrast, acetylcholine produced significant increase in the relaxant activity on the effluent of the perfused internal mammary artery with both intraluminal and extraluminal perfusion. The intraluminal and extraluminal release of endothelium-derived relaxing factor (EDRF) by acetylcholine (10(-5) M) can be inhibited by site-specific administration of atropine (10(-5) M). These experiments indicate that certain agonists can induce the release of EDRF only by binding to intravascular receptors while other agonists can induce endothelium-dependent vasodilatation by acting on neural side receptors.

The chronic gastrointestinal manifestations of Chagas disease: [review]

Chagas disease is an infectious disease caused by the protozoan Trypanosoma cruzi. The disease mainly affects the nervous system, digestive system and heart. The objective of this review is to revise the literature and summarize the main chronic gastrointestinal manifestations of Chagas disease. The chronic gastrointestinal manifestations of Chagas disease are mainly a result of enteric nervous system impairment caused by T. cruzi infection. The anatomical locations most commonly described to be affected by Chagas disease are salivary glands, esophagus, lower esophageal sphincter, stomach, small intestine, colon, gallbladder and biliary tree. Chagas disease has also been studied in association with Helicobacter pylori infection, interstitial cells of Cajal and the incidence of gastrointestinal cancer.

The effect of guanylate cyclase inhibitors on non-adrenergic and non-cholinergic neurogenic relaxations of the South American opossum lower esophageal sphincter.

South American (SA) opossum lower esophageal sphincter (LES) circular smooth muscle relaxes by activation of enteric nerves elicited by EFS (electrical field stimulation, 0.5 ms, 48 V, 0.5-8 Hz for 10 s). The identity of the mediator released and the cellular mechanism, however, remain to be fully elucidated. The purpose of this study was to determine the effect of the enzyme soluble guanylate cyclase (cGC) inhibitors, cystamine (100 microM), methylene blue (30 microM), LY 83583 (6-anilino-5,8 quinoledione, 10 microM) and ODQ (H-[1,2,4]oxadiazolo[4,3]quinoxalin-1-one, 1 microM) on the relaxations induced by EFS and by exogenous NO (nitric oxide, 0.5 mM) or NO-donors on SA opossum LES smooth muscle strips. EFS caused frequency-dependent relaxations, which were inhibited by NO-synthase inhibitors and abolished by tetrodotoxin. Cystamine did not affect relaxations caused by EFS and NO or NO-donor. Methylene blue also failed to affect EFS-caused relaxations, although it was capable of inhibiting relaxation induced by NO. LY 83583 inhibited relaxations induced by NO, but did not affect those induced by EFS or by SNAP and HXA. ODQ abolished relaxations caused by EFS at lower frequencies and by HXA (hydroxylamine, 10 microM) and SNAP (S-nitroso-N-acetyl penicillamine, 10 microM). Relaxations at higher frequencies of EFS and induced by SNP (sodium nitroprusside, 30 microM) and NO were only reduced by ODQ. These findings indicate that activation of the cGC can be involved in relaxations induced by EFS at lower frequencies, but other mechanisms can be involved at higher frequencies of EFS and caused by SNP or NO.

Comparison of the effects of sublingual isosorbide dinitrate and cardiomyotomy on esophageal emptying in patients with chagasic megaesophagus

Os efeitos da cardiomiotomia cirúrgica e do dinitrato de isossorbitol sobre o esvaziamento esofagiano em 18 portadores de megaesôfago chagásico. O esvaziamento esofagiano foi medido três vezes em cada paciente: duas vezes antes e uma vez após a realizaçäo da cardiomiotomia; 5mg de dinitrato de isossorbitol foi administrado por via sublingual 5 minutos antes de um dos estudos pré-operatórios. Os resultados revelaram que o dinitrato de isossorbitol e a cardiomiotomia aceleram o esvaziamento esofagiano com intensidade semelhante, embora a cardiomiotomia determine completo esvaziamento do esôfago mais freqüentemente do que o dinitato de isossorbitol

Influência da idade na pressäo do esfíncter inferior do esôfago / Influence of aging on lower esophageal sphincter pressure

Com o objetivo de avaliar a influência da idade na pressäo do esfíncter inferior do esôfago (EIE) estudou-se 52 pessoas normais, 129 com diagnóstico de doença de Chagas e 63 com diagnóstico de esclerose sistêmica, divididas em três grupos, de acordo com a idade: 10 a 29 anos, 30 a 39 anos e 50 a 70 anos. A pressäo foi medida pela manometria, com sonda aberta e perfusäo contínua, na expiraçäo, com retirada intermitente do cateter, tendo como referência a pressäo intragástrica. Näo houve diferença na média da pressäo do EIE entre os três grupos nas pessoas normais (p=0,72) e nos pacientes com esclerose sistêmica (p=0,33). Nos pacientes chagásicos com idades entre 50 e 70 anos, a pressäo do EIE (17 ñ 8 mmHg, x ñ DP) foi significativamente menor (p=0,03) do que nos pacientes com idades entre 10 e 29 anos (22 ñ 9 mmHg). Concluiu-se que, na doença de Chagas, os pacientes com idades acima de 50 anos têm tendência a ter pressäo do EIE menor do que os pacientes com idades abaixo de 30 anos, o que näo acontece nas pessoas normais e pacientes com esclerose sistêmica