Lower urinary tract dysfunction in chronic Chagas disease: clinical and urodynamic presentation.

PURPOSE: To describe and give an estimation of the prevalence of urinary disorders in chronic Chagas disease, since most clinical research has been centered on the description of the cardiac and digestive forms. METHODS: To explore this topic, a cross-sectional study was conducted in 137 Bolivian adults of both sexes suffering from symptomatic chronic Chagas disease. All patients presenting confirmed chagasic cardiomyopathy, megacolon or both underwent a urologic symptom questionnaire, uroflowmetry, urinary tract ultrasonography and a creatinine assay. When urinary abnormality was detected, a complete urodynamic study was proposed including cystometry, pressure-flow studies and urethral pressure profile. RESULTS: Out of all study patients, 35 (26%) had a Chagas cardiomyopathy, 81 (59%) a megacolon, and 21 (15%) a megacolon associated with cardiomyopathy. In all, 63% presented urinary disorders defined by IPSS > 7 and/or ICIQ SF > 1. Among them, 62% were incontinent, mainly by bladder overactivity, and 45% presented grade 2 or 3 renal insufficiency. Of 49 patients, the urodynamic study identified 34 patients with detrusor overactivity (69%), mostly in those with Chagas megacolon. Median bladder functional capacity, urethral closure pressure and bladder compliance had normal values. Moreover, 36% of these patients presented moderate hypocontractility, without significant post-void residual. CONCLUSIONS: This study evidenced lower urinary tract dysfunction in a majority of chronic chagasic patients; those presenting megacolon were more likely to suffer from urinary incontinence. These results strongly suggest including routine urological clinical investigation in chronic Chagas patients, as urinary incontinence due to overactive bladder is frequently observed in this population.

Megacolon andino y vólvulo del sigmoides de la altura: Presentación de 418 casos entre 2008 - 2012 en el hospital C. Monge - Puno, Perú / Andean megacolon and sigmoid volvulus in the high altitude: Presentation of 418 cases between 2008 - 2012 at C. Monge Hospital, Puno, Peru

Objetivo: El presente estudio describe el manejo médico y quirúrgico del vólvulo de sigmoides debido a dolicomegacolon andino en un hospital a una altitud mayor a 3000 msnm. Material y métodos: Estudio descriptivo, observacional, transversal de 418 pacientes con diagnóstico de vólvulo de sigmoides; admitidos inicialmente por cuadros de obstrucción intestinal, en el Hospital de Juliaca Carlos Monge - Puno, Perú, durante el periodo 2008-2012. Los datos fueron procesados a través del programa SPSS versión 21. Resultados: Se registraron 418 pacientes, la media de edad fue de 60 años, rango 18-89 años, con una proporción hombre/mujer de 3,5/1. El manejo no quirúrgico se hizo en 64 (15,4%), el tratamiento empleado fue de enema salino 20 casos 31% y sonda rectal 44 (69%), se presentó recurrencia en 27 pacientes (45%), los cuales tuvieron cirugía con resección anastomosis primaria, de estos la mortalidad correspondió a 8 pacientes (30%). De los 354 pacientes sometidos a manejo quirúrgico de emergencia 325 fueron sometidos a sigmoidectomia con anastomosis primaria (92%), mientras 29 tuvieron colostomía a lo Hartmann (8%), la morbilidad para ambos procedimientos fue de 52 casos (14,7%), la mortalidad para ambos procedimientos fue de 45 casos (12,7%). Conclusiones: El vólvulo sigmoides debido a megacolon andino tuvo una edad media de 60 años. El 15,4% tuvo manejo no quirúrgico, la tasa de recurrencia fue de 45%, mortalidad de 30%. El 84,7% tuvo manejo quirúrgico; el 92% tuvo resección anastomosis primaria y 8% colostomía a lo Hartmann, la morbilidad fue de 14,7% y la mortalidad de 12,7%.

Objective: The present study describes the medical and surgical management of sigmoid volvulus due to Andean dolicomegacolon in a hospital at an altitude above 3000 m. Material and methods: A descriptive, observational, crosssectional study of 418 patients diagnosed with sigmoid volvulus; Admitted initially due to intestinal obstruction, in the Hospital of Juliaca Carlos Monge. Puno-Perú, during the period 2008-2012. The data were processed through the SPSS software version 21. Results: A total of 418 patients were enrolled, the mean age was 60 years, range 18-89 years, and the male/female ratio was 3.5/1. Nonsurgical management was done in 64 (15.4%), the treatment used was saline enema 20 cases (31%) and rectal catheter 44 (69%), recurrence was present in 27 patients (45%), who had surgery with primary anastomosis resection, of which the mortality corresponded to 8 patients (30%). Of the 354 patients undergoing emergency surgical management, 325 were submitted to sigmoidectomy with primary anastomosis (92%), while 29 had Hartmann's colostomy (8%), the morbidity for both procedures was 52 cases (14.7%), Mortality for both procedures was 45 cases (12.7%). Conclusions: In patients with sigmoid volvulus due to Andean megacolon the mean age was 60 years. The 15.4% had non-surgical management, the recurrence rate was 45%, and mortality 30%. Patients with surgical management was 84.7%, from this group; 92% had primary anastomosis resection and 8% Hartmann colostomy, morbidity was 14.7% and mortality was 12.7%.

[Andean megacolon and sigmoid volvulus in the high altitude. Presentation of 418 cases between 2008 - 2012 at C. Monge Hospital, Puno, Peru]. / Megacolon andino y vólvulo del sigmoides de la altura. Presentación de 418 casos entre 2008 - 2012 en el hospital C. Monge Puno, Perú.

OBJECTIVE: The present study describes the medical and surgical management of sigmoid volvulus due to Andean dolicomegacolon in a hospital at an altitude above 3000 m. MATERIAL AND METHODS: A descriptive, observational, crosssectional study of 418 patients diagnosed with sigmoid volvulus; Admitted initially due to intestinal obstruction, in the Hospital of Juliaca Carlos Monge. Puno-Perú, during the period 2008-2012. The data were processed through the SPSS software version 21. RESULTS: A total of 418 patients were enrolled, the mean age was 60 years, range 18-89 years, and the male/female ratio was 3.5/1. Nonsurgical management was done in 64 (15.4%), the treatment used was saline enema 20 cases (31%) and rectal catheter 44 (69%), recurrence was present in 27 patients (45%), who had surgery with primary anastomosis resection, of which the mortality corresponded to 8 patients (30%). Of the 354 patients undergoing emergency surgical management, 325 were submitted to sigmoidectomy with primary anastomosis (92%), while 29 had Hartmann's colostomy (8%), the morbidity for both procedures was 52 cases (14.7%), Mortality for both procedures was 45 cases (12.7%). CONCLUSIONS: In patients with sigmoid volvulus due to Andean megacolon the mean age was 60 years. The 15.4% had non-surgical management, the recurrence rate was 45%, and mortality 30%. Patients with surgical management was 84.7%, from this group; 92% had primary anastomosis resection and 8% Hartmann colostomy, morbidity was 14.7% and mortality was 12.7%.

[Megacolon and sigmoid volvulus: incidence and physiopathology]. / Megacolon y vólvulo de sigmoides: incidencia y fisiopatología.

The etiology of Megacolon is multiple. One of these causes and the most frequent is Chagas disease. Its complication: sigmoid volvulus was de main diagnosis in the admitted patients at the Bolivian and Japanese Gastroenterological Institute of Cochabamba Bolivia. It usually affects people of a low economic income. In this Gastroenterological Hospital a transversal and prospective study has been done, in order to know the real incidence and the physiopathology of this disease. In a six year period, from 2000 to 2006, 8.954 patients were admitted to the Hospital: of these, 814 (9.09%), where diagnosticated as lower intestinal obstruction. In 608 (74.7%) the final diagnosis was sigmoid torsion. Radiological diagnosis was made in 84% of the patients and endoscopic decompression was successful in 88.7%. As reported in the medical literature, the main cause of megacolon in this part of the world is Chagas disease. In our investigation 22% (98 patients), were serology positive to Chagas disease, and another 21.44% (95 patients) were serology negative. They were coca leaf chewers. One of coca leaf compounds is cocaine which blocks the adrenaline and noradrenaline degradation by mean of monoamine oxidase inactivation. These two hormones stay a long term of time in the target organ: the large bowel. By this mean chronic and persistent vessel constriction develops intestinal wall atrophy and lower resistance to the intraintestinal pressure.

The significantly reduced number of interstitial cells of Cajal in chagasic megacolon (CM) patients might contribute to the pathophysiology of CM.

In addition to neurons, interstitial cells of Cajal (ICC) play an important role in coordinating intestinal motility with a pacemaker function. This study aimed to quantitatively analyze ICC, neurons, and muscular area, the latter to correct for quantitation errors resulting from dilation in case of a megacolon and from the dispersion of ICC that can be attributed to muscular hypertrophy. We analyzed 30 colon samples: ten chagasic megacolon (CM), ten chagasic colons without megacolon (CXM), and ten nonchagasic control patients (NC). We measured the area of muscularis propria and counted the number of neurons of the myenteric plexus in a histological section of an intestinal ring and the number of ICC at the level of the myenteric plexus and circular muscle layer, the latter in a section immunohistochemically stained for CD117. Muscular hypertrophy occurred only in the CM group. Compared to the NC group, we found in the CM group a statistically significant reduction of 80 % in the number of neurons, 60 % in the number of ICC in the myenteric plexus, and 38 % in the area of circular muscle. In the CXM group, these numbers were highly variable, and their reduction, less pronounced. We conclude that the number of ICC is significantly reduced in CM patients, and that this might contribute to the pathophysiology of CM. However, the development of CM requires severe denervation, whereas CXM generally exhibits less than 50 % denervation, favoring the hypothesis that the reduction in ICC number is, in part, a consequence of denervation.

Chronic Chagas disease with cardiodigestive involvement and the TcVI infective form of Trypanosoma cruzi. A case report.

We report a patient with megacolon associated with TcVI infective lineage form of Trypanosoma cruzi. Although this megacolon was considered idiopathic, Chagas disease was suspected and diagnosed because of the concomitant cardiovascular involvement. Based on this case, we discuss the suitability of Chagas diagnosis in patients with tract motility involvement.

[Radiological study on megacolon cases in an endemic area for Chagas disease]. / Estudo radiológico do megacólon em área endêmica de doença de Chagas.

INTRODUCTION: A radiological study on the colon of patients from an endemic Chagas disease zone was conducted using the simplified opaque enema technique of Ximenes et al. METHODS: The study involved 291 individuals with a mean age of 48.8 ± 12.5 years-old, of whom 222 were seropositive for Chagas disease. Anteroposterior, posteroanterior and left lateral view radiographs were analyzed by visual inspection and measurement of the largest rectal and sigmoid diameters. RESULTS: From the visual inspection, megacolon was diagnosed in 14 (6.3%) Chagas disease patients. The mean diameter of the rectal ampulla among the Chagas patients was 6.3 ± 1.0 cm, similar to the measurement in non-Chagas individuals: 6.2 ± 1.0 cm (p= 0.391). The mean sigmoid loop diameter in the Chagas patients was 5 ± 1.6 cm, which was larger than among the non-Chagas individuals: 4.4 ± 0.8 cm (p= 0.001). CONCLUSIONS: excluding the evident and probable megacolon cases, the Chagas disease population continued to present a significantly larger mean sigmoid diameter than that observed among non-Chagas individuals (p= 0.003).

Estudo radiológico do megacólon em área endêmica de doença de Chagas / Radiological study on megacolon cases in an endemic area for Chagas disease

INTRODUÇÃO: Foi realizado estudo radiológico do cólon em pacientes de zona endêmica da doença de Chagas usando-se a técnica do enema opaco simplificado de Ximenes e cols. MÉTODOS: Participaram 291 pacientes, com idade media de 48,8 (±12,5) anos, sendo 222 soropositivos para doença de Chagas. Fizeram radiografias na posição ântero-posterior, póstero-anterior e perfil lateral esquerdo, que foram analisadas por inspeção visual e medida do maior diâmetro em centímetros do reto e sigmoide. RESULTADOS: À inspeção visual, foi possível diagnosticar megacólon em 14 (6,3 por cento) pacientes chagásicos. A média do diâmetro da ampola retal dos chagásicos 6,3 (±1,0)cm foi semelhante a dos não-chagásicos 6,2 (±1,0)cm (p=0,391) e o diâmetro médio da alça sigmoide dos chagásicos 5 (±1,6)cm foi maior que o dos não chagásicos 4,4 (±0,8 )cm, (p=0,001). CONCLUSÕES: Excluindo-se os casos de megacólon evidente e de provável megacólon, a população chagásica continuou com o diâmetro médio do sigmoide significantemente maior (p=0,003) que a não chagásica.

INTRODUCTION: A radiological study on the colon of patients from an endemic Chagas disease zone was conducted using the simplified opaque enema technique of Ximenes et al. METHODS: The study involved 291 individuals with a mean age of 48.8(±12.5) years-old, of whom 222 were seropositive for Chagas disease. Anteroposterior, posteroanterior and left lateral view radiographs were analyzed by visual inspection and measurement of the largest rectal and sigmoid diameters. RESULTS: From the visual inspection, megacolon was diagnosed in 14 (6.3 percent) Chagas disease patients. The mean diameter of the rectal ampulla among the Chagas patients was 6.3 (±1.0)cm, similar to the measurement in non-Chagas individuals: 6.2 (±1.0) cm (p= 0.391). The mean sigmoid loop diameter in the Chagas patients was 5 (±1.6)cm, which was larger than among the non-Chagas individuals: 4.4 (±0.8)cm (p= 0.001). CONCLUSIONS: excluding the evident and probable megacolon cases, the Chagas disease population continued to present a significantly larger mean sigmoid diameter than that observed among non-Chagas individuals (p= 0.003).

Chagas' disease and ageing: the coexistence of other chronic diseases with Chagas' disease in elderly patients / Doença de Chagas e envelhecimento: a associação de outras enfermidades crônicas em pacientes idosos chagásicos

This study aimed to identify the main comorbidities in elderly chagasic patients treated in a reference service and identify possible associations between the clinical form of Chagas' disease and chronic diseases. Ninety patients aged 60 years-old or over were interviewed and their clinical diagnoses recorded. The study population profile was: women (55.6 percent); median age (67 years); married (51.1 percent); retired (73.3 percent); up to four years' education (64.4 percent); and earning less than two minimum wages (67.8 percent). The predominant forms of Chagas' disease were the cardiac (46.7 percent) and mixed forms (30 percent). There was a greater proportion of mild cardiac dysfunction (84.1 percent), frequently in association with megaesophagus. The mean number of concurrent diseases was 2.856 ± 1.845, and 33 percent of the patients had four or more comorbidities. The most frequent were systemic arterial hypertension (56.7 percent), osteoporosis (23.3 percent), osteoarthritis (21.2 percent) and dyslipidemia (20 percent). Positive correlations were verified between sex and comorbidities and between age group and comorbidities.

Este trabalho objetivou avaliar o perfil sociodemográfico e identificar as principais co-morbidades de idosos chagásicos, buscando associação entre forma clínica da doença de Chagas e enfermidades crônicas. Foi realizada entrevista e levantamento dos diagnósticos clínicos de 90 chagásicos com idade > 60 anos. Encontrou-se: mulheres (55,6 por cento), mediana de 67 anos, casados (51,1 por cento) e renda mensal inferior a dois salários-mínimos (67,8 por cento). A forma clínica predominante foi a cardíaca (46,7 por cento), seguida da mista (30 por cento). Houve maior proporção de cardiopatia leve (84,1 por cento), sendo frequente a associação com megaesôfago. Trinta e três por cento apresentavam quatro ou mais co-morbidades, dentre elas: hipertensão arterial (56,7 por cento), osteoporose (23,3 por cento), osteoartrite (21,2 por cento) e dislipidemia (20 por cento). Obteve-se correlação positiva entre gênero e co-morbidades, faixa etária e co-morbidades.

Chagas' disease and ageing: the coexistence of other chronic diseases with Chagas' disease in elderly patients.

This study aimed to identify the main comorbidities in elderly chagasic patients treated in a reference service and identify possible associations between the clinical form of Chagas' disease and chronic diseases. Ninety patients aged 60 years-old or over were interviewed and their clinical diagnoses recorded. The study population profile was: women (55.6%); median age (67 years); married (51.1%); retired (73.3%); up to four years' education (64.4%); and earning less than two minimum wages (67.8%). The predominant forms of Chagas' disease were the cardiac (46.7%) and mixed forms (30%). There was a greater proportion of mild cardiac dysfunction (84.1%), frequently in association with megaesophagus. The mean number of concurrent diseases was 2.856 +/- 1.845, and 33% of the patients had four or more comorbidities. The most frequent were systemic arterial hypertension (56.7%), osteoporosis (23.3%), osteoarthritis (21.2%) and dyslipidemia (20%). Positive correlations were verified between sex and comorbidities and between age group and comorbidities.

Tratamiento quirúrgico del megacolon del adulto: análisis de 62 pacientes / Surgical treatment of megacolon in adults: analysis of 62 patients

Antecedentes: Estudios previos sobre el megacolon del adulto en Santiago sugieren un cambio epidemiológico con una disminución relativa de la enfermedad de Chagas. El objetivo de este estudio es analizar los resultados del tratamiento quirúrgico del megacolon en nuestro medio en la última década, con especial referencia al cambio epidemiológico y su eventual impacto en el tipo de cirugía efectuado. Material y Método: Revisión retrospectiva de los pacientes intervenidos en forma consecutiva por un megacolon, la morbilidad mayor y los resultados alejados. Se comparan estos resultados con una serie histórica de la institución. Resultados: Se trata de 62 pacientes, el 58 por ciento hombres, con un promedio de edad de 41,2 años (15-84). Casi la mitad de los pacientes había sido sometido a una destorsión endoscópica o a una operación de Hartmann por un vólvulo del sigmoides. La etiología del megacolon fue chagásica en el 31 por ciento de los casos, idiopática en el 52 por ciento y congénita en el 11 por ciento. las intervenciones efectuadas fueron la colectomia total en el 37 por ciento de los casos, la operación de Duhamel en el 35 por ciento y la resección anterior en el 27 por ciento. La morbilidad quirúrgica mayor alcanzó al 11 por ciento, debiendo reoperarse 6 pacientes, sin mortalidad operatoria. Las complicaciones quirúrgicas se presentaron mayoritariamente en pacientes chagásicos sometidos a una operación de Duhamel con sutura primaria. Sólo en un paciente fue necesario deshacer la anastomosis por dehiscencia de sutura y tres pacientes con problemas sépticos se manejan satisfactoriamente con una ileostomía proximal. Al corte del estudio hay 52 pacientes controlados con un promedio de 48 meses (extremos 6-108). Los resultados funcionales alejados son satisfactorios, sin diferencias significativas según el tipo de intervención ni de la etiología del megacolon. Conclusión: Se confirma la disminución de la enfermedad de Chagas del 48 por ciento al 31 por ciento como causa del megacolon del adulto en nuestro medio. El aumento relativo del megacolon idiopático se refleja en el incremento de la colectomía total con respecto a la serie precedente. La técnica quirúrgica de elección depende de la edad y estatus fisiológico del paciente, de la variedad del megacolon y de la forma de presentación clínica.

Distribución y forma de presentación clínica del megacolon chagßsico en 96 pacientes serológicamente positivos a Trypanosoma Cruzi del Hospital San Juan de Dios: Santiago, Chile: 1990-2000 / Regional distribution and clinical finding of chagas' megacolon among 96 patients seropositive for Trypanosoma Cruzi from the San Juan de Dios Hospital in Santiago, Chile

La enfermedad de Chagas en Chile, es una infección parasitaria prevalente entre la I y la VI regiones del país, estim´´andose los infectados en alrededor de 400.000 personas. La infección por Trypanosoma cruzi puede presentarse en forma asintomática o manifestarse con cardiopatía o megaformaciones digestivas. El costo de mantención anual de un cardiópata chagásico es de alrededor de 500 dólares, pero no se ha establecido cual es el costo del megacolon chagásico, patología seguramente més costosa debido al componente quirúrgico que involucra. Con el objetivo de establecer como se distribuye la patología digestiva, específicamente el megacolon en pacientes seropositivos para T. cruzi, se estudiaron 96 fichas de pacientes con diagnóstico de enfermedad de Chagas procedentes del Hospital San Juan de Dios, Santiago de Chile, en el período 1990-2000. Los resultados mostraron que de las 96 fichas estudiadas, 66 correspondieron a casos crónicos asintomßticos, 4 a cardiopatías chagásicas, 10 a esofagopatía y 16 a megacolon chagásico, correspondientes a 6 mujeres y 10 hombres. Desde el punto de vista clínico, los síntomas més importantes del megacolon chagásico fueron la retención de heces o gases, el dolor abdominal, la distensión abdominal, la constipación y el compromiso del estado general. Con respecto a tratamiento, lo recomendable es la cirugía y dentro de ella la operación de Duhamell-Haddad que es actualmente la intervención de elección.

Aspectos clínicos, radiológicos e histopatológicos del megacolon del adulto en Chile: análisis de 100 casos / Clinical, radiological and histopathological aspects of megacolon in Chilean adults: analysis of 100 cases

Se analiza en forma retrospectiva las características clínicas, radiológicas e histopatológicas de 100 pacientes resecados por un megacolon del adulto en un período de 13 años. La enfermedad de Chagas fue la etiología predominante con el 48 porciento de los casos, seguida del megacolon idiopático (MI) en el 38 porciento, el Hirschprung (H) de presentación tardía en el 6 porciento y un grupo misceláneo asociado a enfermedades neuropsiquiátricas, uso prolongado de drogas sicotrópicas y abuso de laxantes en el 8 porciento. El tiempo de tránsito colónico y la biopsia rectal son pilares fundamentales en la identificación etiológica de un megacolon, una vez excluída la enfermedad de Chagas. La colectomía total con ileorrectoanastomosis es la técnica de elección en el tratamiento del MI. Los casos complicados con vólvulo del sigmoides sólo requieren de una sigmoidectomía. Preferimos la operación de Duhamel modificada por Haddad para los casos de megacolon chagásico y congénito

Chagasic megacolon associated to colan cancer: report of a case fram an endemic region of chagas'disease

É relatado um raro caso de associaçäo de megacolo chagásico e câncer do cólon em uma paciente de regiåo endêmica de doença de Chagas - Estado de Goiás, Brasil. Paciente do sexo feminino, 57 anos, com obstipaçåo crônica há 10 anos passanddo até 15 dias sem evacuar, enema opaco mostrava um megassigmóide com uma lesåo estenosante de cólon transverso; o ECG era compatível com cardiopatia chagásica (BRD 3.ºgrau e HBAE); a paciente foi submetida á cirurgia de Duhamel-Haddad e evoluiu posteriormente com metástases pulmonares e hepáticas. Såo discutidos os aspectos patológicos, epidemiológicos e clínicos da forma digestiva da doença dde Chagas e a associaçåo com câncer colorretal

The surgical treatment of megaesophagus and megacolon.

The effect of Chagas' disease on the digestive tract is evaluated based on the experience acquired in the surgical management of 929 cases of megaesophagus: 807 in the nonadvanced state of the disease and 122 with dolichomegaesophagus. The 807 subjects with nonadvanced megaesophagus were submitted to wide esophagocardiomyectomy on the anterior esophagogastric junction combined with an antireflux valvuloplasty procedure. There was no mortality. On the other hand, dolichomegaesophagus was always resected, with an esophagogastroplasty through the esophageal bed. The index of mortality of the series was 4.1% (5/122) and the main postoperative complications were pleural effusion (22.1%) and fistula of the esophagogastric anastomosis (8.2%). Over the long term the patients adapted well to the operation and gained weight. For the treatment of the megacolon, an easier technique has been employed: resection of the dilated sigmoid colon and colorectal anastomosis just above the anorectal ring. In 30 patients, no leakages, infection or other major complications were seen. The patients, after 1 year of follow-up, had a normal bowel transit.

Incidência de megacólon sintomático em portadores de megaesôfago chagásico / Incidence of symptomatic megacolon in patients with chagasic megaesophagus

Os autores analisam a incidência de megacólon associado a megaesôfago num período de sete anos. Entre 192 portadores de megaesôfago foram investigados, através de enema opaco, apenas os doentes que apresentavam sintomas sugerindo comprometimento intestinal. Foram diagnosticados 15 casos (7,8%) desta associaçäo. Entre o grupo com megaesôfago e o grupo com a associaçäo megaesôfago e megacólon, näo foram encontradas diferenças significativas quanto ao sexo e idade dos pacientes e grau de megaesôfago. Os sintomas esofágicos, no momento do diagnóstico, precederam os intestinais em 93,3% dos doentes. O tratamento foi variado, mas recentemente, os autores obtiveram bons resultados com o tratamento simultâneo, através de cardiomiotomia de Heller com técnica de Lortat-Jacob modificada e hemicolectomia esquerda

[Incidence of symptomatic megacolon in patients with chagasic megaesophagus]. / Incidência de megacólon sintomático em portadores de megaesôfago chagásico.

The authors analyze the incidence of megacolon associated to megaesophagus during a 7 year period. Of the 192 patients with megaesophagus only 15 who presented associated intestinal symptoms were further investigated through barium enema. No statistically significant differences were found between the group with megaesophagus and the group presenting association of megaesophagus and megacolon as to sex and age of the individuals and severity of megaesophagus. The esophageal symptoms preceded the intestinal symptoms in 93.3% of the cases. Many treatments were used, but recently good results were obtained by the association of Heller's cardiomyotomy with modified Lortat-Jacob's technique and left hemicolectomy.

Evidências do declínio da ocorrência do megaesôfago e do megacolon chagásicos: estudo epidemiológico no Hospital das Clínicas de Ribeiräo Preto / Evidence for a decline in the occurrence of chagasic megaesophagus and megacolon: on epidemiological study at the University Hospital of Ribeiräo Preto

Em levantamento de 496 casos de megaesofago e/ou megacolon chagasicos internadosd no Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto e com diagnostico efetuado no período de 1979 a 1990 foram encontrados indícios de que a ocorrência de "megas" acha-se em declínio. Evidenciou-se que: 1) näo foi detectado nenhum paciente com menos de 20 anos de idade; 2) ao longo do período em estudo, houve aumento progressivo da mediana das idades dos pacientes; 3) comparativamente a observaçöes anteriores de outros autores, concernentes ao megaesofago (1939 e 1968) e ao megacolon (1950 e 1976), revelou-se sensível deslocamento para a direita da curva de distribuiçäo dos casos segundo os grupos etários e nítida reduçäo do percentual de casos com menos de 40 anos de idade; 4) entre os pacientes com menos de 40 anos, os naturais do Estado de Säo Paulo (considerada zona limpa da doença há cerca de 10 anos) contribuiram em proporçäo nitidamente menor do que os naturais de outros Estados. Os dados obtidos sugerem que nos ultimos anos as populaçöes v em sendo protegidas contra a transmissäo vetorial da doença de Chagas, reduzindo-se consequentemente, o aparecimento de casos de "megas" nos grupos etários mais jovens