RESUMO

The aim of this study was to investigate the plasma levels of the CCL3 and CCL4 chemokines in patients with the cardiac and digestive clinical forms of chronic Chagas disease and in cardiac patients with and without left ventricular systolic dysfunction (LVSD). Plasma samples from 75 patients were evaluated by enzyme-linked immunosorbent assay (ELISA) to confirm infection by T. cruzi. Plasma levels of the CCL3 and CCL4 chemokines were measured using Milliplex® MAP assay (Millipore). There were no significant differences in the levels of CCL3 and CCL4 between patients with the digestive and cardiac clinical forms of Chagas disease. Moreover, no significant differences were found between patients without LVSD and those with LVSD. Higher CCL3 and CCL4 plasma levels were found in patients with LVSD compared to those with the digestive form of the disease. The CCL3 and CCL4 chemokines might not be involved in differential susceptibility to the digestive and cardiac clinical forms of chronic Chagas disease, and it seems they do not influence the development of LVSD.

Assuntos

RESUMO

Chagas disease, caused by Trypanosoma cruzi, can affect the heart, esophagus and colon. The reasons that some patients develop different clinical forms or remain asymptomatic are unclear. It is believed that tissue immunogenetic markers influence the tropism of T. cruzi for different organs. ABO, Secretor and Lewis histo-blood group systems express a variety of tissue carbohydrate antigens that influence the susceptibility or resistance to diseases. This study aimed to examine the association of ABO, secretor and Lewis histo-blood systems with the clinical forms of Chagas disease. We enrolled 339 consecutive adult patients with chronic Chagas disease regardless of gender (cardiomyopathy: n=154; megaesophagus: n=119; megacolon: n=66). The control group was composed by 488 healthy blood donors. IgG anti-T. cruzi antibodies were detected by ELISA. ABO and Lewis phenotypes were defined by standard hemagglutination tests. Secretor (FUT2) and Lewis (FUT3) genotypes, determined by Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), were used to infer the correct histo-blood group antigens expressed in the gastrointestinal tract. The proportions between groups were compared using the χ2 test with Yates correction and Fisher's exact test and the Odds Ratio (OR) and 95% Confidence Interval (95% CI) were calculated. An alpha error of 5% was considered significant with p-values <0.05 being corrected for multiple comparisons (pc). No statistically significant differences were found for the ABO (X2: 2.635; p-value=0.451), Secretor (X2: 0.056; p-value=0.812) or Lewis (X2: 2.092; p-value=0.351) histo-blood group phenotypes between patients and controls. However, B plus AB Secretor phenotypes were prevalent in pooled data from megaesophagus and megacolon patients (OR: 5.381; 95% CI: 1.230-23.529; p-value=0.011; pc=0.022) in comparison to A plus O Secretor phenotypes. The tissue antigen variability resulting from the combined action of ABO and Secretor histo-blood systems is associated with the digestive forms of Chagas disease.

Assuntos

RESUMO

Bezoar is a cluster of swallowed and undigested material in the gastrointestinal tract which can cause intestinal obstruction. It has multiple subtypes and the phytobezoar (composed of vegetable fiber) is the most common. We report a patient admitted with intestinal obstruction caused by impaction of multiples seeds of jaboticaba in the rectum. The treatment included multiple enemas, laxatives and digital maneuvers and it was effective after four days. Only one similar report was found in the literature. (AU)

Bezoar trata-se de um aglomerado de material deglutido e não digerido no trato gastrointestinal que pode causar quadro de obstrução intestinal. Existem múltiplos subtipos, sendo o mais comum o fitobezoar (composto por fibras vegetais). Foi relatado o caso de uma paciente admitida com quadro de suboclusão intestinal causada por impactação de múltiplos caroços de jabuticaba em reto. O tratamento instituído foi conservador com múltiplos enteroclimas, laxativos e quebra digital, efetivos após quatro dias. Somente um caso semelhante foi encontrado na literatura. (AU)

Assuntos

RESUMO

O linfoma colorretal primário é uma doença rara (0.2 a 0.6 por cento de todas as neoplasias colônicas), apresentando pior prognóstico quando comparado com o linfoma gástrico primário ou com o adenocarcinoma do cólon. É uma doença com sintomatologia inespecífica, o que dificulta o diagnóstico precoce. O objetivo deste relato é mostrar um caso de linfoma primário do cólon, revisar critérios diagnósticos e tratamento.

The primary colorectal lymphoma is a rare disease (0.2 to 0.6 percent of all colonic neoplasias), that has a worse prognosis than primary gastric lymphoma or colon adenocarcinoma. The poor signals makes the early diagnosis difficult. The objectives of this report is to describe a case of primary colon lymphoma, revise diagnosis criteria and treatment.

Assuntos

RESUMO

BACKGROUND: Rectoanal inhibitory reflex is not always evident in patients with chagasic megacolon. This may be due to insufficient volumes of air used during insufflation for the manometric examination. AIMS: To identify the volume of air necessary to induce rectoanal inhibitory reflex in patients with chagasic megacolon and to observe its prevalence in these individuals. METHODS: Rectoanal inhibitory reflex in 39 patient with chagasic megacolon was studied by means of anorectal manometry using the balloon method. The balloon was insufflated using sequential volumes up to 300 mL to induce reflex. RESULTS: Rectoanal inhibitory reflex was identified in 43.6% of the patients using a mean volume of 196 mL of insufflated air (standard error = 13.5). CONCLUSION: Rectoanal inhibitory reflex can be induced in patients with chagasic megacolon when greater volumes of air are used.

Assuntos

RESUMO

BACKGROUND: Rectoanal inhibitory reflex is not always evident in patients with chagasic megacolon. This may be due to insufficient volumes of air used during insufflation for the manometric examination. AIMS: To identify the volume of air necessary to induce rectoanal inhibitory reflex in patients with chagasic megacolon and to observe its prevalence in these individuals. METHODS: Rectoanal inhibitory reflex in 39 patient with chagasic megacolon was studied by means of anorectal manometry using the balloon method. The balloon was insufflated using sequential volumes up to 300 mL to induce reflex. RESULTS: Rectoanal inhibitory reflex was identified in 43.6 percent of the patients using a mean volume of 196 mL of insufflated air (standard error = 13.5). CONCLUSION: Rectoanal inhibitory reflex can be induced in patients with chagasic megacolon when greater volumes of air are used.

RACIONAL: O reflexo inibitório retoanal nem sempre é evidente nos pacientes com megacólon chagásico. Acredita-se que isso ocorra devido à utilização de volumes insuficientes de insuflação de ar, ao exame manométrico, para induzi-lo. OBJETIVO: Quantificar a média de volume de ar necessário para induzir o reflexo inibitório retoanal em pacientes com megacólon chagásico e verificar sua prevalência. MÉTODOS: Estudou-se o reflexo inibitório retoanal em 39 pacientes com megacólon chagásico por meio da manometria anorretal, utilizando-se o método do balão. Para indução do reflexo foram insuflados volumes seqüenciais de até 300 mL de ar. RESULTADOS: O reflexo inibitório retoanal foi encontrado em 43,6 por cento dos pacientes, com média de ar insuflado de 196 mL (erro padrão = 13,5). CONCLUSÃO: O reflexo inibitório retoanal pode ser induzido em pacientes com megacólon chagásico, quando utilizados maiores volumes de insuflação de ar.

Assuntos

RESUMO

PURPOSE: Chagasic megacolon occurs frequently in central Brazil. There are several surgical techniques for the treatment of megacolon and no consensus on which one is the best. Our goal is to present a new surgical treatment for chagasic megacolon. METHODS: One hundred forty-seven patients with chagasic megacolon were submitted to surgical treatment between January 1985 and December 1995. Fourteen patients were lost to follow-up because they could not be reached. Patients were evaluated preoperatively and submitted to rectosigmoidectomy with interposition of an isoperistaltic segment of ileum between the descending colon and the rectum. RESULTS: There were three deaths in the postoperative period, two because of complications caused by septic peritonitis and one because of hypovolemic shock. Major complications occurred in 5.4 percent of the cases: four dehiscences at the ileocolic anastomosis and two at the ileorectal anastomosis. Minor complications corresponding to 3.1 percent of the total included two with abdominal wall infection, one with a temporary infection, and one with a cardiac arrhythmia. Four patients (3.1 percent) had recurrence of constipation. CONCLUSION: Rectosigmoidectomy with interposition of an ileal segment is a new therapeutic option for chagasic megacolon that has several advantages in relation to the other techniques because of its ease of execution, lack of complications such as those seen in pull-through procedures, and a low recurrence rate.

Assuntos