RESUMO
Humans have profoundly impacted the distribution of plant and animal species over thousands of years. The most direct example of these effects is human-mediated movement of individuals, either through translocation of individuals within their range or through the introduction of species to new habitats. While human involvement may be suspected in species with obvious range disjunctions, it can be difficult to detect natural versus human-mediated dispersal events for populations at the edge of a species' range, and this uncertainty muddles how we understand the evolutionary history of populations and broad biogeographical patterns. Studies combining genetic data with archaeological, linguistic and historical evidence have confirmed prehistoric examples of human-mediated dispersal; however, it is unclear whether these methods can disentangle recent dispersal events, such as species translocated by European colonizers during the past 500 years. We use genomic DNA from historical museum specimens and historical records to evaluate three hypotheses regarding the timing and origin of Northern Bobwhites (Colinus virginianus) in Cuba, whose status as an endemic or introduced population has long been debated. We discovered that bobwhites from southern Mexico arrived in Cuba between the 12th and 16th centuries, followed by the subsequent introduction of bobwhites from the southeastern USA to Cuba between the 18th and 20th centuries. These dates suggest the introduction of bobwhites to Cuba was human-mediated and concomitant with Spanish colonial shipping routes between Veracruz, Mexico and Havana, Cuba during this period. Our results identify endemic Cuban bobwhites as a genetically distinct population born of hybridization between divergent, introduced lineages.
Assuntos
Colinus , Hibridização Genética , Animais , Humanos , Ecossistema , Evolução Biológica , CubaRESUMO
Rivers frequently delimit the geographic ranges of species in the Amazon Basin. These rivers also define the boundaries between genetic clusters within many species, yet river boundaries have been documented to break down in headwater regions where rivers are narrower. To explore the evolutionary implications of headwater contact zones in Amazonia, we examined genetic variation in the Blue-capped Manakin (Lepidothrix coronata), a species previously shown to contain several genetically and phenotypically distinct populations across the western Amazon Basin. We collected restriction site-associated DNA sequence data (RADcap) for 706 individuals and found that spatial patterns of genetic structure indicate several rivers, particularly the Amazon and Ucayali, are dispersal barriers for L. coronata. We also found evidence that genetic connectivity is elevated across several headwater regions, highlighting the importance of headwater gene flow for models of Amazonian diversification. The headwater region of the Ucayali River provided a notable exception to findings of headwater gene flow by harboring non-admixed populations of L. coronata on opposite sides of aâ <â 1-km-wide river channel with a known dynamic history, suggesting that additional prezygotic barriers may be limiting gene flow in this region.
Assuntos
Passeriformes , Humanos , Animais , Passeriformes/genética , Brasil , Filogenia , Evolução Biológica , DNA Mitocondrial/genética , RiosRESUMO
The Neotropics harbor the most species-rich freshwater fish fauna on the planet, but the timing of that exceptional diversification remains unclear. Did the Neotropics accumulate species steadily throughout their long history, or attain their remarkable diversity recently? Biologists have long debated the relative support for these museum and cradle hypotheses, but few phylogenies of megadiverse tropical clades have included sufficient taxa to distinguish between them. We used 1288 ultraconserved element loci spanning 293 species, 211 genera, and 21 families of characoid fishes to reconstruct a new, fossil-calibrated phylogeny and infer the most likely diversification scenario for a clade that includes a third of Neotropical fish diversity. This phylogeny implies paraphyly of the traditional delimitation of Characiformes because it resolves the largely Neotropical Characoidei as the sister lineage of Siluriformes (catfishes), rather than the African Citharinodei. Time-calibrated phylogenies indicate an ancient origin of major characoid lineages and reveal a much more recent emergence of most characoid species. Diversification rate analyses infer increased speciation and decreased extinction rates during the Oligocene at around 30 Ma during a period of mega-wetland formation in the proto-Orinoco-Amazonas. Three species-rich and ecomorphologically diverse lineages (Anostomidae, Serrasalmidae, and Characidae) that originated more than 60 Ma in the Paleocene experienced particularly notable bursts of Oligocene diversification and now account collectively for 68% of the approximately 2150 species of Characoidei. In addition to paleogeographic changes, we discuss potential accelerants of diversification in these three lineages. While the Neotropics accumulated a museum of ecomorphologically diverse characoid lineages long ago, this geologically dynamic region also cradled a much more recent birth of remarkable species-level diversity. [Biodiversity; Characiformes; macroevolution; Neotropics; phylogenomics; ultraconserved elements.].
Assuntos
Peixes-Gato , Caraciformes , Animais , Biodiversidade , Fósseis , FilogeniaRESUMO
The advent of next-generation sequencing allows researchers to use large-scale datasets for species delimitation analyses, yet one can envision an inflection point where the added accuracy of including more loci does not offset the increased computational burden. One alternative to including all loci could be to prioritize the analysis of loci for which there is an expectation of high informativeness. Here, we explore the issue of species delimitation and locus selection with montane species from two anuran genera that have been isolated in sky islands across the southern Brazilian Atlantic Forest: Melanophryniscus (Bufonidae) and Brachycephalus (Brachycephalidae). To delimit species, we obtained genetic data using target enrichment of ultraconserved elements from 32 populations (13 for Melanophryniscus and 19 for Brachycephalus), and we were able to create datasets that included over 800 loci with no missing data. We ranked loci according to their number of parsimony-informative sites, and we performed species delimitation analyses using BPP with the most informative 10, 20, 40, 80, 160, 320, and 640 loci. We identified three types of phylogenetic node: nodes with either consistently high or low support regardless of the number of loci or their informativeness and nodes that were initially poorly supported where support became stronger as we included more data. When viewed across all sensitivity analyses, our results suggest that the current species richness in both genera is likely underestimated. In addition, our results show the effects of different sampling strategies on species delimitation using phylogenomic datasets.
Assuntos
Anuros/classificação , Anuros/genética , Florestas , Filogenia , Animais , Oceano Atlântico , Brasil , Filogeografia , Especificidade da EspécieRESUMO
BACKGROUND: Hypoplasia or congenital absence of the anterior cruciate ligament (ACL) is a rare disorder occurring in â¼1 in every 6000 births. Although some patients with hypoplasia or agenesis of the ACL may not complain of instability, others desire to participate in more demanding activities that require the stability of a competent ACL. There are limited reports of surgical treatment of this patient population. The purpose of this study was to report ACL reconstruction in a case series of patients with symptomatic congenital ACL deficiency. METHODS: A retrospective medical record review of the surgical treatment of 14 knees (13 patients) with congenital absence of the ACL at a tertiary care institution from 1995 to 2012 was performed. Patients with a minimum of 1 year of clinical follow-up were eligible for inclusion. RESULTS: The mean age at time of surgery was 12.6 (range, 3 to 22), including 6 patients <12 years of age. Mean follow-up was 2.9 years (range, 1 to 6.6). Nine of 13 patients (69%) had underlying congenital abnormalities/associated syndromes. Preoperative Lachman and pivot shift examination was International Knee Documentation Committee grade C or D in all but 1 knee. ACL reconstruction was performed with combined intra-articular/extra-articular physeal sparing reconstruction with iliotibial band (n=5), autograft hamstring (n=2) or bone-patellar tendon-bone (n=3), or allograft (n=4). Multiligament reconstruction of associated ligamentous deficiency was performed in 7 knees (50%). Postoperative Lachman and pivot shift testing was International Knee Documentation Committee (IKDC) grade A or B in all but 1 knee. One patient with congenital absence of multiple knee ligaments required revision ACL reconstruction surgery, with concurrent first-time posterior cruciate ligament reconstruction, due to persistent instability. None required revision surgery due to graft tear at a minimum of 1-year follow-up. CONCLUSIONS: Surgical stabilization of symptomatic congenital ACL insufficiency, with associated ligamentous reconstruction as required on a case-by-case basis, results in improved stability at early clinical follow-up, with low complication rates. LEVEL OF EVIDENCE: Level IV-retrospective case series.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirurgia , Instabilidade Articular/congênito , Articulação do Joelho/cirurgia , Ligamento Patelar/transplante , Adolescente , Adulto , Ligamento Cruzado Anterior/anormalidades , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Instabilidade Articular/cirurgia , Masculino , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Transplante Autólogo , Adulto JovemRESUMO
The evolution of ant agriculture, as practised by the fungus-farming 'attine' ants, is thought to have arisen in the wet rainforests of South America about 55-65 Ma. Most subsequent attine agricultural evolution, including the domestication event that produced the ancestor of higher attine cultivars, is likewise hypothesized to have occurred in South American rainforests. The 'out-of-the-rainforest' hypothesis, while generally accepted, has never been tested in a phylogenetic context. It also presents a problem for explaining how fungal domestication might have occurred, given that isolation from free-living populations is required. Here, we use phylogenomic data from ultra-conserved element (UCE) loci to reconstruct the evolutionary history of fungus-farming ants, reduce topological uncertainty, and identify the closest non-fungus-growing ant relative. Using the phylogeny we infer the history of attine agricultural systems, habitat preference and biogeography. Our results show that the out-of-the-rainforest hypothesis is correct with regard to the origin of attine ant agriculture; however, contrary to expectation, we find that the transition from lower to higher agriculture is very likely to have occurred in a seasonally dry habitat, inhospitable to the growth of free-living populations of attine fungal cultivars. We suggest that dry habitats favoured the isolation of attine cultivars over the evolutionary time spans necessary for domestication to occur.
Assuntos
Formigas/fisiologia , Evolução Biológica , Ecossistema , Fungos/fisiologia , Simbiose , Animais , Formigas/genética , Domesticação , Proteínas de Insetos/genética , Filogenia , Floresta Úmida , Análise de Sequência de DNA , América do SulRESUMO
Genomic studies are revealing that divergence and speciation are marked by gene flow, but it is not clear whether gene flow has played a prominent role during the generation of biodiversity in species-rich regions of the world where vicariance is assumed to be the principal mode by which new species form. We revisit a well-studied organismal system in the Mexican Highlands, Aphelocoma jays, to test for gene flow among Mexican sierras. Prior results from mitochondrial DNA (mtDNA) largely conformed to the standard model of allopatric divergence, although there was also evidence for more obscure histories of gene flow in a small sample of nuclear markers. We tested for these 'hidden histories' using genomic markers known as ultraconserved elements (UCEs) in concert with phylogenies, clustering algorithms and newer introgression tests specifically designed to detect ancient gene flow (e.g. ABBA/BABA tests). Results based on 4303 UCE loci and 2500 informative SNPs are consistent with varying degrees of gene flow among highland areas. In some cases, gene flow has been extensive and recent (although perhaps not ongoing today), whereas in other cases there is only a trace signature of ancient gene flow among species that diverged as long as 5 million years ago. These results show how a species complex thought to be a model for vicariance can reveal a more reticulate history when a broader portion of the genome is queried. As more organisms are studied with genomic data, we predict that speciation-with-bouts-of-gene-flow will turn out to be a common mode of speciation.
Assuntos
Fluxo Gênico , Especiação Genética , Genética Populacional , Passeriformes/genética , Animais , DNA Mitocondrial/genética , Genômica , México , Modelos Genéticos , Filogenia , Polimorfismo de Nucleotídeo Único , Análise de Sequência de DNARESUMO
The complexities of the relationships between plant and soil microbial communities remain unresolved. We determined the associations between plant aboveground and belowground (root) distributions and the communities of soil fungi and bacteria found across a diverse tropical forest plot. Soil microbial community composition was correlated with the taxonomic and phylogenetic structure of the aboveground plant assemblages even after controlling for differences in soil characteristics, but these relationships were stronger for fungi than for bacteria. In contrast to expectations, the species composition of roots in our soil core samples was a poor predictor of microbial community composition perhaps due to the patchy, ephemeral, and highly overlapping nature of fine root distributions. Our ability to predict soil microbial composition was not improved by incorporating information on plant functional traits suggesting that the most commonly measured plant traits are not particularly useful for predicting the plot-level variability in belowground microbial communities.
Assuntos
Fenômenos Fisiológicos Bacterianos , Biodiversidade , Fungos/fisiologia , Microbiologia do Solo , Árvores/fisiologia , Microbiota , Panamá , Raízes de Plantas/fisiologia , Floresta Úmida , Clima TropicalRESUMO
Since the recognition that allopatric speciation can be induced by large-scale reconfigurations of the landscape that isolate formerly continuous populations, such as the separation of continents by plate tectonics, the uplift of mountains or the formation of large rivers, landscape change has been viewed as a primary driver of biological diversification. This process is referred to in biogeography as vicariance. In the most species-rich region of the world, the Neotropics, the sundering of populations associated with the Andean uplift is ascribed this principal role in speciation. An alternative model posits that rather than being directly linked to landscape change, allopatric speciation is initiated to a greater extent by dispersal events, with the principal drivers of speciation being organism-specific abilities to persist and disperse in the landscape. Landscape change is not a necessity for speciation in this model. Here we show that spatial and temporal patterns of genetic differentiation in Neotropical birds are highly discordant across lineages and are not reconcilable with a model linking speciation solely to landscape change. Instead, the strongest predictors of speciation are the amount of time a lineage has persisted in the landscape and the ability of birds to move through the landscape matrix. These results, augmented by the observation that most species-level diversity originated after episodes of major Andean uplift in the Neogene period, suggest that dispersal and differentiation on a matrix previously shaped by large-scale landscape events was a major driver of avian speciation in lowland Neotropical rainforests.
Assuntos
Aves/classificação , Aves/genética , Especiação Genética , Filogenia , Floresta Úmida , Clima Tropical , Animais , Biodiversidade , Modelos Biológicos , Dados de Sequência Molecular , Panamá , Rios , América do SulRESUMO
BACKGROUND: Haldane's Rule, the tendency for the heterogametic sex to show reduced fertility in hybrid crosses, can obscure the signal of gene flow in mtDNA between species where females are heterogametic. Therefore, it is important when studying speciation and species limits in female-heterogametic species like birds to assess the signature of gene flow in the nuclear genome as well. We studied introgression of microsatellites and mtDNA across a secondary contact zone between coastal and interior lineages of Western Scrub-Jays (Aphelocoma californica) to test for a signature of Haldane's Rule: a narrower cline of introgression in mtDNA compared to nuclear markers. RESULTS: Our initial phylogeographic analysis revealed that there is only one major area of contact between coastal and interior lineages and identified five genetic clusters with strong spatial structuring: Pacific Slope, Interior US, Edwards Plateau (Texas), Northern Mexico, and Southern Mexico. Consistent with predictions from Haldane's Rule, mtDNA showed a narrower cline than nuclear markers across a transect through the hybrid zone. This result is not being driven by female-biased dispersal because neutral diffusion analysis, which included estimates of sex-specific dispersal rates, also showed less diffusion of mtDNA. Lineage-specific plumage traits were associated with nuclear genetic profiles for individuals in the hybrid zone, indicating that these differences are under genetic control. CONCLUSIONS: This study adds to a growing list of studies that support predictions of Haldane's Rule using cline analysis of multiple loci of differing inheritance modes, although alternate hypotheses like selection on different mtDNA types cannot be ruled out. That Haldane's Rule appears to be operating in this system suggests a measure of reproductive isolation between the Pacific Slope and interior lineages. Based on a variety of evidence from the phenotype, ecology, and genetics, we recommend elevating three lineages to species level: A. californica (Pacific Slope); A. woodhouseii (Interior US plus Edwards Plateau plus Northern Mexico); A. sumichrasti (Southern Mexico). The distinctive Edwards Plateau population in Texas, which was monophyletic in mtDNA except for one individual, should be studied in greater detail given habitat threat.
Assuntos
DNA Mitocondrial/genética , Especiação Genética , Passeriformes/genética , Animais , Núcleo Celular/genética , Feminino , Fluxo Gênico , Hibridização Genética , Masculino , México , Repetições de Microssatélites , Dados de Sequência Molecular , Passeriformes/classificação , Isolamento ReprodutivoRESUMO
Apesar de apresentar diminuição em sua incidência, a doença de Chagas aina é a terceira doença tropical mais frequente. A endoscopia digestiva alta (EDA) cresce em importância como metódo auxiliar para eses pacientes, principalmente na avaliação da mucosa e diagnóstico de neoplasias. Até o presente momento, não se encontra na literatura uma classificação para padronizar a descrição das alterações endoscópicas nos pacientes com megaesôfago. Tal classisficação que tivesse boa correlação radiológica, poderia facilitar o tratamento desses pacientes, reduzindo o número de exames. Objetivos: Apresentar uma proposta de classificação endoscópica para pacientes com megaesôfago. Material e Método: Sessenta e cinco pacientes consecutivos com megaesôfago foram avaliados por dois endoscopistas experientes, cegos entre si, durante um único exame. A análise estatistica realizada pelo teste de Kappa, comparando os resultados obtidos com os achados radiológicos pela classificação de Rezende, além de análise da variaçãointerobservador. resultados: Os endoscopistas apresentaram indice de concordância excelenmte (K= 0,90) quando comparados entre si e concordâancia forte (K=0,67) quando comparados com a classificação radiológica. Conclusões: Esta classificação pode ser útil, já que parece haver boa concordância com os achados radiológicos e ser facilmente reproduzida. Novos estudos são necessários para comprovar os benefícios de sua utilização na prática clínica.
Assuntos
Humanos , Masculino , Feminino , Adulto , Acalasia Esofágica/classificação , Doença de Chagas/epidemiologia , EndoscopiaRESUMO
According to the WHO, 16-18 million people in Central and South America are infected by Trypanosoma cruzi. Chagasic achalasia affects between 7.1% and 10.6% of the population. The aim of this study was to evaluate the effects of Botox injections in the clinical response and esophageal function of patients with dysphagia due to chagasic achalasia. In total, 24 symptomatic patients with chagasic achalasia were randomly chosen to receive Botulinum Toxin (BT) or saline injected by endoscopy in the lower esophageal sphincter (LES). Patients were monitored with a clinical score of dysphagia and an objective assessment (esophagograms, scintillography, manometry, and nutritional assessment) for a period of 6 months. Clinical improvement of dysphagia was statistically significant (P < 0.001) in patients receiving BT when compared with the placebo. There was no significant difference in the placebo group regarding clinical score, LES basal pressure and esophageal emptying time. Esophageal emptying time in the toxin group was significantly lower than in the placebo (P=0.04) after 90 days. There were non-significant increases in esophageal emptying of 25.36% and 17.39%, respectively, at 90 and 180 days, in the BT group (P=0.266). Gender, age, and baseline LES pressure did not influence the response to BT. Our data strongly suggests that intrasphincteric injection of BT in LES is clinically effective in the treatment of chagasic achalasia.
Assuntos
Antidiscinéticos/administração & dosagem , Toxinas Botulínicas/administração & dosagem , Doença de Chagas/complicações , Acalasia Esofágica/tratamento farmacológico , Acalasia Esofágica/etiologia , Adolescente , Adulto , Idoso , Método Duplo-Cego , Esquema de Medicação , Acalasia Esofágica/diagnóstico , Junção Esofagogástrica/efeitos dos fármacos , Esofagoscopia , Feminino , Seguimentos , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Probabilidade , Estudos Prospectivos , Recuperação de Função Fisiológica , Valores de Referência , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period. PATIENTS AND METHODS: We studied 30 patients with pancreatic pseudocyst that presented some indication for treatment: persistent abdominal pain, infection or cholestasis. Clinical evaluation was performed with a pain scale, 0 meaning absence of pain and 4 meaning continuous pain. Pseudocysts were first evaluated by abdominal CT scan, and after endoscopic retrograde pancreatography the patients were treated by transpapillary or transmural (cystduodenostomy or cystgastrostomy) drainage. Pseudocyst resolution was documented by serial CT scans. RESULTS: 25/30 patients could be treated. Drainage was successful in 21 (70% in an 'intention to treat' basis). After a mean follow-up of 42 +/- 35.82 weeks, there was only 1 (4.2%) recurrence. A total of 6 complications occurred in 37 procedures (16.2%), and all but 2 were managed clinically and/or endoscopically: there was no mortality related to the procedure. Patients submitted to combined drainage needed more procedures than the other groups. There was no difference in the efficacy when we compared the three different drainage methods. CONCLUSIONS: We concluded that pancreatic pseudocyst endoscopic drainage is possible in most patients, with high success rate and low morbidity.
Assuntos
Drenagem/métodos , Pseudocisto Pancreático/cirurgia , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Endoscopia do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Stents , Resultado do TratamentoRESUMO
BACKGROUND: Enteral feeding by percutaneous endoscopic gastrostomy is indicated as long-term nutritional support for children with neurologic impairment and dysphagia. We report our experience with percutaneous endoscopic gastrostomy and evaluate the age range of children with cerebral palsy who benefit most with weight and height gain. METHODS: In a prospective study, from August 1996 to August 1997, 20 endoscopic gastrostomies were performed in 20 children diagnosed with cerebral palsy (16), myopathy (2), and brain trauma (2). The mean age was 6.5 years and the mean follow-up 5.9 months. All patients had severe mental impairment and oropharyngeal dysphagia. They were followed up monthly on an outpatient basis by both the gastroenterologist and the dietitian, who assessed gastrostomy complications and performed anthropometric measurements. RESULTS: All 20 patients benefited from enteral nutrition with a statistically significant gain in weight (p < 0.01), and there was a trend toward improved weight/height ratio in children under 4 years of age according to Z-score and mid-arm muscle area (p < 0.01). Triceps skinfold thickness failed to reach statistical significance. There were no immediate complications related to the procedure. Perforations occurred with three (15%) tubes, and the plugs for introduction of food had to be replaced after 4 months of use. All complications, namely formation of granulation tissue at the stoma (7), stoma infection (4), gastroesophageal reflux pneumonia (3), and pneumoperitoneum (1) were managed clinically. CONCLUSIONS: Endoscopic gastrostomy is a safe procedure for children. Enteral feeding resulted in a trend toward a normalized weight/height ratio for children with cerebral palsy younger than 4 years and significant weight gain in those older than 12 years.
Assuntos
Transtornos de Deglutição/terapia , Nutrição Enteral , Gastrostomia , Estado Nutricional , Adolescente , Antropometria , Lesões Encefálicas/terapia , Paralisia Cerebral/terapia , Criança , Pré-Escolar , Transtornos de Deglutição/etiologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Doenças Neuromusculares/terapia , Resultado do TratamentoRESUMO
Botulinum toxin (BT) has recently been indicated as an alternative treatment of idiopathic achalasia with a success rate of 60-70%. One-third of BT-treated cases either fail to respond or fail to sustain the response beyond 6 months. An explanation for BT therapeutic failure would be that the lower esophageal sphincter muscular layer (LES) may be missed as injection is delivered 'blindly'. We aimed to evaluate the percentage of exact endoscopically 'blind' LES punctures using echoendoscopy after the injection of BT for the treatment of Chagas' achalasia (CA). Five patients with CA (mean age 53 years) were randomized to receive 1.2 ml of BT or the same amount of saline injected endoscopically. Echoendoscopy was performed immediately after puncture. Patients were evaluated by the clinical score of dysphagia, radiological examination, upper endoscopy and esophageal manometry and followed up for 6 months. All puncture sites were identified: 17 out of 20 (85%) in the muscle layer and 3 out of 20 (15%) in the submucosa. The three patients in the treatment group showed clinical improvement (average clinical score fell from 14 to 2 after 7 days, and remained at 4 after 6 months of follow-up). The mean pressure of the LES dropped by 29%. Neither patient in the placebo group showed clinical improvement, and the mean pressure of the LES increased by 35%. Endoscopic 'blind' injection of BT into the LES through endoscopy for the management of achalasia is a safe and reproducible technique and has a high percentage of exactness.
Assuntos
Toxinas Botulínicas/uso terapêutico , Doença de Chagas/terapia , Acalasia Esofágica/terapia , Toxinas Botulínicas/administração & dosagem , Humanos , Pessoa de Meia-IdadeRESUMO
Botulinum toxin (BT) has been used in neurology, ophthalmology, otorhinolaryngology and gastroenterology. Twenty-four patients with oropharyngeal dysphagia treated with BT injection into the cricopharyngeal muscle were reported, with good results in up to 79% of the patients. Different techniques were used to inject BT: percutaneous (guided by electromyography, computed tomography or videofluoroscopy) or direct injection during esophagoscopy (with a rigid esophagoscope). We report the first case of oropharyngeal dysphagia treated by BT injection into the cricopharyngeal muscle using a flexible scope, with clinical, radiological and manometric improvement. A reduction in the disability score 4 to 2 and sustained capacity to maintain adequate oral caloric intake were observed. The patient was also able to have the tracheotomy orifice closed and the gastrostomy tube removed after 3 months. Manometry showed a 38% reduction in the upper esophageal sphincter pressure with the presence of pharyngeal waves that were previously absent. After 1 year of follow-up, the patient was in good condition with mild dysphagia for solid foods. This is another case of complex dysphagia and relative hyperfunction of the cricopharyngeal muscle successfully treated with BT injection.
Assuntos
Antidiscinéticos/administração & dosagem , Toxinas Botulínicas/administração & dosagem , Idoso , Endoscopia , Humanos , Injeções Intramusculares/métodos , Masculino , Músculos FaríngeosRESUMO
With increased use of percutaneous endoscopic gastrostomy, it became clear that neurologically impaired patients might benefit from its use. From August 1996 to July 1997, we performed 19 percutaneous endoscopic gastrostomies in patients with neurological sequelae, who were incapable to maintain their nutritional status by oral ingestion or had repeated episodes of aspiration. Sixteen patients were followed prospectively, from 30 days to 11 months (median: 6.4 months). Average weight (38.2 kg to 44.8 kg), BMI (14.8 kg/m2 to 17.8 kg/m2), weight/height ratio (23.5 kg/cm to 28 kg/cm), mid-upper arm circumference (19.4 cm to 21.6 cm) and triceps skinfold thickness (10.3 mm to 12.6 mm) were significantly increased (P < 0.01). Before percutaneous endoscopic gastrostomy, there were 10 (10/16, 62.5%) patients with grade III thinness. In this group, 3/10 patients (30%) showed improvement to grade I (two individuals) and II (one patient). All but five patients (68.75%) were below the fifth percentile of normal distribution for mid-upper arm circumference. One patient (6.2%) showed improvement of her status (between 25th and 50th percentiles). Four patients (25%) started the follow-up below the fifth percentile for normal distribution of triceps skinfold thickness, and showed no improvement. There were no early complications secondary the procedure. Late complications included granulation tissue on ostomy site (18.8%) and ostomy infection (6.2%). Statistical analysis showed significant improvement of anthropometric data. Percutaneous endoscopic gastrostomy is a simple, highly successful and safe procedure, when performed in neurologically impaired patients. It is efficient as a long-term enteral feeding method.
Assuntos
Doenças do Sistema Nervoso Central/complicações , Nutrição Enteral/métodos , Gastrostomia , Distúrbios Nutricionais/terapia , Estado Nutricional , Adolescente , Adulto , Idoso , Antropometria , Humanos , Pessoa de Meia-Idade , Distúrbios Nutricionais/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
BACKGROUND: Upper gastrointestinal endoscopy has been reported as a risk factor for the transmission of Helicobacter pylori. The aim of this study was to evaluate the possibility of transmission of H. pylori infection by upper gastrointestinal endoscopy in patients who had previously had such procedures in a low disinfection level environment. METHODS: The study included 1082 patients. Patients that had undergone upper gastrointestinal endoscopy or were treated with antibiotics 15 days before the index endoscopy were excluded. H. pylori infection was diagnosed by ultra-rapid urease test. Variables analyzed were age, gender, type of dyspepsia (organic or functional), and the number of previous upper gastrointestinal endoscopies. RESULTS: Overall prevalence of H. pylori infection was 60%. Patients ranged in age from 13 to 94 years (mean = 45.8, SD = 15.7) and the number of previous upper gastrointestinal endoscopies ranged from 0 to 20 (mean = 1.5, SD = 2.4). In 53.3% of the patients, upper gastrointestinal endoscopy revealed some mucosal lesion (organic dyspepsia). Prevalence of H. pylori infection was higher in patients with organic rather than functional dyspepsia (71.1% vs. 47.1%, p < 0.001). There was no statistically significant difference in the mean number of upper gastrointestinal endoscopies in patients with and without H. pylori infection. CONCLUSIONS: We concluded that there was no association between history of upper gastrointestinal endoscopy and current H. pylori infection in this study population.
Assuntos
Infecção Hospitalar/transmissão , Dispepsia/microbiologia , Endoscópios Gastrointestinais , Contaminação de Equipamentos , Infecções por Helicobacter/transmissão , Helicobacter pylori , Controle de Infecções , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Infecção Hospitalar/complicações , Infecção Hospitalar/diagnóstico , Feminino , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: Esophageal band ligation is considered to be as efficient as endoscopic sclerotherapy, with a lower complication rate, including bacteremia. There are few studies comparing the two methods. The aim of this study was to compare the incidence of bacteremia after both treatments in patients with portal hypertension secondary to schistosomiasis. METHODS: Endoscopic sclerotherapy and band ligation were performed using standard techniques. Blood samples were obtained 5 and 30 minutes after endoscopic band ligation or sclerotherapy and cultured for aerobic and anaerobic organisms. RESULTS: In the sclerotherapy group 2 of 43 (4.6%) blood cultures were positive (Peptostreptococcus sp and Streptococcus mitis). A similar result was obtained in the band ligation group: 2 of 35 (5.7%) had positive cultures, both with Staphylococcus aureus. CONCLUSIONS: There is no difference in the frequency of bacteremia after treatment of esophageal varices with endoscopic sclerotherapy or endoscopic band ligation in patients with portal hypertension secondary to schistosomiasis.
Assuntos
Bacteriemia/epidemiologia , Varizes Esofágicas e Gástricas/terapia , Esofagoscopia/efeitos adversos , Hipertensão Portal/complicações , Hepatopatias Parasitárias/complicações , Esquistossomose/complicações , Escleroterapia/efeitos adversos , Esplenopatias/complicações , Adulto , Idoso , Bacteriemia/microbiologia , Sangue/microbiologia , Varizes Esofágicas e Gástricas/etiologia , Esofagoscopia/métodos , Feminino , Humanos , Hipertensão Portal/sangue , Incidência , Ligadura/efeitos adversos , Ligadura/métodos , Hepatopatias Parasitárias/parasitologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Esquistossomose/parasitologia , Escleroterapia/instrumentação , Esplenopatias/parasitologiaRESUMO
Helicobacter pylori is a Gram negative bacteria that colonizes gastric epithelial cells. It has been associated with several gastric disease including chronic gastritis and peptic ulcer. Helicobacter pylori infection diagnosis can be done with invasive and non-invasive methods. In invasive methods an endoscopic gastric mucosa biopsy specimen is used. In our study we compare the sensitivity, specificity, costs and applicability of four invasive diagnostic tests: culture, urease ultra-rapid test, histology (Giemsa and Hematoxilineosin stain) and fuchsin stained mucosal slides. Urease test was the easiest, fastest diagnostic test, with sensitivity of 86% and specificity of 100%, being also the cheapest test. We concluded that it should be the test of choice for Helicobacter pylori infection diagnosis.