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Overwhelming helminthiasis is still a problem in endemic areas, especially in immunocompromised patients. We report a case of invasive intestinal strongyloidiasis that was clinically expressed as acute abdominal distress in a 73-year-old man from São Paulo who had been receiving methylprednisone, 20 mg/day, for one year for osteoarthritis. A surgical specimen from the ileum revealed invasive enteritis with severe infestation by Strongyloides stercoralis. The patient died of sepsis 6 days after surgery. The possibility of invasive strongyloidiasis should be considered in the differential diagnosis of acute abdominal distress in patients undergoing immunosuppressive therapy.

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The early and late effects of wound healing on tumour development at a distant site were evaluated morphologically in an experimental model of colon carcinogenesis induced by 1,2-dimethylhydrazine (DMH). Random bred male Wistar rats were given subcutaneous injections of DMH (20 mg/kg) or saline, once a week, for eight weeks. One week after the last DMH injection the animals received a full thickness skin wound in their dorsal skin and the wound was left open to heal by second intention. Control and DMH treated rats, with or without skin wounds were sacrificed at the twelfth and twentieth weeks. The colons were removed and the incidence, distribution and morphology of any tumours were recorded. Tumours induced by DMH in the colonic mucosa increased in size during the experiment. At the twelfth week, just after healing of the skin wound was complete, the total number of tumours in the colonic mucosa and the number of tumours per rat was significantly higher in the skin-wounding DMH-treated group than in the unwounded group. No differences on tumour incidence and multiplicity were observed among the groups at the twentieth week. Histologically the number of poorly differentiated mucin-secreting carcinomas was increased in the skin-wounding DMH-treated group than in the unwounded group at the twelfth week. This effect was not observed at the twentieth week. The present results suggest that wound healing enhances tumour development at a distant site. This effect coincides with the period of repair and does not have a marked impact on later stages of tumour progression.

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The objective of this study was to evaluate the efficacy of fibrin adhesive made up of snake venom and bubaline fibrinogen by rat colon anastomosis. Eighty rats were randomly assigned into 2 experimental groups: GI control (anastomosis with extramucous interrupted suture) and GII (repair suture + fibrin glue). The animals were studied at the following 4 times: T0 - preoperative - T1 - 7th day postoperative, T2 - 14th day postoperative, and T3 - 21th day postoperative. The macroscopic characteristics of the intestinal segment open and closed anastomosis and the bursting strength of the anastomosed segments were observed at each of the above times. The results showed that the anastomosed segments coapted and there was no difference in the bursting strength values between the 2 groups. There was a decrease in the bursting strength values up until de 7th day postoperative in both groups with its progressive increase at the other times. Although important experimental studies using large animals are needed for a better evaluation of tissue repair processes, this adhesive may become a valuable tool for use in anastomosis.

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The morphology and evolution of epithelial lesions that developed at a gastrojejunal stoma due to reflux of duodenal contents were compared with MNNG-induced carcinomas in the pyloric mucosa of rats in a long term experiment. Random bred male Wistar rats were given MNNG in drinking water (100 mg/l) for 12 weeks and then one group was submitted to a gastrojejunal anastomosis at the greater curvature in the oxyntic mucosa. Untreated rats underwent either gastrojejunostomy or gastrotomy. The animals were killed at the 24th and 66th weeks of the experiment. The lesions obtained in the pyloric mucosa and in the mucosa of the gastrojejunal stoma were analyzed histologically using hematoxylin and eosin staining and immunohistochemistry for pepsinogen isoenzyme 1. Duodenal reflux induced proliferative lesions at the gastrojejunal junction that increased in incidence and size with time. Histologically they consisted of benign epithelial proliferation of gastric type. No evidence of malignant transformation within the gastric components of the proliferative lesions at the gastrojejunal stoma was observed even at the 66th week. Adenocarcinomas induced by MNNG in the pyloric mucosa increased in size during the experiment and were morphologically and histochemically distinct from the proliferative lesions at the gastrojejunal junction. In conclusion, proliferative lesions at the gastrojejunal stoma stimulated by duodenal reflux are biologically distinct from adenocarcinomas induced by MNNG in the pyloric mucosa. They do not seem to be precursor lesions of gastric carcinogenesis, as they do not undergo malignant transformation even after long-term, up to 66 weeks, follow-up.

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UNLABELLED: The objective of the present study was to investigate changes in colon wall in rats with fecal peritonitis (Per) associated with sodium diclofenac (SD) by studying breaking strength and tissue collagen concentration. The rats were divided into the following experimental groups: GROUP 1-SD: 60 animals injected intramuscularly with sodium diclofenac at the dose of 2 mg/kg body weight; GROUP 2-Per: 60 animals injected intraperitoneally with a suspension of human feces. Peritonitis was interrupted after six hours of evolution; GROUP 3-Per+SD: 60 animals injected intraperitoneally with a suspension of human feces and receiving SD according to the schedule used for Groups 1 and 2; CONTROL GROUP: 12 animals injected intramuscularly with physiological saline. The animals of Group 1, 2 and 3 were successively sacrificed 2, 4, 7, 14 and 21 days after interruption of peritonitis an/or the beginning of treatment. Under conditions of the experimental model and of the methods used, we conclude that sodium diclofenac, peritonitis and the peritonitis-sodium diclofenac association decrease the breaking strength and the concentration of tissue collagen in the colon segment.

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The evolution and phenotypic expression of mucosal lesions of the gastric stump were investigated in male rats submitted to gastric resection with reconstruction by the Billroth II technique (BII with biliopancreatic reflux, BPR) or by the Roux-en-Y procedure (without BPR). Animals were studied at 24, 36, 54 and 64 weeks after surgery and the phenotypic expression of lesions analysed using routine hematoxylin and eosin staining, immunohistochemical staining for pepsinogen isoenzyme 1 and histochemical procedures for mucins (paradoxical concanavalin A, galactose oxidase Schiff (GOS) and sialidase GOS reactions). BPR was found to be responsible for the formation of adenomatous hyperplasia (AH), increasing in incidence and size with time, since the Roux-en-Y procedure failed to induce the gastric stump lesions observed after BII reconstruction. AHs always occurred in the transition of the gastrojejunal junction, a site offering special conditions for BPR influence, and were classified as gastric (G), intestinal (I) and G+I types according to their phenotypic expression. No pure I type AH was diagnosed at any time point. The G and G+I types developed at approximately equal incidences (i.e., G type 7/17, G+I type 10/17 at the 64th week). It was suggested that both gastric and intestinal mucosal elements were stimulated to proliferate by BPR, with the gastric mucosa tending to demonstrate AH. Intestinal type components of AH were found adjacent to the jejunum and not at the stomach margin, indicating an origin from intestinal mucosa. No metaplasia of the gastric mucosa was observed in any animal after partial gastric resection. In 101 rats submitted to the BII procedure, 5 mucinous adenocarcinomas were eventually diagnosed, mostly located in the subserosa of the gastrojejunal junction. All carcinomas expressed the phenotype of cells of the small intestine. Evidence of malignant transformation within the gastric components of AH was not observed even at the 64th week. In conclusion, all lesions induced by BPR in the rat remnant stomach are benign, and the few true cancers that arise in association are derived from the small intestine.

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The influence of fasting on the potential of diethylnitrosamine (DEN) to initiate liver carcinogenesis was tested in a medium-term assay using the development of putative preneoplastic altered foci of hepatocytes (AFH) as the endpoint. Male Wistar rats fasted for 48 hr were given a single ip injection of DEN (200 mg/kg body weight). Partial hepatectomies were carried out at wk 3 and the rats were killed at wk 8. Fasted rats exhibited a small increase in the numbers of AFH with glutathione S-transferase in the placental form and eosinophilic AFH when compared with non-fasted animals. However, after a 6-wk exposure to 0.05% sodium phenobarbital in the diet, there were no differences in the numbers of AFH between fasted and non-fasted animals. Fasting also increased DEN-dependent centrilobular cell necrosis and specifically drug metabolism as indicated in vivo by a decreased time of paralysis of the lower limbs induced by zoxazolamine (40 mg/kg body weight, ip) and by an unaltered sleeping time induced by sodium pentobarbital (40 mg/kg body weight, ip). The results indicate that although fasting during the initiation stage of carcinogenesis increases DEN hepatoxicity, it does not interfere quantitatively with the development of liver preneoplastic lesions.

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Toxic megacolon occurs in colitis of differing aetiology. This report describes 15 patients with chagasic megacolon with this complication. The clinical signs and symptoms in all patients were pain and progressive abdominal distension accompanied by fever, severe toxaemia and shock. Seven patients developed this clinical pattern after manual removal of faeces. The remaining patients had pain and abdominal distension followed by signs of severe toxaemia when first examined. Nine patients underwent total colectomy with ileostomy (one death), four partial colectomy (all died) and two received medical treatment (both died). At autopsy, three of the four patients undergoing partial colectomy had residual colitis and enteritis. The surgical procedure of choice for this complication of chagasic megacolon is total colectomy.

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Morphological and phenotypical patterns of proliferative epithelial lesions induced in the gastric stump mucosa by duodenal content reflux after Billroth II partial gastrectomy (BII) were evaluated in rats. Control animals were either sham-operated or submitted at different times after BII to Roux-en-Y (RY) surgical procedure which prevents duodenal reflux. The lesions were analysed using routine haematoxylin and eosin staining, immunohistochemical staining for pepsinogen isoenzyme 1 and histochemical procedures for mucins (paradoxical Concanavalin A, galactose oxidase Schiff and sialidase galactose oxidase Schiff reactions). Mucosal hyperplasia (H) was observed in the group submitted to BII procedure 6 weeks after surgery. Adenomatous hyperplasia (AH) also appeared 6 weeks after induction of the reflux and its incidence and size increased until the 54th week of the experiment. RY procedure performed in the normal animals at the beginning of the experiment or at the 24th week after BII gastrectomy led to a significantly lower incidence of AH which was related to the moment of surgery. Most of H was due to pyloric mucosal hyperplasia. AH consisted mainly of gastric type glands but in some animals glands of the intestinal type were present probably originating from the intestinal mucosa. Six mucinous adenocarcinomas were observed, all of them of intestinal type. This study demonstrates that AH induced by BII procedure is a reversible lesion and that the anomalous epithelial proliferation in the stoma may lead to adenocarcinomas.

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Com o objetivo de estudar a necrose isquemica da pequena curvatura gastrica, apos vagotomia gastrica proximal (VGP), foram operados 36 caes distribuidos por sorteio em dois grupos experimentais: Grupo 1 VGP e Grupo 2 - VGP e traumatismo da parede gastrica. Este tipo de traumatismo foi realizado atraves de uma ligadura, englobando a parede gastrica, com fio de algodao no. 10. Pelos resultados obtidos verificamos que a desvascularizacao determinada pelas ligaduras dos pediculos vasculonervosos, na tecnica de VGP, conserva a irrigacao necessaria a nutricao e manutencao dos tecidos da pequena curvatura gastrica. As ligaduras englobando a parede gastrica podem determinar desde necrose parcial ou total, com perfuracao e peritonite, ate lesoes semelhantes a ulcera cronica. Nos casos de necrose parcial da parede gastrica podem ocorrer tambem lesoes da mucosa gastrica tais como: exulceracao, sufusao hemorragica e convergencia de pregas da mucosa para o local de traumatismo

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A irrigacao da pequena curvatura apos vagotomia gastrica proximal (VGP) foi estudada em 77 caes, distribuidos por sorteio em quatro grupos experimentais: Grupo 1controle; Grupo 2 - VGP; Grupo 3 - VGP e esplenectomia e Grupo 4 - VGP e traumatismo da parede gastrica. Estes animais foram estudados imediatamente apos a cirurgia, no 3o. e 7o. dia de pos-operatorio. A desvascularizacao da pequena curvatura, na VGP, conserva a irrigacao necessaria a nutricao das camadas gastricas e quando associada a esplenectomia diminui a irrigacao do fundo gastrico, conservando no entanto suprimento sanguineo para nutricao das areas desvascularizadas. O traumatismo da pequena curvatura, ao se englobar parte das camadas da parede gastrica em uma ligadura, e responsavel por necrose isquemica, a qual atinge areas maior que a englobada pela ligadura. Esta area isquemica pode evoluir para perfuracao ou para ulcera. O metodo da fluorescencia pode auxiliar na localizacao e extensao de areas isquemicas podendo ser util na avaliacao intra-operatoria, apos VGP, na clinica

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E apresentado um caso de colecistite cronica calculosa em paciente de 53 anos portadora de "situs inversus totalis". Apos exploracao radiologica e sonografica a paciente foi submetida a tratamento cirurgico com remissao total de sintomatologia.Em que pese tratar-se de patologia rara a possibilidade desse diagnostico deve ser lembrada, sendo este o objetivo da presente comunicacao

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Com o objetivo de estudar a irrigacao da pequena curvatura gastrica apos vagotomia gastrica proximal, realizou-se arteriografia pos-morte e exame anatomo-patologico em 26 caes, imediatamente apos o termino da cirurgia, no 3o e 7o dia de pos-operatorio. Pelos resultados obtidos concluimos que a desvascularizacao determinada pela vagotomia conserve a irrigacao necessaria a nutricao da parede gastrica. Isto e realizado atraves de amplas anastomoses com os vasos das paredes anterior e posterior da pequena curvatura, nao se observando diferencas quanto a concentracao vascular da pequena curvatura entre estomagos nao operados e vagotomizados. Deste estudo experimental conclui-se que a necrose isquemica da pequena curvatura apos vagotomia gastrica proximal, relatada na clinica, possa ocorrer em consequencia de traumatismo inadvertido da parede gastrica, durante a ligadura dos pediculos vasculo nervosos

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Com o objetivo de avaliar clinicamente, na gastrojejunoanastomose, a sutura continua em plano unico, extramucosa, sem hemostasia previa, foram operados 18 pacientes, comparando-se sua evolucao clinica com outros 15 casos com sutura em 2 planos, apos gastrectomia parcial pela tecnica de Billroth II. O estudo comparativo mostrou vantagens no grupo em que se utilizou a sutura em plano unico, pois, alem do tempo de realizacao da sutura poder ser reduzido permitiu alimentacao mais precoce, sendo tecnicamente viavel, por nao ser sede de deiscencia ou hemorragia

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