RESUMO
Four cases of megaesophagus with esophageal motor disturbances secondary to adenocarcinoma of the cardia are hereby reported. There were common characteristics to all cases such as: 1) short duration of symptoms, 2) grade II megaesophagus by X-Rays with narrowing of the cardia, 3) the endoscopy showed esophageal dilatation and inability to pass the cardia with the endoscope, 4) histology (obtained by endoscopy or surgery) and exfoliative cytology were positive for malignancy, 5) the esophageal motility tests showed aperistalsis of the whole esophagus in all cases, and lack of relaxation of the lower esophageal sphincter in two. The urecholine test was positive in one patient with neoplastic infiltration of the myenteric plexus, 6) in two cases where esophageal resection was performed, infiltration of the Auerbach's plexus by cancer cells was proven. We conclude that in the presence of aperistalsis of the esophagus with or without achalasia of the lower esophageal sphincter, the diagnosis of megaesophagus secondary to cancer of the gastric fundus should be suspected when it is not possible to pass the cardia with the endoscope, even if biopsy and cytology are negative for malignancy.
Assuntos
Adenocarcinoma/complicações , Acalasia Esofágica/etiologia , Neoplasias Gástricas/complicações , Idoso , Cárdia , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , PeristaltismoRESUMO
Se presentan 4 casos de magaesofago secundario a adenocarcinoma de techo gastrico.Las caracteristicas comunes a todos ellos fueron: 1) escasa duracion de los sintomas 2) radiologia compatible con megaesofago grado II y afinamiento de la union esofagogastrica, 3) dialatacion esofagica e imposibilidad para franquear el cardias en la endoscopia, 4) la histologia obtenida por endoscopia o cirugia, y la citologia exfoliativa fueron positivas para neoplasia, 5) la electromanometria mostro en todos los casos aperistalsis de todo el cuerpo esofagico, y en dos esfinter esofagico inferior hipertensivo sin relajacion post-deglucion, 6) en los dos casos en que la reseccion del esofago fue realizada se comprobo infiltracion de los plexos de Auerbach por la neoplasia. Concluimos que en presencia de aperistalsis esofagica con o sin acalasia del esfinter esofagico inferior, debemos sopechar el diagnostico de megaesofago secundario a neoplasia del techo gastrico cuando el endoscopio no puede franquear el cardias, aun cuando la citologia y la biopsia sean negativas para neoplasia
Assuntos
Pessoa de Meia-Idade , Idoso , Humanos , Masculino , Feminino , Acalasia Esofágica , Adenocarcinoma , Neoplasias GástricasRESUMO
Four cases of megaesophagus with esophageal motor disturbances secondary to adenocarcinoma of the cardia are hereby reported. There were common characteristics to all cases such as: 1) short duration of symptoms, 2) grade II megaesophagus by X-Rays with narrowing of the cardia, 3) the endoscopy showed esophageal dilatation and inability to pass the cardia with the endoscope, 4) histology (obtained by endoscopy or surgery) and exfoliative cytology were positive for malignancy, 5) the esophageal motility tests showed aperistalsis of the whole esophagus in all cases, and lack of relaxation of the lower esophageal sphincter in two. The urecholine test was positive in one patient with neoplastic infiltration of the myenteric plexus, 6) in two cases where esophageal resection was performed, infiltration of the Auerbachs plexus by cancer cells was proven. We conclude that in the presence of aperistalsis of the esophagus with or without achalasia of the lower esophageal sphincter, the diagnosis of megaesophagus secondary to cancer of the gastric fundus should be suspected when it is not possible to pass the cardia with the endoscope, even if biopsy and cytology are negative for malignancy.
RESUMO
Se presentan 4 casos de magaesofago secundario a adenocarcinoma de techo gastrico.Las caracteristicas comunes a todos ellos fueron: 1) escasa duracion de los sintomas 2) radiologia compatible con megaesofago grado II y afinamiento de la union esofagogastrica, 3) dialatacion esofagica e imposibilidad para franquear el cardias en la endoscopia, 4) la histologia obtenida por endoscopia o cirugia, y la citologia exfoliativa fueron positivas para neoplasia, 5) la electromanometria mostro en todos los casos aperistalsis de todo el cuerpo esofagico, y en dos esfinter esofagico inferior hipertensivo sin relajacion post-deglucion, 6) en los dos casos en que la reseccion del esofago fue realizada se comprobo infiltracion de los plexos de Auerbach por la neoplasia. Concluimos que en presencia de aperistalsis esofagica con o sin acalasia del esfinter esofagico inferior, debemos sopechar el diagnostico de megaesofago secundario a neoplasia del techo gastrico cuando el endoscopio no puede franquear el cardias, aun cuando la citologia y la biopsia sean negativas para neoplasia
Assuntos
Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Adenocarcinoma , Acalasia Esofágica , Neoplasias GástricasRESUMO
The usefulness of liver scintiscann and its correlation with final diagnosis was evaluated in a retrospective study of 195 patients with suspected hepatic disease. It was found that the overall sensitivity and specificity were 83% and 61%, respectively. These data are in accordance with other previously described. The highest diagnostic accuracy was found in diffuse and focal hepatocellular disease. Multifocal disease group showed the highest false negative interpretations. The role of the factors affecting our results is discussed.
Assuntos
Hepatopatias/diagnóstico por imagem , Fígado/diagnóstico por imagem , Estudos de Avaliação como Assunto , Humanos , Hepatopatias/diagnóstico , Cintilografia , Estudos RetrospectivosRESUMO
En un estudio retrospectivo de 195 pacientes en los que se sospechaba hepatopatia se evaluo la utilidad de la centellografia hepatica en cuanto a su correlacion con el diagnostico de certeza obtenido por otros metodos. Se observo que la sensibilidad y especificidad globales, 83% y 61% respectivamente estan dentro de las cifras ya comunicadas en otras series. En cuanto a la utilidad en las diferentes hepatopatias se observo una muy buena correlacion en la enfermedad difusa y le enfermedad unifocal en tanto que la enfermedad multifocal presento el mayor numero de falsos negativos.Se comentan los factores que pudieron influir en estos resultados
Assuntos
Humanos , Fígado , Hepatopatias , CintilografiaRESUMO
The usefulness of liver scintiscann and its correlation with final diagnosis was evaluated in a retrospective study of 195 patients with suspected hepatic disease. It was found that the overall sensitivity and specificity were 83
and 61
, respectively. These data are in accordance with other previously described. The highest diagnostic accuracy was found in diffuse and focal hepatocellular disease. Multifocal disease group showed the highest false negative interpretations. The role of the factors affecting our results is discussed.
RESUMO
En un estudio retrospectivo de 195 pacientes en los que se sospechaba hepatopatia se evaluo la utilidad de la centellografia hepatica en cuanto a su correlacion con el diagnostico de certeza obtenido por otros metodos. Se observo que la sensibilidad y especificidad globales, 83% y 61% respectivamente estan dentro de las cifras ya comunicadas en otras series. En cuanto a la utilidad en las diferentes hepatopatias se observo una muy buena correlacion en la enfermedad difusa y le enfermedad unifocal en tanto que la enfermedad multifocal presento el mayor numero de falsos negativos.Se comentan los factores que pudieron influir en estos resultados
Assuntos
Humanos , Cintilografia , Fígado , HepatopatiasRESUMO
Out of 90 patients with esophageal achalasia seen during the last decade, we found associated esophageal pathology in 46,6% of the cases. The esophagitis occurred with a frequency of 26,6%, whereas esophageal hiatus hernia was found in 14,4%, benign esophageal stenosis in 5,5%, diverticula in 2,2% and tumors in 2,2%. The role of the different ethiopatogeneic factors is discussed as well as the approach to the above mentioned entities.
Assuntos
Acalasia Esofágica/complicações , Doenças do Esôfago/etiologia , Adolescente , Adulto , Idoso , Criança , Divertículo Esofágico/complicações , Doenças do Esôfago/complicações , Neoplasias Esofágicas/complicações , Estenose Esofágica/complicações , Esofagite/complicações , Junção Esofagogástrica/fisiopatologia , Feminino , Hérnia Hiatal/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
De un total de 90 pacientes portadores de acalasia del esofago estudiados durante la ultima decada, encontramos patologia esofagica asociada a la enfermedad en cuestion en un 46,6% de los casos. Estas fueron esofagitis en 26.6%, hernia hiatal en 14,4%, estenosis benigna en 5,5%, diverticulos en 2,2% y tumores en 2,2%. Se discute la posible etiopatogenia de estas asociaciones y la conducta a seguir en ellas
Assuntos
Acalasia Esofágica , Estenose Esofágica , Esofagite , Hérnia HiatalRESUMO
Out of 90 patients with esophageal achalasia seen during the last decade, we found associated esophageal pathology in 46,6
of the cases. The esophagitis occurred with a frequency of 26,6
, whereas esophageal hiatus hernia was found in 14,4
, benign esophageal stenosis in 5,5
, diverticula in 2,2
and tumors in 2,2
. The role of the different ethiopatogeneic factors is discussed as well as the approach to the above mentioned entities.
RESUMO
De un total de 90 pacientes portadores de acalasia del esofago estudiados durante la ultima decada, encontramos patologia esofagica asociada a la enfermedad en cuestion en un 46,6% de los casos. Estas fueron esofagitis en 26.6%, hernia hiatal en 14,4%, estenosis benigna en 5,5%, diverticulos en 2,2% y tumores en 2,2%. Se discute la posible etiopatogenia de estas asociaciones y la conducta a seguir en ellas