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El doble arco aórtico persistente es una patología caracterizada por anomalías embrionarias en la vascularización, que pueden afectar de manera indirecta a otros sistemas, como el digestivo y el respiratorio. El objetivo de este documento es reportar un caso de doble arco aórtico, persistente en un cachorro Bull terrier, de seis meses de edad. El paciente ingresó a consulta por motivo de regurgitaciones frecuentes y pérdida ponderal. En el estudio radiográfico, se evidenció dilatación esofágica craneal a la base del corazón y en la toracotomía, se confirmó un doble arco aórtico persistente. Se realizó manejo nutricional y posteriormente, corrección quirúrgica de la anomalía vascular. Este es el primer caso de una anomalía de este tipo en Colombia. Se concluye, que un manejo quirúrgico enfocado a liberar el anillo estenosante y a recuperar la función esofágica, son la base terapéutica de este tipo de alteraciones.

Persistent double aortic arch is a pathology characterized by embryonic vascularization anomalies, which can indirectly affect other systems such as the digestive and respiratory systems. The objective of this document is to report a case of persistent double aortic arch in a six-month-old Bull Terrier puppy. The patient was admitted for consultation due to frequent regurgitation and weight loss. The radiographic study revealed cranial esophageal dilation at the base of the heart, and a thoracotomy confirmed a persistent double aortic arch. Nutritional management was performed and subsequently, surgical correction of the vascular anomaly. This is the first case of an anomaly of this type in Colombia. It is concluded that surgical management focused on releasing the stenosing ring and recovering esophageal function are the therapeutic basis for this type of alteration.

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ABSTRACT Background: No study has focused on Health-Related Quality of Life (HRQoL) for Chagas Achalasia patients. Objective: To compare HRQoL between Chagas Achalasia patients and the general population; and to correlate HRQoL with clinical factors that can affect it. Methods: Sixty Chagas Achalasia patients and 50 controls were evaluated. All patients underwent esophageal manometry for the diagnosis of achalasia and esophagogram to determine the grade of megaesophagus. Three questionnaires were used: 1) clinical: the following data were collected: demographic, medical history, body mass index, occurrence of six esophageal symptoms (Esophageal Symptom Score: number of symptoms reported by patients), duration of dysphagia; 2) socio-economic-cultural status evaluation: patients and controls answered seven questions about their socio-economic-cultural conditions; 3) HRQoL: the validated Brazilian-Portuguese version of the Short-form Health Survey (SF-36) questionnaire (license QM020039) was used. It measures health in eight domains: 3a) four physical: physical functioning, role limitations relating to physical health, bodily pain, and general health perception; 3b) four mental: vitality, social functioning, role limitations relating to emotional health, and mental health. These domains can be summarized into Physical and Mental Summary scores. We analyzed correlations between SF-36 Physical/Mental Summary Component scores and the following clinical factors: Esophageal Symptom Score, duration of dysphagia, body mass index, grades of megaesophagus (defined by the esophagogram) and presence/absence of megacolon (defined by opaque enema). Results: Patients and controls had similar age, gender, medical history, and socio-economic-cultural lifestyles (P>0.05). All patients had dysphagia and megaesophagus. SF-36 scores were significantly lower in Chagas Achalasia patients than controls for all eight domains (physicals: P<0.002; mentals: P<0.0027). The Physical and Mental Summary Component scores were also lower in Chagas Achalasia patients than controls (P<0.0062). For patients, the Physical Summary score was negatively correlated to Esophageal Symptom Score (P=0.0011) and positively correlated to body mass index (P=0.02). No other correlations were found. Conclusion: Chagas Achalasia patients have an impaired HRQoL in all physical and mental domains. Patients reporting more symptoms had worse physical domains. Patients with higher body mass index had better physical domains.

RESUMO Contexto: Não encontramos na literatura estudos sobre a qualidade de vida em pacientes com acalásia chagásica especificamente. Objetivo: Comparar a qualidade de vida de pacientes com acalásia chagásica e a da população em geral. Também, correlacionar a qualidade de vida nestes pacientes com fatores clínicos que possam afetá-la. Métodos: Estudamos 60 pacientes com acalásia chagásica e 50 controles. Todos os pacientes foram submetidos à manometria esofágica para diagnóstico de acalásia e esofagograma técnica padrão para determinar o grau do megaesôfago. Usamos 3 questionários: 1) clínico: foram coletados os seguintes dados: demográficos, história clínica, índice de massa corporal, presença de seis sintomas esofágicos (definimos Escore de Sintomas Esofágicos como o número de sintomas relatados pelos pacientes), duração da disfagia; 2) avaliação sócio-econômico-cultural: sete questões sobre as condições sócio-econômico-culturais foram perguntadas para pacientes e controles; 3) qualidade de vida: foi avaliada pelo questionário SF-36, versão validada para o português-Brasil (licença QM020039). Este é um questionário genérico que mede a qualidade de vida em oito domínios: 3a) quatro físicos: capacidade funcional, aspectos físicos, dor corporal, estado geral de saúde; 3b) quatro mentais: vitalidade, aspectos sociais, aspectos emocionais, saúde mental. Estes oito domínios podem ser compilados em dois escores: Sumário dos Escores Físicos e Sumário dos Escores Mentais. Na análise de fatores clínicos que pudessem afetar a qualidade de vida dos pacientes, avaliamos: escores de sintomas esofágicos, duração da disfagia, índice de massa corporal, graus de megaesôfago e presença/ausência de megacólon. Resultados: Os dois grupos (pacientes e controles) apresentaram semelhantes idade, gênero, história médica e condições socioeconômico-culturais (P>0,05). Todos os pacientes tinham disfagia e megaesôfago. Com relação à qualidade de vida, pacientes com acalásia chagásica apresentaram valores significativamente menores do que os controles em todos os domínios do questionário SF-36 (domínios físicos: P<0,002; domínios mentais: P<0,0027). Os Sumários dos Escores Físicos e Mentais também foram significativamente menores em pacientes do que nos controles (P<0.0062). A análise dos fatores clínicos que poderiam afetar a qualidade de vida nos pacientes mostrou que o Sumário dos Escores Físicos se correlaciona negativamente com o Escores Dos Sintomas Esofágicos (P=0,0011) e positivamente com o índice de massa corporal (P=0,02). Não observamos qualquer outra correlação. Conclusão: Pacientes com Acalásia Chagásica têm pior qualidade de vida que a população em geral, em todos os domínios físicos e mentais. Pacientes que relataram mais sintomas apresentaram pior qualidade de vida nos domínios físicos. Pacientes com valores maiores de índice de massa corporal apresentaram melhor qualidade de vida nos domínios físicos.

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Background: Aberrant right subclavian artery is only rarely observed in veterinary medicine. Some animals may present postprandial regurgitation and progressive weight loss, which is considered an incidental finding unrelated to clinical alterations. Advanced imaging techniques such as thoracic CT scan, magnetic resonance imaging (MRI) and contrast angiography are used for the accurate detection of lesions, anatomical changes and specific information about vascular rings. This paper describes the clinical changes, imaging exams and therapeutic approach in a female dog with megaesophagus induced by an aberrant right subclavian artery. Case: A 2-month-old female bull terrier, weighing 1.6 kg, with a history of regurgitation immediately or a few minutes after a meal, diarrhea, polyphagia, progressive emaciation and apathy for 45 days, was treated at a University Veterinary Hospital. The dog's physical examination revealed 7% dehydration and body condition score 1 (scale 1 to 5), but no cardiac or pulmonary alterations upon auscultation. The hematological analysis and renal and hepatic serum enzymes were within the normal range for the species. In view of the presumptive clinical diagnosis of vascular anomaly, suggested by the contrast X-ray examination, a chest tomography was performed, which revealed altered aortic arch shape and contours, and a posterior aneurysm in the area of abnormal connection of the right subclavian artery. The patient was released with a prescription for conservative dietary management for megaesophagus. Within two weeks, the patient returned with a report of a good response to the prescribed therapy, absence of vomiting and diarrhea, and an increase in body weight. Surgical correction was recommended, but has not been performed so far, but conservative treatment for megaesophagus was continued. No further episodes of regurgitation were identified during the nine-month follow-up period. Discussion: In the case reported here, the right subclavian artery is considered anatomically atypical because it arises directly from the aortic arch. This vascular anomaly passes on to the right pectoral limb, dorsal to the esophagus, contracting it in its dorsal aspect. It tends to affect purebred dogs, occurring more frequently in Irish setters, German shepherds and Labrador retrievers, although it has been described in other breeds such as the bull terrier documented here and mixed breed dogs. Vascular ring anomalies may not cause clinical changes in animals and represent only incidental findings, or they may lead to gastrointestinal changes resulting from esophageal stricture, contributing to megaesophagus and clinical signs of esophageal obstruction, especially in recently weaned puppies. Such alterations were observed in this case, with the dog presenting regurgitation, immediately or a few minutes after a meal, megaesophagus, diarrhea and progressive weight loss. A CT scan was performed to confirm the type and location of the vascular anomaly and diagnostic accuracy, as recommended in the literature. Dietary therapy is one of the approaches adopted for patients presenting with regurgitation resulting from megaesophagus secondary to vascular anomalies. The dog in this report responded well to the medical therapy; nevertheless, the treatment of choice to correct the esophageal obstruction caused by this anomaly is surgical sectioning of the aberrant vessel by right intercostal thoracotomy, given that the degree of esophageal dilation and dysfunction tends to increase over time. However, at this time, the animal's owner decided to suspend the recommended surgical procedure.

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Objetivos: classificar pacientes chagásicos com a forma digestiva da doença associando com variáveis demográficas, clínicas e de utilização de serviços de saúde, além de analisar as possibilidades de atuação da Atenção Primária à Saúde (APS) no manejo e acompanhamento dos casos. Casuística e métodos: estudo transversal com base em dados secundários provenientes de prontuários. Foram utilizadas as classificações do megaesôfago e do megacólon propostas por Rezende (1982) e Silva (2013), respectivamente. Resultados: Foram analisados 156 prontuários, sendo 94 (60,2%) relativos a megaesôfagos, 29 (18,6%) a megacólons e 29 (18,6%) a ambas as formas clínicas. O maior número de internações (p=0,02; OR=3,71) e de dias internados (p<0,01; OR=3,30) foi associado aos pacientes classificados nos grupos III e IV de megaesôfago. Em relação ao sexo masculino (p=0,02), o maior número de internações (p<0,0001) e de dias internados (p<0,0001) foi associado aos pacientes classificados no grau III de megacólon. Conclusões: Concluiu-se que a APS possui papel importante na diminuição da sobrecarga dos serviços de média e alta complexidade com o acompanhamento dos casos estáveis e menos graves e que a melhoria da qualidade de vida dos pacientes chagásicos é um efeito direto que pode ser esperado do protagonismo da APS neste cuidado.

Objectives: To classify chagasic patients with the digestive form of the disease, associating with demographic, clinical, and use of health services variables, in addition to analyzing the possibilities of Primary Health Care (PHC) acting in the management and follow-up of cases. Casuistry and Methods: A cross-sectional study based on secondary data from medical records was conducted. We used the classification of megaesophagus and megacolon proposed by Rezende (1982) and Silva (2013), respectively. Results: 156 medical records were analyzed: 94 (60.2%) related to megaesophagus, 29 (18.6%) to megacolon, and 29 (18.6%) with both clinical forms. The highest number of hospitalizations (p=0.02; OR=3.71) and days hospitalized (p<0.01; OR=3.30) were associated with patients classified in groups III and IV with megaesophagus. Male gender (p=0.02), more hospitalizations (p=0.0001), and more days in the hospital (p=0.0001) were all linked to patients classified as having gradeIII megacolon. Conclusions: We concluded that PHC has an important role in reducing the burden of medium and high-complexity services with the monitoring of stable and less severe cases. It also demonstrated the direct effect of PHC protagonism on the improvement of chagasic patients' quality of life.

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Resumen El megaesófago se presenta entre el 5 % y el 20 % de pacientes con acalasia, un trastorno motor esofágico primario reconocido hace más de 300 años, a considerarse en todo paciente con disfagia no explicada por un proceso obstructivo o inflamatorio luego de un estudio endoscópico detallado. Se presenta el caso de un paciente con disfagia progresiva, en quien se documentó megaesófago como complicación de una acalasia de largo tiempo de evolución, no tratada. Se descartó la enfermedad de Chagas mediante enzimoinmunoensayo (ELISA) e inmunofluorescencia indirecta (IFI), tal como recomiendan las guías actuales. Ante la baja frecuencia de esta entidad en nuestro medio y las implicaciones terapéuticas que tiene para los pacientes con acalasia, se realizó una revisión narrativa en la literatura sobre su diagnóstico y alternativas de manejo.

Abstract Megaesophagus occurs in between 5% and 20% of patients with achalasia. It is a primary esophageal motor disorder that has been known for more than 300 years. It should be considered in all patients with dysphagia that is not explained by an obstructive or inflammatory process after a detailed endoscopic study. The following is the case of a patient with progressive dysphagia, in whom megaesophagus was documented as a complication of untreated, long-standing achalasia. Chagas disease was ruled out by enzyme immunoassay (ELISA) and indirect immunofluorescence (IF), as recommended by current guidelines. Given the low frequency of this entity in our environment and the therapeutic implications for patients with achalasia, a narrative literature review was carried out to describe its diagnosis and treatment alternatives.

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ABSTRACT Background: Open and laparoscopic trans-hiatal esophagectomy has been successfully performed in the treatment of megaesophagus. However, there are no randomized studies to differentiate them in their results. Aim: To compare the results of minimally invasive laparoscopic esophagectomy (EMIL) vs. open trans-hiatal esophagectomy (ETHA) in advanced megaesophagus. Method: A total of 30 patients were randomized, 15 of them in each group - EMIL and ETHA. The studied variables were dysphagia score before and after the operation at 24-months follow-up; pain score in the immediate postoperative period and at hospital discharge; complications of the procedure, comparing each group. Were also studied: surgical time in minutes, transfusion of blood products, length of hospital stay, mortality and follow-up time. Results: ETHA group comprised eight men and seven women; in the EMIL group, four women and 11 men. The median age in the ETHA group was 47.2 (29-68) years, and in the EMIL group of 44.13 (20-67) years. Mean follow-up time was 33 months, with one death in each group, both by fatal aspiration. There was no statistically significant difference between the EMIL vs. ETHA scores for dysphagia, pain and in-hospital complications. The same was true for surgical time, transfusion of blood products and hospital stay. Conclusion: There was no difference between EMIL and ETHA in all the studied variables, thus allowing them to be considered equivalent.

RESUMO Racional: A esofagectomia trans-hiatal aberta e laparoscópica têm sido realizadas com êxito no tratamento do megaesôfago. Porém, não há estudos randomizados para diferenciá-las em seus resultados. Objetivo: Comparar os resultados da esofagectomia minimamente invasiva laparoscópica (EMIL) vs. esofagectomia trans-hiatal aberta (ETHA) no megaesôfago avançado. Método: Foram randomizados 30 pacientes, sendo alocados 15 em cada grupo - EMIL e ETHA. As variáveis estudadas foram escore de disfagia antes e após a operação no seguimento de 24 meses; escore de dor no pós-operatório imediato e na alta hospitalar; complicações do procedimento, comparando cada grupo. Foram também estudados: tempo cirúrgico em minutos, transfusão de hemoderivados, tempo de permanência hospitalar, mortalidade e tempo de seguimento. Resultados: Foram no grupo ETHA, oito homens e sete mulheres; no grupo EMIL, quatro mulheres e 11 homens. Faixa etária mediana no grupo ETHA foi de 47,2 (29-68) anos, e no grupo EMIL de 44,13 (20-67) anos. Tempo de seguimento médio foi de 33 meses, com um óbito em cada grupo, ambos por aspiração fatal. Não houve diferença estatística significativa, entre os grupos EMIL vs. ETHA quanto aos escores de disfagia, dor e complicações intra-hospitalares. O mesmo se verificou, quanto ao tempo cirúrgico, transfusão de hemoderivados e estadia hospitalar. Conclusão: Não houve diferença entre a EMIL e a ETHA em todas as variáveis estudadas, permitindo assim considerá-las equivalentes.

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Abstract Objective: To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays. Materials and Methods: This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening. Results: Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities. Conclusion: The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.

Resumo Objetivo: Identificar e classificar as alterações radiológicas no megaesôfago chagásico no esofagograma e na radiografia simples de tórax. Materiais e Métodos: Foram estudados 35 pacientes com diagnóstico de esofagopatia na manometria. As alterações encontradas no esofagograma foram estratificadas segundo a classificação de Rezende, dividida em quatro categorias, determinadas pelo grau de dilatação e alteração da motilidade do esôfago. Também foi realizada correlação desta classificação com os achados na radiografia de tórax: presença ou ausência de bolha gástrica, nível líquido e alargamento do mediastino. Resultados: A distribuição encontrada, segundo a classificação de Rezende, foi: grau I - 25,7% (9/35); grau II - 8,6% (3/35); grau III - 54,3% (19/35); grau IV - 11,4% (4/35). Nenhum paciente grau I apresentou alterações na radiografia simples. No grau II, o único achado foi a ausência da bolha gástrica (2/3). No grau III, 15 dos 19 pacientes apresentaram achados anormais na radiografia. Já no grau IV, em todos os quatro pacientes identificaram-se anormalidades no exame simples. Conclusão: A classificação de Rezende é praticável, encontrando-se desde achados sutis caracterizando os graus iniciais até a completa acinesia do dolicomegaesôfago. Os achados na radiografia de tórax são mais frequentes em pacientes com estágios avançados da doença e podem fazer aventar o grau da esofagopatia chagásica.

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Astenia esofágica o megaesófago se define por una dilatación patológica del esófago y caracterizado por una insuficiencia progresiva de las olas peristálticas. Esta enfermedad se puede clasificar en: idiopática, congénita o adquirida secundaria. La causa más común del megaesófago secundario es Miastenia gravis. Esta enfermedad se caracteriza por ser una neuropatía que desencadena un trastorno neuromuscular que causa debilidad del músculo esquelético, el esófago, la faringe y la laringe. La debilidad muscular se correlaciona con la mejoría tras el descanso y empeora con el ejercicio. El megaesófago secundario adquirido a la miastenia gravis se caracteriza por la interrupción del reflejo nervioso, controlador de la deglutición que afecta el funcionamiento de los músculos del esófago, lo que lleva a la dilatación pasiva del órgano. Razas como Pastor Alemán, Golden Retriever y Setter Irlandés tienen una mayor predisposición a la enfermedad.(AU)

Esophageal asthenia or megaesophagus is defined as a pathological dilation and progressive failure of peristaltic waves. This disease can be classified in: idiopathic, congenity or acquired secondary. The most common cause of acquired secondary megaesophagus is myasthenia gravis. This disease is defined as a neuropathy that develops a neuromuscular disorder, resulting in muscle weakness, of the esophagus, of the larynx and of the pharynx. The muscle weakness is related to improvement after rest and worsening with exercise. The megaesophagus secondary to myasthenia gravis is defined to nervous reflex breakdown, swallowing controller or lesions that affect the esophageal muscle function, resulting in an organ passive dilation. Breeds like German Shepherd, Golden Retriever and Irish Setter have a greater predisposition to disease.(AU)

Astenia esofágica ou megaesôfago é definido por uma dilatação patológica do esôfago e caracterizado por uma falha progressiva das ondas peristálticas. Essa doença pode ser classificada em: idiopática, congênita ou secundária adquirida. A causa mais comum de megaesôfago secundário adquirido é a miastenia gravis. Tal doença é caracterizada por ser uma neuropatia que desencadeia uma desordem neuromuscular, provocando fraqueza de musculatura esquelética, esôfago, faringe e laringe. A fraqueza muscular está correlacionada com melhora após o descanso e piora com o exercício. O megaesôfago adquirido secundário a miastenia gravis é caracterizado pelo rompimento do reflexo nervoso, controlador da deglutição ou que afeta o funcionamento da musculatura esofágica, levando a dilatação passiva do órgão. Raças como Pastor Alemão, Golden Retriever e Setter Irlandês possuem maior predisposição à doença.(AU)

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Astenia esofágica o megaesófago se define por una dilatación patológica del esófago y caracterizado por una insuficiencia progresiva de las olas peristálticas. Esta enfermedad se puede clasificar en: idiopática, congénita o adquirida secundaria. La causa más común del megaesófago secundario es Miastenia gravis. Esta enfermedad se caracteriza por ser una neuropatía que desencadena un trastorno neuromuscular que causa debilidad del músculo esquelético, el esófago, la faringe y la laringe. La debilidad muscular se correlaciona con la mejoría tras el descanso y empeora con el ejercicio. El megaesófago secundario adquirido a la miastenia gravis se caracteriza por la interrupción del reflejo nervioso, controlador de la deglutición que afecta el funcionamiento de los músculos del esófago, lo que lleva a la dilatación pasiva del órgano. Razas como Pastor Alemán, Golden Retriever y Setter Irlandés tienen una mayor predisposición a la enfermedad.

Esophageal asthenia or megaesophagus is defined as a pathological dilation and progressive failure of peristaltic waves. This disease can be classified in: idiopathic, congenity or acquired secondary. The most common cause of acquired secondary megaesophagus is myasthenia gravis. This disease is defined as a neuropathy that develops a neuromuscular disorder, resulting in muscle weakness, of the esophagus, of the larynx and of the pharynx. The muscle weakness is related to improvement after rest and worsening with exercise. The megaesophagus secondary to myasthenia gravis is defined to nervous reflex breakdown, swallowing controller or lesions that affect the esophageal muscle function, resulting in an organ passive dilation. Breeds like German Shepherd, Golden Retriever and Irish Setter have a greater predisposition to disease.

Astenia esofágica ou megaesôfago é definido por uma dilatação patológica do esôfago e caracterizado por uma falha progressiva das ondas peristálticas. Essa doença pode ser classificada em: idiopática, congênita ou secundária adquirida. A causa mais comum de megaesôfago secundário adquirido é a miastenia gravis. Tal doença é caracterizada por ser uma neuropatia que desencadeia uma desordem neuromuscular, provocando fraqueza de musculatura esquelética, esôfago, faringe e laringe. A fraqueza muscular está correlacionada com melhora após o descanso e piora com o exercício. O megaesôfago adquirido secundário a miastenia gravis é caracterizado pelo rompimento do reflexo nervoso, controlador da deglutição ou que afeta o funcionamento da musculatura esofágica, levando a dilatação passiva do órgão. Raças como Pastor Alemão, Golden Retriever e Setter Irlandês possuem maior predisposição à doença.

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ABSTRACT: Megaesophagus is a rare disease in ruminants characterized by regurgitation of rumen contents. In this paper it was described cases of megaesophagus in two sheep and two goats on a farm in the state of Paraíba, Northeastern Brazil. All animals showed regurgitation of rumen contents and weight loss, with a clinical course of several months. At necropsy all animals presented megaesophagus. Histological examination showed segmental muscle necrosis in the esophagus and skeletal muscles. Serum samples from one sheep and one goat were negative for the presence of blue tongue antibodies by ELISA, and whole blood and muscle samples from one goat were negative for this virus by RT PCR. Epidemiological data and pathology suggested that the disease could have been caused by some toxic plant, but known plants causing segmental muscle necrosis were not observed in the areas where the disease occurred.

RESUMO: Megaesôfago é uma enfermidade rara em ruminantes caracterizada por regurgitação do conteúdo ruminal. Neste trabalho, descrevem-se casos de megaesôfago em dois ovinos e dois caprinos no Estado da Paraíba. Todos os animais apresentaram regurgitação do conteúdo ruminal e emagrecimento, com evolução de vários meses. Nas necropsias dos animais, observou-se dilatação esofágica e, em exames histológicos, necrose muscular segmentar no esôfago e músculos esqueléticos. Não foram encontrados anticorpos para o vírus da língua azul nos soros de um ovino e um caprino pela técnica de ELISA. Sangue total e músculo de um caprino resultaram negativos para esse vírus por RT PCR. Sugere-se que a doença seja causada por alguma planta tóxica, mas não foram encontradas plantas conhecidas por causarem necrose segmentar muscular nos piquetes onde ocorreu a doença.

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Megaesophagus is a rare disease in ruminants characterized by regurgitation of rumen contents. In this paper it was described cases of megaesophagus in two sheep and two goats on a farm in the state of Paraíba, Northeastern Brazil. All animals showed regurgitation of rumen contents and weight loss, with a clinical course of several months. At necropsy all animals presented megaesophagus. Histological examination showed segmental muscle necrosis in the esophagus and skeletal muscles. Serum samples from one sheep and one goat were negative for the presence of blue tongue antibodies by ELISA, and whole blood and muscle samples from one goat were negative for this virus by RT PCR. Epidemiological data and pathology suggested that the disease could have been caused by some toxic plant, but known plants causing segmental muscle necrosis were not observed in the areas where the disease occurred.(AU)

Megaesôfago é uma enfermidade rara em ruminantes caracterizada por regurgitação do conteúdo ruminal. Neste trabalho, descrevem-se casos de megaesôfago em dois ovinos e dois caprinos no Estado da Paraíba. Todos os animais apresentaram regurgitação do conteúdo ruminal e emagrecimento, com evolução de vários meses. Nas necropsias dos animais, observou-se dilatação esofágica e, em exames histológicos, necrose muscular segmentar no esôfago e músculos esqueléticos. Não foram encontrados anticorpos para o vírus da língua azul nos soros de um ovino e um caprino pela técnica de ELISA. Sangue total e músculo de um caprino resultaram negativos para esse vírus por RT PCR. Sugere-se que a doença seja causada por alguma planta tóxica, mas não foram encontradas plantas conhecidas por causarem necrose segmentar muscular nos piquetes onde ocorreu a doença.(AU)

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BACKGROUND: Idiopathic esophageal achalasia is an inflammatory disease of unknown origin, characterized by aperistalsis of the esophageal body and failure of the lower esophageal sphincter in response to swallowing, with consequent dysphagia. AIM: To demonstrate the results of surgical therapy in these patients, evaluating the occurred local and systemic complications. METHODS: Were studied retrospectively 32 patients, 22 of whom presented non-advanced stage of the disease (Stage I/II) and 10 with advanced disease (Stage III/IV). All of them had the clinical conditions to be submitted to surgery. The diagnoses were done by clinical, endoscopic, cardiological, radiological and esophageal manometry analysis. Pre-surgical evaluation was done with a questionnaire based on the most predisposing factors in the development of the disease and the surgical indication was based on the stage of the disease. RESULTS: The patients with non-advanced stages were submitted to cardiomyotomy with fundoplication, wherein in the post-surgical early assessment, only one (4,4%) presented pulmonary infection, but had a good outcome. In patients with advanced disease, seven were submitted to esophageal mucosectomy preserving the muscular layer, wherein one patient (14,2%) presented dehiscence of gastric cervical esophagus anastomosis as well as pulmonary infection; all of these complications were resolved with proper specific treatment; the other three patients with advanced stage were submitted to transmediastinal esophagectomy; two of them presented hydropneumothorax with good evolution, and one of them also presented fistula of the cervical esophagogastric anastomosis, but with spontaneous healing after conservative treatment and nutritional support. The two patients with fistula of the cervical anastomosis progressed to stenosis, with good results after endoscopic dilations. In the medium and long term assessment done in 23 patients, all of them reported ...

RACIONAL: A acalásia idiopática do esôfago é doença inflamatória de causa desconhecida, caracterizada por aperistalse do corpo do esôfago e falha do relaxamento do esfíncter esofágico inferior em resposta às deglutições, com consequente disfagia. OBJETIVO: Demonstrar os resultados da terapêutica cirúrgica desses pacientes, avaliando suas complicações locais e sistêmicas. MÉTODOS: Foram estudados retrospectivamente 32 pacientes portadores de acalásia idiopática do esôfago, sendo 22 com doença não avançada (Grau I/II) e 10 com doença avançada (Grau III/IV); todos tinham condições clínicas de serem submetidos à terapêutica cirúrgica. O diagnóstico foi realizado por meio de análise clínica, endoscópica, cardiológica, radiológica e manométrica. Foi realizada avaliação pré-operatória com questionário baseado nos fatores mais predisponentes ao desenvolvimento da doença, e a indicação da técnica cirúrgica foi baseada no grau da lesão. RESULTADOS: Os pacientes com doença não avançada foram submetidos à cardiomiotomia com fundoplicatura, sendo que na avaliação precoce do pós-operatorio apenas um deles (4,4%) apresentou infecção pulmonar, mas com boa evolução. Os pacientes com doença avançada em sete foi realizada a mucosectomia esofágica com conservação da túnica muscular, sendo que um paciente (14,2%) apresentou deiscência da anastomose esofagogástrica cervical e também infecção pulmonar, tendo ambas complicações sido resolvidas com tratamento específico; os outros três com doença avançada foram submetidos à esofagectomia transmediastinal, sendo que dois apresentaram hidropneumotórax, com boa evolução; um destes pacientes também apresentou fistula da anastomose esofagogástrica cervical, mas com fechamento espontâneo após tratamento conservador e suporte nutricional. Os dois pacientes que apresentaram fistula da anastomose cervical, evoluíram com estenose, mas com boa evolução após dilatações endoscópicas. Na avaliação a médio e longo prazos realizada ...

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La acalasia es una enfermedad que se caracteriza por la ausencia del peristaltismo esofágico, falta de relajación del esfínter esofágico inferior y por la presencia de una zona de alta presión en la parte inferior del esófago. Hasta la actualidad no se conoce manera alguna de mejorar la actividad peristáltica del esófago en los pacientes con acalasia. La peristalsis del músculo liso esofágico son el resultado de la lesión de inervación que compromete al plexo mientérico esofágico con degeneración de las células ganglionares.

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As anomalias dos anéis vasculares são alterações congênitas provocadas por defeitos na embriogênese dos arcos aórticos, sendo a persistência de arco aórtico direito a mais comum. Essas anomalias podem, por muitas vezes comprimir estruturas adjacentes como traqueia e esôfago, causando dispneia e disfagia. Embora não exista sinal clínico patognomônico para a alteração, a regurgitação é a principal alteração encontrada.As radiografias torácicas contrastadas são preferidas em relação as radiografias simples, entretanto, o diagnóstico definitivo é conseguido no momento da exploração cirúrgica. O tratamento da anomalia é cirúrgico,entretanto, as condições clínicas de cada paciente devem ser levadas em consideração antes de se optar pelo procedimento cirúrgico. O presente trabalho tem como objetivo relatar o sucesso no tratamento clínico-cirúrgico de um cão da raça dogue alemão, portador de persistência de arco aórtico direito.AU

The anomalies of congenital vascular rings are caused by defects in embryogenesis from the aortic arch, and persistent right aortic arch most common. These anomalies may, for often compress adjacent structures such as the trachea and esophagus, causing dyspnea and dysphagia. Although there is no pathognomonic clinical signs for the amendment, regurgitation is the main alteration found. Thoracic radiographs are contrasted preferred over the plain radiographs, however, a definitive diagnosis is achieved at the time of surgical exploration. The surgical treatment of this anomaly is, however, the clinical conditions of each patient should be taken into consideration before opting for surgery. This study aims to report success in medical and surgical treatment of a dog breed German Dog carrier persistent right aortic arch.

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As anomalias dos anéis vasculares são alterações congênitas provocadas por defeitos na embriogênese dos arcos aórticos, sendo a persistência de arco aórtico direito a mais comum. Essas anomalias podem, por muitas vezes comprimir estruturas adjacentes como traqueia e esôfago, causando dispneia e disfagia. Embora não exista sinal clínico patognomônico para a alteração, a regurgitação é a principal alteração encontrada.As radiografias torácicas contrastadas são preferidas em relação as radiografias simples, entretanto, o diagnóstico definitivo é conseguido no momento da exploração cirúrgica. O tratamento da anomalia é cirúrgico,entretanto, as condições clínicas de cada paciente devem ser levadas em consideração antes de se optar pelo procedimento cirúrgico. O presente trabalho tem como objetivo relatar o sucesso no tratamento clínico-cirúrgico de um cão da raça dogue alemão, portador de persistência de arco aórtico direito.

The anomalies of congenital vascular rings are caused by defects in embryogenesis from the aortic arch, and persistent right aortic arch most common. These anomalies may, for often compress adjacent structures such as the trachea and esophagus, causing dyspnea and dysphagia. Although there is no pathognomonic clinical signs for the amendment, regurgitation is the main alteration found. Thoracic radiographs are contrasted preferred over the plain radiographs, however, a definitive diagnosis is achieved at the time of surgical exploration. The surgical treatment of this anomaly is, however, the clinical conditions of each patient should be taken into consideration before opting for surgery. This study aims to report success in medical and surgical treatment of a dog breed German Dog carrier persistent right aortic arch.

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JUSTIFICATIVA E OBJETIVOS: A doença de Chagas é uma infecção parasitária, endêmica, em várias regiões do Brasil. Nas últimas décadas, a via de transmissão predominante foi modificada de vetorial para congênita, devido ao êxodo rural e aos métodos mais eficazes de combate aos vetores. Alguns pacientes jovens apresentam manifestações crônicas e intensas, consequentes da transmissão congênita. O objetivo deste estudo foi relatar um caso de uma paciente com doença de Chagas de transmissão vertical com manifestações variadas da doença. Ressalta-se a importância de se conhecer diversas formas de transmissão e, ademais, enfatiza-se a importância de realizar adequado pré-natal em áreas endêmicas para possível diagnóstico, tratamento precoce e acompanhamento clínico. RELATO DO CASO: Paciente do sexo feminino, 20 anos, solteira, apresentando há 8 meses dispneia aos mínimos esforços, precordialgia, epigastralgia e tosse seca, evoluindo com disfagia, confirmando-se o diagnóstico de insuficiência cardíaca com exames complementares. A investigação prosseguiu com provas sorológicas, eletrocardiograma, radiografia do coração e vasos da base (RCVB), Ecodopplercardiograma, confirmando-se: IgG positivo para Chagas em dois testes sorológicos (hemaglutinação indireta e imunofluorescência para T. Cruzi), alterações eletrocardiográficas difusas, megaesôfago grau II, cardiomegalia grau III. Foi realizado tratamento etiológico com benzonidazol (Rochagan®) para doença de Chagas crônica de início recente. Apesar da dificuldade na obtenção dos exames complementares,objetivando maior acurácia no diagnóstico e melhor acompanhamento do tratamento, concluiu-se que era um caso de doença de Chagas congênita, uma vez que a história familiar era positiva e a paciente não teve contato com triatomídeos (morou sempre na área urbana) e a transmissão vetorial está diminuindo devido às campanhas de erradicação dos vetores...

BACKGROUND AND OBJECTIVES: Chagas disease is a parasitic infection, endemic in several regions of Brazil. In recent decades the predominant route of transmission changed from vectorial to congenital, due to rural exodus and more effective methods for fighting the vectors. Some young patients have chronic and severe manifestations due to congenital transmission. The aim of this study was to report a case of a young adult patient with Chagas disease vertical transmission, with varied clinical manifestations of the disease. The importance of knowing the various forms of transmission was emphasized and also of the importance of prenatal assistance in endemic areas for possible early diagnosis, treatment and clinical follow up. CASE REPORT: Female patient, 20 years old, single, has presented experiencing, for the previous 8 months, dyspnea on exertion, constrictive chest pain, epigastric pain, and dry cough associated with progressive dysphagia; the diagnosis of heart failure was confirmed by complementary tests. The investigation progressed with serological tests, electrocardiogram, chest teleradiograph, echodopplercardiogram, confirming: IgG positive for Chagas disease, in two different serological tests (indirect hemagglutination assay and immunofluorescence for T cruzi), diffuse electrocardiographic changes, grade II megaesophagus, grade III cardiomegaly. Etiological treatment was conducted with benzonidazol (Rochagan®) for chronic Chagas disease of recent onset. Despite the difficulty in obtaining additional tests, aiming greater accuracy in the diagnosis and better monitoring of the treatment, it was concluded that it was a case of congenital Chagas disease, since family history is positive and the patient denied having contact with triatomids (hematophagus bugs) as she has always lived in urban areas, and because vectorial transmission is declining due to campaigns for eradication of the vectors...

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Background: Megaesophagus is a disease characterized by widespread dilation of the esophagus, with partial or total loss of the organ peristalsis, produced by a neuromuscular disorder and it can be present as manifestation of several diseases. The most common sign on animals is the regurgitation, which usually happens right after the ingestion of solids. The diagnosis is based on the clinical signs and radiographic exam, where it is possible to observe a contrasted and extensive esophagus. The clinical treatment consists of small semi-solid or liquid meals served in small amounts, with the animal in elevated position. This work reports a swine megaesophagus, occurred in one of the animals housed in the Sector of Clinic and Reproduction of Swine of the Universidade Federal de Santa Maria (UFSM), RS, Brazil..Case: A male swine, six months of age was housed in the center of artifi cial insemination, showing some adaptation difficulties to the new facilities, climate, as well as feeding. A reduced feed intake was observed, however, without alterations behavioral or sanitary. The animal was trained progressively for semen collection, presenting eventually regurgitation, which became more frequent with the insistence in feeding. Usually the refl ux happened fi ve to ten minutes after the ingestion of ration and/or water, with variable volume, texture and aspect similar to the saliva

Background: Megaesophagus is a disease characterized by widespread dilation of the esophagus, with partial or total loss of the organ peristalsis, produced by a neuromuscular disorder and it can be present as manifestation of several diseases. The most common sign on animals is the regurgitation, which usually happens right after the ingestion of solids. The diagnosis is based on the clinical signs and radiographic exam, where it is possible to observe a contrasted and extensive esophagus. The clinical treatment consists of small semi-solid or liquid meals served in small amounts, with the animal in elevated position. This work reports a swine megaesophagus, occurred in one of the animals housed in the Sector of Clinic and Reproduction of Swine of the Universidade Federal de Santa Maria (UFSM), RS, Brazil..Case: A male swine, six months of age was housed in the center of artifi cial insemination, showing some adaptation difficulties to the new facilities, climate, as well as feeding. A reduced feed intake was observed, however, without alterations behavioral or sanitary. The animal was trained progressively for semen collection, presenting eventually regurgitation, which became more frequent with the insistence in feeding. Usually the refl ux happened fi ve to ten minutes after the ingestion of ration and/or water, with variable volume, texture and aspect similar to the saliva

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O presente relato descreve o caso clínico de um cão, fêmea, sem raça definida de cinco anos de idadecom apresentação clínicopatológica de dermatomiosite generalizada de início na vida adulta. A apresentação dermatológica consistiu de lesões ulceradas e crostosas, com edema associado, localizadas mormente em membros, axilas e cabeça. A miosite manifestou-se por atrofia muscular e megaesôfago, que regrediram espontaneamente. A despeito da conduta terapêutica utilizada, a doençadermatológica mostrou-se clinicamente refratária aos fármacos n ormalmente preconizados. (AU)

The present report describes a clinical case of a five years old female dog, not defined breed, clinical and pathological presentation of widespread dermatomyositis who had the beginning in the adult life. The dermatological presentation consists in crusting and ulcerative lesions with edema associated, usually located in members, armpit and head. The myositis was demonstrated by muscular atrophy and megaesophagus, who return spontaneous. Despite the treatment protocol used, the dermatologycaldisease not demonstrated clinical responsive to the drugs who often been prescribed. (AU)

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Background: Megaesophagus is a disease characterized by widespread dilation of the esophagus, with partial or total loss of the organ peristalsis, produced by a neuromuscular disorder and it can be present as manifestation of several diseases. The most common sign on animals is the regurgitation, which usually happens right after the ingestion of solids. The diagnosis is based on the clinical signs and radiographic exam, where it is possible to observe a contrasted and extensive esophagus. The clinical treatment consists of small semi-solid or liquid meals served in small amounts, with the animal in elevated position. This work reports a swine megaesophagus, occurred in one of the animals housed in the Sector of Clinic and Reproduction of Swine of the Universidade Federal de Santa Maria (UFSM), RS, Brazil..Case: A male swine, six months of age was housed in the center of artifi cial insemination, showing some adaptation difficulties to the new facilities, climate, as well as feeding. A reduced feed intake was observed, however, without alterations behavioral or sanitary. The animal was trained progressively for semen collection, presenting eventually regurgitation, which became more frequent with the insistence in feeding. Usually the refl ux happened fi ve to ten minutes after the ingestion of ration and/or water, with variable volume, texture and aspect similar to the saliva

Background: Megaesophagus is a disease characterized by widespread dilation of the esophagus, with partial or total loss of the organ peristalsis, produced by a neuromuscular disorder and it can be present as manifestation of several diseases. The most common sign on animals is the regurgitation, which usually happens right after the ingestion of solids. The diagnosis is based on the clinical signs and radiographic exam, where it is possible to observe a contrasted and extensive esophagus. The clinical treatment consists of small semi-solid or liquid meals served in small amounts, with the animal in elevated position. This work reports a swine megaesophagus, occurred in one of the animals housed in the Sector of Clinic and Reproduction of Swine of the Universidade Federal de Santa Maria (UFSM), RS, Brazil..Case: A male swine, six months of age was housed in the center of artifi cial insemination, showing some adaptation difficulties to the new facilities, climate, as well as feeding. A reduced feed intake was observed, however, without alterations behavioral or sanitary. The animal was trained progressively for semen collection, presenting eventually regurgitation, which became more frequent with the insistence in feeding. Usually the refl ux happened fi ve to ten minutes after the ingestion of ration and/or water, with variable volume, texture and aspect similar to the saliva

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Background: Megaesophagus is a disease characterized by widespread dilation of the esophagus, with partial or total loss of the organ peristalsis, produced by a neuromuscular disorder and it can be present as manifestation of several diseases. The most common sign on animals is the regurgitation, which usually happens right after the ingestion of solids. The diagnosis is based on the clinical signs and radiographic exam, where it is possible to observe a contrasted and extensive esophagus. The clinical treatment consists of small semi-solid or liquid meals served in small amounts, with the animal in elevated position. This work reports a swine megaesophagus, occurred in one of the animals housed in the Sector of Clinic and Reproduction of Swine of the Universidade Federal de Santa Maria (UFSM), RS, Brazil.. Case: A male swine, six months of age was housed in the center of artificial insemination, showing some adaptation difficulties to the new facilities, climate, as well as feeding. A reduced feed intake was observed, however, without alterations behavioral or sanitary. The animal was trained progressively for semen collection, presenting eventually regurgitation, which became more frequent with the insistence in feeding. Usually the reflux happened five to ten minutes after the ingestion of ration and/or water, with variable volume, texture and aspect similar to the saliva and pH varying from eight to nine. The animal kept normal appetite, however with slow and progressive loss weigh. It was submitted to endoscopy and contrast radiographic study, leading to megaesophagus confirmation. After the diagnostic, it was suggested the hypothesis that the pathology was developed due to a serious stressful situations of adaptation imposed to the animal, which might contributed triggering the process. Discussion: Megaesophagus is characterized basically by dilation and increase of the organ, peristaltism absence, presence of tertiary contractions and the absence of total or partial inferior sphincter relaxation. These changes could lead to dysphagia that, consequently could compromise the nutritional state. Besides regurgitation, loss weight and anormal development, it is possible to observe cough, mucoid and purulent nasal discharge, as well as dyspnea with pneumonia due to the concomitant aspiration. Among the clinical signs presented by the animal, it is possible to report the regurgitation time in variable frequencies and the loss weight. The diagnosis performed in this animal was based on observation of clinical signs and radiographic exam, where it was possible to visualize a dilated esophagus. The treatments in cases like this usually are in order to provide support conditions or through surgical procedures. The first is characterized by changes on animal management practices, besides the utilization of drugs such as antibiotics, prokinetic and antacids. By the other hand the surgical methods are supported by several techniques, such as the esophagus-diaphragmatic cardioplasty, Heller myotomy, associated to fundoplication. Some animals with congenital idiopathic megaesophagus are able to recover themselves while the ones which are acquired are irreversible. Regarding to the secondary megaesophagus, once the cause is removed the animal has chance of recovering. Therefore, the prognostic for secondary and congenital megaesophagus range from reserved to favorable, while for the acquired cases it is not favorable (as this case report).

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