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Items 1-17 of 17 |
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One page. |
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Clinical and endoscopic aspects in the evolution of patients with bleeding peptic ulcer--a cohort study.
Segal F, Prolla JC, Maguilnik I, Wolff FH
Clinical Hospital of Porto Alegre, Department of Internal Medicine, Federal University of Rio Grande do Sul-UFRGS, RS, Brazil.
[Medline record in process]
BACKGROUND: Bleeding ulcers are a major problem in public health and represent approximately half of all the cases of upper gastrointestinal hemorrhage in the United States. This study aims to determine the prognostic value of factors such as clinical history, laboratory and endoscopic findings in the occurrence of new episodes of bleeding in patients who have upper gastrointestinal hemorrhage caused by gastric or duodenal peptic ulcer. METHODS: A cohort study with 94 patients was designed to investigate prognostic factors to the occurrence of new episodes of bleeding. RESULTS: From the 94 patients studied, 88 did not present a new bleeding episode in the 7 days following hospital admission. The incidence of rebleeding was significantly higher in those patients with hemoglobin < 6 g/dL at the admission (P = 0.03, RR = 6.2). The localization of the ulcers in bulb was positively associated to rebleeding (P = 0.003). The rebleeding group needed a greater number of units transfunded (P = 0.03) and the time of hospitalization was longer than the time of the hemostasia group (P = 0.0349). CONCLUSIONS: The identification of patients with risk of death by bleeding peptic ulcer remains as a challenge, once few factors are capable of predicting the severity of the evolution. The identification of such factors will alow the choice of the better therapeutic conduct improving the diagnosis and decreasing the rate of rebleeding and the mortality. Copyright 2000 Academic Press.
PMID: 11236268
Karyometry in Barrett's esophagus.
da Silva VD, Prolla JC, Sharma P, Sampliner R, Thompson D, Bartels PH
Department of Pathology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
[Medline record in process]
OBJECTIVE: To derive a progression curve for lesions in Barrett's esophagus based on karyometric features. STUDY DESIGN: High-resolution imagery of 900 nuclei from normal gastric tissue, Barrett's metaplasia, Barrett's high grade dysplasia and adenocarcinoma of the esophagus was recorded. Karyometric features were computed, and nuclear signatures and lesion signatures for these lesions were derived. A progression curve was defined. RESULTS: Esophageal lesions were distinctly different from the normal gastric fundus tissue, with nuclei from Barrett's metaplasia deviating from normal almost as much as nuclei from high grade dysplasia and adenocarcinoma. There was considerable case-to-case variability and overlap between lesions histologically assigned to different diagnostic categories. CONCLUSION: The karyometric data suggest that Barrett's metaplasia is a more developed lesion than previously assumed. Copyright 2000 Academic Press.
PMID: 11233742
[Micronuclei research the esophageal mucosa and its relationship with risk factors with cancer of the esophagus].
[Article in Portuguese]
Dietz J, Diehl AS, Prolla JC, Furtado CD, Furtado AD
Hospital Nossa Senhora Conceicao e Hospital de Clinicas de Porto Alegre, Porto Alegre, RS.
PURPOSE: To demonstrate the frequency of micronucleus in esophageal mucous cells of smokers, consumers of alcoholic beverages and "mate" drinkers. METHODS: Material collected from the midlle esophagus in 250 consecutive patients submitted to upper digestive endoscopy was stained with acridine orange and the cytologist determined the number of micronuclei vizualized per each 500 cells examined. RESULTS: The frequency of micronucleated cells did not vary significantly (p > 0.05) when the following variables were considered: sex, place of residence (rural or urban), type of care (outpatient or inpatient), ingestion of alcohol. For two variables, smoking and "mate" consumption, there were significant differences in the frequency of micronuclei in the categories exposed and formerly exposed in relation to never exposed. CONCLUSION: A higher frequency of micronucleus in the esophageal mucous in smoking and "mate" drinkers was evidenced by this study. Copyright 2000 Academic Press.
PMID: 11070510
Combined carcinoembryonic antigen and cytopathologic examination in ascites.
Torresini RJ, Prolla JC, Diehl AR, Morais EK, Jobim LF
Department of Internal Medicine, Federal University of Rio Grande do Sul, Brazil.
OBJECTIVE: To investigate use of the combined carcinoembryonic antigen (CEA) test and cytopathologic examination to improve the diagnosis of neoplastic vs. nonneoplastic ascites. STUDY DESIGN: The tests were performed prospectively on 130 patients with ascites whose effusions were submitted for cytologic examination. RESULTS: Sixty-seven patients had epithelial tumors, and the cytologic examination was positive in 39 (58.2%). The CEA level was > or = 11.0 ng/mL in 36 patients (53.73%). CEA was helpful in the diagnosis in 18 cases, increasing to 57 (85.07%) the number of positive diagnoses. Eight samples of nonepithelial tumors had low levels of CEA. In 55 patients with nonneoplasic ascites the cytopathologic examination was negative, but the CEA assay was > 11.0 ng/mL in 3 patients. CONCLUSION: The cytopathologic examination should be performed in all cases, and the CEA assay should be done in suspected cases of epithelial neoplasia in which the cytologic examination was negative, there was uncertainty about the histologic type of neoplasia, or a diagnosis of nonepithelial neoplasia was made. When ascitic leukocytosis or hepatic failure is present, one should be cautious in interpreting the CEA assay because false positivity can occur. Copyright 2000 Academic Press.
PMID: 11015979
[High temperature "mate" infusion drinking in a population at risk for squamous cell carcinoma of the esophagus].
[Article in Portuguese]
de Barros SG, Ghisolfi ES, Luz LP, Barlem GG, Vidal RM, Wolff FH, Magno VA, Breyer HP, Dietz J, Gruber AC, Kruel CD, Prolla JC
Grupo de Estudos e Pesquisa em Cancer de Esofago (GEPECE) do Hospital de Clinicas de Porto Alegre e da Faculdade de Medicina, Universidade Federal do Rio Grande do [email protected]
"Mate", a popular hot infusion of a herb (Ilex paraguayensis) drunk in large volumes, is a known risk factor for squamous cell carcinoma of the esophagus and there is a suspicion that high temperature of boiled water used for the infusion may contribute for carcinogenesis. METHODS: We measured the temperature of "mate" infusion drunk by a sample of the population at risk for this carcinoma in Taquara, southern Brazil. We interviewed inhabitants for drinking habits and the temperature of the infusion was measured with high precision thermometers. Temperature of the infusion was asked to consumers and their estimate compared to our measurements. We considered 60 degrees C or higher as "hot". RESULTS: In 36 residencies, 107 individuals were drinking "mate". Most individuals drank it daily (97.2%), and the medium daily volume was 1,265 ml (SD +/- 1,132 mL) ranging from 250 to 6,000 mL. The measured temperature was 60 degrees C or higher in 72% of residencies with medium of 63.4 degrees C (51-78 degrees C) and median 64.4 degrees C. CONCLUSION: In this study, "mate" was consumed in large volumes at high temperature and individuals did not estimate correctly the temperature of infusion. High temperatures of "mate" may contribute to carcinogenesis in this population. Copyright 2000 Academic Press.
PMID: 10962624
Esophageal dysplasias are detected by endoscopy with Lugol in patients at risk for squamous cell carcinoma in southern Brazil.
Freitag CP, Barros SG, Kruel CD, Putten AC, Dietz J, Gruber AC, Diehl AS, Meurer L, Breyer HP, Wolff F, Vidal R, Arruda CA, Luz LP, Fagundes RB, Prolla JC
Gastroenterology and Pathology Services, Hospital de Clinicas de Porto Alegre, Brazil.
Diagnosis of squamous cell carcinoma of the esophagus is usually late. Staining of the mucosa with Lugol's solution during endoscopy has been suggested to identify early cancer/dysplasia and may improve prognosis. Lugol was tested during endoscopy in 96 asymptomatic subjects at risk for this tumor, who were found to have atypias after exfoliative cytology in southern Brazil. Biopsies were obtained in Lugol's 'stained' and 'unstained' areas in the esophageal mucosa and the histologic results were compared. 'Unstained' areas were present in 64 (66.7%) instances: 44 'unstained' areas over mucosa with normal appearance revealed seven dysplasias (four high and three low grade), whereas 20 'unstained' areas with visible lesions contained only one dysplasia (low grade). 'Stained' areas in 96 (100%) subjects showed two additional dysplasias (one high and one low grade). In this study, Lugol 'unstained' areas were of great value for detection of dysplasias (sensitivity = 80%; specificity = 63%; p = 0.01, Fisher's exact test; CI = 95%; odds ratio = 6.7). Copyright 2000 Academic Press.
PMID: 10631911
[Prevalence of adenocarcinoma of the esophagus and esophagogastric junction in a 10 year period at a cancer referral center in southern Brazil].
[Article in Portuguese]
de Barros SG, Vidal RM, Luz LP, Ghisolfi ES, Barlem GG, Komlos F, Wolff FH, Breyer HP, Putten AC, Dietz J, Kruel CD, Gruber AC, Prolla JC
Grupo de Estudos e Pesquisas em Cancer de Esofago, GEPECE, Hospital de Clinicas de Porto Alegre. [email protected]
There is increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction in the USA and Europe, however, data in Brazil are scanty. OBJECTIVE AND METHODS: We reviewed all histology confirmed esophageal and esophagogastric junction cancer reports during a 10-year period (1987-1996) obtained by upper digestive endoscopy biopsies at a cancer referral center in Southern Brazil. Cancer cases were classified in three categories: adenocarcinoma, squamous cell carcinoma, and others. RESULTS: Among 349 cases, adenocarcinoma was found in 53 (15.2%), squamous cell carcinoma in 283 (81.1%) and others in 13 (3.7%). CONCLUSIONS: In this study, the prevalence of adenocarcinoma was 15%. Copyright 2000 Academic Press.
PMID: 10511877
Esophageal dysplasia and chronic esophagitis: detection at upper gastrointestinal tract endoscopy.
Gruber AC, de Barros SG, Putten AC, Gigante L, Coelho N, Sekine S, Prolla JC
Grupo de Estudos e Pesquisa em Cancer do Esofago (GEPECE) do Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
Cancer of the esophagus becomes symptomatic at an advanced phase with a late diagnosis, when the tumor is already incurable. Early diagnosis has been shown to improve the survival rates. Conventional esophagoscopy is largely available but its sensitivity to detect early cancer or precancerous lesions remains controversial. In this study we tested the sensitivity of conventional esophagoscopy to identify suspicious areas and compared to histopathology of endoscopic biopsies to detect dysplasia and chronic esophagitis in a population at risk for cancer in southern Brazil. Adult males scheduled to have outpatient endoscopy were examined by two experienced endoscopists and any small (< 5 mm) plaque, nodule, erosion, hyperemia and or friable areas of the mucosa were biopsied and looked for the presence of early cancer or precancerous lesions. Normal appearing mucosa at the middle third of the esophagus was also biopsied and results compared for sensitivity, specificity, positive and negative predictive value. Of the 89 individuals with satisfactory biopsies, 3 had dysplasias, 29 moderate or severe chronic esophagitis and 57 normal findings at the histopathological study. We found no early cancer. We found two large, vegetating lesions confirmed to be advanced squamous cell carcinoma but they were excluded from analysis. To detect dysplasia or moderate/severe chronic esophagitis conventional esophagoscopy had a sensitivity of 40.6%, specificity of 78.9%, positive predictive value of 52% and negative predictive value of 70.3. CONCLUSIONS: In this study, conventional esophagoscopy had a low sensitivity to detect dysplasias and/or chronic esophagitis and techniques to improve endoscopic identification of these lesions in individuals at risk for cancer are much needed. Copyright 2000 Academic Press.
Publication Types:
PMID: 10347708
Rapid rescreening of cervical smears for internal quality control.
Diehl AR, Prolla JC
Hospital de Clinicas de Porto Alegre, RS, Brazil.
OBJECTIVE: To assess the performance of quick rescreening as an internal quality control for cervical smears previously screened as negative and to compare this method with clinically indicated rescreening of negative smears and with further 10% random rescreening. STUDY DESIGN: In a small-workload laboratory with many different types of indications for cytology, during a three-month period, all gynecologic cytology smears considered negative for significant findings (anything above atypical squamous cells of undetermined significance (ASCUS)/atypical glandular cells of undetermined significance (AGUS) in the Bethesda System) or inadequate were quickly rescreened using a 10 x objective. RESULTS: Of the total 2,188 smears processed, 164 (7.5%) were excluded from rapid review because they were positive on routine screening, and 2,024 cases were subjected to rapid rescreening: 1,925 (95.1%) cases were considered negative and 99 (4.9%) positive for significant findings; 58 of the latter were confirmed and 41 not confirmed by the cytopathologist's detailed examination. The 58 confirmed cases were classified as: 43 ASCUS/AGUS, 14 of low grade squamous intraepithelial lesion and 1 of invasive cancer. No cases of high grade squamous intraepithelial lesion were detected. CONCLUSION: Considering that the routine screening and internal quality control of the laboratory had detected 117 positive cases, the additional 58 represent a definite increase in the efficiency of a small-workload laboratory. In such a clinical setting, no additional case of a high grade lesion was detected by rapid rescreening. The increase in cost and time was considered very reasonable, and the method was incorporated as quality control for the laboratory. Clinically indicated rescreening of negative smears and random 10% rescreening after random rescreening did not add significantly to quality assurance. Copyright 2000 Academic Press.
PMID: 9684583
Imagequest. A model self-assessment and self-teaching program for cytopathology.
Prolla JC, da Silva VD, Muller RL, Muller RL
Hospital de Clinicas de Porto Alegre, Cytopathology Laboratory, Brazil.
OBJECTIVE: To develop a low-cost program for providing self-assessment and training for cytopathologists. STUDY DESIGN: Using an optical microscope with a color charge coupled device connected to a personal computer equipped with an ISA bus frame grabber, images were digitized. After the selection of proper images, they were attached to 100 questions with a single answer and five options each. For every question, references accompanied the answer. A colorful score and sounds were played while each question and its corresponding answer were on the screen in order to stimulate the learning process. RESULTS: A low-cost, attractive, effective program for providing self-assessment and training for cytopathologists was developed. CONCLUSION: The use of a high-level programming language permits the creation of a simple, assisted, programmable interface with accessibility for upgrades and customization for every pathologist. This feature permits the insertion of new questions, an essential feature to preserve the usefulness of the program for the future. Copyright 2000 Academic Press.
PMID: 9305390
Comparison of conventional microscopy and digitized imaging for diagnosis in serous effusions.
da Silva VD, Prolla JC, Diehl AR, Baldo MF, Muller RL
Hospital de Clinicas de Porto Alegre, Brazil.
OBJECTIVE: To compare diagnoses made from conventional microscopy and digitized imaging in preparation for teleconsultation cytopathology services that are affordable and efficient. STUDY DESIGN: One hundred six consecutive serous effusions received in the cytopathology laboratory of a general hospital in Porto Alegre, RS, Brazil, were studied. The diagnoses by the senior cytopathologist at the conventional microscope were considered the standard and identified 61 cases negative and 45 positive for malignant cells (40 epithelial and 5 nonepithelial). The same pathologist digitized 461 selected fields for analysis by a second experienced cytopathologist (observer A) and a senior cytotechnologist (observer B) without knowledge of the standard diagnoses. Ten cases were studied in daily sessions of one hour each. The diagnoses were negative for malignant cells, positive for malignant cells (epithelial) and positive for malignant cells (nonepithelial). RESULTS: The following kappa values were found: 0.91 (observer A and observer B versus standard) and 0.86 (observer A versus observer B). CONCLUSION: Remote digitized imaging diagnosis in serous effusions is possible and has a high degree of concordance with diagnosis by conventional microscopy. Similar studies involving a larger group of cytopathologists and cytotechnologists should be done to identify interobserver variability. Copyright 2000 Academic Press.
PMID: 9196802
Correlation of endoscopic cytology and histology in oesophageal cancer: results in Porto Alegre, RS--Brazil.
Frantz MA, Prolla JC
Cytopathology Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS--Brazil.
A retrospective study of oesophageal cytopathology at the Hospital de Clinicas de Porto Alegre (HCPA), RS, Brazil, from 1989 to 1992 was made assess the sensitivity, specificity, predictive values and accuracy of endoscopic cytology and biopsy; and study the correlation between cytopathological and histopathological diagnosis. Specimens from 94 patients were available for review. The final diagnosis was based on surgical pathology and follow up. The 81 patient with cancer of the oesophagus had the following sex distribution: 64 males and 17 females(a 3.7-1 ratio). No tumour was found in 13 patients. The following conclusions were made: (i) there is excellent correlation between cytology and histology in oesophageal lesions sampled by endoscopy; (ii) a correct positive cytologic report was obtained in 77 (95%) of the 81 proven oesophageal cancers; a false-negative or unsatisfactory result was given in four patients. A false-positive diagnosis of cancer was not made. There were 13 true-negative reports. These findings result in a sensitivity of 83% with 95% CI of 74.82-91.18%; a specificity of 100% (CI of 98.5-100%) a positive predictive value of 100% (CI of 99.25-100%); a negative predictive value of 48% (CI of 29.16-64.84%); (iv) of 81 patients with proven cancer, in 79 (98%) at least one of the methods was positive. In only two patients with cancer were both methods negative. These finding result in a combined sensitivity of 98% (CI of 94.92-100%); a specificity of 100% (CI of 98.5-100%); a positive predictive value of 100% (CI of 99.31-100%); and a negative predictive value of 87% CI of 70-100%). Our series confirms the value of the combined use of cytology and biopsy for the investigation of oesophageal lesions. Copyright 2000 Academic Press.
PMID: 8833873
Pleural fluid adenosine deaminase and lymphocyte proportion: clinical usefulness in the diagnosis of tuberculosis.
De Oliveira HG, Rossatto ER, Prolla JC
Federal University of Rio Grande do Sul, Brazil.
Adenosine deaminase (ADA) and lymphocyte proportion are known to be independently elevated in tuberculous effusions, but are non-specific, and false positive results are frequent. To overcome this problem the combined use of both parameters was prospectively studied in 276 patients with pleural effusion seen at Porto Alegre, Brazil. Using a cut-off level of 40 U/l at 37 degrees C (method of Giusti19) for ADA activity and lymphocyte proportion of more than 50%, the correct diagnosis of tuberculosis (sensitivity) was made in 90.7% (CI 87.3-94.1%) of 54 patients. A specificity of 97.7% (CI 95.9-99.5%) was recorded. Five false positive diagnoses of tuberculous effusion were made. Five false negative diagnoses were made: three cases with haematogenous tuberculous dissemination with low ADA levels, and two other patients with low lymphocyte proportion. The combined use of ADA activity determination and lymphocyte proportion is a highly efficient diagnostic strategy of low cost, that merits wider use. Copyright 2000 Academic Press.
PMID: 8173028
[Geographical differences in esophageal neoplasm mortality in Rio Grande do Sul].
[Article in Portuguese]
Prolla JC, Dietz J, da Costa LA
Hospital de Clinicas de Porto Alegre, RS.
Mortality data from cancer of esophagus were studied in the 24 microregions of the State of Rio Grande do Sul (RS), Brazil, from 1970 to 1989, in males and females. The mortality data were calculated through information from the Health Department of RS and the population was obtained in IBGE and FEE. The average, the standard deviation and, by linear regression, the angular parameter of the temporal series for the State and each microregion, were calculated. We noticed great differences between the average of death rates in the 24 microregions, with values between 16.49 to 4.74, in males. The microregions of the south of the State, where there are many farms, revealed higher death rates of mortality by esophageal cancer. The tendency showed to be ascending in 54% of the microregions, in the males. Copyright 2000 Academic Press.
PMID: 8162085
[Mortality from uterine cervix cancer in Rio Grande do Sul].
[Article in Portuguese]
Dietz J, Prolla JC, Pohlmann PR, Loss JF, Da Costa LA, Daudt AW, Grassi P, Achutti AC
Hospital de Clinicas de Porto Alegre, RS.
The mortality from cervical cancer was studied by checking the death rates in Rio Grande do Sul (RS) and in its 24 microregions. Each tendency (linear regression), in the period from 1970 to 1989, was also investigated. We have also studied the relative rates of this kind of cancer, the comparison with the rate in other places and the risk factors. The data were obtained at the Office of Health in Rio Grande do Sul as well as in the Statistics and Geography Brazilian Institute and World Health Organization. The average mortality rates/100,000 women in RS (1970-1989) was 3.8, with ascending tendency. Important differences in the death rates in the 24 microregions in RS were observed and they ranged from 2.5 to 6.7. The cervical cancer was the fourth cause of death in women from RS (mortality by cancer), in 1989. Papillomaviruses and smoking were important factors in the development of cervical cancer. Copyright 2000 Academic Press.
PMID: 8281197
The diagnosis of Pneumocystis carinii pneumonia by cytologic evaluation of Papanicolaou and Leishman-stained bronchoalveolar specimens in patients with the acquired immunodeficiency syndrome.
Tregnago R, Xavier RG, Pereira RP, Prolla JC
Pulmonary Divisions, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil.
The presence of foamy alveolar casts or flocculent material in Papanicolaou and Leishman-stained smears of bronchoalveolar lavage (BAL) fluid is said to be indicative of infection with Pneumocystis carinii. We have investigated the sensitivity and specificity of this method of diagnosing pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome (AIDS). Patients (n = 114) with diffuse lung infiltrates were submitted to fibreoptic bronchoscopy and BAL. Seventy of them were patients with AIDS. The other 44 individuals were not infected by the human immunodeficiency virus (HIV). Pneumocystis carinii organisms were identified on Grocott's methenamine silver (GMS)-stained BAL smears in 30 patients with AIDS. Flocculent material was present in the Papanicolaou and Leishman-stained smears from all of these cases. Conversely, P. carinii were not seen on GMS-stained smears in the remaining 84 individuals with or without AIDS. No flocculent material was observed in Papanicolaou or Leishman-stained smears in these 84 patients. We concluded that the presence of flocculent material in Papanicolaou or Leishman-stained smears of BAL fluid is indicative of P. carinii pneumonia in patients with AIDS. Copyright 2000 Academic Press.
PMID: 7683507
Upper gastrointestinal fiberoptic endoscopy in pediatric patients.
Prolla JC, Diehl AS, Bemvenuti GA, Loguercio SV, Magalhaes DS, Silveira TR
Upper gastrointestinal fiberendoscopy in pediatric patients is done safely and under local anesthesia in most instances. This study of 47 children confirmed the value of fiberendoscopy in establishing the etiology of upper gastrointestinal hemorrhage and the presence of esophageal varices. It also contributed significantly to the management of patients with disphagia, pyrosis, epigastric pain, and ingestion of foreign bodies. No significant morbidity was caused. Copyright 2000 Academic Press.
PMID: 6605895
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