OBJECTIVE: Many changes in mucosal morphology are observed following ileal pouch construction, including colonic metaplasia and dysplasia. Additionally, one rare but potential complication is the development of adenocarcinoma of the reservoir. The aim of this study was to evaluate the most frequently observed histopathological changes in ileal pouches and to correlate these changes with potential risk factors for complications. METHODS: A total of 41 patients were enrolled in the study and divided into the following three groups: a non-pouchitis group (group 1) (n = 20; 8 males; mean age: 47.5 years) demonstrating optimal outcome; a pouchitis without antibiotics group (group 2) (n = 14; 4 males; mean age: 47 years), containing individuals with pouchitis who did not receive treatment with antibiotics; and a pouchitis plus antibiotics group (group 3) (n = 7; 3 males; mean age: 41 years), containing those patients with pouchitis who were administered antibiotics. Ileal pouch endoscopy was performed, and tissue biopsy samples were collected for histopathological analysis. RESULTS: Colonic metaplasia was found in 15 (36.6%) of the 41 patients evaluated; of these, five (25%) were from group 1, eight (57.1%) were from group 2, and two (28.6%) were from group 3. However, no correlation was established between the presence of metaplasia and pouchitis (p = 0.17). and no differences in mucosal atrophy or the degree of chronic or acute inflammation were observed between groups 1, 2, and 3 (p>0.45). Moreover, no dysplasia or neoplastic changes were detected. However, the degree of mucosal atrophy correlated well with the time of postoperative follow-up (p = 0.05). CONCLUSIONS: The degree of mucosal atrophy, the presence of colonic metaplasia, and the degree of acute or chronic inflammation do not appear to constitute risk factors for the development of pouchitis. Moreover, we observed that longer postoperative follow-up times were associated with greater degrees of mucosal atrophy.

RACIONAL: Existe consenso que os recém-natos são particularmente propensos a desenvolverem infecções gastrointestinais devido a múltiplos fatores dentre eles a hipóxia. Há facilidade de colonização anormal e destruição de bactérias com absorção de toxinas. OBJETIVO: Identificar micro-organismos no leite materno depois de estocado em refrigerador a 4°C e também depois do aquecimento, e pesquisar se os sinais laboratoriais encontrados teem alguma correlação clínica. MÉTODOS: As amostras coletadas contemplaram as três fases do leite materno. Em 16 casos, colostro foi obtido como amarelado até a segunda semana do nascimento. Em 14 casos o tipo transicional, entre colostro e leite maduro, ocorreu de sete e 15 dias depois do nascimento. Em 14 casos o leite maduro foi obtido também entre sete e 15 dias. Os diversos tipos foram subdivididos de acordo com o período de conservação e de aquecimento. RESULTADOS: Os micro-organismos que não cresceram foram: Salmonella sp, Molds/leavens e Pseudomonas aeruginosa. Foram observados coliformes totais e fecais. Não ocorreu crescimento bacteriano significativo. Cresceram mesófilos aeróbicos, Staphilococcus aureus e Bacillus cereus. Embora com esses crescimentos, não houve repercussão clínica nos recém-nascidos. CONCLUSÕES: Nas condições propostas neste estudo, não houve crescimento significativo de coliformes fecais, Salmonella sp, Molds/leavens e Pseudomonas aeruginosa; os micro-organismos que cresceram mantiveram-se acima no nível de detecção (mesófilos aeróbicos, coliformes totais, Stapholococcus aureus e Bacillus cereus). As taxas de micro-organismos mesmo sendo mais altas que as estabelecidas como toleráveis não influenciaram na estabilidade clínica dos recém-nascidos; o leite materno coletado, transportado e armazenado nas condições deste estudo foram seguras e podem ser utilizadas até 24 horas após terem sido armazenadas em refrigerador a 4°C.

BACKGROUND: There is a consensus among many authors that the newborn (NB) is particularly prone to infections of the gastrointestinal tract for multiple factors, such as the hypoxia and the artificial milk. These factors facilitate the abnormal bacterial colonization and promote a drawback in the destruction of the toxins of such bacterias. AIM: To identify the microorganisms in the breast milk, after its storage in the refrigerator at 4°C, as well as after heating and to relate the eventual clinical NB signs with the microbiologic laboratory results of the breast milk which was offered. METHODS: The samples collected contemplated the three phases of post-natal breast milk. In 16 cases, the colostrum type was obtained as yellowish milky secretion, up to the beginning of the second week after the birth. In 14 cases, the transition type was obtained as intermediate product of the mother's milk, between colostrum and the mature milk, between the 7th and the 15th day after the birth. In 14 cases, the mature type was obtained as a white opaque liquid, of light smell and sweet taste, from the 15th day after birth. The milk types obtained in the three presentations were subdivided according to the period of conservation and heating in the group colostrums, transition and mature. RESULTS: The microorganisms which did not present growth were: Salmonella sp, Molds/leavens and Pseudomonas aeruginosa. The total coliforms and fecal coliforms were observed. There was no significant microorganisms growth. The aerobic mesophiles, Staphilococcus aureus and Bacillus cereus were also observed. These microorganisms presented growth, but the NBs did not present damage in their clinical status. CONCLUSIONS: Under this conditions of collecting and storage, there was no fecal coliforms, Salmonella sp, Molds/leavens and Pseudomonas aeruginosa; the microorganisms which grew up, kept themselves above the limits of detection (aerobic mesophiles, total coliforms, Stapholococcus aureus and Bacillus cereus; microbian rates, even when higher than the ones stablished, did not influence the clinical status of the NB; the breast milk collected, transported and stored under the conditions presented in this study can be safely used up to 24 hours after being stored in a refrigerator at 4°C.

INTRODUÇÃO: O risco de desenvolvimento de carcinoma esofágico em portadores de megaesôfago é 33 vezes superior ao da população em geral. Possível explicação para este fenômeno poderia estar relacionada à produção de compostos N-nitrosos na luz do órgão, a partir da transformação de nitratos da dieta em nitritos, mediada por bactérias em suspensão no líquido de estase e com o contato crônico destes carcinógenos com a mucosa esofágica. OBJETIVO: Analisar a microbiota esofágica em pacientes portadores de megaesôfago de etiologia chagásica, com especial atenção para a presença de bactérias com capacidade de redução de nitratos. CASUÍSTICA: Foram estudados prospectivamente 15 pacientes portadores de megaesôfago chagásico com idades variando de 28 a 73 anos, sendo 9 do sexo feminino e 6 do sexo masculino, que foram divididos em 3 grupos iguais de 5, de acordo com o grau de dilatação do esôfago, segundo a classificação de Rezende et al. (Grau I, Grau II e Grau III). MÉTODO: A coleta do líquido de estase para estudo microbiológico era realizada através de sonda de Levine nº 14, que era passada pela boca, por dentro de uma cânula de intubação orotraqueal nº 7,5, mantendo-se sua extremidade escondida, a fim de evitar sua contaminação. RESULTADOS: Foram obtidas 93,3% de culturas positivas com grande variedade de microrganismos e predomínio de aeróbios Gram-positivos e anaeróbios. As concentrações de microrganismos foram tanto maiores, quanto maior o grau de dilatação do esôfago. Entre os microrganismos encontrados, o Staphylococcus sp, Corynebacterium sp, Peptostreptococcus sp e a Veillonella sp foram aqueles identificados como tendo a capacidade de redução de nitratos a nitritos. CONCLUSÃO: No megaesôfago chagásico há bactérias na luz do órgão com capacidade de redução de nitratos da dieta, passo importante na produção de compostos N-nitrosos.

BACKGROUND: The risk of development of spin cell carcinoma of the esophagus is 33 times higher in patients with chagasic achalasia. It is possible that the production of N-nitroso compounds in the esophageal lumen by of bacterial action in the stasis liquid that reduce nitrates from diet into nitrites may play a role in this process. AIM: To analyze qualitatively and quantitatively the microbiota in chagasic megaesophagus with special attention to bacteria capable of transforming nitto reduction. PATIENTS: Fifteen patients (six men and nine women) were prospectively studied, with ages varying from 28 to 73 years. Patients were divided into three sub-groups according to Rezende et al. classification of esophageal dilation (grade I, grade II and grade III). METHOD:The sample collection was performed using a method specially developed to avoid contamination with microorganisms of the oral cavity and oropharynx, using a Levine catheter nº 14 and a 7,5 oro-traqueal tube. RESULTS: Ninety three point three percent of the cultures were positive, with great bacterial variability and predominance of a variety of aerobic Gram-positive and anaerobic bacteria. The bacterial concentrations were generally more elevated in grade III in comparison to grade I and grade II. Among the microorganisms found, Staphylococcus sp, Corynebacterium sp, Peptostreptococcus sp e a Veillonella sp were those with the capability of nitrate reduction. CONCLUSION: It was concluded that patients with megaesophagus present some bacteria in the esophageal lumen that are able to reduce nitrates intro nitrites, an important step in the formation of N-nitroso compounds.