Os autores descrevem o caso de uma doente de 26 anos internada no Serviço de Medicina por sub-oclusão intestinal complicada por pneumonia, anemia normocítica e parâmetros biológicos de inflamação elevados. Esta sintomatologia surgiu num quadro de diarreia crónica e perda ponderal, numa doente com episódios de diarreia na infância, tendo sido questionada a etiologia deste quadro com envolvimento sistémico. O estudo complementar confirmou a hipótese de Doença Celíaca associada à presença de invaginação intestinal complicada por pneumonia. A evolução clínica e laboratorial foi favorável, após antibioterapia e instituição da dieta sem glúten. Os autores destacam a necessidade de rever as várias formas de expressão da doença considerando-a como uma condição frequente mas sub-diagnosticada, podendo condicionar o desenvolvimento de complicações significativas.

The authors describe a case of a 26 year-old woman admitted to the Medicine Department because of partial intestinal obstruction associated with a pneumonia, inflammatory anaemia and biological parameters of inflammation. This condition happened after chronic diarrhoea and weight loss, referring also episodes of diarrhoea in her childhood. The investigation has confirmed possible celiac disease associated to enteroenteric intussusception complicated with pulmonary infection. The clinical evolution was favourable after antibiotherapy and gluten-free diet. We present this case reflecting the need of reviewing and thinking on the various forms of the disease’s expression, considering it to be a not uncommon condition. Celiac disease is underdiagnosed, and can carry serious damage.

O carcinoma gástrico é uma neoplasia com distribuição mundial, estando as fases avançadas da doença associadas à metastização à distância para múltiplos órgãos. Contudo, as metástases para o cólon são raras e habitualmente surgem como recidiva da doença, geralmente nos primeiros 5 anos após o diagnóstico. Os autores apresentam o caso clínico de um doente do sexo masculino, 69 anos de idade, com um quadro clínico de diarreia aquosa, de predomínio nocturno, sem sangue, muco ou pus, acompanhada de dor abdominal. Os exames complementares de diagnóstico revelaram a presença de metástases cólicas, como forma de apresentação de um adenocarcinoma gástrico, do tipo difuso, com células em anel desinete.

Worldwide gastric carcinoma is a common malignancy and advanced stages of the disease result in distant metastases to multiple organs. Metastasis to the colon are rare and usually arise as recurrence of the disease, mostly in the first five years after diagnosis. The authors present a case of a 69 year old male with symptoms of watery diarrhoea, mostly nocturnal, without blood, mucus or pus, together with abdominal pain. Diagnostic workup revealed the presence of colonic metastases as the first manifestation of a diffuse type gastric adenocarcinoma, with signet ring cell.

Background and aims: capsule endoscopy (CE) can be prevented by difficulties in swallowing the device and/or its gastric retention. In such cases, endoscopic delivery of the capsule to duodenum is very useful. We describe the indications and outcomes of cases in which traditional endoscopic techniques allowed placement of the capsule in duodenum. Patients and methods: this is a retrospective, descriptive case series. All patients in the above conditions were identified and indications for CE, endoscopic-placement technique, complications and completeness of small bowel imaging were registered. Results: endoscopic-assisted delivery of the capsule was necessary in 13 patients (2.1% of all CE; 7 males; mean age - 47.9 ± 24.9 years, range 13 to 79 years). Indications for endoscopic delivery included: inability to swallow the capsule (7), gastric retention in previous exams (3), abnormal upper gastrointestinal anatomy (3). In eight patients, the capsule was introduced in GI tract with: foreign body retrieval net alone (3), retrieval net and a translucent cap (2), prototype delivery device (2) or a polypectomy snare (1). Five patients ingested the capsule that was then placed in duodenum with a polypectomy snare (3) or a retrieval net (2). No major complications occurred. Complete small bowel examination was possible in 10 patients (77%). Conclusions: endoscopic placement of capsule endoscope in the duodenum is rarely needed. However it may be safely performed by different techniques avoiding some limitations of CE. The best methods for endoscopic delivery of the capsule in the duodenum seem to be a retrieval net with a translucent cap when the patient is unable to swallow the device or a retrieval net only to capture the capsule in the stomach when the patient swallows it easily.

Antecedentes y objetivos: la cápsula endoscópica puede resultar inútil en caso de dificultad para tragar el dispositivo y/o de retención gástrica del mismo. En tales casos, llevar la cápsula hasta el duodeno mediante endoscopia resulta muy útil. Describimos las indicaciones y los resultados de unos casos en que las técnicas endoscópicas tradicionales permitieron llevar la cápsula hasta el duodeno. Pacientes y métodos: se trata de una serie descriptiva y retrospectiva de casos. Se identificaron todos los pacientes en las situaciones citadas y se anotaron las indicaciones de la cápsula endoscópica, la técnica endoscópica de colocación, las complicaciones y el grado de cobertura del intestino delgado por las imágenes. Resultados: la colocación endoscópica de la cápsula se hizo necesaria en 13 pacientes (2,1% de todas las endoscopias con cápsula; 7 varones; media de edad - 47,9 ± 24,9 años, intervalo de 13 a 79 años). Las indicaciones de la colocación endoscópica fueron: incapacidad para tragar la cápsula (7), retención gástrica en exploraciones previas (3) y anomalías de la anatomía digestiva alta (3). En ocho casos, la cápsula se introdujo en la vía GI mediante: sólo la red para recuperar cuerpos extraños (3), la red y un capuchón transparente (2), el prototipo de un dispositivo a tal efecto (2) o una asa de polipectomía (1). Cinco pacientes ingirieron la cápsula, llevada después al duodeno con una asa de polipectomía (3) o una red para cuerpos extraños (2). No se produjeron complicaciones de importancia. La enteroscopia total fue posible en 10 pacientes (77%). Conclusiones: la colocación endoscópica de la cápsula en el duodeno sólo es necesaria rara vez, puede realizarse de forma segura con distintas técnicas y soluciona algunas de las principales limitaciones de la cápsula endoscópica. Las mejores metodologías son la utilización de una red y un capuchón transparente cuando el paciente no pudo ingerir la cápsula y sólo una red para capturarla en el estómago si la traga fácilmente.

A Heterotopia Gástrica no esófago é uma entidade frequente, normalmente assintomática. Na maioria das situações representa a presença de pequenas áreas de mucosa plana com glândulas fúndicas situadas no esófago superior. Os autores apresentam um caso de heterotopia gástrica revelando-se sob a forma de um pólipo esofágico composto por epitélio do tipo antral. A remoção endoscópica da lesão permitiu a resolução clínica e sintomática no caso descrito.

Heterotopic Gastric Mucosa in the esophagus is a frequent, though usually asymptomatic condition. Most of the cases present as a flat area of the fundic-type gastric mucosa in the upper esophagus. We present a case of a polypoid heterotopic gastric mucosa with an antral pattern. Endoscopic removal of the lesion provided clinical relief and cure.

An experiment to study the control of dieback on young coffee plants cultivar Catuaí was carried out in a Latosol B Terra Roxa at Tejupá, State of São Paulo, in 1978/80. The treatments consisted of several levels of NK fertilization under three different conditions: windbreak - Cajanus cajan (L.) Millsp.; fungicide - cuprous oxide; windbreak plus fungicide. The grain yields of treatments under protection of windbreak plus fungicide were higher than the yields of isolated treatments where only fungicide or windbreak were used. Although the average of grain yield of N treatments were higher than the (2N)K treatment, the effects of NK fertilization on the control of the dieback could not be conclusive in this experiment. There was a high variation in grain yield within the same treatment.