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Introduction: The association between gastroesophageal reflux disease (GERD) and laryngeal disorders has been much debated in recent years. Recent studies suggest an association between laryngeal symptoms and pharyngeal symptoms extra-esophageal reflux, as atypical presentation of Gastroesophageal Reflux Disease. Objectives: To correlate the presence of laryngeal to the grades of erosive esophagitis. Methods: A prospective study. Patients with findings of esophagitis on endoscopy were categorized according to LosAngeles and submitted a questionnaire followed by laryngoscopy. The chi-square test was used for statistical analysis (p Results: Patients with typical symptoms of gastroesophageal reflux disease accounted for 96.6%. Eighteen had changes consistent with class A (60%), class B with seven (7%) and 5 with classes C + D (16.6%). The presence of laryngeal changes were more prevalent in more severe esophagitis (grades C and D Los Angeles) when compared to milder forms (classes A and B), a statistically significant difference (p Conclusion: The laryngeal disorders are frequent findings in patients with esophagitis, more frequent the greater the degree of esophageal injury.

RACIONAL: As medicações mais frequentemente prescritas e usadas de forma crônica por pacientes com queixas dispépticas pertencem ao grupo dos inibidores de bomba de prótons cujo principal representante é o omeprazol, utilizado clinicamente a cerca de 20 anos. Estudos recentes têm postulado a relação entre o uso crônico desta medicação e alterações proliferativas macroscópicas e microscópicas da mucosa do fundo e corpo gástrico, principalmente os pólipos de glândulas fúndicas. OBJETIVO: Analisar a frequência e o tipo de alterações proliferativas gástricas em usuários crônicos de inibidores de bomba de prótons e sua associação com idade, dose utilizada, tempo de uso, sintomatologia e infecção pelo Helicobacter pylori. MÉTODO: Estudo transversal de prevalência realizado no Serviço de Endoscopia Digestiva do Hospital de Clínicas da Universidade Federal do Paraná. Aplicado questionário com informações quanto ao uso destas drogas e realizada endoscopia digestiva alta em sujeitos em uso contínuo desta classe de medicamentos há pelo menos 12 meses. Realizadas biópsias de fundo, corpo e antro gástrico em todos os pacientes. Pólipos eram retirados ao serem identificados, para análise histopatológica. Realizada pesquisa do Helicobacter pylori por teste de urease e análise histopatológica. RESULTADOS: Vinte e dois indivíduos foram incluídos sendo que seis (27,3%) apresentaram alterações proliferativas da mucosa oxíntica. Destes, dois (9,1%) apresentavam pólipos fúndicos esporádicos e quatro apresentavam exclusivamente alteração proliferativa microscópica como formação cística glandular. Houve significância estatística (p 60 anos e estas alterações. Não houve associação entre dose de uso, tempo de uso, sintomatologia e infecção pelo Helicobacter pylori. CONCLUSÕES: Ocorrem alterações proliferativas de mucosa oxíntica em indivíduos em uso crônico de inibidores de bomba de prótons. A associação entre idade e alterações proliferativas apresentou significância estatística. BACKGROUND: The medications most often prescribed and used chronically by patients with dyspeptic symptoms belong to the group of inhibitors of proton pump whose main representative is omeprazole, used clinically about 20 years. Recent studies have postulated the relationship between chronic use of this medication and macroscopic and microscopic proliferative changes in mucosal of gastric body, especially the fundic gland polyps. AIM: To analyze the frequency and type of gastric proliferative changes in chronic users of proton pump inhibitors proton and its association with age, dose, time of use, symptoms and Helicobacter pylori infection. METHODS: A survey of prevalence was conducted in Digestive Endoscopy Service, Hospital de Clínicas, Federal University of Paraná, using questionnaire referring the use of these drugs and performed in subjects using this class of drugs during at least 12 months prior to the endoscopy. Gastric biopsies of fundus, body and antrum were performed in all patients. Polyps were removed when present for histopathological analysis. Research on Helicobacter pylori was done by urease test and histopathology. RESULTS: Twenty-two individuals were included of which six (27.3%) had proliferative changes of the mucosa. Of these, two (9.1%) had sporadic fundic polyps and four only microscopic proliferative change as cystic glandular formation. Statistic significant (p 60 years and these changes was found. There was no association between dose of use, time of use, symptoms and Helicobacter pylori infection. CONCLUSIONS: It was observed the existence of proliferative mucosa changes in individuals with chronic use of inhibitors of proton pump. In this group, the association between age and proliferative changes was significant.

Contexto - Pacientes com acromegalia apresentam maiores chances de desenvolver pólipo e câncer colorretal e, sendo considerados integrantes do grupo de risco, necessitam serem submetidos aos exames de rastreamento. Por sua vez, na acromegalia, o maior comprimento do cólon e a formação de alças intestinais complexas podem prever maiores dificuldades técnicas e aumentar o risco em potencial de complicações durante o exame de colonoscopia convencional. A colonografia tomográfica computadorizada, também denominada colonoscopia virtual, é uma tecnologia inovadora e segura, que está revolucionando o diagnóstico das neoplasias do cólon e do reto. Objetivo - Analisar o desempenho da colonografia tomográfica computadorizada no rastreamento de pólipos colorretais em pacientes com acromegalia. Métodos - Estudo prospectivo com 21 pacientes acromegálicos, 12 do sexo masculino e 9 do sexo feminino, idade média de 49 anos, assintomáticos, submetidos a colonografia tomográfica computadorizada e colonoscopia convencional. A colonografia tomográfica computadorizada foi realizada com aparelho de tomografia computadorizada helicoidal multislice da marca GE. A colonoscopia convencional foi realizada, no mesmo dia, sem prévio conhecimento do diagnóstico da colonografia tomográfica computadorizada. O estudo avaliou a capacidade da colonografia tomográfica computadorizada para detectar pacientes acromegálicos com pólipos colorretais e a identificação de cada lesão colorretal descrita pela colonoscopia. Resultados - Em dois pacientes (2/21) a colonoscopia convencional foi incompleta. Entretanto, em todos os pacientes a colonografia tomográfica computadorizada foi completa na avaliação colorretal. Na primeira fase (“por paciente”), a colonografia tomográfica computadorizada diagnosticou oito de nove pacientes com pólipos colorretais e mostrou 88% de sensibilidade, 75% de especificidade e 81% de precisão. Na segunda fase (“por pólipo”), dos 21 pacientes acromegálicos incluídos no estudo, 12 apresentaram colonoscopia convencional normal. Um total de 19 pólipos foram identificados em 9 pacientes. Dez dos 19 pólipos eram menores que 10 mm e 9 foram iguais ou maiores que 10 mm. A colonografia tomográfica computadorizada identificou 7 dos 9 pólipos ≥10 mm descritos pela colonoscopia convencional e somente 6 dos 10 pólipos pequenos detectados pela colonoscopia convencional. A análise histológica das lesões ressecadas revelaram 12 adenomas tubulares, 6 pólipos hiperplásicos e 1 adenoma túbulo-viloso com um foco de adenocarcinoma. Conclusão - São apresentados os primeiros relatos da realização de colonografia tomográfica computadorizada no rastreamento de pólipos colorretais em doentes com de acromegalia. Neste estudo, a colonografia tomográfica computadorizada realizou avaliação colorretal completa e sem complicações em todos os pacientes acromegálicos. A colonografia tomográfica computadorizada apresentou boa sensibilidade, especificidade e precisão para identificar pacientes acromegálicos com presença de pólipos colorretais de qualquer diâmetro e melhores resultados no diagnóstico de pólipos grandes quando comparados com pequenas lesões polipóides. Context - Acromegalic patients have better chances to develop colorectal polyps and cancer and, considered a high-risk group, need to undergo frequent screening examinations. Moreover, in acromegalia, the increased bowel length and the intestinal loop complexity can lead to higher levels of technical difficulties and increase the risks of complications at conventional colonoscopy. Computed tomographic colonography, also known as virtual colonoscopy, is an innovative and secure technology which is revolutionizing the diagnosis of colon and rectum neoplasias. Objective - To analyze computed tomographic colonography performance for the screening of colorectal polyps in acromegalic patients. Methods - A prospective study of 21 asymptomatic acromegalic patients, 12 male and 9 female, average age 49, who underwent computed tomographic colonography and conventional colonoscopy. Computed tomographic colonography was performed with a GE Helical Multislice Computed Tomography Apparatus. Conventional colonoscopy was performed in the same day, without previous knowledge of the computed tomographic colonography diagnostics. The study evaluated the capacity of computed tomographic colonography to detect patients with colorectal polyps and identify each colorectal lesion described by the colonoscopy. Results - In two patients (2/21), conventional colonoscopy was incomplete. However, in all patients computed tomographic colonography was complete. In Phase I (“per patient”), computed tomographic colonography diagnosed eight of the nine patients with colorectal polyps and showed 88% sensitivity, 75% specificity and 81% accuracy. In Phase II (“per polyp”), out of the 21 acromegalic patients included in this study, 12 presented normal findings at conventional colonoscopy. A total of 19 polyps were identified in 9 patients. Ten of the 19 polyps were smaller than 10 mm, and 9 were equal to or larger than 10 mm. Computed tomographic colonography identified 7 of the 9 polyps ≥10 mm described by conventional colonoscopy and only 6 of the 10 small polyps identified at conventional colonoscopy were detected by computed tomographic colonography. The histological analysis of resected lesions revealed 12 tubular adenomas, 6 hyperplastic polyps and 1 colonic tubulo-villous adenoma with an adenocarcinoma focus. Conclusion - The authors present the first reports of computed tomographic colonography in the screening of colorectal polyps in acromegalic patients. In this study, computed tomographic colonography was performed without complications and a complete and safe colorectal evaluation was possible in all acromegalic patients. Moreover, computed tomographic colonography presented good sensitivity, specificity and accuracy for the identification of acromegalic patients with polyps of any size and better results in the diagnosis of large polyps, when they were compared to small polypoid lesions.

*Aim:* To analyze the CTC performance for the screening of colorectal polyps in acromegalic patients. *Materials and Methods:* A prospective study of 21 acromegalic patients, 12 male and 9 female, average age 49, who underwent CTC and CC. CTC was performed with a GE Helical Multislice Computed Tomography Apparatus. The colonoscopy was performed, in the same day, without previous knowledge of the CTC diagnostics. The study evaluated the capacity of CTC to detect patients with colorectal polyps and identify each colorectal lesion described by CC. *Results:* In two patients (2/21), CC was incomplete. However, in all patients CTC was complete. In Phase I (“Per Patient”), CTC diagnosed 8 of the 9 patients with colorectal polyps and showed 88% sensitivity, 75% specificity and 81% accuracy. In Phase II (“Per Polyp”), out of the 21 acromegalic patients included in this study, 12 presented normal findings at CC. A total of 19 polyps were identified in 9 patients. 10 of the 19 polyps were smaller than 10 mm, and 9 were equal to or larger than 10. CTC identified 7 of the 9 polyps ≥ 10 mm described by CC and only 6 of the 10 small polyps identified at CC were detected by CTC. The histological analysis of resected lesions revealed 12 tubular adenomas, 6 hyperplastic polyps and 1 colonic tubulo-villous adenoma with an adenocarcinoma focus. *Conclusion:* In this study, CTC was performed without complications and a complete and safe colorectal evaluation was possible in all acromegalic patients. Moreover, CTC showed good sensitivity to identify acromegalic patients with colorectal polyps.

Excessive doses of basic amino acids such as L-arginine are able to injure the pancreas of rats.To describe and evaluate the biochemical and histological characteristics of acute pancreatitis in rats induced by L-arginine during the installation, development and repair stages of the pancreatic inflammatory process. MATERIAL AND METHODS - The study group consisted of 105 male Wistar rats. The rats in the experimental group (n = 70) received 500 mg/100 g of corporal weight L-arginine injection intraperitoneally. In the control group (n = 35), isotonic saline solution was injected. Ten rats in the experiment group and five in the control group were analyzed after 6, 12, 24, 48, and 72 hours, on the 7th and 14th days. During those times, blood samples were collected for laboratory testing and samples from the pancreas were collected for an optical microscopy analysis.From 12 to 24 hours after the injection of L-arginine, the amylase serum levels raised to their peak values when compared to the rats in the control group, decreasing gradually, reaching an equal level after the 48th hour and being significantly lower after 72 hours and 7 days. The enzymatic activity returned to its basal level after 14 days. The amylase values were normal in all the times evaluated in the control group. In optical microscopy, after the injection of L-arginine, a pancreatic architecture histologically preserved was observed after 6 hours, evidencing an important interstitial edema in 24 hours. After 48 hours, the acinar architecture was partially destroyed with focal cellular necrosis, reaching its maximum severity after 72 hours. On the 7th, the tissue necrosis and the edema had diminished, and the regeneration of the acinar architecture initiated. The pancreatic structural reconstruction could be observed after 14 days. Pancreatic histological changes were not found in the control group.- Experimental acute pancreatitis induced by L-arginine leads to pancreatic necrosis showing self-limited evolution with pancreas regeneration in 2 weeks.

Racional - Doses excessivas de aminoácidos básicos como a L-arginina têm a capacidade de lesar o pâncreas de ratos. Objetivo -Descrever e avaliar as características bioquimicas e h isto lógicas da pancreatite aguda induzida pela L-arginina em ratos durante a instalação, desenvolvimento e reparação do processo inflamatório pancreático. Materiul e Métodos -A amostra constituiu-se de I 05 ratos machos, da linhagem Wistar. Aos ratos do grupo experimento (n = 70) administrou-se injeção intraperitonial de 500 mg/1 00 g de peso corporal de L-arginina. No grupo controle (n = 35) foi injetada solução salina isotônica. Analisaram-se 10 animais do grupo experimento e 5 do grupo controle em cada período de 6 h, 12 h, 24 h, 48 h, 72 h, 7 dias e 14 dias. Durante os tempos determinados coletou-se sangue para exames laboratoriais e o pâncreas para análise em microscopia óptica. Resultados- Doze a 24 horas após a injeção de L-arginina os níveis séricos de amilase atingiram valores máximos, comparados àqueles dos ratos controle, decrescendo gradualmente, alcançou-os nas 48 horas sendo significativamente menor após 72 horas e 7 dias. A atividade enzimática retornou a níveis basais após 14 dias. Os valores de amilase estavdm normais em todos os tempos avaliados nos animais do grupo controle. Na microscopia óptica, após injeção de L-arginina, observou-se arquitetura pancreática histologicamente preservdda no período de 6 hords, evidenciando-se em 24 homs importante edema intersticial. Após 48 horas, a arquitetura acinar estava parcialmente destruída com necrose celular focal, atingindo sua máxima severidade ao ultapassar 72 homs. No 72 dias a necrose tecidual e o edema haviam diminuído, iniciando-se a regeneração da arquitetura acinar. Observou-se a reconstrução estrutuml pancreática após 14 dias. No grupo controle não se encontrar-se alterações histológicas pancreáticas. Conclusão - A pancreatite aguda experimental induzida pela L-arginina induz a necrose pancreática, apresentando evolução auto-limitada com regeneração do pâncreas em 2 semanas. Background- Excessiw doses o f basic amino acids such as L-arginine are able to in jure the pancreas o f rats. Aim -To describe and evaluate the biochemical and histological characteristics of acute pancreatitis in rats induced by L-argirtine during the installation, development and repair stages o f the pancreatic inflammatory process. Material and Methods- The study group consisted o f 105 male Wistar rats. The rats in the experimental group (n = 70) received 500 mg/100 g of corporal weight L-arginine injection intraperitoneally. In the control group (n = 35), isotonic saline solution was injected. Ten rats in the experiment group and five in the control group were analyzed after 6, 12, 24, 48, and 72 hours, on the 7th and 14th days. During those times, blood samples were collected for laboratory testing and samples from the pancreas were collected for an optical microscopy analysis. Results- From 12 to 24 hours after the injection o f L-arginine, the amylase serum leveis raised to their peak values when compared to the rats in the contro1 group, decreasing gradually, reaching an equal levei after the 48'• hour and being significantly lower after 72 hours and 7 days. The enzymatic activity returned to its basal levei after 14 days. The amylase values were normal in ali the times evaluated in the control group. In optical microscopy, after the injection o f L-arginine, a pancreatic architecture histologically preserved was observed after 6 hours, evidencing an important interstitial edema in 24 hours. After 48 hours, the acirrar architecture was partially destroyed with focal cellular necrosis, reaching its maximum severity after 72 hours. On the 7", the tissue necrosis and the edema had diminished, and the rcgeneration o f the acirrar architecturc initiatcd. The pancreatic structural reconstruction could be observed after 14 days. Pancreatic histological changes were not found in the control group. Conclusion - Experimental acute pancreatitis induced by L-arginine leads to pancreatic necrosis showing self-limited evolution with pancreas regeneration in 2 weeks.