Resumo Pacientes portadores de megaesôfago chagásico foram submetidos à endoscopia digestiva alta e coleta do material com pinças e sondas especiais, em condições estéreis. Foram realizadas quatro coletas, sendo uma do líquido de estase e três fragmentos da mucosa esofagiana respectivamente a um, três e cinco centímetros da transição esôfago-gástrica (linha Z). O material foi enviado em meio de cultura aos laboratórios de microbiologia e de anatomia patológica para a identificação dos germes presentes. Posteriormente, os resultados foram correlacionados ao grau de evolução do megaesôfago segundo a classificação de FerreiraSantos. Observou-se que é alta a incidência de germes patogênicos no megasôfago, independentemente do grau de dilatação, transformando a cirurgia para o tratamento desta afecção em potencialmente contaminada. Não houve diferença significativa quanto à positividade das culturas em relação ao grau de dilatação esofágica. Palavras-chaves: Doença de Chagas. Megaesôfago. Microflora.Abstract Chagasic patients with megaesophagus were submitted to an endoscopy of the upper digestive tract and the samples were collected with special instruments under sterilized conditions. One of the four samples collected was from the stase liquid and the other three samples were collected from fragments of the esophageal mucosa at one, three and five centimeters from the esophageal-stomach transition (Z line). The samples were analized by the Microbiology and Pathologic labs for the identification of microorganisms. After that, the results were correlated with the degree of mega esophagus according to Ferreira-Santos. We observed that the incidence of pathogenic microorganism is very high in megaesophagus, with no relation with the degree of dilatation making the surgery for the treatment of this afection potencially contaminated. There was no significant difference concerning the positivity of the culture relating to the degree of esophagus dilatation. Key-words: Chagas' disease. Megaesophagus. Microflora. O portador de megaesôfago apresenta estase alimentar crônica devido ao obstáculo funcional conseqüente à acalásia do cárdia, o que, somado à desnutrição presente na maioria destes pacientes, favorece a proliferação bacteriana na luz do esôfago. Sabe-se que esses indivíduos apresentam pneumonia de repetição, além de maior incidência de complicações infecciosas pós-operatórias, principalmente, pulmonares, mediastinais e da ferida cirúrgica. Disciplina de Cirurgia do Aparelho Digestivo da Faculdade de Medicina do Triângulo Mineiro (FMTMApesar de existirem poucas referências na literatura a respeito da flora normal do esôfago, destaca-se o estudo publicado por Trabulsi 6 que considera o órgão estéril. Gagliardi 3 , estudando a flora bacteriana de indivíduos sem esofagopatia, encontrou uma flora esofagiana transitória e semelhante à da orofaringe. Bermudez et al 1 , ao estudarem doentes com tumor de esôfago, observaram que os microorganismos mais isolados foram a Cândida albicans (33,3%), Peptostrepcoccus e Bacteroides...

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Summary We present a case report of a hyaluronic acid filler‐induced complication documented using high‐frequency ultrasound. We regard the scientific value of the case as indicating the benefit that ultrasound provides for the management and documentation of this complication. This technology has been becoming increasingly widespread in the care of patients who experience unwanted effects of hyaluronic acid filler because it can be used for the high‐resolution visualization of skin layers as well as the differentiation of filler types and their relationships with adjacent tissues (via gray scale or B‐mode ultrasound) and blood vessels (via color Doppler ultrasound). In addition, it was possible to conclude that external vascular compression causes clinical repercussions, a fact that is often questioned by some dermatologists. This questioning is based on the vast vascularization and anastomosis of arteries of the face, which should permit compensation for vascular compression. However, in this case, there was no doubt that compression caused a region of low output with the clinical manifestation of peri‐oral pallor. Ultrasound was used to document the compression of a vessel by the filler; after application of hyaluronidase, increased vessel lumen and clinical reversal of hypoperfusion in the affected area were observed.

Intralesional corticoid infiltration guided by 22-MHz ultrasound is a new, noninvasive, and safe dermatological method for the treatment of foreign body granuloma. The great advantage of the procedure is that the medication is delivered straight to the desired target, preventing adverse treatment effects in noninjured areas.