Primary cutaneous amyloidosis: Clinical, laboratorial and histopathological study of 25 cases. Identification of gammaglobulins and C3 in the lesions by immunofluorescence

25 cases of primary cutaneous amyloidosis are studied. 16 patients had macular amyloidosis (MPA) and 9 lichen amyloidosus (LPA). γ-Globulins were increased in 50% of the patients. IgG and IgA were increased in the serum of 5 and 3 patients with MPA and 4 and 2 patients with LPA, respectively. Volume of amyloid deposits was similar in both forms. By direct immunofluorescence we demonstrated IgG in the amyloid deposits of 21 of the 25 cases and C3 in 13; IgM was present in 9 cases of MPA and in 3 cases of LPA. MPA was more frequent than LPA; histologically, it was impossible to distinguish MPA from LPA; correlation between serum levels of γ-globulins and their presence in amyloid deposits was weak; MPA and LPA seem to be distinct clinical manifestations of the same disease and itching does not cause transformation of MPA in LPA.

Parasitoses em lactentes de 0-12 meses atendidos na Faculdade de Medicina de Botucatu - São Paulo

Infestation by protozoa and/or helminths is considered to be extremely rare in infants. We therefore reviewed the records of all infants up to 12 mth of age attending the Paediatric Department from January 1973 to June 1977, in order to assess the frequency of stool examinations for parasites within this age group, the percentage of positive results in these examinations, and some personal characteristics which propitiated parasitic infestation. Some characteristics of the investigated infants were compared to those of a representative sample of the total number of infants attending during the same period. Stool examinations were realized in 11.8% of the 1,162 attending patients and of those, 15.3% were positive. The proportion of positive cases became 24.0% when the infants in whom there was a history of parasites being passed were included. Ascaris lumbricoides and Giardia lamblia were the parasites most frequently found, respectively in 42.8% and 37.1% of the positive cases. The only detected difference between the control group and the group of infants who had parasitologic examinations was the presence of diarrhea, significantly more frequent in the investigated group. The proportion of positive cases was significantly greater in girls, in infants older than 6 mth and when diarrhea was present for up to 15 days, than in boys, in infants up to 6 mth of age and in chronic diarrhea, respectively. Our results show that parasites were investigated in only a small percentage of infants under 1 yr of age, but that in this age group already, parasitic infestation does occur with a certain frequency. As investigated cases were selected, mainly due to the presence of diarrhea, the real prevalence of parasitism in infants under 1 yr of age was impossible to evaluate.

ESTUDO CLINICO DO TETANO. REVISAO - 1994

The author did a review entitled clinical aspects of tetanus emphasizing the etiology, epidemiology, pathogenesis, diagnostic, clinical aspects, differential diagnosis, laboratorial tests, treatment, complications and prophylaxis.

O RATO COMO MODELO EXPERIMENTAL DO DIABETES - ESTUDO CLINICO-LABORATORIAL

In this study, 90 Wistar rats were used. They were equally divided into three experimental groups - control group (CG), diabetic group (DG) and treated diabetic group (TG). The analyzed parameters were clinical (behavior, activity, general aspect, weight, water ingestion and diuresis) and biochemical (fasting glycemia and urinary glycosis). The diabetes was induced by alloxan and, then, treated with insulin associated to oral hypoglycemic (acarbosis). Observations were made at 5 experimental moments, as it follows: 1, 3, 6, 9, and 12 months after the diabetes induction. The results were submitted to variance analysis, with 5% of significance level. The DG presented lower weight and higher diuresis level than the CG and TG. The water ingestion of the CG was similar to TG. The glycemia levels were higher in DG than in CG, at every experimental moment. The TG, however, presented glycemia similar to the CG, except for the dosages at 3, and 9 months. They urinary glycosis of the DG and TG were similar between themselves, but higher than the one of the CG.

Penfigo foliaceo no Hospital das Clinicas da Faculdade de Medicina de Botucatu, SP

BACKGROUND - Pemphigus foliaceus is an autoimmune bullous disease that is endemic in Brazil and in other South American countries such as Paraguay, Bolivia, Peru and Colombia. OBJECTIVES - To compare the observed clinical and epidemiological data with those referred in the literature. METHOD - Retrospective study in patients with pemphigus foliaceus admitted to and treated at University Hospital of the School of Medicine of Botucatu, SP, Brazil, from 1976 to 1993, analyzing the following variables: age, sex, race, origin and onset of disease. RESULTS - From 1976 to 1993, 63 patients were treated, with an average of 3.7 cases/year. Patients within the age range of 20 to 60 years old were the most affected. Most of the patients were white, females being slightly more affected than males. The majority of male patients were rural workers. Some towns presented higher incidence of cases. Most of the patients from rural areas became sick mainly in summer and in autumn. Occurrence of similar cases was observed in blood-related family members and neighbors. CONCLUSIONS - Clinical and epidemiological data were similar to those referred in the literature.

Paracoccidioidomycosis: Survey and clinical aspects from the Department of Dermatology of the School of Medicine of Botucatu (Sao Paulo - Brazil)

Background - Paracoccidioidomycosis is the most frequent among the systemic mycoses in Brazil. Objective: To study the cases of paracoccidioidomycosis diagnosed from 1976 to 1996 at the Department of Dermatology of the School of Medicine of Botucatu. Methods - Descriptive study obtained from specific protocols comprising anamnesis, clinical- dermatological-laboratorial examination, treatment and follow-up of the patients. Results - Paracoccidioidomycosis was diagnosed in 1.04% of the dermatologic outpatients assisted from 1976 to 1996. In 315 cases, 89.8% were male, 61.9% were over forty and 53.7% were rural workers. The complaints were related more to oropharyngolaryngeal (53.6%) or cutaneous (23.8%) lesions or adenopathy (10.2%). Seventy patients had already been treated in other health services. The chronic multifocal clinical from was the most common: 80.6% of the cases, followed by the acute-subacute (juvenile type) 15.5%. The disease was pulmonary in 80.0%, oropharyngolaryngeal in 69.2% and cutaneous in 45.7%. Th treatment: Amphotericin B in 146 patients, Ketoconazole - 88, Itraconazole - 56, Sulfonamide derivatives - 146 and Terbinafine in 3. The lethality index resulting from the disease or its treatment was 2.0%. Conclusions - The high number of cases, showing the regional relevance of the disease and the high percentage of tegumentary complaints and the high number of relapsing are remarkable.

Diagnóstico laboratorial de hemoglobinopatias em populações diferenciadas

The inherited haemoglobinopathies are a heterogeneous group of recessive disorders that include the thalassaemias and sickle cell disease. Nearly a thousand mutant alleles have now been characterized. The mutations are regionally specific and in most cases the geographical and ethnic distribution shave been determined providing the foundation for a program of control through screening, genetic counseling and prenatal diagnosis. The diagnosis of hemoglobinopathies requires care for the methodologies applied and the population group which will be evaluated. The information about the abnormal hemoglobin, the medical and psychological aspects and genetic counseling of the carriers and their families are goals of great importance for the success of preventive programs in this area. Aiming to evaluate the laboratory methods for hemoglobinopathy screening and their use in clinical laboratories, we have compared abnormal hemoglobins incidence in the different population groups: blood donors, anemia carriers, newborn and students. The laboratory methods applied involved eletrophoretic proceedings, cytological and biochemical analysis. Within the period from September 1999 through January 2000, we analyzed 524 individuals with varied types of abnormal hemoglobins. Among blood donors, we diagnosed two sickle cell carriers, which suggest the necessity for better care in the process of selection of blood donor candidates. The current interest in the medical and social aspects of sickle cell anemia has resulted in a great increase in methodology research leading to the development of sickle cell screening techniques.

Hidrocistoma écrino e apócrino na pálpebra - Casuística na Faculdade de Medicina de Botucatu- São Paulo

Background - Hidrocystomas ecrine and apocrine may be observed in the eyelids. Objective - The purpose of this study was to observe the occurrence of eyelid hidrocystoma (eccrine or apocrine), as well as the relation between clinical and histopathological diagnosis. Patients and Methods - 42 patients were selected, with a total of 52 lesions, attended between January 1990 to April 1999, at the Botucatu Medical School, with diagnosis of hidrocystoma confirmed by histopathology diagnosis. Result - Hidrocystoma occurred in 0.07% of patients undergoing lesion removal during this period. Eccrine and the apocrine hidrocystoma were frequently observed in female patients, aged over 40 years. The clinical picture ranged from about 1 to 5 years. The lesions were mainly located in the lower eyelid and presented as a single lesion. The clinical diagnosis agreed with the histopathological diagnosis in 67.31% of the apocrine hidrocystomas, and 9.62% of the eccrine hidrocystomas. Conclusions - Apocrine hidrocystoma was the most frequently observed eyelid hidrocystoma. The correlation between clinical and histopathological diagnosis was higher for apocrine hidrocystomas.

Toothbrushing with vegetable oil: a clinical and laboratorial analysis.

The dentifrices currently available in the marketplace contain many anticariogenic substances, fluoride and abrasives aimed to better clean the dental surface, remove dental plaque, improve salivary flow and its buffer capacity and reduce colonies of bacteria such as S. mutans, the causative agent of dental caries. The objective of this study was to evaluate the possibility of adequately removing dental plaque using an experimental almond oil dentifrice (Titoil) with no abrasives or antiplaque agents. This study was carried out with 80 volunteers, all of them 18-year-old recruits from the military training school of Araçatuba -- SP. Saliva sampling and dental plaque disclosing were undertaken both before and after 28 days of toothbrushing with a low abrasive dentifrice (Group 1: 40 volunteers) or with Titoil (Group 2: 40 volunteers). Statistical analysis of the results revealed that the experimental dentifrice (Titoil) did not interfere with salivary flow and reduced dental plaque more than the low abrasive dentifrice, improved the salivary buffer capacity and decreased salivary S. mutans (Caritest-SM) as much as regular dentifrices. It was concluded that if the dental industry replaces abrasive by vegetable oil in dentifrices, these will be more effective in maintaining oral health and will cause less dental abrasion.

Doença pulmonar obstrutiva crônica

The chronic obstructive lung disease is reviewed with emphasys on its epidemiology and risk factors. The diagnosis, clinical aspects pulmonary, functional alterations and laboratorial findings are discussed. The treatment is also reviewed, based on the actual consensus, considering the following classes of approaches: bronchodilators, inhaled β-agonists, corticoids, methilxanthines, prolonged domiciliar-orygen therapy.