Caso para diagnóstico

Apresenta-se um caso de bullosis diabeticorum, doença rara associada ao diabetes mellitus crônico e complicações como a neuropatia ou nefropatia. As bolhas são tensas e grandes, com pouca inflamação circundante e localização acral, regredindo espontaneamente em cerca de três semanas. O exame histopatológico é inespecífico, e o diagnóstico diferencial deve ser feito com a epidermólise bolhosa, os pênfigos, o penfigóide bolhoso, queimaduras e erisipelas bolhosas.

Mitose como fator prognóstico para biópsia de linfonodo sentinela em melanoma fino

Paciente, sexo feminino, 23 anos, com melanoma extensivo superficial em dorso, Breslow 0,35 mm, Clark II, sem ulcerações e com 2 mitoses / mm². Foi submetida à ampliação de margem e biópsia de dois linfonodos sentinela (axila esquerda). O exame anatomopatológico mostrou micrometástases, no seio subcapsular de ambos. Seguindo a recomendação do American Joint Commitee on Cancer 2009, a paciente foi submetida à linfadenectomia axilar total, sem outros linfonodos metastáticos. A aplicação da dermatoscopia vem permitindo maior precisão diagnóstica de melanoma cutâneo, contribuindo para maior proporção de melanoma fino ao diagnóstico. A taxa mitótica foi incluída como um importante fator prognóstico para melanomas finos pelo American Joint Commitee on Cancer 2009, sugerindo biópsia para esses pacientes

Imunoglobulinas e C3 no granuloma paracoccidióidico

Utilizou-se o modelo experimental de paracoccidioidomicose, em camundongos, induzida pela inoculação endovenosa de suspensão de formas cerebriformes do P. brasiliensis (cepa Bt2; 1x10(6) formas viáveis/animal), para avaliar, após 2, 4, 8, 16 e 20 semanas: 1. A presença de imunoglobulinas e C3 nos granulomas pulmonares, por imunofluorescência direta; 2. A resposta imune humoral (imunodifusão) e celular (teste do coxim plantar), e 3. A histopatologia das lesões. Os camundongos apresentaram resposta imunocelular positiva desde a 2a. semana, com depressão transitória na 16a. semana, e anticorpos desde a 4a. semana, com pico na 16a. semana. Os granulomas pulmonares foram epitelióides, com numerosos fungos e microabscesses; a extensão das lesões foi progressiva até a 16a. semana, com regressão discreta na 20a. semana. Desde a 2a. semana, houve deposição de IgG e C3 na parede dos fungos no interior dos granulomas e a presença de células IgG positivas no halo linfomononuclear periférico; estes achados foram máximos entre a 4a. e 16a. semanas. Não se detectou depósito de IgG e C3 no interstício dos granulomas. IgG e C3 parecem exercer papel precoce e importante na defesa do hospedeiro contra o P. brasiliensis, contribuindo possivelmente para a destruição dos fungos e bloqueando a difusão de antígenos para fora dos granulomas.

Histopatologia endometrial e fertilidade de éguas portadoras de pneumovagina tratadas através das técnicas cirúrgicas de Caslick ou Pouret

Com o objetivo de avaliar a evolução da condição endometrial após as cirurgias de Caslick e Pouret, empregou-se cada uma destas técnicas em um grupo de sete éguas, com histórico de subfertilidade e portadoras de pneumovagina, que justificassem, por sua conformação vulvar, a aplicação destas cirurgias. A avaliação da condição endometrial foi feita através dos exames de biópsia do endométrio, realizados imediatamente antes da cirurgia e aos 15 e 60 dias de pós-operatório e ainda pela verificação das taxas de fertilidade em ambos os grupos, durante a estação reprodutiva do ano subseqüente. A comparação dos resultados dos exames do período pós em relação ao pré-operatório evidenciou modificações histopatológicas suficientemente sutis para não levar a mudanças na classificação endometrial durante o período de observação, porém a melhora obtida nas taxas de fertilidade nos grupos experimentais permitiram concluir que as cirurgias corretivas de Caslick e Pouret proporcionaram melhora do desempenho reprodutivo de éguas portadoras de pneumovagina.

Natural killer cell activity in experimental paracoccidioidomycosis of the Syrian hamster

Com o objetivo de avaliar a atividade de células natural killer na paracoccidioidomicose experimental do hamster, 80 hamsters foram infectados por via intratesticular com Paracoccidioides brasiliensis e sacrificados após 24h, 48h, 96h, 1, 2, 4, 8 e 11 semanas de infecção. Como controle foram avaliados 40 hamsters normais, não infectados. Os animais foram submetidos ao estudo da atividade citotóxica de células NK pela técnica de single-cell assay e da resposta imune humoral pelas técnicas de imunodifusão dupla e Elisa. A produção do fator inibidor da migração de macrófagos em presença de Phytohemaglutinina e antígeno de P. brasiliensis e a histopatologia das lesões foram estudadas após 1,4, 8e 11 semanas de infecção. Os animais infectados, quando comparados aos controles, apresentaram níveis de atividade NK significativamente elevados durante as 4 primeiras semanas de infecção, havendo diminuição dessa atividade a partir da 8ª semana. Foi observada correlação inversa entre atividade NK e níveis de anticorpos específicos e, associação entre diminuição da atividade NK, depressão de resposta imune celular e aumento da extensão das lesões histopatológicas. Os resultados sugerem que após ativação inicial, as células NK são incapazes de controlar a disseminação do fungo pelos tecidos. A depressão da atividade NK na fase tardia da infecção parece estar relacionada com os distúrbios imunorregulatórios associados à paracoccidioidomicose.

Serial Mitsuda tests for identification of reactional tuberculoid and reactional borderline leprosy forms

The authors studied the Mitsuda reaction in 37 leprosy patients (18 reactional tuberculoid, 19 reactional borderline cases) and compared the results with clinical findings, histopathology and bacilloscopy. Evaluation of the Mitsuda reaction was carried out on days 30, 60, 90 and 120. Most of the reactional tuberculoid patients showed a Mitsuda reaction of +++ in opposition to the reactional borderline patients who showed only +. Bacilloscopic analysis revealed that in 75% of the reactional tuberculoid cases there were rare or no bacilli; bacilli were present in 95% of the reactional borderline cases. The authors conclude that reactional tuberculoid cases have a greater ability to clear bacilli than reactional borderline cases, and that the Mitsuda reaction is a useful tool for the differentiation between these two types of leprosy.

Correlation among immune response, morphogenesis of the granulomatous reaction and spleen lymphoid structure in murine experimental paracoccidioidomycosis

We studied the correlation among cellular immune response, the pattern of lung granulomatous lesions and alterations in spleen lymphoid structure in Swiss mice inoculated intravenously with Paracoccidioides brasiliensis strain 18. The animals were evaluated at 24, 48 and 96 h after infection and further studied weekly for 18 weeks by: (i) the macrophage migration inhibition test with phytohemagglutinin (PHA) and P. brasiliensis antigen (PbAg); and (ii) histopathology of the lung and spleen lesions. One group of animals was gamma -irradiated (8 Gy), infected under the same conditions and evaluated for the pattern of lung granulomatous lesions and spleen lymphoid structure at 24, 48 and 96 h after infection. During the first week of infection, the non-irradiated animals presented a positive response to PHA and PbAg, compact granulomas in the lungs and a typical hyperplasia of the spleen white pulp. However, from weeks 2 to 5, a depression of the cell-mediated immunity (CMI) response to PHA and PbAg was observed in association with granulomas presenting only large mononuclear cells and lacking both giant cells and a peripheral halo of small mononuclear cells. This pattern of granuloma formation was similar to that seen in gamma -irradiated animals, whose cells involved in CMI were absent. After week 7, the non-irradiated animals showed granulomas characterized by the presence of giant cells and a peripheral halo of small mononuclear cells. This type of granuloma was formed concomitantly with recovery of the CMI and of the lymphoid structure of the spleen. The results showed a correlation among granulomas composed of large mononuclear cells, hypoplasia of the splenic tissue and impaired CMI. This correlation indicated that although granuloma morphogenesis per se does not depend on the activation of CMI, this response is important at later stages during modulation of the cellular composition of the granulomas.

Effects of prolonged oral administration of fumonisin B(1) and aflatoxin B(1) in rats

The effects of prolonged oral administration (21 days) of fumonisin B(1) (FB(1)) and aflatoxin B(1) (AFB(1)) were evaluated on male Wistar rats. The animals were housed in individual metabolic cages and submitted to the following treatments: 1-0 mug AFB(1) + 0 mg FB(1)/100g bw.; 2-72 mug AFB(1)+ 0 mg FB(1)/100 g bw; 3-0 mug AFB(1) + 0.5 mg FB(1) g bw; 4-0 mug AFB(1) + 1.5 mg FB(1)/100 g bw; 5-72 mug AFB(1) + 0.5 mg FB(1)/100g bw; 6-72 mu gAFB(1) + 1.5 mg FB(1)/100g bw. on day 21, the rats were sacrificed for evaluation. The results showed that treated animals presented differences in body weight and absolute/relative weights of liver and kidney as well as altered hepatic function and cholesterol blood levels. Rats fed with the greatest doses of AFB(1) and FB(1) gained less weight (2.79 g/day) at the end of the experimental period; their blood concentrations of liver enzymes aspartate aminotransferase (AST) and alkaline phosphatase (AP) were above control levels (130.35 mu /l and 471.00 mu /l, respectively). Blood cholesterol increased in the groups treated with the highest dose of FB(1) or FB(1) associated with AFB(1). Histopathology revealed the occurrence of apoptosis in the liver of rats exposed to FB(1). The association of aflatoxin B(1) with fumonisin B(1) at higher dose probably potentiated the effects of the higher dose of fumonisin B(1)acting singly.

The Brazilian pediatric myelodysplastic cooperative group strategies: are they relevant to improve educational approach and correct diagnosis?

Brazil is a wide country with huge contrasts. Its peculiarities can highlight environmental factors that could influence the frequencies of different cancers. The standard treatment and results achieved from several different areas of the country may not be found in others. The establishment of a national cooperative group has the potential to improve outcomes. The The Brazilian Cooperative Group on Pediatric Patients with Myelodysplastic Syndrome (BCG-MDS-PED) was first organized in January 1997 as a working group of hematologists, pediatric oncologists, pediatric-hematologists, molecular biologists and other professionals in order to study pediatric (age < 18 years) MDS. Six distinct subcommittees constituted with members from several universities: cytology, histopathology, clinical, cytogenetics, molecular biology and epidemiology. The goals of the BCG-MDS-PED were: (i) to offer support for diagnosis and orientation for treatment; (ii) educational Support for the colleagues all over the country and (iii) research on pathogenesis and new approaches for pediatric MDS patients. There are socio-economical differences among the five regions of the country. The BCG-MDS-PED believes that it is absolutely necessary to Study the clinical, cellular, molecular and epidemiological aspects of MDS, taking in account these peculiar differences among populations and regions. Since 1997, 114 pediatric cases were referred to the BCG-MDS-PED from 21 centres. Seven Brazilian states have sent cases to the group, 31 patients were referred from universities, 73 patients from pediatric oncology units (foundations) and 10 patients came from private clinics. Some of these patients have been followed up and/or treated by the physician who referred them to the BCG-MDS-PED for confirmation of the initial diagnosis. The majority of these physicians have required orientation on diagnostic and treatment issues, as well as to complete cytogenetic and molecular studies. From these 114 patients, 64 patients were confirmed as MDS. We believe that, the more numerous the MDS-studied cases, the more experienced will be the referee group on clinical and laboratory features on childhood MDS in Brazil. (C) 2002 Published by Elsevier B.V. Ltd.

Interferon Alpha-2B and liver resection to treat multifocal hepatic epithelioid hemangioendothelioma: A relevant approach to avoid liver transplantation

Background. Hepatic epithelioid hemangioendothelioma is a rare malignant tumor of vascular origin with frequent multifocal appearance. Liver resection may cause tumor spread. Liver transplantation has been indicated for unresectable nodules. We hypothesized that adjuvant interferon treatment is effective to prevent metastasis after liver resection. We report a case of multifocal hepatic epithelioid hemangioendothelioma successfully treated with interferon pulse therapy and bilobar hepatic resection.Methodology. CT scan and magnetic resonance imaging diagnosed three nodules in the liver (segments IV, VI and VII). Histopathology and specific immunostaining of a percutaneous nodule biopsy confirmed the diagnosis of hepatic epithelioid hemangioendothelioma. The treatment protocol included daily interferon alpha 2b 9 weeks before and 1 week after resection of liver segments IV, VI and VII.Results. The postoperative outcome was complicated by a self-limited biliary fistula. The patient remains tumor free at 3 years after liver resection and currently enjoys excellent health.Conclusion. Interferon pulse therapy and hepatic resection was a good option to treat multifocal bilobar hepatic epithelioid hemangioendothelioma; it may prevent metastasis dissemination.

Study of pulmonary experimental paracoccidioidomycosis by analysis of bronchoalveolar lavage cells: Resistant vs. susceptible mice

Adult Swiss (susceptible) and BALB/c (non-susceptible) mice were inoculated by the intravenous route with 1 x 10(6) yeast cells of Paracoccidioides brasiliensis, strain 18. Immunologic parameters, histopathology and features of the bronchoalveolar lavage (BAL) were evaluated at week 2, 4, 8 and 16 post-infection. The pulmonary infection was progressive in Swiss mice and regressive in BALB/c mice. The numbers of total cells, lymphocytes and polymorphonuclear neutrophils increased in BAL, as well as the percentages of giant cells, and CD4 and CD8 positive cells. The ultrastructural study of BAL cells revealed a predominance of macrophages and a frequency of 13.2% of type II pneumocytes. As the infection progressed, the number of fungal cells and spreading macrophages, as well as the stimulated release of H2O2 by macrophages, increased. The animals exhibited an exacerbation of the humoral immune response and a depression of cellular immunity during the infection. There was a good correlation between the intensity and the pattern of the pulmonary histopathology and the cellular findings in the BAL. The present model reproduces some anatomoclinical patterns of the human disease and shows that BAL may be a useful tool in monitoring the pulmonary infection caused by P. brasiliensis.

Use of topical mitomycin C in myoplasty of the medial rectus muscle of rabbits

To possibly reduce postoperative adhesions that occur after ocular myoplasties, we investigated the topical effects of 0.04% mitomycin C on the repaired areas of the medial rectus muscle using an equine renal capsule preserved in 98% glycerin for reinforcement of the sutures. Twenty-four rabbits, divided into two groups of 12 animals each [untreated (control) and treated group (MMC)], were submitted to surgical rupture of the medial rectus muscle of one eye and repair of the defect 24 h later with sutures and an equine renal capsule. Post-operative prophylactic treatment of the two groups consisted of the administration of eye drops containing neomycin, polymyxin B and dexamethasone at regular 6-h intervals for eight consecutive days and daily rinsing with physiological saline. MMC animals received additional treatment with topical 0.04% mitomycin C every 6 h for 14 consecutive days. Slit lamp biomicroscopy showed greater irritation of the ocular surface in MMC animals during the first days post operatively. Adhesions were observed at 15 and 30 days of assessment in the two groups, but were more extensive in control animals at 60 days. Histopathology revealed inflammatory exudation in both groups, which was greater in MMC animals. Mitomycin C (0.04%) instilled at 6-h intervals for 14 consecutive days reduced the occurrence of fibrosis in the myoplastic areas. However, the equine renal capsule was found to be of little benefit for the reinforcement of myoplasties.

Melanocitoma dérmico fribroso em bezerra

Melanomas are neoplasm not frequent in rattle. They constitute less than 2% of all the bovine turners. This report describes a 11-month-old female Holstein heifer hearing a subcutaneous mass of tissue approximately 18 x 8 cm surrounding the right eye, extending to the top of the neck. This mass appeared when the animal was 4-month-old. A biopsy sample taken to histopathology revealed neoplastic tissue composed of melanin-loaded cells and not disorganized connective tissue fibers. Partial pigment removal, utilizing potassium permanganate technique, revealed large nucleus in thp melanocitic cells. In some of these cells, a nucleolus was evident. Considering that previous reports on fibrous dermic melanocytoma are rarer in the literature, these findings are documented.

Infiltrative myelopathy by paracoccidioidomycosis. A review and report of nine cases with emphasis on bone marrow morphology

Aims: To report nine additional well-defined cases with infiltrative myelopathy by paracoccidioidomycosis (PCM), to describe the specific lesions and infection-related stromal abnormalities, to review the literature on this type of involvement and to introduce a new cause of granulomatous lesions of bone marrow.Methods and results: Different bone marrow specimens were studied (aspirated smears, aspirated clots, biopsy imprints and biopsies) from nine patients with acute or subacute forms of PCM known to have PCM infiltrative myelopathy.Conclusions: the biopsy specimens were the best for demonstrating bone marrow involvement by PCM. The lesions varied from compact and focal granulomas with few fungal cells to numerous disseminated fungal cells within a loose granulomatous inflammatory reaction, with a continuum between these extremes suggesting a spectrum of immune response to the fungi. Other findings such as bone marrow fibrosis, parenchymal coagulative necrosis and bone necrosis were also observed in the affected areas.

EFFECT OF ASCORBIC-ACID DEFICIENCY ON THE GROWTH, GILL FILAMENT LESIONS AND BEHAVIOR OF PACU FRY (PIARACTUS-MESOPOTAMICUS HOLMBERG, 1887)

The effect of ascorbic acid deficiency was determined in Piaractus mesopotamicus Holmberg, 1887, fish (pacu) under laboratory conditions. A total of 120 fish with an average body weight of 8.64 +/- 1.62 g and measuring 6.15 +/- 0.33 cm in length at the beginning of the experiment were fed diets containing 0, 50, 100 or 200 mg palmitate-coated ascorbic acid/kg dry ration for a period of 24 weeks with measurements every 4 weeks. The experiment was conducted in 20 fiber-cement aquaria of 81-liter capacity. Each aquarium was supplied with dechlorinated water at a flow rate of 1 l/min. Water temperature was measured daily and pH, dissolved oxygen, alkalinity and water conductivity were determined weekly. A fully randomized experimental design was utilized, with 5 replicates of each treatment and 6 fish per aquarium. Ascorbic acid-supplemented fish presented significantly increased growth when compared to unsupplemented fish. Furthermore, unsupplemented fish presented a higher incidence of hyperplasia, hypertrophy and dysplasia of the bone cartilage of gill filaments. The gill lamellae of unsupplemented fish had twisted cartilage and an inflammatory infiltrate at the ends. Anorexia and increased handling stress were also observed in fish fed the unsupplemented diet. The present study suggests that 50 mg ascorbic acid/kg dry ration is sufficient to improve development of pacu fingerlings but the optimum level under aquarium conditions, determined by regression analysis, is 139 mg ascorbic acid/kg dry ration.