Histerectomia e as doenças ginecológicas benignas: o que está sendo praticado na Residência Médica no Brasil?

OBJETIVO: avaliar o ensino e a prática da histerectomia no Brasil nas diferentes regiões do país e compará-las com dados da literatura mundial. MÉTODOS: foram enviados questionários aos 132 Serviços de Residência Médica de Ginecologia e Obstetrícia do Brasil cadastrados pelo Ministério da Educação e Cultura em 2003. O mesmo continha nove questões sobre indicações em casos de doenças benignas, procedimentos operatórios, uso de antibioticoprofilaxia, fios para sutura da cúpula vaginal e complicações. Para a análise dos resultados, foram aplicados os testes de Friedman, Kruskal-Wallis e chi2, conforme a natureza das variáveis. RESULTADOS: nos 48,5% de questionários respondidos ou justificados (não-respostas), houve predomínio da região Sudeste (62%). A via operatória preferencial foi a abdominal, variando de 60 a 100% em média (p<0,001), seguida da via vaginal (10-40%) e da vídeo-assistida (6%). Em 94% dos Serviços, a via vídeo-assistida foi referida como não-empregada. A principal indicação de histerectomia foi a miomatose (60,4%; p<0,001), seguida de adenomiose (8,3%) e sangramento uterino anormal (7,5%). Quanto à antibioticoprofilaxia sistêmica, 94% dos Serviços utilizaram cefalosporina de primeira geração. Não houve diferença estatisticamente significante entre o emprego do fio de sutura no fechamento da cúpula vaginal (catgut® simples, catgut® cromado ou Vicryl®) e a formação de granuloma neste local. A principal complicação foi o granuloma de cúpula vaginal (p=0,002). CONCLUSÕES: as vias operatórias, as indicações, a antibioticoprofilaxia, os fios utilizados para a sutura da cúpula vaginal e as complicações das histerectomias foram similares nas diversas regiões do país e estão em consonância com a literatura mundial.

Pitiose eqüina no Pantanal brasileiro: aspectos clínico-patológicos de casos típicos e atípicos

A pitiose eqüina é doença endêmica no Pantanal Brasileiro e causa prejuízos significativos a eqüinocultura. Neste trabalho são relatados 16 casos de pitiose subcutânea em eqüinos no Pantanal Sul-Matogrossense, que foram divididos em onze casos típicos e cinco casos atípicos, de acordo com o quadro clínico e o tempo de duração das lesões. O diagnóstico foi confirmado pela detecção de anticorpos específicos pelo teste ELISA, isolamento do agente e histopato-lógico. A duração da doença variou entre 1 e 6 meses nos casos típicos e superior a 12 meses nos casos atípicos. As lesões dos casos típicos caracterizavam-se por granulomas subcutâneos, ulcerados, com abundante secreção serossangui-nolenta e prurido. Nos casos atípicos foram observadas lesões subcutâneas caracterizadas por grandes massas "tumorais" circunscritas, recobertas por pele escura, sem ulcerações e com pouca secreção. Os animais estavam em bom estado nutricional e as lesões apresentavam-se de aspecto organizado, às vezes pedunculadas. Histologicamente, foi observado tecido de granulação com muitos eosinófilos nos casos típicos, enquanto os atípicos, se caracterizaram por hiperplasia pseudo-epiteliomatosa da epiderme e infiltrado eosinofílico. As características clínicas e histopato-lógicas completas das duas formas clínicas e os possíveis fatores responsáveis pelas diferenças entre as duas formas são apresentados e discutidos.

Outbreaks of rhinofacial and rhinopharyngeal zygomycosis in sheep in Paraíba, northeastern Brazil

Two outbreaks of zigomycosis with rhinofacial and two other with rhinopharyngeal lesions involving fungi with filamentous coaenocytic hyphae characteristic of entomoph-thoramycetous fungi are reported in the state of Paraíba, northeastern Brazil. One outbreak of rhinofacial zygomycosis occurred during the rainy season affecting 5 sheep. Another outbreak of the clinical form affected one out of 40 sheep during the dry season. Common clinical signs of the rhinofacial infection were bilateral serosanguineous nasal discharge with swelling of nostrils, upper lip, and the skin of the face. At necropsy the nasal mucosa showed dark brownish ulcerated areas which extended from the mucocutaneous region to 10cm inside the nasal vestibule. The mucosa of the hard palate was also ulcerated. The cutting surface of nostrils and palate showed a brownish or red spongeous tissue of friable consistency. One outbreak of rhinopharyngitis took place on an irrigated coconut farm; 7 out of 60 adult sheep were affected. Another outbreak affected a sheep in a flock of 80 during the dry season. Clinical signs as noisy respiration and dyspnoea due to mechanical blockage of the nasal cavities, swelling of the nostrils, and serosanguineous nasal discharge were observed. Six out of 8 sheep in this group showed exophthalmia, keratitis and unilateral corneal ulceration of the eye. The sheep either died of their infection or were euthanized after a clinical course of 7-30 days. At necropsy there was a dense yellow exudate in the nasopharyngeal area affecting the ethmoidal region, turbinate bones, paranasal sinuses, hard and soft palates, orbital cavity, pharynges, regional muscles and lymph nodes. Histopathologically both forms of the disease showed multifocal granulomas with an eosinophilic necrotic reaction (Splendore-Hoeppli phenomenon) containing ribbon-type coenocytic hyphae with 7-30mum in diameter similar to hyphae of zygomycetous fungi, possibly Conidiobolus spp. Outbreaks of both forms of mycotic rhinitis are common in northeastern Brazil and in other regions of the country.

Acute toxicity and histopathological alterations of Roundup® herbicide on "cachama blanca" (Piaractus brachypomus)

Acute toxicity of the glyphosate -N (phosphonomethyl) glycine- herbicide, Roundup®, in juveniles of cachama blanca, (Piaractus brachypomus), was evaluated and the histopathological lesions were assessed. The 96 h lethal concentration 50 was 97.47mg.L-1 (P<0.05). In the gill, necrotic and proliferative lesions were detected. In the liver, congestion, degenerative foci, hyaline droplets and lipidic vacuolization of the hepatocytes were observed. In the stomach mild hyperplasia of mucous cells was detected, which was also observed in the skin. In this latter tissue, a large increase in the thickness of the epidermis with necrotic lesions, infiltration of leukocytes and melanin pigment were observed. In the brain, degenerative foci of neuronal bodies in the telencephalon associated with gliosis and infiltration of eosinophilic granule cells/mast cells were shown. In conclusion, gills, liver, skin and brain are susceptible to Roundup®. Moreover, effects on the central nervous system could affect olfaction as well as individual and group behavior, the reproductive performance of the fish and hence have repercussions at the population level.

Ultrastructural characterization of bovine umbilical cord blood cells

The umbilical cord blood (UCB) is an important source of pluripotent stem cells, which motivated researches on ontogeny and transplantation. The morphological characterization of umbilical cord cells is the first step to establish subsequent experiments on these areas. Although some information on humans can be found, no data on UCB is available for bovines. Therefore, this work is the first attempt to conduct an ultrastructural characterization of bovine umbilical cord blood. Blood was collected from the umbilical cord of twenty fetuses by punction of the umbilical vein. Samples were processed for whole leucocytes observation by centrifugation and the buffy coat was collected. Cells were washed and pelleted and prepared according to the standard protocol of the transmission electron microscopy. The presence of cells with morphologic characteristics compatible with the precursors from the erythrocytic, neutrophilic, eosinophilic, basophilic, and lymphocytic lineages was observed. Atypical cells with peculiar morphological features, strongly similar to apoptotic cells, were seen. Bovine neutrophils with three types of cytoplasmic granules were also found in the blood. The ultrastructural characteristics of observed bovine UCB cells where similar to those found in other species, suggesting that bovines could possibly constitute an experimental model for approaches on UCB cells research.

Prevalência dos tumores cutâneos de equinos diagnosticados no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria, Rio Grande do Sul

Este estudo teve como objetivo determinar a prevalência das dermatopatias tumorais de equinos diagnosticadas no Laboratório de Patologia Veterinária (LPV) da Universidade Federal de Santa Maria (UFSM), Rio Grande do Sul. Para isso, foram revisados os protocolos de biópsia de pele de equinos, arquivados no LPV-UFSM, entre janeiro de 1999 e dezembro de 2009. Em todos os casos, foram considerados os diagnósticos morfológicos que constavam nos protocolos. Durante esse período foram submetidas ao LPV-UFSM 139 amostras cutâneas de equinos. Dessas 139 amostras, 108 (77,6%) eram de tumores cutâneos, neoplásicos ou não; os outros 31 casos consistiam de dermatoses não tumorais. Dos 108 equinos, 53 (49,1%) eram fêmeas e 37 (34,2% %) eram machos, em 18 (16,7%) casos não estava descrito no protocolo o sexo. Quanto à raça, 66 (61,1%) eram de raça pura e 13 (12%) não tinham raça definida; em 29 (26,9%) protocolos não havia a descrição da raça. A raça mais prevalente foi a Crioula (44/108 [40,7%]), o restante dos 22 equinos de raça pura pertencia a outras sete raças diferentes. Quanto à idade, as categorias mais prevalentes em ordem decrescente foram a de 1-5 anos (47/108 [43,5%]) e a de 6-14 anos (21/108 [19,5%]), cavalos com 15 anos ou mais representaram 11,1% (12/108). Apenas um cavalo tinha menos de um ano de idade. Em 27 protocolos não constava a idade. Os tumores mais prevalentes incluíram: sarcoide (62/108 [57,4%]); carcinoma de células escamosas (11/108 [10,2%]); pitiose (9/108 [8,3%]); tecido de granulação (7/108 [6,5%]; e o granuloma eosinofílico (4/108 [3,8%]). Os outros tumores contaram com aproximadamente 14% dos casos.

Equine leukoencephalomalacia (ELEM) due to fumonisins B1 and B2 in Argentina

In August 2007 an outbreak of neurological disease and sudden death in Arabian horses occurred in a farm located in Coronel Rosales County, Buenos Aires Province, Argentina. The animals were on a pasture of native grasses and supplemented ad libitum with corn kernels and wheat bran. Three horses were observed having acute neurologic signs including blindness, four leg ataxia, hyperexcitability, aimless walking and circling, followed by death in two of them. Four other horses were found dead overnight without a history of neurologic signs. The morbidity, mortality and lethality rates were 11.6%, 10% and 85.7%, respectively. Grossly, the brain showed focal areas of hemorrhage, brown-yellow discoloration and softening of the sub-cortical white matter. The microscopic brain lesions consisted of extensive areas of malacia within the white matter of the cerebral hemispheres, brainstem and cerebellum, characterized by rarefaction of the white matter with cavitations filled with proteinaceous edema, multifocal hemorrhages and mild infiltration by neutrophils, and rare eosinophils. Swollen glial cells with abundant eosinophilic cytoplasm, distinct cell borders, intracytoplasmic deeply eosinophilic globules and eccentric, hyperchromatic, occasionally pyknotic nucleus were present throughout the areas of rarefaction hemorrhage, edema and necrosis. The feed supplements contained 12,490µg/kg of fumonisin B1 and 5,251µg/ kg of fumonisin B2. This is the first reported outbreak of ELEM associated with consumption of feed supplements containing high concentrations of fumonisins in Argentina.

Avian pox virus infection in a common barn owl (Tyto alba) in southern Brazil

A young common barn owl (Tyto alba) was referred to the Núcleo de Reabilitação da Fauna Silvestre (Nurfs), Federal University of Pelotas (UFPel), after been found in a barn of a brick factory in the urban area of Pelotas, Rio Grande do Sul, Brazil. The bird was apathic, weak and with crusty lesions in the featherless areas (eyes, beak, legs), and died soon after arrival at Nurfs. Necropsy and histopathological examination of the lesions were carried out. The hyperplasia and hypertrophy of the cutaneous lesions, several eosinophilic intracyto-plasmic inclusion bodies in epithelial cells (Bollinger bodies), as well as particles characteristic of poxvirus, observed by electronic microscopy, confirmed the infection by avian poxvirus, what highlights the importance of Tyto alba as carrier of the virus in the wild.

Spinal cord compression in cattle after the use of an oily vaccine

An outbreak of compressive myelopathy in cattle associated with the improper use of an oil vaccine is described. Neurological signs were observed in 25 out of 3,000 cattle after 60 days of being vaccinated against foot and mouth disease. The clinical picture was characterized by progressive paralysis of the hind limbs, difficulty in standing up, and sternal recumbency during the course of 2-5 months. A filling defect between the L1 and L3 vertebrae was seen through myelography performed in one of the affected animals. A yellow-gray, granular and irregular mass was observed in four necropsied animals involving the spinal nerve roots and epidural space of the lumbar (L1-L4) spinal cord; the mass was associated with a whitish oily fluid. This fluid was also found in association with necrosis of the longissimus dorsi muscle. Microscopic changes in the epidural space, nerve roots, and spinal musculature were similar and consisted of granulomas or pyogranulomas around circular unstained spaces (vacuoles). These spaces were located between areas of severe diffuse hyaline necrosis of muscle fibers and resembled the drops of oil present in the vaccine.

Outbreak of infectious laryngotracheitis in large multi-age egg layer chicken flocks in Minas Gerais, Brazil

A recent (November 2010) outbreak of infectious laryngotracheitis (ILT) in a multi-age laying hen facility in Minas Gerais state, Brazil, is described. Previous ILT outbreak in laying hens was only notified in São Paulo state, Brazil, in 2002. In the outbreak described here, the affected population was approximately eight million hens, with flock sizes ranging from 100,000 to 2,900,000 chickens. The average mortality ranged from 1 to 6%, and morbidity was around 90% (most of the twenty seven farms of the area were positive for ILT virus). Three multi-age laying farms from one company were selected for this report. Clinical signs included prostration, dyspnea, conjunctivitis, occasional swelling of the paranasal sinuses and bloody mucous nasal discharge. Severely affected chickens presented with dyspnea, gasping and became cyanotic before death. At necropsy, these chickens had fibrinous exudate blocking the larynx and the lumen of cranial part of the trachea. In addition, conjunctivitis with intense hyperemia, edema and sinuses with caseous exudate were present. On histopathology, there were marked necrosis and desquamation of respiratory ephitelium and conjunctiva with numerous syncytial cells formation and fibrinous exudate. Moderate to marked non suppurative (especially lymphocytes and plasma cells) infiltration in the lamina propria also was observed. Sixteen out of 20 examined chickens, eosinophilic intranuclear inclusion bodies were observed in the syncytial cells. The DNA extracted from larynx and trachea produced positive PCR results for ILT virus (ILTV) DNA using formalin-fixed, paraffin embedded (FFPE) samples. Amplicons from a small region of ICP4 gene were submitted to sequencing and showed 100% identity with ILTV EU104910.1 (USA strain), 99% with ILTV JN596963.1 (Australian strain) and 91% with ILTV JN580316.1 (Gallid herpesvirus 1 CEO vaccine strain) and JN580315.1 (Gallid herpesvirus 1 TCO vaccine strain).

Outbreaks of vesicular disease caused by Vaccinia virus in dairy cattle from Goiás State, Brazil (2010-2012)

Cases of vesicular and exanthematic disease by Vaccinia virus (VACV) have been reported in dairy herds of several Brazilian regions, occasionally also affecting humans. The present article describes eight outbreaks of vesicular disease caused by VACV in dairy herds of six counties of Goiás state, Midwestern Brazil (2010-2012), involving a total of 122 cows, 12 calves and 11 people. Dairy cows (3 to 9 years old) were affected in all cases and calves (2 to 9 months old) were affected in five outbreaks, presenting oral lesions. The morbidity ranged between 8 and 100% in cows, and 1.5 to 31% in calves. In the cows, the clinical signs started with vesicles (2-7mm), painful and coalescent papules (3-8 mm), which resulted in ulcers (5-25mm) and scabs in teats, and, occasionally, in the muzzle. The clinical course lasted from 16 to 26 days. The histopathology of bovine skin samples revealed superficial perivascular inflammatory infiltrate of lymphocytes, plasma cells, neutrophils, macrophages and multifocal areas of acanthosis, spongiosis, hipergranulosis and parakeratotic or orthokeratotic hyperkeratosis with adjacent focally extensive ulcers. Eosinophilic inclusion bodies were noted in the cytoplasm of the keratinocytes. PCR to vgf gene of Orthopoxvirus was positive in samples collected from all outbreaks, and in some cases, genomic VACV sequences were identified by nucleotide sequencing of the PCR amplicons. Infectious virus was isolated in cell culture from scabs from one outbreak. Antibodies to Orthopoxvirus were detected in at least 3 or 4 animals in most outbreaks, by ELISA (outbreaks 1, 2, 3, 4, 5 and 7) or virus-neutralization (outbreak 6). Neutralizing titers ranging from 8 to 64 in outbreak 6. In all outbreaks, VACV infection was suspected based on the clinical and pathological findings and it was confirmed by laboratory tests. Upon the etiological confirmation, other agents associated with vesicular disease were discarded. In all outbreaks, at least one milker who handled the affected cows developed malaise, headache, fever, painful vesico-pustular lesions mainly in the hands, but also in the neck and nose. These results confirm the circulation of VACV in the region and call attention for a correct diagnosis and the adoption of prophylactic and control measures.

Development of an indirect ELISA to detect Corynebacterium pseudotuberculosis specific antibodies in sheep employing T1 strain culture supernatant as antigen

Corynebacterium pseudotuberculosis is the etiologic agent of caseous lymphadenitis (CLA), a chronic disease that affects goats and sheep, characterized by granuloma formation in subcutaneous and internal lymph nodes. CLA causes significant economic losses to commercial goat herds. In this study, we aimed to test secreted antigens secreted from T1 strain bacteria grown in brain heart infusion (BHI) broth in an indirect ELISA system to determine the presence of specific immunoglobulins against C. pseudotuberculosis. We analyzed the BHI antigen electrophoretic profile and the recognition pattern by infected sheep sera samples. The ELISA results were compared with multiplex PCR assay and IFN-gamma production. The ELISA was able to discriminate between negative and positive animals, with a sensitivity of 89% and a specificity of 99%, using microbiological isolation as gold standard. When this assay was compared with multiplex PCR and specific IFN-gamma quantification, six discrepant results were found among thirty-two samples. We concluded that the ELISA using antigens secreted from C. pseudotuberculosis T1 strain growth in BHI broth culture can be used for the serodiagnosis of CLA in sheep.

Actinomicose atípica em bovinos

Casos de actinomicose com apresentação atípica são descritos em dois bovinos. Em ambos os casos notou-se uma aumento de volume extenso e duro na maxila. A maxila dos dois bovinos tomou um aspecto de favo de mel como resultado da rarefação destrutiva e da proliferação óssea regenerativa. Na superfície de corte as lesões consistiam de tecido fibroso branco e brilhante em meio ao qual numerosos grânulos amarelos podiam ser vistos. Tratos fistulosos podiam ser demonstrados em meio às lesões. Em cortes corados pela hematoxilina e eosina as lesões consistiam de ilhas de inflamação piogranulomatosa em meio a extenso estroma fibroso. No centro do granuloma havia uma massa basofílica de forma irregular cercada por uma zona com projeções eosinofílicas radiadas (reação de Splendore-Hoeppli). Ao redor da massa radiada havia uma zona de neutrófilos cercada por uma camada de macrófagos epitelioides e ocasionais células gigantes multinucleadas. Uma camada externa de linfócitos e plasmócitos limitava o granuloma do extenso estroma conjuntivo que o cercava. Na coloração de Gram, a parte central da colônia revelava um aglomerado de micro-organismos em forma de bastonetes, com morfologia compatível com Actinomyces bovis. Uma vez que a apresentação pouco usual das lesões levou a má interpretação diagnóstica inicial nestes casos, a descrição detalhada das lesões é feita aqui com o objetivo de ajudar no diagnóstico diferencial feito por veterinários clínicos e inspetores de carne.

Caracterização histológica e imuno-histoquímica das lesões de tuberculose em bovinos e de linfadenite granulomatosa em suínos

Mycobacterium sp. induz inflamação granuloma-tosa em diferentes espécies animais. Mycobacterium bovis e o complexo Mycobacterium avium são importantes patógenos de bovinos e suínos e podem causar infecção em humanos, principalmente imunossuprimidos. Perdas na produção, barreiras comerciais e prejuízos por condenação de carcaças em abatedouro/frigorífico estão atrelados à ocorrência dessas infecções, com prejuízos econômicos significativos. Foi realizado um estudo de casos diagnosticados como tuberculose em bovinos e linfadenite granulomatosa em suínos no Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) no período de janeiro de 2007 a dezembro de 2011. Dados referentes à raça, ao sexo, à idade e ao histórico clínico foram compilados dos livros de registro e analisados. As características histológicas das lesões em linfonodos e pulmões foram avaliadas em Hematoxilina-Eosina, com predomínio de células gigantes nas lesões de tuberculose bovina e de macrófagos epitelioides em suínos. As técnicas histoquímicas de Ziehl-Neelsen e Tricrômico de Masson foram utilizadas para evidenciar, respectivamente, bacilos álcool-ácido resistentes e tecido conjuntivo fibroso nas lesões. A técnica de imuno-histoquímica foi utilizada em aproximadamente 30% dos casos estudados de cada espécie, selecionados aleatoriamente, para a caracterização do infiltrado linfocítico. Foram utilizados os anticorpos anti-CD3 para a marcação de linfócitos T e anti-CD79αcy para a marcação de linfócitos B. Linfócitos T predominaram nas lesões em ambas as espécies, com diferença estatisticamente significativa entre as médias dos linfócitos T e linfócitos B. Foi usado o teste t pareado, com t=5,501 (p<0,001) nas lesões dos bovinos e t=5,826 (p<0,001) para as lesões de linfadenite dos suínos. Adicionalmente foram marcados macrófagos com o uso do anticorpo anti-CD68 para bovinos e anti-Lisozima para suínos. Além desses, o anticorpo policlonal anti-Mycobacterium tuberculosis foi utilizado para a detecção de bactérias do gênero Mycobacterium, com imunomarcação positiva em todos os casos e, nos casos dos suínos, houve marcação anti-Mycobacterium avium.

Pythiosis in sheep from Paraná, southern Brazil

Abstract: This paper reports pythiosis in a sheep from southwestern Paraná, Brazil, confirmed by indirect ELISA (Enzime-Linked Immunosorbent Assay) and immunohistochemistry, as well as it describes the macro and microscopic injuries, in order to understand the pathogenicity. A 4-year-old ewe from a flock of 30 Santa Inês sheep, raised semi-extensively with access to a weir, showed cachexia, bilateral enlargement in nasal region, a serous and bloody secretion with a fetid odor from its nose and swollen submandibular and retropharyngeal lymph nodes. Blood collection was performed trough jugular vein puncture in order to make complete blood cell count (CBC) and to obtain serum for the subsequent serological examination. As the hematological counts were within the normal range for sheep, the animal was euthanized and submitted to necropsy. Indirect ELISA resulted positive for pythiosis. Necropsy revealed necrosis of the hard palate with a diameter of 3.5cm and extending up to the nasal cavity, forming a fistula. Submandibular and retropharyngeal lymph nodes were enlarged and edematous on section. Microscopic findings for submandibular and retropharyngeal lymph nodes consisted in moderate infiltration of eosinophils mainly in the subcapsular sinus, characterizing reactive eosinophilic lymphadenitis. The nasal cavity revealed rhinitis and oral cavity stomatitis with necro-eosinophilic and pronounced multifocal granulomatous infiltration and presence of hyphae. Hyphae found in palate and nasal cavity were positive for Pythium insidiosum by Grocott's method and immunohistochemistry, the last one considered to be confirmatory for the pathogen diagnostic. This report has an important epidemiological aspect, as it is the first case of pythiosis in sheep confirmed by serology in South Brazil and an alert of possible infection by the pathogen in floodplains.