Significance of bile-duct changes in schistosomiasis

Lesions involving the intra-hepatic biliary ducts in schistosomiasis have been reported in the literature, both in mice and man, but there are no data concerning their quantitative, evolutionary or post curative chemotherapeutic aspects on record. In order to obtain such data an investigation on this subject was attempted. Mice infected with 50 Schistosoma mansoni cercariae were submitted to a liver biopsy at the 9th week post-infection, and treated with 400mg/bw praziquantel immediately afterwards. Infected and non-infected controls were submitted to the same procedures. By 19 weeks from cercarial exposure all surviving animals were sacrificed. The biliary ducts were counted on histological sections and the results were expressed as biliary ducts/portal spaces. This quantitative evaluation was compared with that from normal controls and revealed hyperplasia as the main biliary duct change (p<0.007) in schistosomiasis. Hyperplastic changes underwent only mild partial and not statistically significant regression after specific chemotherapy (p>0.05). Infected and untreated animals presented ductal changes that did not differ from those of the treated group. Measurements of serum bilirrubin (total and direct), and gamma-glutamyl-transpeptidase (gamma-GT) did not reveal significant differences when animals from the several groups were compared. Thus, bile ducts exhibit a proliferative response in relation to neighboring S. mansoni injury to portal areas, but although these lesions are histopathologically impressive, they lack a functional or prognostic significance.

Choque séptico puerperal por Streptococcus β-hemolítico e síndrome de Waterhouse-Friderichsen

É relatado caso excepcional de puérpera de 15 anos com choque séptico pelo Streptococcus beta-hemolítico do grupo A e síndrome de Waterhouse-Friderichsen, observado à necropsia. São revistos aspectos do diagnóstico, patogênese e evolução da infecção (sepse) puerperal associada à hemorragia e insuficiência das supra-renais.

Malária álgida: um diagnóstico sindrômico

São relatados dois casos de pacientes com malária por Plasmodium falciparum, evoluindo com síndrome do choque. Receberam suporte hemodinâmico em unidade de terapia intensiva, sem uso de antibióticos, evoluindo com melhora. Malária álgida deve ser um diagnóstico sindrômico, de etiologia diversa (desidratação, infecção bacteriana, sangramento e/ou insuficiência adrenal).

Prevalence and clinical features of celiac disease in patients with hepatitis B virus infection in Southern Brazil

Introduction Celiac disease is an autoimmune disorder that involves gluten intolerance and can be triggered by environmental factors including hepatitis B virus (HBV) infection. This study aimed to describe the prevalence of celiac disease in individuals with HBV infection and to describe the clinical and laboratory characteristics of celiac disease associated with HBV. Methods This cross-sectional study included 50 hepatitis B patients tested for IgA anti-endomysial antibodies (EMAs) and tissue anti-transglutaminase (TTG) between August 2011 and September 2012. Results Fifty patients were included with a mean age of 46.0 ± 12.6 (46.0) years; 46% were female and 13% were HBeAg+. Six patients had positive serology for celiac disease, four were EMA+, and five were TTG+. When individuals with positive serology for celiac disease were compared to those with negative serology, they demonstrated a higher prevalence of abdominal pain (100% vs. 33.3%, p = 0.008), lower median creatinine (0.7mg/dL vs. 0.9mg/dL, p = 0.007) and lower mean albumin (3.6 ± 0.4g/L vs. 3.9 ± 0.3g/L, p = 0.022). All individuals with positive serology for celiac disease underwent upper digestive endoscopy, and three of the patients exhibited a macroscopic pattern suggestive of celiac disease. Histologically, five patients demonstrated an intra-epithelial lymphocytic infiltrate level > 30%, and four patients showed villous atrophy associated with crypt hyperplasia on duodenal biopsy. Conclusions An increased prevalence of celiac disease was observed among hepatitis B patients. These patients were symptomatic and had significant laboratory abnormalities. These results indicate that active screening for celiac disease among HBV-infected adults is warranted.

Pheochromocytoma treated by laparoscopic surgery

OBJECTIVE: To evaluate the results of the laparoscopic technique in the treatment of adrenal pheochromocytoma. METHOD: Ten patients, 7 men and 3 women, between 10 and 67 years of age (mean 48) with pheochromocytoma underwent transperitoneal laparoscopic adrenalectomy and were evaluated retrospectively, based on clinical, laboratory, and pathological diagnosis. In all cases there was a solid unilateral adrenal tumor, 5 on the left side and 5 on the right side, whose greater diameter varied from 7 to 80 mm (mean 32). Nine of the 10 patients were chronically hypertensive or had already had hypertensive crises. One patient was normotensive, but presented metabolic alterations suggestive of adrenergic hyperfunction. RESULTS: No deaths occurred in this series. There were two (20%) conversions to open surgery, one due to venous bleeding and one due to the difficulty of dissection behind the vena cava in a patient presenting a partially retro-caval tumor. Surgical time in the 8 non-converted cases ranged from 70 to 215 minutes (mean 136). One patient (10%) received blood transfusion, and another (10%) presented two complications - acute renal failure and a subcutaneous infection. Both had been converted to open surgery. None of the non-converted cases was transfused or presented complications. Hospital discharge occurred between the 2nd and 11th post-operative day (mean 3). The pathological exam of the surgical specimens confirmed the diagnoses of pheochromocytoma in all 10 cases, one of them associated with an aldosterone-producing cortical tumor. CONCLUSIONS: Laparoscopic adrenalectomy for selected patients presenting pheochromocytoma is feasible and provides good results.

Diffuse panbronchiolitis: an underdiagnosed disease? Study of 4 cases in Brazil

BACKGROUND: Diffuse panbronchiolitis is a clinical pathologic condition characterized by chronic inflammation of respiratory bronchioles, with clinical features that position it as a differential diagnosis among the sinopulmonary syndromes. METHODS AND RESULTS: We present 4 cases (1 Black, 2 Japanese descendants, and 1 Japanese), living in Brazil, in which the diagnosis was made by the clinical and radiological features and confirmed by transbronchial biopsy. The clinical findings included chronic sinusitis, productive cough, rhonchi, and wheezes. The pulmonary function tests showed an obstructive pattern. High resolution computerized tomography showed a diffuse nodular pattern, airway ectasia, and airway wall thickening. The biopsy showed interstitial accumulation of foam cells and lymphoid cells in the walls of respiratory bronchioles: 2 of our cases had bronchus-associated lymphoid tissue hyperplasia. We searched for the HLA Bw54 in all of our patients, but only 1 was positive. A low dose macrolide treatment was introduced, resulting in with clinical and functional improvement. A score that rated the extent of nodules, airway ectasia, mucus plugging, and airway wall thickening was applied on pre- and post-treatment High resolution computerized tomography results, revealing an improvement in tomographic pattern related to that observed in the pulmonary function tests. CONCLUSION: We conclude that diffuse panbronchiolitis is a systemic disease that is not exclusive to the Asian population, whose clinical and radiological features should be better known by occidental pulmonary physicians.

Adrenocortical tumors: results of treatment and study of Weiss's score as a prognostic factor

PURPOSE: The differential diagnosis between benign and malignant adrenal cortical tumors circumscribed to the gland is controversial. One hundred and seven patients with adrenal cortex tumors (excluding those with primary hyperaldosteronism) were studied to assess the 5-year survival rate of adults, children, patients stratified by pathological stage, and patients stratified according to Weiss's score of <3 or >3. METHODS: The patients were evaluated both clinically and biochemically. One hundred and five patients underwent surgery and were classified pathologically as stages I, II, III, or IV. The tumors were weighed, measured, and classified according to Weiss's criteria and divided into 2 groups: <3 and >3. RESULTS: After 5 years, the survival rate was 77.5% for the whole group, 74.61% for the adults, 84.3% for the children, 100% for stage I, 83.9% for stage II, 33% for stage III, and 11.7% for stage IV groups. Additionally, after 5 years, 100% of the patients with tumors with Weiss's score <3 were alive compared to 61.65% of those with Weiss's score >3. The average weights of the tumors of score <3 and >3 were 23.38 g ± 41.36 g and 376.3 ± 538.76 g, respectively, which is a statistically significant difference. The average sizes of tumors of Weiss's score <3 and >3 were 3.67 ± 2.2 cm and 9.64 ± 5.8 cm, respectively, which is also a statistically significant difference. CONCLUSIONS: Weiss's score may be a good prognostic factor for tumors of the adrenal cortex. Additionally, there was a statistically significant difference between the average weight and size of tumors with benign behavior (Weiss's score <3) and those with malignant behavior (Weiss's score >3).

Parâmetros endócrinos em ratos tratados cronicamente com extrato concentrado de Stevia rebaudiana (Bert.) Bertoni

Os efeitos de princípios ativos de S.revaudiana sobre parâmetros endócrinos de ratos foram estudados após administração crônica (60 dias) de extrato aquaso bruto(decocto) concentrado nas folhas desse planeta, começando em idade pré-púbere (25 a 30 dias de idade). Foram feitas as seguintes determinações: glicemia, níveis séricos de T3, T4 e T3R, união de [3H] R1881 à fração citosólica de próstata, teor de zinco em próstata, testículo, glândula salivar submandibular e pâncreas, e conteúdo hídrico em testículo e próstata. Estudou-se também a curva de ganho de peso corporal e os pesos terminais de testículo, próstata, vesícula seminal, glândula submandibular e adrenal. Os resultados deixaram potente que o grupo experimental não diferiu do controle significativamente em nenhum dos parâmetros analisados, exceto quanto ao peso de vesícula seminal, que diminuiu em 608, tanto em termos absolutos como em relação ao peso corporal. Conclui-se que os parâmetros endócrinos estudados no rato não são fundamentalmente alterados por doses farmacológicas de princípios ativos de S.rebaudiana.

Avaliação do funcionamento do eixo HPA em deprimidos por meio de medidas basais: revisão sistemática da literatura e análise das metodologias utilizadas

Objetivo Realizar revisão sistemática da literatura para conhecer a atividade do eixo hipotálamo-pituitária-adrenal (HPA) em deprimidos considerando-se as medidas basais dos hormônios e analisar criticamente as metodologias utilizadas. Métodos Foi realizada busca de artigos nas bases de dados PubMed e SciELO. Na primeira base de dados, introduziram-se as palavras-chave “depressive disorder” e “HPA axis”, e na segunda utilizaram-se os termos “depression” ou “depressão” e “HHA” ou “HPA axis”. Optou-se por pesquisa realizada em humanos adultos, em inglês e português, do ano 2000 até 2011. Resultados Dos 27 artigos selecionados, obtiveram-se como resposta do eixo HPA tanto hiperatividade como atividade desregulada, hipoatividade ou não alteração. Tais resultados dependem das variáveis e dos hormônios estudados, do fluido coletado – plasma, urina, saliva, líquido cefalorraquidiano – do horário de coleta, do número de coletas, da análise estatística utilizada, do subtipo de doença depressiva, entre outros. Conclusão: Os resultados não apresentam consenso em relação à atividade do eixo HPA. Considerando as variáveis estudadas, o eixo HPA, na maioria das vezes, apresenta-se disfuncional na presença da depressão.

Hiperplasia supra-renal congênita por deficiência de 11-ß-hidroxilase

Este artigo tem o objetivo de relatar o diagnóstico e a evolução clínica de um paciente de 15 anos portador de uma disfunção congênita da esteroideogênese adrenal, que pode apresentar-se como hipertensão arterial de diagnóstico muitas vezes tardio (adolescência), virilização ou formas perdedoras de sal (nascimento e infância).

Lipoides do plasma normal

1. In a series of 21 normal cases we found for fatty acids per 100 cc. of plasma an average of 332 mgm., being 314 mgm. for the male sex and 350 mgm. for the female sex. 2.- For lecithin, in four normal cases we found per 100 cc. of plasma 182 mgm. estimated by the contents is phosphorus which ranged from 6.12 to 9.0 mgrs. 3.- Cholesterol in 20 normal cases showed 172 mgm. per 100 cc. of plasma. The averages were 151 mgm. for men and 194 mgm. for women. 4.- The readings of the fractions were 2.01 for the ratio fatty acids divided by lecithins 0.90 for lecithin divided by cholesterol and 1.93 for fatty acids divided by cholesterol. 5.- On comparing the results obtained by us with those reported in foreign literature an absolute conformity is noted chiefly with the values supplied by Bloor and Horiuchi for the ratios among the various lipoid fractions. The average for Cholesterol is comparable with that obtained by Myers but is slightly under that of Bloor's. The lecithin contents found by us did not reach such high values as those supplied by foreign authors.

Sôbre a hiperplasia celular no mixoma infectuoso do coelho

Definite hyperplasia of cells occurs in the skin lesions of the infectious myxoma of rabbits, more visible in such stages in which the intercellular basophilic substance is rather scanty (fig. 2). The increase in number of cells is the result of simplified forms of mitosis (modified type of mitosis, pseudoamitosis) which might readily be mistaken for amitosis in their final stages. Budding (figs. 20, 28, 29, 30) as well as constriction of the nucleus (figs. 18, 31, 32), and the formation of giant-cells (figs. 33, 34) are not rare. During the entire process the nuclear membrane does not desintegrate as in typical mitosis. Division of the cytoplasm following division of the nucleus has been demonstrated (fig. 17). Typical mitosis is practically absent. The cells which undergo hyperplasia present remarkable changes in their dimension, shape, and structure. The nucleus and cell-body are considerably enlarged (figs. 6, 7, 8). The shape of the nucleus is modified (figs. 8, 10, 15). Hypertrophy of nuclein, either as an intranuclear network (spireme?, figs. 9, 23), or in the form conspicuous, deeply staining masses which appear not to be homogeneous but to be composed of small particles closely clumped ("mulberries"?, figs. 12, 13, 14, 25, 26) occurs in most cells. While some of these pictures are probably related to necrosis of the cells as started by most of the previous workers, it is lekely that some of them may represent developmental stages of the modified mitosis (pseudoamitosis) here reported. In fact, fine cytological details not ordinarily preserved in necrotic cells (figs. 35, 36, 37) may be demonstrated in the socalled myxoma-cells subtted to approved cytological methods of study (fixation in B-15 and P. F. A.-3, staining in iron-hematoxylin).

Estudos sobre a atividade dos extratos da suprarenal

Studies have been carried out on the method of Britton and Silvette modified by Reinecke and Kendall, for the evaluation of cortico-adrenal extracts, based on the deposition of glycogen in the liver of adrenaletomized rats. The test was performed in a total of 180 normal and adrenalectomized rats. The extracts tested were: a) an aqueous extract of cortico-adrenal cortex prepared by the Swingle and Pfiffner technique; b) the same extract added with ascorbic acid (Supracortin Labor); c) desoxycorticosterone acetate (Percortol Ciba and Syncortyl Roussell). Male rats were used, ranging from 40-200g, fed since the 18 th days old with a special diet, in which they were maintained until the day before the injection. Adrenalectomy was performed under urethane anesthesia. The fourth day after operation, food was removed and they were fasted for 24 hours. In the morning of the fifth day, injections of the material to be assayed were given at hourly and two hours intervals, during four to eight hours. One or two hours after the last injection, the animals were sacrified, the livers removed and dropped into a hot 30% solution of potassium hydroxide, and worked by Good, Kramer and Somogyi method. The glycogen was calculated as milligrams per lOOg of body and liver weight. The results obtained are shown in the tables I, II, and III. When several dosages of the same sample of extract were made (5 animals each dose), the amount of glycogen deposited in the liver per lOOg of body and liver weight, was found to be a positive function of the dose injected. The graph 2, shows these results. The synthetic compounds were ineffective. Our results are in agreement with those of Reinecke and Kendall and of Olson et al.

On the determination of reducing corticosteroids

1. The authors preconize the use of Folin-Ciocalteu's reagent in the colorimetric determination of reducing cortcosteroids. 2. The reaction follows Beer's law in the range 0-50 μg of 11-desoxycorticosterone. 3. Determinations made in human urine and adrenal glands of rats and guinea pigs are comparable with results obtained by other methods.

Hiperglicemia na intoxicação escorpiônica experimental em cão

The production of hyperglycemia during the acute phase of scorpion poisoning produced by T. bahiensis in dogs is confirmed now. The highest degree on average, was reached 10 minutes after the injection of venom. In our hands, the previous bilateral adrenalectomy did not avoid the hyperglycemia. The average of the blood sugar level has been similar to that observed in dogs with adrenal glands, the highest blood sugar level was also registered after 10 minutes. The hyperglycemia obtained in adrenolectomized dogs is, probably, due to the liberation of Sympatin (Nor-adrenalin and adrenalin) as a consequence of the central excitation by the poison on the hepatic nerves and other ganglionar terminations of the Sympathetic Nervous System. Our present researches suggest that the venom has adrenergic action besides the central action.