Mycobacterial subcutaneous arteritis

The authors report three patients with subcutaneous erythematous nodules in different phases of development, inespecific systemic symptoms, positive PPD test, and normal chest X-rays. The histopathological study of the older nodules showed a granulomatous arteritis with a few acid-fast bacilli in the vascular wall. The nodules at an early phase showed an inespecific panniculitis with some acid-fast bacilli in apparently normal cutaneous vessels. These findings suggest that the mycobacterium has a vascular tropism and may cause a primary granulomatous arteritis.

Course of infection and histopathological lesions in mice infected with seventeen Trypanosoma cruzi strains isolated from chronic patients

Mice were infected with blood forms of 17 Trypanosoma cruzi strains recently isolated from chronic patients, which were dassified as of low, medium or high virulence on grounds of the prepatent period, parasitemia and mortality at the acute phase. A total of 212 mice were studied after 3, 6, 9 and 12 months of infection. In the chronic phase, intracellular parasites were detected in 11.0%,27.9%and 54.0,% of mice inoculated, respectively, with the low, medium and high virulent strains (r= 0.98, p < 0.005). Heart fibrosis was also related to virulence, affecting 5.7%, 11.6%and30.8% (r = 0.98, p < 0.001) of the mice inoculated with the above strains; a similar relationship was observed between intensity and frequency of the heart inflammatory reaction and the severity of infection at its early stage. Necrotizing arteritis was detected in 12.2% of the inoculated animals and this lesion was related to the infection duration rather than to strain characteristics. Inflammatory lesions and tissue parasitism were stable within the period of observation, whereas fibrosis was Progressive. The findings suggest that mice may reproduce heart lesions resembling human pathology and that organ damage apparently depends on the parasite virulence.

Comparison between Adventitial and Intimal Inflammation of Ruptured and Nonruptured Atherosclerotic Plaques in Human Coronary Arteries

OBJECTIVE: To verify the possible role of adventitial inflammation in atherosclerotic plaque vulnerability and coronary artery remodelling. METHODS: We compared the mean numbers of lymphocytes in the adventitia and in the plaque of ruptured thrombosed and stable equi-stenotic coronary segments of 34 patients who died due to acute myocardial infarction. We also analysed adventitial microvessels, adventitial fibrosis and the external elastic membrane. RESULTS: In the adventitia, the numbers of lymphocytes and microvessels/mm² were 69.5±88.3 and 60.9± 32.1 in culprit lesions and 16.4 ± 21.1 and 44.3±16.1 in stable lesions (p<0.05); within the plaques, the mean number of lymphocytes was 24±40.8 in culprit lesions and 10.9±13.2 in stable ones (p=0.17). The mean percent area of adventitial fibrosis/cross-sectional area of the vessel was significantly lower in unstable plaques (p<0.001). The confocal images showed holes in the external elastic membrane. CONCLUSION: Unstable plaques exhibit chronic pan-arteritis, accompanied by enlargement, medial thinning, and less fibrosis than in stable lesions, which is compatible with vessel aneurysm. Adventitial inflammation may contribute significantly to atheroma instability.

Doença de Takayasu com grave envolvimento cardíaco e arterial em pré-escolar

Neste artigo os autores descrevem um caso de arterite de Takayasu em uma criança de apenas 3 anos de idade, ressaltando-se a raridade dessa doença nessa faixa etária. A criança foi atendida em serviço de urgência em estado pós-comicial de convulsão tônico-clônica generalizada. Após exame clínico detalhado, vasta propedêutica e evolução do quadro clínico, fez-se o diagnóstico de doença de Takayasu com grave envolvimento cardíaco e arterial. O relato desse caso alerta pediatras e cardiologistas para o reconhecimento dessa entidade em crianças de baixa idade, nos países em que ela é pouco diagnosticada.

Sobre a nefrosclerose maligna

1º - Das aus den oeffentlichen Krankenhäusern von Rio de Janeiro stammende Sektionsmaterial umfasst einen beträchtlichen Prozentzatz von Individuen schwarzer und gemischter Rasse. Es besteht durchweg aus Angehörigen der sozial und oekonomisch niedersten Bevölkerungsschichten der Stadt und ihrer Vororte, die gemessen am Standard der Gesamtbevölkerung unter den dürftigsten hygienischen Bedingungen leben. So fanden sich unter 212 Autopsien aus dem Anfall der Pathologisch-Anatomischen Abteilung des Institutes Oswaldo Cruz im Jahr 1920 bei 111 Fällen schwarze oder Mischlinsfarbe protokolliert, (52,3%). Unter 349 Sektionen der gleichen Abteilung im Jahr 1938 waren 184 (= 52,7%) von Individuen von schwarzer oder gemischter Rasse. Ein derartiges Material bietet guenstige Bedingungen fuer die Untersuchung der Bedeutung der Rassenzugehoerigkeit als aetiologischem und pathogenem Faktor fuer bestimmte Affektionen, bei welchen sie in der Literatu in diesem Sinn angeführt worden ist. 2º - Unter 1080 Sektionen von Indiduen männlichen Geschlechts jeder Altersstufe aus dem Material der gleichen Abteilung der Jahre 1918-1926 fanden sich bei 214 Faellen syphilitische Befunde protokolliert. (19,8% der Faelle.) 129 (12%) wiesen eine Aortitis oder Arteritis syphilitica auf. 3º - Das histologische Material einer Serie von 528 Autopsien von Individuen im Alter unter 40 Jahren wurde auf das Vorkommen der fuer Nephrosclerose maligna (FAHR) typisch erachteten pathologischen Veraenderungen untersucht. Es wurden 4 Faelle festgestellt, die das Bild dieser Nephropathie zeigten. Unter den 528 Individuen dieser Gruppe waren 244 Weisse, (46,2%) 274 Schwarze oder Mischlinge (51,8%) Bei 10 war die Rassenzugehoerigkeit nicht ersichtlich. 4º - Unter Heranziehung von 6 weiteren Faellen aus anderen Serien von Sektionen der letzten 4 Jahre beläuft sich die Gesamtzahl der mikroskopisch festegestellen Faelle von Nephrosclerose maligna unter dem Material der Pathologisch-Anatomischen Abteilung des Institutes auf 10. Bei einem dieser Faelle (weiblichen Geschlechts) fand sich diese Nephropathie zusammen mit einer congenitalen Missbildung (Aplaise der linken Niere, des Ovarium und der Tube dieser Seite und Hypoplasie des Uterus). 7 dieser Faelle waren maennlichen Geschlechts. 3 waren von weisser, 2 von schwarzer Rasse, 5 waren mischrassig. 5º - Unsere Beobachtungen bieten keinen Anhalt fuer die Annahme, dass der Syphilis oder der Rassenzugehoerigkeit eine besondere Bebeutung fuer die Pathogenese der Nephrose maligna zukommt.