Fistula treatment: the unresolved challenge.

Fistulas are common complications in Crohn's disease, as their cumulative prevalence reaches up to two thirds of the patients in the long term. Fistulas worsen the overall patient prognosis, with permanent sphincter and perineal tissue destruction as well as professional and personal disabilities. The importance of healing these fistulas has been less well appreciated than mucosal healing for luminal disease. Management should not be left to any specialty alone, but requires an optimal combination of surgery, infection control, and immunosuppression. Outcome of therapy beyond fistula drainage is unclear and the means of assessing healing over a long time period is poorly characterized. Recent studies suggested that a substantial proportion of patients can achieve fistula healing with surgical and medical therapies. However, studies that measure the benefit of integrated approaches, of early intervention and of precise healing assessment are still missing. Such information is particularly needed in this subset of sick patients that undergo substantial physical and emotional distress because of pain, discharge, incontinence, perineal and genital disfigurement. The advent of adequate pelvic imaging, improved surgical outcomes, and potent biological therapies make it timely to develop best-management strategies and appropriateness of care criteria.

A new species of Probursata Bravo-Hollis, 1984 (Mogenea: Heteraxinidae: Heteraxininae) parasite of Oligoplites spp. (Osteichthyes: Carangidae) from the coast of the state of Rio de Janeiro, Brazil

Probursata brasiliensis n. sp., a gill filament parasite of carangid fishes, O. palometa (Cuvier), Oligoplites saurus (Bloch & Schneider), and O. saliens (Bloch), from the Brazilian coast, is described and illustrated. The new species differs from Probursata veraecrucis Bravo-Hollis, 1984, the type and only species of this genus by the presence of spines in the auricular expansions of the genital atrium, by the trifurcate supplementary process of the clamp's midsclerite, and by having a larger number of tests and clamps. This is the first record of the genus Probursata Bravo-Hollis, 1984, in the South Atlantic Ocean.

Biphally in Biomphalaria glabrata (Say, 1818) (Pulmonata, Planorbidae)

We describe a biphallic specimen of Biomphalaria glabrata (Say, 1818) from the municipality of Caeté, State of Minas Gerais, Brazil. The conformation of the two penial complexes, with a common genital pore on the left side. suggests that both have copulatory capacity. Based on a review of literature type of biphally appears to be reported for the first time in planorbids.

Two new species of Pseudotelorchis (Digenea, Telorchiidae), parasites of the Caiman, Caiman crocodilus yacare (Reptilia, Crocodylia) from the Pantanal Mato-Grossense, Brazil

Pseudotelorchis caimanis n. sp. and P. yacarei n. sp. are described based on specimens collected from Caiman crocodilus yacare (Daudin) in the Pantanal Mato-grossense, Brazil. This is the first record of any species of Telorchiidae Stunkard, 1924, parasitizing crocodilians. Pseudotelorchis caimanis n. sp. differs from P. comapactus, the only species described in the genus with seminal receptacle, testes in tandem, and genital pore lateral to acetabulum. Pseudotelorchis yacarei n. sp. differs from the two other species for its body shape, for infecting the intestine instead of the uterus, by having regularly disposed instead of irregulary disposed uterine loops, and by having the vitelline glands disposed in longitudinal lateral lines instead of in lateral bunches.

Two new mermithidis (Nematoda: Mermithidae) parasites of Simulium wolffhuegeli Roubaud and S. jujuyense (Paterson & Shannon) (Diptera: Simuliidae) in Argentina

Two new species of mermithids (Nematoda: Mermithidae), Gastromermis doloresi n. sp. a parasite of Simulium wolffhuegeli Roubaud and Hydromermis doloresi n. sp. a parasite of S. jujuyense (Paterson & Shannon) from Córdoba, Argentina, are described and illustrated. G. doloresi n. sp. is characterized by having medium sized, pear-shaped and oval amphids, eight hypodermal chords all around the body, cylindrical S-shaped vagina, single long spicule 528 [mi]m, whith teh sculpture tip, three rows of genital papillae in which the middle row contains 17 pre-anal and 9 post-anal papillae, and lateral rows contain 18 papillae. Hydromermis doloresi n. sp. can be distinghished by the following: medium sized, pear-shaped amphids, eight hypodermal chords, a cylindrical, S-shaped vagina, one short curved spicule with sculpture and genital papillae in three rows. The medium ventral row of papillae has 4 double and 9 single pre-anal papillae and 3 double and 6 single port-anal papillae, lateral rows have 18 single papillae each.

Proterodiplostome Parasites (Digenea, Proterodiplostomidae) of the Caiman, Caiman crocodilus yacare (Reptilia, Crocodylia) in the Pantanal mato-Grossense, Brazil, with the description of two new species

Two new species are described from the caiman. Caiman crocodilus yacare. Proterodiplostomum breve n. sp. differs from all other species in the genus by the following chacacteristics: (1) the paraprostate gland is shorter and club-shaped; (2) the genital cone is, in average, eight times longer than that of P. medusae; (3) the genital atrium is larger and without pseudosuckers; (4) the oral sucker and pharynx are longer; and (5) there are larger numbers of papillae surrounding the tribocytic organ (40) against 20 in P. longum, 16 in p. tumidilum, 8 in P. ophidum, and 16-18 in P. medusae. Proterodiplostomum globulare n. sp. differs from all the other species in the fenus by the following characteristics: (1) from P. tumidilum, P. lomgum, P. medusae, and P. breve n. sp. for the absense of pseudosuckers or muscular bunches in the inferior wall of the genital atrium; (2) the shape of the paraprostate gland, which is globular and not cylindrical as in P. longum, P. tumidilum, P. medusae, and P. ophidum; (3) the size of the tribocytic organ 201-407 long, 183-495 wide, while is 138-270 long, 102-292 wide in P. medusae, and 138-270 long, 255 wide in P. ophidum; (4) the number of papillae in the tribocytic organ (18-20) in P. globulare and 16-18 in P. medusae, and 8 in P. ophidum. Specimens belonging to six other species of proterodiplostomes are recorded for the first time infecting the caiman, C. c. yacare in the Pantanal Mato-grossense, Brazil, namely: Proterodiplostomum medusae, P. tumidilum, Cystodiplostomum hollyi, Prolecithodiplostomum constrictum, Paradiplostomum abbreviatum, and Herpetodiplostomum caimancola.

Comparative study of four species of Trichuris roederer, 1761 (Nematoda, Trichurinae) by scanning electron microscopy

A comparative morphological study of Trichuris travassosi, T. vulpis, T. discolor and T. suis was perfomed using scanning electron microscopy. Cuticular inflation associated with the bacillar band, vulva and male external genital appendages were analyzed. Qualitative and quantitative analyses of these structures were made for each species; they are of taxonomic value.

Variation between geographical populations of Lutzomyia (Nyssomyia) whitmani (Antunes & Coutinho, 1939) sensu lato (Diptera:Psychodidae:Phlebotominae) in Brazil

Phylogenetic analysis of morphometric and biological characters indicated that there are two distinct forms of Lutzomyia whitmani in Brazil: one is present both north and south of the River Amazonas in the State of Pará while the other occurs in northeast Brazil, in the State of Ceará, and further south, including the type locality in State of Bahia. The Amazonian form is reportedly neither strongly anthropophilic nor synanthropic, and it is the vector of Leishmania shawi; whereas the southern form is often collected peridomestically, while biting man, and has been found infected with Le.(V.) braziliensis. The ratio of the length of the genital filaments to that the genital pump was found to be consistently smaller in males of the Amazonian populations. A middle repetitive DNA element was isolated by differentially screening a genomic library made using Amazonian material, and the sequence was diagnostic for this form of Lu. whitmani (being absent or occurring in low copy number in the southern form). The total evidence suggests there are at least two, geographically-isolated forms of Lu. whitmani, which may represent different cryptic species.

Specific Identification of Biomphalaria tenagophila and Biomphalaria occidentalis Populations by the Low Stringency Polymerase Chain Reaction

Although Biomphalaria occidentalis and B. tenagophila are indistinguishable on the basis of shell morphology and the majority of their genital organs, only the latter is susceptible to infection with Schistosoma mansoni. Thus, the identification of these species is fundamental to epidemiological studies of schistosomiasis. Here we describe a simple and rapid method for differentiating B. tenagophila from B. occidentalis based on low stringency polymerase chain reaction and using a pair of primers specific for the amplification of the 18S rRNA gene. Analysis of the low stringency product profiles of populations of these snails from different geographical regions confirmed this approach as being applicable to the identification of B. tenagophila and B. occidentalis in cases where classical morphology is inconclusive

Morphology and Histology of the Female Reproductive System of Abedus ovatus Stal (Belostomatidae: Hemiptera: Insecta)

In Abedus ovatus Stal, the female reproductive system consists of a pair of ovaries leading to oviduct and opens out by genital aperture. Each ovary is composed of five telotrophic ovarioles, with four different regions, terminal filament, germarium, vitellarium and pedicel. Germarium and vitellarium are the germ tubes in which the development of oocyte occurs. In the germarium, the differentiation of trophocytes into young oocytes was observed in three zones, ZI, ZII and ZIII. Further development of oocytes in the vitellarium could be divided into seven stages, STI STVII. The developed eggs are lodged in the pedicel

Acanthocollaritrema umbilicatum Travassos, Freitas & Bührnheim, 1965 (Digenea: Acanthocollaritrematidae) from the Common Snook, Centropomus undecimalis, from Itamaracá, State of Pernambuco, Brazil

Acanthocollaritrema umbilicatum Travassos, Freitas and Bührnheim, 1965, is the only species of Acanthocollaritrematidae described up to the moment. The systematic position of this species and the validity of the family has been questioned by the possible presence of a gonotyl and a genital atrium associated to the acetabulum. In this paper, specimens of this trematode, collected from Centropomus undecimalis cultivated at Itamaracá, State of Pernambuco, northeast Brazil, were studied under optical and scanning electron microscopy, and compared with available sintypes. Gonotyl and genital atrium were not observed and both family and species are considered valid taxonomic entities. A. umbilicatum is redescribed with the adition of new morphological information.

Maladie de Behçet: d'Hippocrate aux antagonistes du TNF-alpha

Behçet's disease is a systemic vasculitis affecting small and large vessels (arteries, veins, veinules), characterized by recurrent oral ulcerations, genital ulcerations, inflammation of the eye and skin lesions. It can also involve articulations, central nervous system and gastro-intestinal tract. The etiology of this disease is still unknown, but the most largely discussed hypothesis is that of an important inflammatory response triggered by an infectious agent in a genetically susceptible host. The diagnostic is a based on clinical elements, because no specific diagnostic test exists. The treatment of Behçet's disease is depending on the clinical involvement and has been enlarged in recent years by TNF-alpha-blockers which constitute undoubtedly an important progress in the management of this complex disease.

Binema bonaerensis n. sp. (Oxyurida: Thelastomatidae) parasite of Neocurtilla claraziana saussure (Orthoptera: Gryllotalpidae) in Argentina

The nematode Binema bonaerensis n. sp. (Oxyurida: Thelastomatidae) is described from the intestine of the mole cricket of Neocurtilla claraziana Saussure (Orthoptera: Gryllotalpidae) from Buenos Aires Province, Argentina. It is distinguished mainly by having a conical tail; three sclerotized arches in the buccal cavity; an excretory pore inmediately posterior to the base of the esophagus and the presence of five pairs of male genital papillae with one pair preanal and four pairs postanal.

The Nlrp3 inflammasome regulates acute graft-versus-host disease.

The success of allogeneic hematopoietic cell transplantation is limited by acute graft-versus-host disease (GvHD), a severe complication accompanied by high mortality rates. Yet, the molecular mechanisms initiating this disease remain poorly defined. In this study, we show that, after conditioning therapy, intestinal commensal bacteria and the damage-associated molecular pattern uric acid contribute to Nlrp3 inflammasome-mediated IL-1β production and that gastrointestinal decontamination and uric acid depletion reduced GvHD severity. Early blockade of IL-1β or genetic deficiency of the IL-1 receptor in dendritic cells (DCs) and T cells improved survival. The Nlrp3 inflammasome components Nlrp3 and Asc, which are required for pro-IL-1β cleavage, were critical for the full manifestation of GvHD. In transplanted mice, IL-1β originated from multiple intestinal cell compartments and exerted its effects on DCs and T cells, the latter being preferentially skewed toward Th17. Compatible with these mouse data, increased levels of active caspase-1 and IL-1β were found in circulating leukocytes and intestinal GvHD lesions of patients. Thus, the identification of a crucial role for the Nlrp3 inflammasome sheds new light on the pathogenesis of GvHD and opens a potential new avenue for the targeted therapy of this severe complication.

Virus Papiloma Humano en el carcinoma escamoso de cabeza y cuello

Els carcinomes de cèl•lules escamoses de cap i coll (CCECC) estan relacionats en un 80% dels casos amb el tabac i/o l’alcohol. Per altra banda, la infecció per virus papil•loma humà (VPH), la malaltia de transmissió sexual més freqüent als Estats Units actualment, ha resultat ser oncogènica no només a nivell genital sinó també a nivell del tracte aero-digestiu superior, sobretot a oro-faringe. Els estudis realitzats a posteriori han demostrat que els pacients amb CCECC VPH+ no fumadors ni bebedors, solen ser més joves, presentar diferents marcadors tumorals, respondre més al tractament i tenir millor pronòstic.