Esclerose: uma opção de tratamento para os nódulos tireoidianos císticos

OBJETIVO: Verificar o efeito da injeção percutânea de etanol guiada por ultra-sonografia no tratamento dos nódulos tireoidianos císticos. MATERIAIS E MÉTODOS: Comparou-se o volume de 34 nódulos benignos císticos, em 30 pacientes (26 do sexo feminino e quatro do sexo masculino), antes e uma média de 3,9 meses depois da alcoolização. O volume inicial dos nódulos foi avaliado por dois observadores, que realizaram a ultra-sonografia em momentos diferentes, sem qualquer informação prévia a respeito do tamanho dos nódulos, cuja finalidade foi conhecer a variação interobservador das medidas ecográficas. RESULTADOS: A média de volume dos nódulos antes do tratamento foi de 12,3 ± 18,0 ml. A média de redução de volume foi de 74,0 ± 26,1% (p = 0,0001), e 20,6% (7/34) deles desapareceram. Não houve correlação entre o volume inicial e o percentual de redução dos nódulos. A média de variação das medidas interobservadores foi de 0,5 ml para um alfa de 5%. Dor moderada, no momento da aplicação, foi a complicação mais freqüente. CONCLUSÃO: A injeção percutânea de etanol é uma opção segura e eficaz no tratamento dos nódulos tireoidianos císticos.

Fatal Outcome of Multiple Clinical Presentations of Human Herpesvirus 8-related Disease After Solid Organ Transplantation.

Kaposi sarcoma is the most common human herpesvirus 8 (HHV-8)-related disease described after solid organ transplantation. Multicentric Castleman disease and hemophagocytic syndrome are other potential HHV-8-induced entities but are less frequently reported. We describe the case of a liver transplant recipient who presented with an acute febrile illness 1 year after transplantation with a rapidly fatal outcome. Autopsy revealed 3 distinct HHV-8-related entities: Kaposi sarcoma, HHV-8-associated multicentric Castleman disease with microlymphomas and a severe hemophagocytic syndrome. Retrospective serologic tests suggested that HHV-8 was likely transmitted by the seropositive donor at the time of transplantation. To our knowledge, this is the first case of copresentation of 3 clinical presentations of HHV-8-mediated human disease in the post-transplant setting. Considering the absence of systematic screening of organ donors/recipients for HHV-8 infection, HHV-8-related illness should be suspected in transplant recipients who present with acute febrile illness, systemic symptoms, lymphadenopathies, and/or multiorgan failure to rapidly document the diagnosis and provide timely an adequate treatment.

L'infundibulite, une cause rare (?) de diabète insipide central [Infundibulitis, an unusual case of central diabetes insipidus].

We report the case of a 53 year old patient who was admitted with polyuria, polydipsia associated with fatigue, depression and sexual dysfunction. Central diabetes insipidus with hypogonadotrophic hypogonadism was diagnosed by a water restriction test and different static and dynamic hormonal dosages. Nodular thickening of the pituitary stalk was noted on the MRI and the biopsy permitted a histological diagnosis of infundibulitis.

Improving coronary artery bypass graft durability: use of the external saphenous vein graft support.

Coronary bypass grafting remains the best option for patients suffering from multivessel coronary artery disease, and the saphenous vein is used as an additional conduit for multiple complete revascularizations. However, the long-term vein graft durability is poor, with almost 75% of occluded grafts after 10 years. To improve the durability, the concept of an external supportive structure was successfully developed during the last years: the eSVS Mesh device (Kips Bay Medical) is an external support for vein graft made of weft-knitted nitinol wire into a tubular form with an approximate length of 24 cm and available in three diameters (3.5, 4.0 and 4.5 mm). The device is placed over the outer wall of the vein and carefully deployed to cover the full length of the graft. The mesh is flexible for full adaptability to the heart anatomy and is intended to prevent kinking and dilatation of the vein in addition to suppressing the intima hyperplasia induced by the systemic blood pressure. The device is designed to reduce the vein diameter of about 15-20% at most to prevent the vein radial expansion induced by the arterial blood pressure, and the intima hyperplasia leading to the graft failure. We describe the surgical technique for preparing the vein graft with the external saphenous vein graft support (eSVS Mesh) and we share our preliminary clinical results.

Contraste hepatobiliar: diagnóstico diferencial das lesões hepáticas focais, armadilhas e outras indicações

A caracterização das lesões hepáticas focais é muito importante. A ressonância magnética é considerada o melhor método de imagem para a avaliação destas lesões, mas não permite o diagnóstico em todos os casos. Os contrastes hepatobiliares aumentam a acurácia diagnóstica da ressonância magnética e diminuem o número de lesões hepáticas indefinidas. Suas principais indicações são a diferenciação entre hiperplasia nodular focal e adenoma, caracterização de carcinoma hepatocelular em pacientes cirróticos, detecção de metástases hepáticas pequenas, avaliação da anatomia biliar e identificação de fístulas biliares pós-operatórias. A utilização dos contrastes hepatobiliares pode reduzir a necessidade de procedimentos diagnósticos invasivos e de avaliação complementar por outros exames de imagem, além de diminuir a necessidade de exames de acompanhamento.

Tumores hepáticos incomuns: ensaio iconográfico - Parte 1

A maioria dos tumores hepáticos primários malignos é representada pelo carcinoma hepatocelular e pelo colangiocarcinoma, entretanto, uma variedade de outras lesões hepáticas incomuns pode ser encontrada. Lesões comuns como o hemangioma, a hiperplasia nodular focal e as metástases são bem conhecidas e já foram extensamente documentadas na literatura. O diagnóstico das lesões hepáticas típicas pode ser feito com alguma segurança utilizando-se os diversos métodos de imagem; por outro lado, as lesões incomuns são geralmente um desafio diagnóstico para o radiologista. Nesta primeira parte do estudo abordaremos cinco tumores hepáticos incomuns - o angiossarcoma, o angiomiolipoma, o cistoadenoma/carcinoma biliar, o hemangioendotelioma epitelioide e o carcinoma hepatocelular fibrolamelar -, suas principais características e achados de imagem, com foco na tomografia computadorizada e na ressonância magnética.

Modeling the transport phenomena within arterial wall: porous media approach

The transport of macromolecules, such as low-density lipoprotein (LDL), and their accumulation in the layers of the arterial wall play a critical role in the creation and development of atherosclerosis. Atherosclerosis is a disease of large arteries e.g., the aorta, coronary, carotid, and other proximal arteries that involves a distinctive accumulation of LDL and other lipid-bearing materials in the arterial wall. Over time, plaque hardens and narrows the arteries. The flow of oxygen-rich blood to organs and other parts of the body is reduced. This can lead to serious problems, including heart attack, stroke, or even death. It has been proven that the accumulation of macromolecules in the arterial wall depends not only on the ease with which materials enter the wall, but also on the hindrance to the passage of materials out of the wall posed by underlying layers. Therefore, attention was drawn to the fact that the wall structure of large arteries is different than other vessels which are disease-resistant. Atherosclerosis tends to be localized in regions of curvature and branching in arteries where fluid shear stress (shear rate) and other fluid mechanical characteristics deviate from their normal spatial and temporal distribution patterns in straight vessels. On the other hand, the smooth muscle cells (SMCs) residing in the media layer of the arterial wall respond to mechanical stimuli, such as shear stress. Shear stress may affect SMC proliferation and migration from the media layer to intima. This occurs in atherosclerosis and intimal hyperplasia. The study of blood flow and other body fluids and of heat transport through the arterial wall is one of the advanced applications of porous media in recent years. The arterial wall may be modeled in both macroscopic (as a continuous porous medium) and microscopic scales (as a heterogeneous porous medium). In the present study, the governing equations of mass, heat and momentum transport have been solved for different species and interstitial fluid within the arterial wall by means of computational fluid dynamics (CFD). Simulation models are based on the finite element (FE) and finite volume (FV) methods. The wall structure has been modeled by assuming the wall layers as porous media with different properties. In order to study the heat transport through human tissues, the simulations have been carried out for a non-homogeneous model of porous media. The tissue is composed of blood vessels, cells, and an interstitium. The interstitium consists of interstitial fluid and extracellular fibers. Numerical simulations are performed in a two-dimensional (2D) model to realize the effect of the shape and configuration of the discrete phase on the convective and conductive features of heat transfer, e.g. the interstitium of biological tissues. On the other hand, the governing equations of momentum and mass transport have been solved in the heterogeneous porous media model of the media layer, which has a major role in the transport and accumulation of solutes across the arterial wall. The transport of Adenosine 5´-triphosphate (ATP) is simulated across the media layer as a benchmark to observe how SMCs affect on the species mass transport. In addition, the transport of interstitial fluid has been simulated while the deformation of the media layer (due to high blood pressure) and its constituents such as SMCs are also involved in the model. In this context, the effect of pressure variation on shear stress is investigated over SMCs induced by the interstitial flow both in 2D and three-dimensional (3D) geometries for the media layer. The influence of hypertension (high pressure) on the transport of lowdensity lipoprotein (LDL) through deformable arterial wall layers is also studied. This is due to the pressure-driven convective flow across the arterial wall. The intima and media layers are assumed as homogeneous porous media. The results of the present study reveal that ATP concentration over the surface of SMCs and within the bulk of the media layer is significantly dependent on the distribution of cells. Moreover, the shear stress magnitude and distribution over the SMC surface are affected by transmural pressure and the deformation of the media layer of the aorta wall. This work reflects the fact that the second or even subsequent layers of SMCs may bear shear stresses of the same order of magnitude as the first layer does if cells are arranged in an arbitrary manner. This study has brought new insights into the simulation of the arterial wall, as the previous simplifications have been ignored. The configurations of SMCs used here with elliptic cross sections of SMCs closely resemble the physiological conditions of cells. Moreover, the deformation of SMCs with high transmural pressure which follows the media layer compaction has been studied for the first time. On the other hand, results demonstrate that LDL concentration through the intima and media layers changes significantly as wall layers compress with transmural pressure. It was also noticed that the fraction of leaky junctions across the endothelial cells and the area fraction of fenestral pores over the internal elastic lamina affect the LDL distribution dramatically through the thoracic aorta wall. The simulation techniques introduced in this work can also trigger new ideas for simulating porous media involved in any biomedical, biomechanical, chemical, and environmental engineering applications.

Tuberous sclerosis complex with oral manifestations: A case report and literature review

Introduction: Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome produced by a number of genetic mutations. The disease is characterized by the development of benign tumors affecting different body systems. The most common oral manifestations of TSC are fibromas, gingival hyperplasia and enamel hypoplasia. Clinical Case: A 35-year-old woman diagnosed with TSC presented with a reactive fibroma of considerable size and rapid growth in the region of the right lower third molar. Discussion: In the present case the association of TSC with dental malpositioning gave rise to a rapidly evolving reactive fibroma of considerable diameter. Few similar cases can be found in the literature. Patients with TSC present mutations of the TSC1 and TSC2 genes, which intervene in cell cycle regulation and are important for avoiding neoplastic processes. No studies have been found associating TSC with an increased risk of oral cancer, though it has been shown that the over-expression of TSC2 could exert an antitumor effect. Careful oral and dental hygiene, together with regular visits to the dentist, are needed for the prevention and early detection of any type of oral lesion. The renal, pulmonary and cardiac alterations often seen in TSC must be taken into account for the correct management of these patients.

Role of human hydroxysteroid (17beta) dehydrogenase type 1 (HSD17B1) in steroid-dependent diseases in females –novel indications for HSD17B1 inhibitors. Phenotypic analysis of transgenic mice overexpressing human HSD17B1.

Hormone-dependent diseases, e.g. cancers, rank high in mortality in the modern world, and thus, there is an urgent need for new drugs to treat these diseases. Although the diseases are clearly hormone-dependent, changes in circulating hormone concentrations do not explain all the pathological processes observed in the diseased tissues. A more inclusive explanation is provided by intracrinology – a regulation of hormone concentrations at the target tissue level. This is mediated by the expression of a pattern of steroid-activating and -inactivating enzymes in steroid target tissues, thus enabling a concentration gradient between the blood circulation and the tissue. Hydroxysteroid (17beta) dehydrogenases (HSD17Bs) form a family of enzymes that catalyze the conversion between low active 17-ketosteroids and highly active 17beta-hydroxysteroids. HSD17B1 converts low active estrogen (E1) to highly active estradiol (E2) with high catalytic efficiency, and altered HSD17B1 expression has been associated with several hormone-dependent diseases, including breast cancer, endometriosis, endometrial hyperplasia and cancer, and ovarian epithelial cancer. Because of its putative role in E2 biosynthesis in ovaries and peripheral target tissues, HSD17B1 is considered to be a promising drug target for estrogen-dependent diseases. A few studies have indicated that the enzyme also has androgenic activity, but they have been ignored. In the present study, transgenic mice overexpressing human HSD17B1 (HSD17B1TG mice) were used to study the effects of the enzyme in vivo. Firstly, the substrate specificity of human HSD17B1 was determined in vivo. The results indicated that human HSD17B1 has significant androgenic activity in female mice in vivo, which resulted in increased fetal testosterone concentration and female disorder of sexual development appearing as masculinized phenotype (increased anogenital distance, lack of nipples, lack of vaginal opening, combination of vagina with urethra, enlarged Wolffian duct remnants in the mesovarium and enlarged female prostate). Fetal androgen exposure has been linked to polycystic ovary syndrome (PCOS) and metabolic syndrome during adulthood in experimental animals and humans, but the genes involved in PCOS are largely unknown. A putative mechanism to accumulate androgens during fetal life by HSD17B1 overexpression was shown in the present study. Furthermore, as a result of prenatal androgen exposure locally in the ovaries, HSD17B1TG females developed ovarian benign serous cystadenomas in adulthood. These benign lesions are precursors of low-grade ovarian serous tumors. Ovarian cancer ranks fifth in mortality of all female cancers in Finland, and most of the ovarian cancers arise from the surface epithelium. The formation of the lesions was prevented by prenatal antiandrogen treatment and by transplanting wild type (WT) ovaries prepubertally into HSD17B1TG females. The results obtained in our non-clinical TG mouse model, together with a literature analysis, suggest that HSD17B1 has a role in ovarian epithelial carcinogenesis, and especially in the development of serous tumors. The role of androgens in ovarian carcinogenesis is considered controversial, but the present study provides further evidence for the androgen hypothesis. Moreover, it directly links HSD17B1-induced prenatal androgen exposure to ovarian epithelial carcinogenesis in mice. As expected, significant estrogenic activity was also detected for human HSD17B1. HSD17B1TG mice had enhanced peripheral conversion of E1 to E2 in a variety of target tissues, including the uterus. Furthermore, this activity was significantly decreased by treatments with specific HSD17B1 inhibitors. As a result, several estrogen-dependent disorders were found in HSD17B1TG females. Here we report that HSD17B1TG mice invariably developed endometrial hyperplasia and failed to ovulate in adulthood. As in humans, endometrial hyperplasia in HSD17B1TG females was reversible upon ovulation induction, triggering a rise in circulating progesterone levels, and in response to exogenous progestins. Remarkably, treatment with a HSD17B1 inhibitor failed to restore ovulation, yet completely reversed the hyperplastic morphology of epithelial cells in the glandular compartment. We also demonstrate that HSD17B1 is expressed in normal human endometrium, hyperplasia, and cancer. Collectively, our non-clinical data and literature analysis suggest that HSD17B1 inhibition could be one of several possible approaches to decrease endometrial estrogen production in endometrial hyperplasia and cancer. HSD17B1 expression has been found in bones of humans and rats. The non-clinical data in the present study suggest that human HSD17B1 is likely to have an important role in the regulation of bone formation, strength and length during reproductive years in female mice. Bone density in HSD17B1TG females was highly increased in femurs, but in lesser amounts also in tibias. Especially the tibia growth plate, but not other regions of bone, was susceptible to respond to HSD17B1 inhibition by increasing bone length, whereas the inhibitors did not affect bone density. Therefore, HSD17B1 inhibitors could be safer than aromatase inhibitors in regard to bone in the treatment of breast cancer and endometriosis. Furthermore, diseases related to improper growth, are a promising new indication for HSD17B1 inhibitors.

Histopathological features of infections caused by Fusarium oxysporum and F. solani in purple passionfruit plants (Passiflora edulis Sims)

The purple passionfruit plant, Passifloraedulis Sims, ranks second in fruit exportation in Colombia, and its main destination is the European market. However, its production is affected by several diseases, including fusariosis. This paper presents the histopathological features of different tissues affected by the pathogens Fusarium oxysporum and Fusarium solani. Both microorganisms produce similar responses on the plant: colonization of xylem vessels by hyphae and microconidia, hypertrophy and hyperplasia of the cambium, xylem and phloem; destruction of xylem fibers and amyloplasts in parenchymatous cells; and production of gels by the plant. However, there are differences in the colonization mechanism, F. solani penetrates and is concentrated especially at the collar zone, while F. oxysporum penetrates the roots and moves through the vascular system to colonize the plant.

Compatibilidade entre a inoculação de rizóbios e fungicidas aplicados em sementes de feijoeiro-comum

O objetivo do presente estudo foi avaliar os efeitos do tratamento de sementes de feijoeiro com diferentes fungicidas na sobrevivência de estirpe de Rhizobium tropici (SEMIA 4077) e Rhizobium freirei (SEMIA 4080), na nodulação das plantas e na produtividade da cultura. Foram conduzidos dois ensaios em substrato esterilizado, sob condições de casa de vegetação e um ensaio no campo experimental da Embrapa Agropecuária Oeste, em Dourados, MS, num Latossolo Vermelho distroférrico típico. Os fungicidas (princípios ativos) utilizados nos ensaios foram: (1) carbendazim + tiram (Produto A); (2) carbendazim + tiram (Produto B); (3) carboxin + tiram; (4) fludioxonil + metalaxil-M; (5) fludioxonil + metalaxil-M + tiabendazol; (6) fluazinam + tiofanato metílico; (7) fipronil + tiofanato metílico + piraclostrobina; (8) clorotalonil + tiofanato metílico. A sobrevivência das estirpes de R. tropici inoculadas nas sementes de feijoeiro foi afetada pela aplicação dos fungicidas, principalmente por aqueles com modo de ação de contato. Observou-se ainda, com a aplicação dos fungicidas, redução na nodulação das plantas de feijoeiro, especialmente da massa nodular, tanto nos ensaios conduzidos em substrato esterilizado, em casa de vegetação, quanto no experimento a campo, onde também observou-se redução na produtividade do feijoeiro pela aplicação da maioria dos fungicidas avaliados. Os fungicidas que mais afetaram o rendimento de grãos foram carbendazim + tiram (Produto B) e carboxin + tiram. Os produtos fipronil + tiofanato metílico + piraclostrobina, fludioxonil + metalaxil-M + tiabendazol e fludioxonil + metalaxil-M não afetaram a produtividade da cultura, embora a massa seca de nódulos tenha sido reduzida em todos os ensaios.

Anatomical changes on coffee leaves infected by Pseudomonas syringae pv. garcae

ABSTRACTAlthough poorly studied, the bacterial halo blight is an important disease in the major coffee-producing states of Brazil. External damage and anatomical changes on leaves were measured in seedlings of Coffea arabica cv. Mundo Novo, susceptible to Pseudomonas syringae pv. garcae, by using histological sections obtained at 10 and 20 days after inoculation (DAI). The changes on the epidermis were smaller than the lesions measured in the mesophyll, irrespective of the evaluated colonization period, showing that the internal damage caused by the bacterium represent twice the damage observed externally. From the inoculation site, lysis occurred on the epidermal cells and on the palisade and spongy parenchyma cells, with strong staining of their cellular contents, as well as abnormal intercellular spaces in the palisade parenchyma, hypertrophy and hyperplasia of mesophyll cells and partial destruction of chloroplasts. Additionally, this study revealed the presence of inclusion bodies in epidermal and mesophyll cells. Bacterial masses were found in the apoplast between and within mesophyll cells. Bacteria were also observed in the bundle sheath and vascular bundles and were more pronounced at 20 DAI, not only near the inoculation site but also in distant areas, suggesting displacement through the vascular system. These results can be useful to understand this plant-pathogen interaction.

Dependência de micorrizas para a nodulação de leguminosas arbóreas tropicais

As espécies de leguminosas Piptadenia gonoacantha e Piptadenia paniculata apresentam dificuldade para nodular e crescer em substratos esterilizados, o que dificulta a seleção de estirpes de rizóbio eficientes dessas espécies. As plantas que apresentam nódulos no campo estão micorrizadas. Assim, a boa resposta das plantas no campo pode ser devida à presença de FMAs. O objetivo deste trabalho foi estudar o efeito da micorrização sobre a nodulação e crescimento de plantas de P. gonoacantha e P. paniculata. Os experimentos foram realizados em casa de vegetação, na Embrapa Agrobiologia, Rio de Janeiro. As plantas foram inoculadas com estirpes de rizóbio específicas de cada espécie e com os fungos Gigaspora margarita e Glomus clarum. Ambas as espécies vegetais demonstraram-se altamente responsivas à inoculação com FMAs. Plantas que receberam rizóbios e fungos micorrízicos apresentaram-se noduladas, com maior produção de matéria seca. Já as plantas inoculadas apenas com rizóbio não exibiram nódulos e tiveram menor acúmulo de matéria seca. As plantas de P. gonoacantha apresentaram maior conteúdo de P na parte aérea quando inoculadas com FMAs. Esses resultados indicam que a micorrização é necessária para a nodulação e crescimento satisfatórios das espécies estudadas, e sugere-se a inoculação com FMAs para a seleção de estirpes eficientes de rizóbio em leguminosas com dificuldade de crescimento no sistema convencional de seleção de estirpes.

Fontes de nitrogênio e caule decomposto de Mauritia flexuosa na nodulação e crescimento de Enterolobium contortsiliquum

Avaliaram-se fontes de nitrogênio (N) e proporções de caule decomposto de buritizeiro (Mauritia flexuosa L.f.) na nodulação, crescimento e nos índices biométricos das mudas de tamboril [Enterolobium contortsiliquum (Vell.) Morong] na região sudoeste do Piauí. O delineamento experimental foi inteiramente casualizado em esquema fatorial 3x5, com cinco repetições. Foram testadas três fontes de N (N-mineral, N do substrato e inoculação com a estirpe Bradyrhizobium elkanii BR 4406) e cinco proporções de caule decomposto de buritizeiro:solo (v/v, %): 0: 100; 10: 90; 20: 80; 40: 60; 80: 20. A emergência das plântulas foi avaliada diariamente até o décimo terceiro dia após a semeadura. Aos 80 dias, as mudas foram coletadas para as determinações da nodulação, do crescimento e dos índices biométricos. As mudas que foram cultivadas com os substratos contendo caule decomposto de buritizeiro apresentaram maior crescimento e nodulação, em relação às que foram cultivadas no substrato 0: 100 (caule decomposto de buritizeiro: solo). A obtenção de máximo Índice de Qualidade de Dickson foi com 48: 52 (caule decomposto de buritizeiro: solo), sendo, portanto, esta a proporção recomendada para a produção de mudas. Com relação às fontes de nitrogênio, a estirpe BR 4406 não foi eficiente em promover ganhos no teor de nitrogênio e matéria seca da parte aérea, em relação ao tratamento com N-mineral. As populações nativas de bactérias diazotróficas presentes no substrato que não recebeu N-mineral e nem inoculação foram capazes de nodular eficientemente o tamboril, uma vez que promoveram acréscimos no teor de nitrogênio e matéria seca da parte aérea equivalentes ao tratamento adubado com N-mineral.

Doença de castleman simulando neoplasia pancreática

A 33-year-old man presented to our department with a 4-month history of right quadrant abdominal pain. Physical examination was normal. A chest X-ray showed no remarkable findings. Ultrasonography demonstrated a hypoechoic mass measuring 6 cm in the head of the pancreas. Computed tomography confirmed a solid mass in the pancreas without Wirsung or bile duct dilatation. At laparotomy, excision a 6 cm egg-shaped and hypervascular mass in the head of the pancreas was performed. Histologically, the features were consistent with Castleman disease. Castleman's disease is a rare, usually benign lymphoid condition described by Castleman (1954) and characterized by giant lymph nodes. Surgical resection is diagnostic and curative.