Testicular schistosomiasis as differential diagnosis for testicular nodules: a case report

AbstractDespite its infrequent occurrence, testicular schistosomiasis forming pseudo-tumors can be considered in the differential diagnosis of testicular tumors, especially in areas where the parasitic disease is endemic. In this report, we present a case of testicular schistosomiasis caused by Schistosoma mansoni and mimicking a testicular neoplasm. We describe the patterns of a testicular nodule on ultrasonography and magnetic resonance images in a 46-year-old man. The nodule was removed after a pre-operative diagnosis of a non-malignant lesion. Histology demonstrated granulomas with epithelioid macrophages and eosinophils around S. mansoni eggs within a fibrous tissue that formed a nodular structure.

A formação em rastreio e intervenções breves do álcool muda as atitudes dos profissionais de saúde ocupacional? : estudo quasi experimental exploratório para uma estratégia para o meio laboral

RESUMO - Estudos anteriores nos Cuidados de Saúde Primários (CSP) apontam para um incremento da Deteção Precoce (DP) e Intervenções Breves (IB) em pacientes com Problemas Ligados ao Álcool (PLA) após formação apropriada dos profissionais de saúde (com melhoria das suas atitudes). Este estudo quasi experimental, exploratório, é pioneiro no âmbito da Saúde Ocupacional (SO) para a implementação de Rastreio/DP e IB nos PLA. O objetivo principal foi avaliar se uma formação sobre Rastreio/DP e IB pode melhorar as atitudes dos profissionais de SO ao lidar com os PLA em Meio Laboral (PLAML). Foi aplicado um questionário em duas partes: Q1/pré-formação (variáveis sociodemográficas, profissionais, competências em alcoologia, experiência pessoal com álcool/familiares com PLA, dificuldades em lidar com trabalhadores com PLA, AUDIT-C e SAAPPQ) e Q2/pós-formação (avaliação da formação e das atitudes SAAPPQ - Adequação, Legitimidade, Motivação, Autoestima e Satisfação). Os resultados na amostra (N=39) revelaram um aumento sobretudo na Adequação e Satisfação. No entanto, naqueles com níveis baixos das atitudes pré-formação constou-se melhoria das atitudes à excepção da Autoestima e foram encontradas algumas associações com as características do perfil inicial dos participantes. Sugerem-se estudos posteriores para identificação de pacotes formativos mais efetivos e propostas para um Plano integrador de RIB para PLAML

Detection of Leishmania (Viannia) DNA in leucocytes from the blood of patients with cutaneous leishmaniasis

ABSTRACTINTRODUCTION:Cutaneous leishmaniasis (CL) is a serious and global public health issue, with the potential of developing a mucosal form, occurring as subclinical cases, and showing recurrence despite previous treatment.METHODS:Polymorphonuclear and mononuclear DNA obtained from 49 patients was subjected to polymerase chain reaction for detection of Leishmania (Viannia).RESULTS:DNA was detected in mononuclear cells from two patients with active primary lesions positive for CL, with infection periods of 3 and 6 months, respectively.CONCLUSIONS:The DNA of Leishmania (Viannia) indicates probable parasite dissemination possibly explaining subclinical case emergence, lesion recurrence, and mucosal lesion appearance.

Vascular lesions of the lumbar epidural space: magnetic resonance imaging features of epidural cavernous hemangioma and epidural hematoma

The authors report the magnetic resonance imaging diagnostic features in two cases with respectively lumbar epidural hematoma and cavernous hemangioma of the lumbar epidural space. Enhanced MRI T1-weighted scans show a hyperintense signal rim surrounding the vascular lesion. Non-enhanced T2-weighted scans showed hyperintense signal.

Müllerian adenosarcoma of the uterus with sarcomatous overgrowth following tamoxifen treatment for breast cancer

Müllerian adenosarcoma with sarcomatous overgrowth presented by a 52-year-old female patient after adjuvant tamoxifen treatment for breast carcinoma is described. The diagnosis was made on histological basis after curettage and complementary total hysterectomy with bilateral salpingo-oophorectomy. The immunohistochemical study showed high expression of estrogen receptors in the epithelial component of the lesion and irregularly positive findings in the stroma. The proliferative activity evaluated by Ki-67 immunoexpression was higher in the stroma than the epithelium. Some of the stromal cells showed rhabdomyoblastic differentiation. The association of tamoxifen use and development of mesenchymal neoplasms is discussed.

Necrotizing fasciitis in a newborn infant: a case report

We report the case of a one-day-old newborn infant, female, birth weight 1900 g, gestational age 36 weeks presenting with necrotizing fasciitis caused by E. coli and Morganella morganii. The newborn was allowed to fall into the toilet bowl during a domestic delivery. The initial lesion was observed at 24 hours of life on the left leg at the site of the venipuncture for the administration of hypertonic glucose solution. Despite early treatment, a rapid progression occurred resulting in a fatal outcome. We call attention to the risk presented by this serious complication in newborns with a contaminated delivery, and highlight the site of the lesion and causal agents.

Recurrent spontaneous breast hematoma: report of a case and review of the literature

BACKGROUND: Breast hematomas are common after traumas, surgeries, or contusions. They are rarely spontaneous, but they can occur spontaneously in patients with hematologic disease or with coagulation disorders. MATERIAL AND METHODS: The authors report a clinical case of a 48-year-old female with a 27-year history of paroxysmal nocturnal hemoglobinuria who underwent mammography screening because of a painless palpable moveable node in the upper inner quadrant of the right breast. RESULTS: Mammography showed a partially defined heterogeneous node of 35 mm without microcalcifications in the upper inner quadrant of the right breast which, associated with the clinical features, seemed to be an hematoma. Further mammography and ultrasound after 45 days showed retrocession of the lesion, and another mammography obtained after 60 days was normal. Seventy-five days after the first episode, the patient complained of another node with a skin bruise in the upper outer quadrant of the same breast, which seemed to be a recurrent hematoma. Two months later the mammography obtained was normal. CONCLUSION: Breast hematoma must be thought of as a differential diagnosis for a breast node, regardless of previous trauma or hematologic disorders.

Computed tomography-guided cutting needle biopsy of pulmonary lesions

PURPOSE: To report the experience of a radiology department in the use of computed tomography - guided cutting needle biopsy of pulmonary nodules, by evaluating diagnostic yield and incidence of complications. METHODS: This is a retrospective analysis of 52 consecutive patients who underwent lung lesion biopsy guided by computed tomography, performed between May 1997 and May 2000. Thirty-five patients were male and 17 were female, with ages ranging from 5 to 85 years (median, 62 years). The size of the lesions ranged from 1.8 to 15 cm (median, 5.4 cm). RESULTS: In a total of 52 biopsies of lung lesions, 51 biopsies (98.1%) supplied appropriate material for histopathological diagnosis, with 9 diagnosed (17.3%) as benign and 42 (80.8%) as malignant lesions. Specific diagnosis was obtained in 44 (84.6%) biopsies: 4 benign (9.1%) and 40 (90.9%) malignant lesions. The sensitivity, specificity, and accuracy of the cutting needle biopsies for determining presence of malignancy were 96.8%, 100%, and 97.2%, respectively. Complications occurred in 9 cases (17.3%), including 6 cases (11.5%) of small pneumothorax, 1 (1.9%) of hemoptysis, 1 (1.9%) of pulmonary hematoma, and 1 (1.9%) of thoracic wall hematoma. All had spontaneous resolution. There were no complications requiring subsequent intervention. CONCLUSION: The high sensitivity and specificity of the method and the low rate of complications have established cutting needle biopsy as an efficient and safe tool for the diagnosis of lung lesions. In our hospital, cutting needle biopsy is considered a reliable procedure for the evaluation of indeterminate pulmonary nodules.

An experimental model for the transplantation of fetal central nervous system cells to the injured spinal cord in rats

INTRODUCTION: Traumatic spinal cord injury is one of the most disabling conditions occurring in man and thus stimulates a strong interest in its histopathological, biochemical, and functional changes, primarily as we search for preventive and therapeutic methods. PURPOSE: To develop an experimental model for transplantation of cells from the fetal rat central nervous system to the site of an injured spinal cord of an adult rat in which the transplanted cells survive and become integrated. This experimental model will facilitate investigations of factors that promote regeneration and functional recovery after spinal cord trauma. MATERIAL AND METHODS: Fifteen adult Wistar rats underwent laminectomy, and an spinal cord lesion was made with microdissection. Fetal spinal cord tissue was then transplanted to the site of the injury. The rats were monitored over a 48-hour period, and then their vertebral column was completely removed for histological analysis. RESULTS: In 60% of transplanted rats, the fetal tissue at the injured site remained viable in the site of the lesion.

Anorectal leiomyomas: report of two cases with different anatomical patterns and literature review

Gastrointestinal mesenchymal tumors comprise a rare group of gastrointestinal tract wall tumors that have long been a source of confusion and controversy, especially in terms of pathological classification, preoperative diagnosis, management strategies, and prognosis. This report describes the clinical manifestations and management of 2 rectal leiomyomas and reviews the pertinent literature. Case 1: A 44-year-old woman was admitted reporting a nodule in the right para-anal region for the previous 2 years. At proctological examination, a 4-cm diameter fibrous mass situated in the para-anal region that produced an arch under the smooth muscle on the right rectal wall just above the anorectal ring was noted. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed the lesion and detected no other abnormalities. Surgical treatment consisted of wide local resection of the tumor through a para-anal incision, with no attempts to perform lymphadenectomy. Case 2: A 40-year-old male patient was admitted reporting constant anal pain for 4 months. He presented a 3-cm submucosal nodule at the anterior rectal wall just above the dentate line. After 2 inconclusive preoperative biopsies, transanal resection of the tumor was performed. Histological analysis of the specimen showed a benign leiomyoma. A review of the literature is presented, emphasizing some clinical and therapeutic aspects of this unusual rectal tumor.

Natural history of stenosis in the iliac arteries in patients with intermittent claudication undergoing clinical treatment

PURPOSE: Inspite of the long experience with the treatment of intermittent claudication, little is known about the natural history of stenotic lesions in the iliac segment. With the advent of endovascular treatment, this knowledge has become important. METHODS: Fifty-two stenosis, diagnosed using arteriography, in 38 claudicant patients were analyzed. After a minimum time interval of 6 months, a magnetic resonance angiography was performed to determine whether there was arterial occlusion. The primary factors that could influence the progression of a stenosis were analyzed, such as risk factors (smoking, hypertension, diabetes, sex, and age), compliance with clinical treatment, initial degree of stenosis, site of the stenosis, and length of follow-up. RESULTS: The average length of follow-up was 39 months. From the 52 lesions analyzed, 13 (25%) evolved to occlusion. When occlusion occurred, there was clinical deterioration in 63.2% of cases. This association was statistically significant (P = .002). There was no statistically significant association of the progression of the lesion with the degree or site of stenosis, compliance with treatment, or length of follow-up. Patients who evolved to occlusion were younger (P = .02). The logistic regression model showed that the determinant factors for clinical deterioration were arterial occlusion and noncompliance with clinical treatment. CONCLUSIONS: The progression of a stenosis to occlusion, which occurred in 25% of the cases, caused clinical deterioration. Clinical treatment was important, but it did not forestall the arterial occlusion. Prevention of occlusion could be achieved by early endovascular intervention or with the development of drugs that might stabilize the atherosclerotic plaque.

Estudo da vascularização dos nervos periféricos e da sua influência na regeneração nervosa : estudo experimental e no cadáver humano

RESUMO: Na clínica, a recuperação funcional que se segue a uma lesão nervosa raramente é atingida na sua totalidade. A reinervação, quer motora, quer sensitiva, ocorre geralmente com maior ou menor deficit. Interessa, então, identificar os factores que podem interferir na regeneração nervosa. O neurónio é a unidade anatómica fundamental do sistema nervoso periférico e é muito vulnerável à isquemia pela grande distância que existe entre o corpo neuronal e a extensão do axónio, que pode ser de apenas alguns milímetros ou até atingir um metro. É, por isso, fundamental o estudo da vascularização do nervo periférico e da sua influência na regeneração nervosa. O resultado deste estudo pode levar ao desenvolvimento de técnicas cirúrgicas que criem as condições que garantam, por sua vez, a revascularização precoce do nervo periférico em caso de lesão, ou mesmo em caso de doenças, nas quais a vascularização do nervo está alterada como, por exemplo, na neuropatia diabética. O estudo da vascularização do nervo periférico realizou-se através da investigação da vascularização do nervo mediano do cadáver humano, pela investigação da vascularização do nervo isquiático do rato Wistar e do Plexo Braquial (PB) do mesmo. A vascularização do PB do rato não é muito diferente daquela que é reportada na espécie humana, existindo uma homologia entre o rato e o Homem no que diz respeito à morfologia e à vascularização do PB. Através da comparação angiomorfológica entre o nervo isquiático do rato e o nervo mediano humano, concluíu-se que a microvascularização do nervo isquiático do rato e do mediano humano são muito semelhantes, o que suporta a utilização do rato como modelo experimental de lesões do nervo mediano humano. Para a avaliação da influência da vascularização na regeneração nervosa foi feita a análise da eficácia de enxerto de tubo de membrana amniótica humana imunologicamente inerte, de enxerto de veia jugular externa autóloga e de auto-enxerto de nervo, na reparação de um defeito de 10 milímetros no nervo isquiático do rato, na presença de um fornecimento vascular axial, comparando-se com os mesmos procedimentos em estudos realizados anteriormente, sem suprimento vascular. Os ratos foram avaliados funcionalmente através do estudo das pegadas, da electroneurografia e da força de flexão ao nível do tornozelo, e estruturalmente, através das avaliações histológicas e morfométricas, da taxa de recuperação do peso dos músculos gastrocnémio e solhear e da marcação axonal retrógrada com True Blue às 4, 8 e 12 semanas. Os nervos reconstruídos apresentaram uma arquitectura normal, incluindo a arquitectura vascular. A membrana amniótica foi bem tolerada, persistindo imunologicamente em torno do nervo até à 12.ª semana. Concluiu-se também que, na presença de um suprimento vascular axial local, a membrana amniótica humana e as veias autólogas são, pelo menos, tão eficazes como os auto-enxertos nervosos na reconstrução de defeitos nervosos de 10 milímetros.--------------------------------------ABSTRACT: At the clinic, the functional recovery that follows a nerve lesion is rarely achieved in full. The neuron is very vulnerable to ischemia that’s why it is essential to study the vascularization of the peripheral nerve and its influence on the nerve’s regeneration. The outcome of this study may lead to the development of surgical techniques that create the conditions which are necessary to ensure an early revascularization in case of a peripheral nerve injury. This study investigated the vascularization of the median nerve of the human cadaver and the vascularization of the sciatic nerve of the Wistar rat and his Brachial Plexus (BP) through animal experimentation. The mouse's BP vascularization is not so different from the one that is reported in the human species. An angiomorphological comparison between the mouse sciatic nerve and the human median nerve concluded that the microvascularizations are very similar, which supports the use of the mouse as an experimental model for the study of median nerve’s lesions. To evaluate the influence of vascularization in the nerve’s regeneration, it was made an assessment of the effectiveness of the human amniotic immuno-inert membrane grafts, of the autologous external jugular vein grafts and of the nerve auto-graft in the repair of a defect of 10 mm on the sciatic nerve of the rat, in the presence of an axial vascular supply, comparing these with the same procedures that were adopted in the previous studies, without vascular supply. The rats were functionally assessed and structurally evaluated (through histological and morphometric evaluations) at the 4.th, 8.th and 12.th weeks. The nerves reconstructed presented a normal architecture, including vascular architecture. The amniotic membrane was well-tolerated immunologically, persisting around the nerve until the 12.th week. As a result, it was also concluded that in the presence of a local axial vascular supply, the human amniotic membrane and the autologous veins are, at least, as effective as the nerve auto-grafts in the reconstruction of the nerve’s defects of 10 mm.

Structural assessment of a masonry vault in Portugal

This paper reports on a structural safety assessment and performance evaluation of the upper choir of the Santa Maria de Belém Church in the Jerónimos monastery, Lisbon, one of the most important cultural heritage buildings in Portugal. The possibility of adding a new 20 t organ to the upper choir and its effects on the church structure's response are presented. A refined and a simplified finite-element model is developed to investigate the structure's performance under self-weight and seismic actions. A sensitivity analysis is performed to investigate the effect of masonry mechanical properties and rib cross-sections on the structural response, given the difficulty in accurately obtaining this information. The results show that the safety level of the structure is acceptable, even in the case of adding a heavy new organ.

Enteroscopia por cápsula e doença de Crohn: Caminhos para a otimização

Tese de Doutoramento em Medicina

Critical analyses of the introduction of liquid-based cytology in a public health service of the state of São Paulo, Brazil

OBJECTIVE The aim of this study was to compare the performance of the current conventional Pap smear with liquid-based cytology (LBC) preparations. STUDY DESIGN Women routinely undergoing their cytopathological and histopathological examinations at Fundação Oncocentro de São Paulo (FOSP) were recruited for LBC. Conventional smears were analyzed from women from other areas of the State of São Paulo with similar sociodemographic characteristics. RESULTS A total of 218,594 cases were analyzed, consisting of 206,999 conventional smears and 11,595 LBC. Among the conventional smears, 3.0% were of unsatisfactory preparation; conversely, unsatisfactory LBC preparations accounted for 0.3%. The ASC-H (atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion) frequency did not demonstrate any differences between the two methods. In contrast, the incidence of ASC-US (atypical squamous cells of undetermined significance) was almost twice as frequent between LBC and conventional smears, at 2.9 versus 1.6%, respectively. An equal percentage of high-grade squamous intraepithelial lesions were observed for the two methods, but not for low-grade squamous intraepithelial lesions, which were more significantly observed in LBC preparations than in conventional smears (2.2 vs. 0.7%). The index of positivity was importantly enhanced from 3.0% (conventional smears) to 5.7% (LBC). CONCLUSIONS LBC performed better than conventional smears, and we are truly confident that LBC can improve public health strategies aimed at reducing cervical lesions through prevention programs.