Carlos Musso

Nandrolone decanoate determines cardiac remodelling and injury by an imbalance in cardiac inflammatory cytokines and ACE activity, blunting of the Bezold-Jarisch reflex, resulting in the development of hypertension.

The aims of this study were to evaluate the effects of nandrolone (ND) on cardiac inflammatory cytokines, ACE activity, troponin I, and the sensitivity of the Bezold-Jarisch reflex (BJR). Male Wistar rats were administered either ND (20 mg/kg; DECA) or vehicle (control animals; CONT) for 4 weeks. BJR was analyzed by measuring the bradycardia and hypotension responses elicited by serotonin administration (2-32 μg/kg). Mean arterial pressure (MAP) was assessed and myocyte hypertrophy was determined by the heart weight/body weight ratio and by morphometric analysis. Matrix collagen deposition was assessed by histological analysis of the picrosirius red-stained samples. Mesenteric vascular reactivity was performed and central venous pressure (CVP) evaluated. Cardiac inflammatory cytokine levels and angiotensin-converting enzyme (ACE) activity were studied as well the biomarker of cardiac lesion, troponin I. DECA group showed enhancement of matrix type I collagen deposition (p < 0.01) and cardiac ACE activity (p < 0.01) compared with the CONT. Interleukin (IL)-10 was reduced (p < 0.01) and pro-inflammatory cytokines (TNF-α and IL-6; p < 0.01) were increased in the DECA group compared with CONT. Cardiac injury was observed in the DECA group shown by the reduction in cardiac troponin I (p < 0.01) compared with the CONT group. Animals in the DECA group also developed myocyte hypertrophy and reduction of BJR sensitivity. The MAP of animals treated with ND reached hypertensive levels (p < 0.01; compared with CONT). No changes in CVP and vascular reactivity were observed in both experimental groups. We conclude that high doses of ND elicit cardiotoxic effects with cardiac remodelling and injury. Cardiac changes reduce the BJR sensitivity. Together, these abnormalities contributed to the development of hypertension in animals in the DECA group.

Pathology of Pyogenic Liver Abscess in Children

ABSTRACT Little is known about preexisting lesions in livers of children with pyogenic liver abscess (PLA). Study of these lesions may elucidate possible predisposing factors for the disease. In Vitória, state of Espirito Santo, Brazil, PLA in children is frequently associated with helminthic infections and eosinophilia. We hypothesize that nematode infection with larvae migrating through the liver is a predisposing factor for PLA, because the infection induces immunomodulation and likely trapping of bacteria in liver granulomas. In this report, we describe observations of 22 cases of PLA in children studied at autopsy (16 cases) or in surgical biopsies (6 cases), including 17 boys and 5 girls ranging in age from 1 to 13 years (mean 4.6 years, median 3.5 years). Multiple abscesses in both lobes were found in 13 cases and a single abscess was found in the right lobe in 10 cases. All cases showed histologically classical pyogenic inflammation without morphological evidence of amoebiasis. In six cases there were granulomas similar to those caused by larva migrans visceralis (from Toxocara or other nematodes) in liver tissue not affected by the abscess. Nematode antigens in central areas of necrosis of granuloma in all six cases and fragments of a larva, possibly of Toxocara, were found on samples immunohistochemically stained with polyclonal anti-Toxocara antibodies. There were numerous eosinophils in abscesses with Charcot-Leyden crystals. Eosinophils were found frequently in portal triads far from the abscess wall. In four cases, in which bile duct ascariasis was found, worms were noted in the bile ducts, and eggs were found in liver parenchyma surrounding the abscess in two cases. Foreign-body granulomas were found in one case in which penetrating trauma was the cause of abscess. In one case there was one histiocytic granuloma whose origin was not determined. The observation of six cases of granuloma similar to larva migrans visceralis (or produced by other nematode larva) in liver tissue not directly affected by the abscess supports the hypothesis that helminth infections with larva migrating through the liver are a predisposing factor for pyogenic hepatic abscess in children.

Cotton block method: one-step method of cell block preparation after fine needle aspiration.

OBJECTIVE To describe the cotton block method, an easy, inexpensive, 1-step method of obtaining a cell block after fine needle aspiration biopsy. STUDY DESIGN Before connection to a 10-mL syringe, the plastic hub of a 22-23-gauge needle is filled with the 3-4-mm, woolly tip of a cotton bud. Aspiration is performed as described elsewhere. After smear preparation, the material remaining in the needle and the material retained in the cotton wool mesh are immediately fixed by aspiration ofa fixative fluid (70% alcoholic formaldehyde-acetic acid). After fixation, the cotton tip is removed and routinely processed for paraffin embedding, and the sections are stained by routine methods used in cytopathology. RESULTS The results demonstrate that the amount and quality of material obtained in the cotton wool tip is similar to that in the traditional cell block obtained from the pellet after centrifugation of aspirated fluid. CONCLUSION The method is easy to perform and cost effective and is a rapid way to prepare cell blocks of high quality, allowing special staining techniques and improving cytohistologic correlation.

Disseminated cerebral thrombotic microangiopathy in a patient with adult's Still disease

OBJECTIVE The aim of this report is to describe a fatal disseminated thrombotic micoangiopathy with renal, pancreatic, and cerebral involvement in a patient with recently diagnosed adults Still disease (ASD). CASE REPORT A previously healthy 15 year old girl was admitted to our hospital. According to the clinical and laboratory data the diagnosis of adults still Disease was established. The treatment was begun and few days after an initial improvement a sudden neurologic deterioration with coma and seizures has occurred. Hours later the patient died. Clinical, laboratorial, and pathologic data will be presented. CONCLUSION To our knowledge this is the second description of a fatal disseminated cerebral thrombotic microangiopathy in a patient with adults Still disease, but with a much more fulminating evolution than previously reported. Some etiopathogenic mechanisms could be shared in these two disorders explaining this coexistence.

Labrea-like hepatitis in Vitoria, Espirito Santo state, Brazil: report of a case

A case of fulminant hepatitis with microvesicular steatosis resembling Labreas fever, diagnosed in Vitoria (ES) is reported. The 16 year old boy presented with severe epistaxis, agitation, jaundice and hemorrhagic vomiting and died two days after admission to the emergency unit of the University Hospital. The disease started five days before with fever, myalgias, dark urine and jaundice and progressed with psychic agitation, torpor and coma. The liver and spleen were not palpable. HBsAg was negative in the serum. The autopsy showed acute hepatitis with lytic necrosis confluent in the midzonal and periportal areas with massive microvesicular steatosis in the remaining hepatocytes. Mononuclear cells predominated in the exudate. The reticulum showed condensation in the necrotic areas without typical bands of collapse. The portal tracts were edematous with mononuclear infiltration and mild bile duct proliferation. Absence of cholestasis. Except for the confluent midzonal and periportal necrosis this case showed several clinical and morphological aspects of the Labrea fever described from the East Amazon, demonstrating that the anatomical picture of this disease probably is not in related to a factor peculiar to the Amazon region.

Decompressive fasciotomy in testicular torsion of the spermatic cord in rats

PURPOSE To evaluate the effect of decompression fasciotomy on testes undergoing torsion of the spermatic cord. METHODS Spermatic cord torsion was induced in 40 Wistar testes for six and 12 hours. At the time of distortion, decompression fasciotomy was performed on half of the animals. After 42 days, the testicles were examined both macroscopically and microscopically. A non-parametric Mann- Whitney U- test was used for statistical analysis. The results were considered significant at p≤0.05. RESULTS Testicular weight; volume and degree of histological alterations were evaluated. When the groups without and with fasciotomy were compared, a 12-hour torsion subgroup in the fasciotomy group was noted to present larger volume, heavier weight and superior histological classification when compared with the 12-hour subgroup in the without fasciotomy group. No differences between the two groups after six hours of torsion were found. No significant changes were noticed in the contralateral testis. CONCLUSIONS Testicular fasciotomy (decompression) benefited the macroscopic and histological aspects of the testicles undergoing cord torsion for a 12-hour period. These results demonstrate the role played by compartment syndrome in the pathophysiology of spermatic cord torsion and the need for decompression.

Abscesso piogênico do fígado e esquistossomose mansônica: observações no Estado do Espírito Santo

A possible association of the acute toxemic form of schistosomiasis and pyogenic liver abscess (PLA) has been recently suggested. As in the west of the Espírito Santo state schistosomiasis is endemic and PLA are frequently diagnosed in the Childrens Hospital of Vitória we reviewed the records of the Hospital during the period from May 1991 to April 1993 to: a) identify all cases of PLA in which Schistosoma mansoni infection was present and b) annotate the procedence of each case to verify if there is an association of the two diseases. 65 cases of PLA were recorded and 39 had the result of a stool examination, being three positive for Schistosoma mansoni (7.6%) and 26 for other helminth (mainly Ascaris and Trichocephalus). The procedence of the patients showed that only 7 (10.7%) came from endemic areas. These results show that an association of Schistosoma mansoni infection and PLA was not significative in the country, where the acute toxemic form is not frequent. The great majority of PLA in this study came from the urban periphery of Vitória, where transmission of schistosomiasis does not occur but intestinal helminth infections are extremely frequent. The great majority of PLA in this study came from the urban periphery of Vitória, where transmission of schistosomiasis does not occur but intestinal helminth infections are extremely frequent. As 40% of these PLA were cryptogenetic it is possible that the immunomodulation induced by intestinal parasites and the liver granulomas produced by the larvae of these helminths would be predisposing factors for pyogenic liver abscess.

Correlação entre níveis de iodo na urina e alterações anatomopatológicas em tireoide

OBJECTIVES To determine iodine nutrition in the population and to correlate levels of iodine found in random samples of urine with pathological changes observed in thyroids collected in this population. MATERIALS AND METHODS Urinary iodine was determined in 30 random samples of urine and the pathological study was carried out in 55 thyroid glands from corpses received by the Department of Forensic Medicine of Vitória, Espírito Santo, Brazil from May to August 2011. RESULTS In 29 urine samples (96.7%) urinary iodine was above the maximum limit recommended by the World Health Organization (WHO), of 300 mg/L. Fourteen thyroids (25.5%) showed the presence of histological changes compatible with thyroiditis. Higher levels of iodine in urine were observed in females and in of thyroid that showed inflammation (thyroiditis). CONCLUSIONS We conclude that, in this population, there is excess iodine intake, and greater incidence of inflammatory thyroid disease.

Ascaris lumbricoides: reinfection in children bearing an established worm burden

To clarify the existence of reinfection in children bearing an established Ascaris lumbricoides infection, the authors evaluated the weight and the length of worms collected from ten cases of ascaridiasis. The worm burden was greater than 27 worms in nine cases. In seven cases the weight and the length of worms showed little variation, with unimodal distribution of values, suggesting that all the worms in each case belong to the same population, originated from a single brood infection or from successive infections over small time intervals. In three cases there was great variation in worm size indicated by the different values for the means and medians and by the high values for the standard deviation and coefficient of variation. In these three cases there was a bimodal distribution of worms size suggesting the coexistence of two distinct populations: one, less numerous, composed of mature worms and the other, more numerous, composed of immature worms, in two cases, and two distinct populations of immature worms in one case. The existence of worms in different stages of maturation indicates that the less mature population was acquired when the mature worms were established in the gut. These results indicate that the reinfection with Ascaris in children bearing an established infection is not rare and resistance induced by a preexisting infection is not the rule.

Apudomas pancreáticos: um desafio para clínicos e cirurgiões

OBJETIVO: O proposito do presente estudo e analisar as dificuldades quanto ao diagnostico, avaliacao prognostica e conduta em sete pacientes portadores de tumores neuroendocrinos do pâncreas (apudomas), estudados na ultima decada, comparando os resultados com aqueles discutidos na literatura. METODO: A idade dos pacientes variou de 15 a 66 anos, com media de 38,4 anos. Todos foram submetidos a alguma forma de resseccao pancreatica por tumores neuroendocrinos. Os exames histologicos foram feitos pelas tecnicas tradicionais e por imuno-histoquimica. RESULTADOS: Tres pacientes tiveram um diagnostico inespecifico de tumor neuroendocrino; dois de vipoma e dois de gastrinoma. As sindromes nao se manifestaram claramente, ainda que cada caso tenha tido um rotulo diagnostico. Os exames por imuno-histoquimica demonstraram a presenca de multiplos hormonios, mas por falta de sintomas clinicos, as correlacoes ficaram prejudicadas na maioria dos casos, havendo correlacao somente em caso de gastrinoma. Um paciente faleceu no pos-operatorio; um sobreviveu sete anos e cinco estao vivos, com sobrevida variando entre tres e cinco anos. CONCLUSOES: Nao houve uma manifestacao sindromica evidente, porem a sobrevida dos pacientes tem sido compativel com os dados de literatura.