Edenilson Eduardo Calore

Postoperative Follow-Up of Anal Condylomata Acuminata in HIV-Positive Patients

AbstractPURPOSE: The purpose of this study was to analyze the postoperative follow-up of HIV-positive patients with anal condylomata acuminata, associating recurrence to the AIDS status. METHODS: Ninety-seven male, homosexual patients with anal condylomata were submitted to surgical treatment from August 1992 to December 1997. Specimens were obtained for histologic investigation of Ki-67 cell proliferation marker and for polymerase chain reaction to define the human papillomavirus type. The patients were advised to return weekly during the first month, and monthly up to the sixth month, to evaluate recurrence. Patients with high-grade anal intraepithelial neoplasia remain in follow-up. RESULTS: Histology revealed low-grade anal intraepithelial neoplasia in 81.44 percent of patients and high-grade lesions in 18.56 percent. The results showed that high-grade lesions were not more frequent in late-stage AIDS patients. Ki-67 expression, a cell proliferation marker, was greater in high-grade than in low-grade anal intraepithelial neoplasia, but had no association with AIDS status. Nononcogenic human papillomavirus 6 and 11 were the commonest types. Comparing papillomavirus types and anal intraepithelial grade, we noticed that both oncogenic and nononcogenic types were responsible for high-grade lesions. All patients healed and 51 (52.6 percent) had recurrence up to the sixth month. AIDS status and papillomavirus type were not associated with recurrence. However, high-grade anal intraepithelial neoplasia patients had more recurrence than those with low-grade lesions. Topical treatment failed in 20 patients (41.6 percent), and these were submitted to new surgical treatment. All of them were in the late stage of AIDS. Three who had high-grade lesions in the first operation had low-grade lesions in specimens from the second surgery. The same histologic pattern was observed in 17 patients who had low-grade lesions in warts removed in the first operation. Other patients with high-grade lesions had no recurrence or evolution to invasive carcinoma from five to ten years of follow-up. CONCLUSION: High-grade anal intraepithelial neoplasia and late-stage AIDS are risk factors for recurrence of anal condylomata.

Experimental mitochondrial myopathy induced by chronic intoxication by Senna occidentalis seeds.

Histochemical and electron microscopic studies of biceps femoris, pectoralis major and rectus femoris of chronically treated birds with seeds of the poisonous plant Senna occidentalis (0.2% external/internal tegment), were performed. The muscles had similar features of human mitochondrial myopathy as ragged-red fibers, cytochrome-oxidase negative fibers, and weak activity of the oxidative enzymes. Fibers with lipid storage were also present. Acid phosphatase activity in rare muscle fibers was also detected, and represents probably a secondary degenerative process. By electron microscopy, enlarged mitochondria with disrupted or excessively branched cristae were seen. The present study presents a new experimental model of mitochondrial myopathy that may be useful for the best knowledge of this group of diseases and for experimental trials of drugs that could reverse the mitochondrial impairment in the mitochondrial myopathies.

Toxicity Testing of Senna occidentalis Seed in Rabbits

The effect was investigated of administering ground Senna occidentalis seeds to rabbits in different concentrations (1%, 2%, 3% and 4%) in the ration. The experiment lasted 30 days and the toxic effects of the plant were evaluated on the basis of weight gain, histopathological, biochemical and morphometric parameters, as well as histochemistry and electron microscopy. Animals that received the ration containing 4% ground S. occidentalis seeds gained less weight (p<0.05) and died in the third week. Histopathology revealed that the heart and liver were the main organs affected, with myocardial necrosis and centrolobular degeneration. There was a reduction in cytochrome oxidase activity in the glycogenolytic fibres, together with muscle atrophy, confirmed by the morphometric studies. Electron microscopy of the liver cells revealed dilated mitochondria, with destruction of the internal cristae.

Protective Effect of Pralidoxime on Muscle Fiber Necrosis Induced by Organophosphate Compounds

OBJECTIVE To determine the protective effect of pralidoxime on muscle fiber necrosis induced by organophosphate acute intoxication in rats. DESIGN Adult male Wistar rats were given oral organophosphate compounds dissolved in glycerol formal: dichlorvos, isofenphos, metamidophos, and diazinon. Half of the animals also received pralidoxime mesylate (20 mg/kg, intraperitoneal). Control animals received only the solvent. Twenty-four hours after treatment, the diaphragm muscle was collected for histological counts of necrotic muscle fibers in transverse sections. RESULTS Metamidophos- and isofenphos-treated animals showed the highest percentage of necrotic muscle fibers: 1.66 +/- 1.112 and 1.34 +/- 0.320, respectively. Diazinon-treated animals had a lower percentage of necrotic fibers: 0.40 +/- 0.032 (p < 0.05) compared to the first 2 products, and dichlorvos-treated animals showed the smallest: 0.05 +/- 0.021 (p < 0.05) when compared to the other 3 products. Pralidoxime reduced necrotic fibers about 20 times in metamidophos-treated animals, 10 times in isofenphos-treated animals and 6 times in diazinon-treated animals. Pralidoxime administration did not increase plasma cholinesterase activity in any group, although symptoms were reduced. CONCLUSIONS Oxime reduced diaphragmatic muscle necrosis in experimental organophosphate intoxication, despite little effect on plasma cholinesterase. Since respiratory insufficiency is an important cause of mortality and morbidity in organophosphate intoxications, early oxime administration may be particularly beneficial.

Citologia anal para rastreamento de lesões pré-neoplásicas

BACKGROUND: High grade intra-epithelial neoplasias (HAIN) are probable precursors of anal carcinoma, with association to high-risk types of Human Papillomavirus (HPV). This progression could be related to severity of the dysplasia and, albeit not yet confirmed, treatment of these lesions would prevent the evolution to cancer. Standardization and improvement of screening methods should therefore be essential to treat or prevent precursor lesions, mainly in patients at risk such as seropositives to Human Immunodeficiency Virus (HIV). The aim of this study was to evaluate if anal cytology, with a cytobrush, could be useful to screen clinic and pre-clinic lesions provoked by HPV. METHODS: Brushes were used to obtain smears from the anal canal of 102 HIV-positive patients with proctologic complaints. There were 86 males and 16 females with a mean age of 37 years. HPV infection was denied by 33 patients, 14 had treated anal warts in the past, 28 had condylomas in the anal verge, seven had internal clinical lesions and 20 had both internal and external condylomas. The smears were submitted to Pappanicolaou and hematoxilin-eosin stains to identify cytological changes including HAIN. T CD4+ lymphocyte counts were also evaluated to check if the immunologic status caused more advanced dysplasia. RESULTS: One smear only proved insufficient. All the others revealed cellular patterns varying from normality to HAIN. Low grade AIN (LAIN) occurred in 30 and HAIN in 13 patients. One patient with HAIN, without a history of HPV infection in the past, presented an anal canal ulcer which at biopsy was diagnosed as invasive squamous-cell carcinoma. T CD4+ cells averaged 281/mm³ for LAIN patients and 438/mm³ for HAIN patients. Analyses disclosed a statistical difference, showing that despite expectations, more advanced dysplasias occurred in patients with higher counts of T CD4+ cells. This fact demonstrated that isolated systemic immunity did not seem to interfere in the genesis of these lesions, suggesting that aspects of local immunity should be studied. Statistical analyses by a 2x2 table revealed sensibility of 74% and specificity of 61%. CONCLUSION: Results suggest that cytology could be used to diagnose anal cancer precursors.

MUSCLE ATROPHY INDUCED IN BROILER CHICKS BY PARTS OF SENNA OCCIDENTALIS SEEDS

Senna occidentalis (formerly Cassia occidentalis) is a common contaminant of agricultural commodities. It is toxic to cattle and poultry, reportedly being responsible for skeletal myodegeneration in these animals. All parts of the plant present toxicity, but the seeds are the most toxic. The toxin(s) responsible for the myodegeneration have not been definitively identified, nor is it known which part of the seeds is most toxic. Intoxication by this plant leads to weight loss with considerable economic repercussions. The effects of the whole seed and of parts of S. occidentalis seeds (1% in commercial feed) were compared on the pectoralis major muscle of broiler chicks intoxicated from birth until 22 days of life. There were severe clinical signals and reduced body weight in birds that received the external tegment of the seed, whereas no adverse effects were observed in birds that received the whole seed or other parts of the seed. Histological and morphometric studies showed an intense muscle fibre atrophy (both type 1 and type 2 fibres were affected) in the group that received 1% external tegment. This study may be the first step to identifying the substance(s) involved in this pathological process.

Squamous intraepithelial lesions in cervical smears of human immunodeficiency virus-seropositive adolescents

Various authors have reported a high rate of human papillomavirus (HPV) infection and HPV‐related neoplasias in human immunodeficiency virus (HIV)‐seropositive women. On the other hand, young women are most susceptible to cervical infection because of immaturity of the cervix, as it appears that HPV has more access to the basal cells of the differentiating epithelium. The purpose of the present work was to study cervical smears of 82 adolescent HIV‐seropositive women (13–21 years of age) to search for cytological evidence of cervical intraepithelial neoplasias. Twenty‐one cases showed characteristic features of HPV infection and squamous intraepithelial lesions (SIL; 25.6%). Sixteen cases aged from 17 to 21 years (mean age 19.5 years) had low‐grade SIL (LSIL; 19.5%) and five cases aged from 18 to 21 years (mean age 20.2 years) had high‐grade SIL (HSIL; 6.1%). There was no significant difference between the mean age of patients with LSIL and HSIL. Two cases had atypical squamous cells of undetermined significance (ASCUS). In the present work it was found that HIV‐seropositive adolescents have a high risk for preneoplastic lesions of the cervix (25.6%) as well as a high incidence of more aggressive lesions (6.1% of HSIL) when compared to the general population of adolescents. As it can be assumed that, if the age of acquisition of the infection in both groups (in the general population and HIV‐seropositive women) is the same, it is probable that HIV infection in adolescents not only increases the frequency of HPV infections but also facilitates the evolution to more aggressive preneoplastic lesions of the cervix due to HPV. Diagn. Cytopathol. 1998;18:91–92.

Effects of long-term administration of Senna occidentalis seeds in the large bowel of rats.

Plants of the genus Senna that contain anthranoides derivatives are frequently used as cathartics. Radiological studies have demonstrated that patients with chronic constipation who have used stimulant laxative have colonic redundancy and dilatation more frequently than patients who have not. The objective of the present work was to study morphological and histochemical changes of the lower gut after administration of Senna occidentalis seeds for a long period to rats, as observed in skeletal muscle fibers. Fragments of the lower gut of young and adult rats treated with S. occidentalis seeds (2% for 171 days and 3% for 61 days in the diet) were submitted to histological and histochemical analysis and to densitometry. The most important finding was decreased oxidative enzyme activity in smooth muscle cells and in myenteric neurons of the large bowel. As oxidative metabolism is essential for ATP and energy production, these results suggest that the functional intestinal disturbance caused by the chronic use of Senna occidentalis as a laxative can be due to a metabolic effect involving energy production, which would decrease colonic motility and cause functional colonic dilatation, but without any irreversible anatomic change.

Expression of Ki-67 can assist in predicting recurrences of low-grade anal intraepithelial neoplasia in AIDS

PURPOSE: The incidence of anogenital squamous-cell carcinoma was observed to have increased since the beginning of the human immunodeficiency virus infection epidemic among male homosexuals, both with acquired immunodeficiency syndrome and without acquired immunodeficiency syndrome. It seems that immunosuppression is the most important risk factor for the progression of anogenital lesions, recurrences of anal condyloma, and development of anal carcinoma, in particular in acquired immunodeficiency syndrome. High-grade anal intraepithelial neoplasia was predominantly observed in the human immunodeficiency virus-positive men. We have also observed a high rate of recurrences of anal lesions in cases of high-grade anal intraepithelial neoplasia. However, there are many cases of recurrences of low-grade anal intraepithelial neoplasia that cannot be predicted by routine histologic studies. By using immunohistochemical methods, we studied the expression of Ki-67 in epithelial cells of low-grade anal intraepithelial neoplasia of patients with acquired immunodeficiency syndrome to try to predict recurrence of these lesions. METHODS: Anal biopsies of 38 patients were studied retrospectively. Of these patients, 14 had no recurrences (Group 1), and 24 patients had recurrence of the anal lesions before one year of follow-up (Group 2). RESULTS: The median percentage of Ki-67-positive cells in Group 1 was 6.3±7.03 and in Group 2 was 24.1±16,72. The difference between Groups 1 and 2 was statistically significant (P<0.001). CONCLUSIONS: Our results showed a high correlation between the percentage of Ki-67-positive cells and recurrences. We concluded that Ki-67 counting in low-grade anal intraepithelial neoplasia can aid in predicting recurrences and therefore aid in the follow-up of these patients.

Progression of cervical lesions in HIV-seropositive women : A cytological study

It has been reported that cervical intraepithelial lesions have a more aggressive course in HIV‐seropositive than in HIV‐seronegative women. In the present investigation, the progression of these cervical lesions was studied in a group of HIV‐seropositive women. Of 1,587 patients, 200 (12.6%) had a cytological diagnosis of squamous intraepithelial lesion (SIL) or invasive carcinoma. In 409 patients, more than one cytological smear was collected in 3½ years. Progression occurred in 39 cases. In 24 (61.5%), the first diagnosis was benign cellular changes (BCC) and the second was low‐grade SIL (LSIL) (1‐yr interval in 21 cases); in 11 (28.2%), the first was BCC, and the second, high‐grade SIL (HSIL) (1‐yr interval in 9 cases); in 2 (5.0%), the first diagnosis was LSIL. and the second, HSIL (1‐yr interval); in 2 (5.0%), the first was HSIL, and the second, invasive carcinoma (2‐yr interval). These results point to the importance of cervical cytologic surveillance in HIV‐seropositive patients. Diagn. Cytopathol. 24:117–119, 2001.