José Eymard Homem Pittella

Primary squamous-cell carcinoma of the cecum and ascending colon

A case of primary squamous-cell carcinoma at the cecum-ascending colon junction is reported as the 17th in world medical literature. Previous reported cases are reviewed and comments on their histogenesis and relationship with adenocarcinoma of the colon are presented.

Coma and death in unrecognized Wernicke's encephalopathy: an autopsy study

Eleven out of 36 autopsied cases of Wernickes encephalopathy had developed coma. None of these patients had the diagnosis during life. There were six men and five women with ages ranging from 26 to 50 years (mean 36.6). Seven of these patients were heavy drinkers, three exhibited signs of severe malnutrition, whereas one was being evaluated for a disseminated gastric cancer and one was in treatment of hyperemesis gravidarum. Two patients were brought to the hospital after found unconscious at home. Neuropathological examination disclosed gross changes in the mammillary bodies in eight cases and microscopic changes in all cases. In one case there was atrophy of the anterior superior part of the vermis. Petechial hemorrhages were observed particularly in the walls of the third ventricle. Microscopically there were in addition to hemorrhages, glial proliferation, endothelial hypertrophy and necrosis of nerve cells and myelin. Central pontine myelinolysis was observed in one case. Wernickes encephalopathy is a clinically underdiagnosed condition. Coma may mask its classical clinical picture or even be the sole manifestation. Although coma points to a poor outlook it may be reversed by thiamine administration. Any patient with coma of unknown etiology should be given parenteral thiamine.

An electron microscope study of the Auerbach's plexus and determination of substance P of the colon in Hirschsprung's disease

The AA present a study of 3 cases of Hirschsprungs disease performed under electron microscopy and whose data seen to suggest that substance P, which is always found in larger amounts in the ganglionic portion of the colon (than in the aganglionic one), may be related with the granular vesicles of Auerbachs plexus.

Prevalência e padrão de distribuição das doenças cerebrovasculares em 242 idosos, procedentes de um hospital geral, necropsiados em Belo Horizonte, Minas Gerais, no período de 1976 a 1997

RESUMO - Objetivo: Descrever a prevalencia e os tipos das doencas cerebrovasculares (DCVs) em individuosidosos necropsiados. Metodo: Foram consultados os laudos neuropatologicos de 242 pacientes com idadeigual ou superior a 61 anos, procedentes em sua maioria do Hospital das Clinicas da Universidade Federal deMinas Gerais, em Belo Horizonte, Minas Gerais, e necropsiados consecutivamente no periodo 1976 a 1997.Resultados: Os principais grupos de doencas do sistema nervoso central (SNC) foram representados por DCVs(71,9%), infeccoes (12,4%), neoplasias (7,1%), traumatismos crânio-encefalicos (3,7%), doencas nutricionais(2,5%) e doencas degenerativas (1,7%). As DCVs mais frequentes foram: aterosclerose (61,2%), doencacerebrovascular hipertensiva (25,6%) e infarto cerebral (14,9%). Observou-se aumento da frequencia e dagravidade da aterosclerose e da frequencia da doenca cerebrovascular hipertensiva com o avancar da idade.Houve associacao significativa entre doenca cerebrovascular hipertensiva e aterosclerose. As DCVs foramclinicamente sintomaticas e as responsaveis diretas pelo obito em 42,7% e 17,3% dos pacientes,respectivamente. Conclusao: As DCVs constituiram o principal grupo de doencas do SNC no idoso. Aaterosclerose e a doenca cerebrovascular hipertensiva foram as principais doencas deste grupo, notando-seaumento de sua frequencia com o avancar da idade e associacao significativa entre ambas.PALAVRAS-CHAVE: doenca cerebrovascular, idoso, necropsia.Prevalence and types of cerebrovascular diseases in 242 hospitalized elderly patients, autopsied in BeloHorizonte, Minas Gerais, Brazil, from 1976 to 1997ABSTRACT - Objective: To describe the prevalence and the types of cerebrovascular diseases (CVDs) in autopsiedelderly individuals. Method: Consecutive clinical charts and neuropathological reports of 242 patients aged61 years or older were reviewed. The patients died in Hospital das Clinicas, Federal University of Minas Gerais,in Belo Horizonte, Minas Gerais, Brazil, from 1976 to 1997. Results: The prevalent diseases of the centralnervous system (CNS) found in decreasing order were: CVDs (71.9%), infections (12.4%), neoplasms (7.1%),head trauma (3.7%), nutritional diseases (2.5%) and degenerative diseases (1.7%). The most common CVDswere cerebral atherosclerosis (61.2%), hypertensive cerebrovascular disease (25.6%) and cerebral infarct (14.9%).There was an increase in prevalence and severity of atherosclerosis and an increase in prevalence of hypertensivecerebrovascular disease with advancing age. A significant association between hypertensive cerebrovasculardisease and atherosclerosis was found. The CVDs patients had clinical stroke and this was the direct cause ofdeath in 42,7% and 17,3% of the cases, respectively. Conclusion: The CVDs were the most prevalent group ofdiseases of the CNS in elderly patients. Atherosclerosis and hypertensive cerebrovascular disease were themost common CVDs, and its prevalence increased with advancing age. Hypertensive cerebrovascular diseasewas significantly associated with atherosclerosis.KEY WORDS: cerebrovascular disease, elderly, autopsy.OBJECTIVE To describe the prevalence and the types of cerebrovascular diseases (CVDs) in autopsied elderly individuals. METHOD Consecutive clinical charts and neuropathological reports of 242 patients aged 61 years or older were reviewed. The patients died in Hospital das Clínicas, Federal University of Minas Gerais, in Belo Horizonte, Minas Gerais, Brazil, from 1976 to 1997. RESULTS The prevalent diseases of the central nervous system (CNS) found in decreasing order were: CVDs (71.9%), infections (12.4%), neoplasms (7.1%), head trauma (3.7%), nutritional diseases (2.5%) and degenerative diseases (1.7%). The most common CVDs were cerebral atherosclerosis (61.2%), hypertensive cerebrovascular disease (25.6%) and cerebral infarct (14.9%). There was an increase in prevalence and severity of atherosclerosis and an increase in prevalence of hypertensive cerebrovascular disease with advancing age. A significant association between hypertensive cerebrovascular disease and atherosclerosis was found. The CVDs patients had clinical stroke and this was the direct cause of death in 42,7% and 17,3% of the cases, respectively. CONCLUSION The CVDs were the most prevalent group of diseases of the CNS in elderly patients. Atherosclerosis and hypertensive cerebrovascular disease were the most common CVDs, and its prevalence increased with advancing age. Hypertensive cerebrovascular disease was significantly associated with atherosclerosis.

Progressive formation of neuritic plaques and neurofibrillary tangles is exponentially related to age and neuronal size. A morphometric study of three geographically distinct series of aging people

Neuronal size and the incidence of neuritic plaques (NPs) and neurofibrillary tangles (NFTs) were morphometrically and quantitatively studied in the entorhinal cortex of 300 autopsied individuals without dementia in three geographically distinct series (Brazil, Germany and Japan), and an additional series including 30 clinically diagnosed Alzheimers disease patients. The mean ages at onset of NPs and NFTs were similar between the three normal series, and the incidence of NPs and NFTs increased exponentially with age, but at different rates. A correlation was found between larger neuronal size and higher incidence of NPs and NFTs. Neuronal size distribution largely seemed to account for the differences between the series. While the onset of neurodegeneration may be tightly programmed, i.e., in a species-specific manner, our data support the idea that the incidence of NPs and NFTs and the progression from NPs to NFTs may vary remarkably, depending on neuronal size.

Central nervous system involvement in experimental trypanosomiasis cruzi

A review of the available literature on central nervous system involvement in experimental trypanosomiasis cruzi is undertaken. From a critical analysis of 26 works on experimental infections with Trypanosoma cruzi (23 on the acute phase, 2 on the chronic phase, and one describing sequentially both phases), all supported by neuropathologic studies, it can be concluded that: 1) central nervous system involvement during the acute phase, in the form of encephalitis in multiple foci, with variable intensity of the parasitism and inflammatory changes, is frequent and well documented; 2) in animals with more severe central nervous system involvement death occurs as a result of the brain lesions or acute chagasic myocarditis, the latter being always present; 3) in animals with more discrete brain involvement death during the acute phase is due to complications not related to the nervous system, among which congestive heart failure secondary to acute chagasic myocarditis, a condition that is always present, regardless of whether or not the central nervous system is infected; 4) it is possible that in surviving animals that had mild encephalitis the inflammatory changes from the acute phase usually regress as the infection progress to the chronic phase.

Granulomatous Amoebic Meningoencephalitis in an Immunocompetent Patient

OBJECTIVE To report a case of granulomatous amoebic encephalitis caused by Balamuthia mandrillaris. DESIGN Case report. SETTING University hospital. PATIENTS An adult female patient without any apparent suppressor immune system factor had central nervous system infection caused by B mandrillaris. MAIN OUTCOME MEASURES Clinical, neuroimaging, and pathology findings. RESULTS This study shows the diagnosis of B mandrillaris encephalitis suspected from a cerebral biopsy specimen and confirmed by immunohistochemical and polymerase chain reaction studies. CONCLUSIONS This study demonstrates that the diagnosis of amoebic encephalitis represents a clinical challenge and confirming diagnoses are made, in most cases, after death. High suspicion, histopathologic examination, and indirect immunofluorescence, polymerase chain reaction, and cytokine studies from tissue and cerebrospinal fluid are the main devices to reach the diagnosis.

HISTOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL STUDY OF THE BRAIN IN THE ACUTE AND CHRONIC PHASES OF EXPERIMENTAL TRYPANOSOMIASIS CRUZI IN DOGS

A histopathological and immunohistochemical study was undertaken of the brains of 12 young purebred Pinscher dogs, eight of which were inoculated intraperitoneally with the Colombiana strain of Trypanosoma cruzi. The four non-infected dogs formed the control group. An immunoperoxidase method was employed for demonstrating amastigotes of T. cruzi in tissue sections. Three infected dogs died in the acute phase; the other five were sacrificed at different stages of the chronic phase, one of them having survived for almost three years after the inoculation. Histopathological and immunohistochemical examination of the brains showed changes only in the infected group. Three of the eight inoculated dogs showed encephalitis in multiple foci. In one of the dogs the lesion was recent, in activity, containing parasites. In the other two dogs the lesions were milder, without parasites, suggesting a process of regression. These three were the dogs which died in the acute phase. The other five infected dogs did not show brain changes, and these were the dogs which were sacrificed at different stages of the chronic phase. Based on these findings, the authors conclude that, in the experimental model used, central nervous system involvement in the acute phase of the infection is not very frequent. In the chronic phase the inflammatory changes and parasites would not have been still observable, firstly because most of these dogs would not have had central nervous system involvement in the acute phase, and secondly because in some dogs there would have been total regression of any mild inflammatory changes which had been present in the acute phase as the infection progressed to the chronic phase.

Open-Ring Enhancement in Pseudotumoral Multiple Sclerosis: Important Radiological Aspect

Introduction. Observation of open-ring enhancement in magnetic resonance imaging (MRI) is considered a specificity marker for diagnosing pseudotumoral multiple sclerosis (MS). This finding is of great value in the differential diagnosis of tumefactive lesions. Case Report. We describe a 55-year-old white woman, with previous history of ovarian cancer and recent history of fatigue and bilateral retroorbital pain. Important bilateral visual impairment evolved over one month. Physical examination detected the presence of right homonymous hemianopia. Cranial MRI showed an expanding lesion with open-ring enhancement. Given the range of diagnostic possibilities, a stereotactic biopsy was performed, and histopathological examination was consistent with an active demyelinating disease. The patient was treated with 1 g of methylprednisolone and symptoms improved following a significant reduction in the lesion. Conclusions. We highlight the MRI results suggestive of pseudotumoral MS, especially open-ring enhancement, which is an important radiologic aspect to diagnosis and can assist in avoiding unnecessary biopsies.

The conformation of the brain plays an important role in the distribution of diffuse axonal injury in fatal road traffic accident

OBJECTIVE A study was made of the brain lesions in 120 random victims of fatal road traffic accidents to determine the frequency and topographic distribution of diffuse axonal damage (DAI) in relation to the midline brain structures. METHOD The identification of axons was carried out with a mouse antibody anti-neurofilament proteins 70-, 160-, and 210-kD. RESULTS DAI was identified in 96 (80%) brains and classified as Grade 1 in 21.9%, as Grade 2 in 51%, and as Grade 3 in 27.1% of the patients. In spite of the diffuse distribution that is characteristic of DAI, damage occurred preferentially in the interhemispheric formations (corpus callosum and fornix) and rostral portion of the brainstem, usually to one side of the midline. CONCLUSION From a mechanical point of view, the interhemispheric formations and the rostral portion of the brainstem act as fixating structures for the cerebral hemispheres during rotational acceleration of the head. It is known that the motion of the cerebral hemispheres is delayed at the points of fixation, where greater stress would be produced, particularly on the side subjected to greater displacement. The frequent involvement by DAI of deep, center-medial brain structures, usually to one side of the midline, supports the mechanism proposed above.