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Malformações do sistema nervoso central: análise de 157 necrópsias pediátricas

The malformations of the central nervous system affect about 5 to 10 children per 1000 births. We studied the central nervous system malformations in 5837 pediatric autopsies performed in the Sector of Anatomic Pathology, Hospital de Clinicas-UFPR, between 1960 and 1995. There were 157 central nervous system malformations (2.69%), the commonest were neural tube defects (61%): 47 cases of anencephaly and 45 cases classified in the group of myeloencephaloceles. The anomalies of the prosencephalic evagination corresponded to 8% of all central nervous system malformations, with seven cases of holoprosencephaly. Posterior fossa malformations occurred in 3%, with three cases of Arnold-Chiari. In the present study, the mortality rate due to central nervous system malformations was higher in the neonatal period.

Immunohistochemical assessment of respiratory viruses in necropsy samples from lethal non-pandemic seasonal respiratory infections

Background/aim Acute respiratory infections are an important cause of childhood morbidity and mortality throughout the world, and viruses have often been reported to be an aetiological agent. This study aimed to identify respiratory viruses in paraffin-embedded samples of paediatric lung necropsy specimens, using immunohistochemistry on tissue microarray slides. Methods Retrospective study in 200 lung tissue samples from children who had died from severe respiratory infections during 1985–2005. Immunoperoxidase assay was performed to detect the viruses that were most commonly associated with respiratory tract infections: influenza virus A (FLU A), influenza virus B (FLU B), respiratory syncytial virus (RSV), adenovirus (AdV) and parainfluenza virus (PIV) types 1, 2 and 3. Results Viruses were detected in 71 (35.5%) cases. Most positive cases were observed in children younger than 6 months. In 42.3% of cases, only one virus was detected: 11 (36.7%) RSV; 7 (23.3%) AdV; 4 (13.3%) PIV2; 3 (10%) FLU A; 2 (6.7%) FLU B; 2 (6.7%) PIV3; and 1 (3.3%) PIV1. Co-infection with more than one virus was observed in 41 (57.7%) cases. No positive correlations were observed between the presence of viral antigens and seasonality of the infection, sex, age or histopathological findings. Conclusions Non-pandemic seasonal respiratory viruses are involved in a significant number of deaths in paediatric patients; these findings highlight the importance of laboratory investigation of these agents in patients hospitalised with severe acute respiratory infections.

Displasia tanatofórica: Relato de dois casos com estudo neuropatológico

We report two cases of thanatophoric dysplasia (TD) with detailed neuropathologic evaluation. One case was representative of TD type I and the other TD type II. The case with TD type I showed macrocephaly, narrow thoracic cage, pulmonary hypoplasia and bowed limbs. Radiological study showed flat vertebral bodies, short curved appendicular skeleton and flaring of metaphyses. The other case (TD type 2) showed macrocephaly, cleft palate, short limbs and cloverleaf skull. Radiological findings were generalized platyspondy with excessive intervertebral disc space heights and a large head. Microscopic examination of both cases revealed temporal lobe polymicrogyria, abnormalities of the hippocampus and heterotopic neuroglial tissue within the meninges. There were no noticeable differences in CNS abnormalities between TD type I and II.We report two cases of thanatophoric dysplasia (TD) with detailed neuropathologic evaluation. One case was representative of TD type I and the other TD type II. The case with TD type I showed macrocephaly, narrow thoracic cage, pulmonary hypoplasia and bowed limbs. Radiological study showed flat vertebral bodies, short curved appendicular skeleton and flaring of metaphyses. The other case (TD type 2) showed macrocephaly, cleft palate, short limbs and cloverleaf skull. Radiological findings were generalized platyspondy with excessive intervertebral disc space heights and a large head. Microscopic examination of both cases revealed temporal lobe polymicrogyria, abnormalities of the hippocampus and heterotopic neuroglial tissue within the meninges. There were no noticeable differences in CNS abnormalities between TD type I and II.

Clinical, neurovascular and neuropathological features in sneddon's syndrome

Sneddons syndrome (SS) is characterized by ischemic cerebrovascular episodes and livedo reticularis. It is more common in young women and can also be associated with valvulopathy, a history of spontaneous abortion, renal involvement and vascular dementia. We describe three cases of young women with this disease. The patients had repeated ischemic cerebral episodes, livedo reticularis and thrombocytopenia. CT and MRI showed strokes and cerebral atrophy. Autopsy in one of the patients revealed cerebral infarctions. Anticardiolipin antibodies were detected in two patients. Antiphospholipid antibodies may be found in some patients with ischemic cerebrovascular events and livedo reticularis. SS may thus be associated with antiphospholipid syndrome. We described three new cases of SS and discuss the pathophysiology of this disease.

Estudo comparativo da biocompatibilidade da submucosa intestinal porcina e pericárdio bovino usados como enxertos na veia cava de cães

PURPOSE To compare the biocompatibility of the bovine pericardium and the small intestine submucosa (SIS) when used to repair a created defect in the inferior vena cava of dogs. METHODS Sixteen male mongrel dogs were submitted to a midline laparotomy incision. An elliptical segment (1.5 x 3.0 cm) of the inferior vena cava, below the renal veins, was excised. In 8 dogs, the A group, a patch of porcine small bowel submucosa was used to repair the defect. In the 8 remaining dogs, the B group, a bovine pericardium was implanted in the vena cava. On the 30th post-operative day an ultrasound was performed in order to identify stenosis. The euthanasia was accomplished in the 40th post-operative day. Stenosis of the vein was observed in 1 dog of A group and in 2 of the B group. RESULTS Partial thrombosis with collateral circulation was evidenced in 1 dog of the bovine pericardium group. A moderated chronic inflammatory process was evidenced in both groups. Microscopic evaluation, regarding endothelization of the implant, collagen deposition, smooth muscle growth, was similar in both groups. CONCLUSION SIS proved to be a functional graft patch for possessing local vena cava remodeling and its biocompatibility was similar to bovine pericardium.

Efeitos da terapia de reposição hormonal na cicatrização de anastomoses de cólon

OBJETIVO: Existe coincidencia entre os sintomas do climaterio e o aparecimento acentuado dos sinais de envelhecimento da pele. Estudos, em modelos animais, mostraram que o estrogeno e uma especie de mediador critico na cicatrizacao de feridas. Os autores apresentam um estudo da influencia da terapia de reposicao hormonal (TRH) em anastomoses de colon, feitas em ratas. METODOS: Utilizam 3 grupos de ratas Wistar, um grupo de ooforectomizadas com TRH feita com 50mg de estrogeno e 2 mg de acetato de medroxiprogesterona, um de ooforectomizadas e sem TRH e um de ratas laparotomizadas e nao ooforectomizadas. Realizaram a ooforectomia e a confirmacao da condicao hormonal apos 28 dias. Em seguida instituiram a TRH ou de solucao fisiologica, diariamente. Apos 2 meses fizeram uma colotomia esquerda com anastomose termino-terminal e estudaram a resistencia e a densidade de colageno com 7 e 14 dias. RESULTADOS: As anastomoses dos colons das ratas sem TRH eram menos resistentes do que as do grupo controle tanto no 7.o dia (p=0,0488) como no 14.o dia (p=0,0115). A densidade de colageno foi menor no 7.o dia (p=0,0210) com menor presenca de colageno I (p=0,0023) e de colageno III (p=0,0470). No 14.o dia estas diferencas permaneceram significantes. Nas anastomoses dos colons das ratas com TRH as diferencas, em relacao ao grupo controle, nao foram significantes. CONCLUSAO: A falta dos hormonios ovarianos leva a menor resistencia e atrasa a maturacao de anastomoses do colon, em ratas e estas deficiencias sao compensadas pela TRH.

Estudo das atipias indeterminadas em relação à prevalência e ao percentual de discordância nos casos do Programa de Prevenção do Câncer Uterino do Paraná

BACKGROUND: The Bethesda Pap Smear System introduced two categories of undetermined atypias: atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGUS). The objective of this study is to report the prevalence and the disagreement percentile of ASCUS and AGUS as diagnosed by the Cervical Cancer Screening Program of Parana and revised by the Unit for External Monitoring of Cytology Quality (UEMCQ). METHODS: The UEMCQ revised 65,753 cervical smears during 25 months and all undetermined atypias were selected. These cases were classified according to their agreement or not and then prevalence was obtained. RESULTS: Before the UEMCQ review, the number of undetermined atypias was 4,067 (5.45%); this number decreased to 3,584 after revising the data. Considering the whole sample, the ASCUS rate was 4.91% (3,235) and AGUS corresponded to only 0.51% (338). Most of the reclassified cases presented negative diagnoses (57.32%). The primary grouped diagnoses, including CIN I and HPV, was responsible for 51.1% of undetermined atypias after reclassification. DISCUSSION AND CONCLUSION: Undetermined atypias were the second most frequent among disagreement diagnosis groups.

Obesity and abdominal wound healing in rats

INTRODUCTION Treatment for obesity essentially has to do with weight loss, which can be achieved through surgical procedures. Despite the considerable rise in the number of such procedures, the relationship between obesity and the healing process has not been totally clarified. PURPOSE To investigate abdominal wound healing in obese Wistar rats on the seventh and fourteenth days following a laparotomy. METHODS Thirty-six Wistar rats were randomly distributed into two groups, the control and experiment group. The control group were fed on either a standard diet for the species and the experiment group were put on a high calorie diet. After 116 days, all the animals were submitted to a laparotomy followed by laparorrhaphy. After euthanasia on the seventh or fourteenth day, fragments of the abdominal wound containing the scar were submitted to histopathological and tensiometric analysis. RESULTS The average weight of the animals from the experiment group was higher than that of the control group (p<0.001). The difference in the resistance of the cutaneous scars was not significant. The aponeurotic scars were more resistant in the control group after seven days (p=0.011) and fourteen days (p=0.040). There was no difference in terms of intensity of the inflammatory reaction and the collagen density was similar in both groups. CONCLUSION In rats, obesity lowered the resistance of the aponeurotic scars but not the skin scars. It did not interfere with the delayed inflammatory response and the collagen density.

Abdominal wall healing in reoperated rats

PURPOSE Experimental evaluation of the abdominal wall healing in reoperations on the same surgical site, by means of macroscopic analysis, histological and breaking strength studies of the surgical scar. METHODS Twenty-four rats were selected and divided in 3 groups (G1, G2 and G3). A medium longitudinal laparotomy was performed, followed by laparorrhaphy on two synthesis planes, using an interrupted suture technique. The reoperations were performed in the same way, on the same surgical site. On the first day of the study all the 24 rats were operated, on the 30th day the 16 animals belonging to G2 and G3 were reoperated, and finally, on the 60th day, the 8 rats from G3 were operated for the third and last time. After 30 days of the last laparotomy of each group, euthanasia was performed. Complications such as adhesions were evaluated during the resection of surgical site. The breaking strength study was performed next, followed by the microscopical collagen analysis, using for that histological cuts stained with picrosirius. RESULTS The adhesions were prevalent in G2 and G3 (16% each) when compared to G1. No significant difference was found in the breaking strength study. Statistically significant difference was observed in collagen concentration analysis. It was found higher mature collagen (type I) as well as total collagen concentration in the groups operated more than once (G2 and G3). The highest concentration of mature collagen (p<0,0001) and total collagen (p<0,0021) were found in G3 followed by G2 and G1 (in this sequence). CONCLUSION The highest mature collagen concentration on the experimental groups, points out the importance of inflammatory activity in the healing process; in the resutures of the abdominal wall the surgical scar maturity is faster acquired than in the primary sutures; in relation to the primary sutures, the resutures of the abdominal wall did not influence in the resistance of the surgical scar.

A neuropatologia no período neonatal: análise de 1616 casos de necropsia

The lesions of the central nervous system represent an important cause of morbid-mortality in the neonatal period. This is due to the vulnerability of the brain to several adverse conditions during gestation and after birth. This study analyses the prevalence and pattern of central nervous system lesions in neonates autopsied at Hospital de Clínicas - Curitiba. There were 5743 pediatric autopsies performed in the Sector of Anatomic Pathology from 1960 to 1995 with 2049 cases corresponding to death during neonatal period. These later autopsies were reviewed and all cases with central nervous system lesions were selected and classified according to sex, age and pattern of central nervous system lesion. The central nervous system was affected in 1616 (78,87%) of neonatal autopsies and there was predominance of intracerebral hemorrhages (73,39%), congenital malformations (4,27%) and infections (3,59%). The hypoxic hemorrhages are the most prevalent central nervous system lesions in the neonatal period, affecting mainly premature babies. There was predominance of central nervous system malformations in the female neonates.