Lúcia Porto Fonseca de Castro

Effect of treatment of hepatic histopathology in children and adolescents with autoimmune hepatitis.

Objective: To evaluate the effects of treatment on liver histopathology of children and adolescents diagnosed with autoimmune hepatitis. Patients and Methods: Histopathological evaluation of liver biopsies performed at diagnosis or early during treatment, compared with biopsies after immunosuppressive treatment of 20 children and adolescents diagnosed with autoimmune hepatitis who presented clinical and biochemical remission for at least 24 months. Liver histopathology was assessed by 2 pathologists. Agreement between their interpretations was analyzed with κ statistics. Results: The age at diagnosis of the 20 patients varied from 1.7 years to 11.6 years (median = 6.6 years); 18 were females. The mean duration of clinical and biochemical remission, up to performance of liver biopsy, was 4.1 years. The mean interval between the initial and posttreatment biopsies was 4.6 years (range 2–9.7 years). Assessing the necroinflammatory activity, a mean reduction by 6.3 (observer 1) and 7.3 (observer 2) in the grading score was observed (P = 0.00000). When staging was assessed, a mean reduction by 1.8 (observers 1 and 2) in the score was observed after treatment (P = 0.00008), and there was no progression toward cirrhosis. No regression of cirrhosis was observed. Conclusions: On histopathological evaluation, the immunosuppressive treatment improved the fibrosis scores, with an arrest in its progression and no development into cirrhosis. Fibrosis control is mainly associated with regression of necroinflammatory activity, which is the main treatment component in autoimmune hepatitis.

Isolation of Helicobacter pylori from the Intestinal Mucosa of Patients with Crohn's Disease

Background:  Helicobacter species are associated with inflammatory bowel disease in rodents and in nonhuman primates. Therefore, we prospectively investigated the presence of Helicobacter species in the intestinal mucosa of patients with and without Crohns disease by culture and polymerase chain reaction (PCR) assays.

A Simple and Economical Modification of the Masson-Fontana Method for Staining Melanin Granules and Enterochromaffin Cells

Enterochromaffin cells from the small intestine of man, guinea pig, dog, chicken, rabbit, cat and rat were stained using the Masson-Fontana ammoniacal silver method with varying dilutions of silver nitrate solution (0.25 to 5 g per 100 ml of distilled water) and incubation temperatures (60 C and 75 C). The 0.5% solution of silver nitrate gave an argentaffin pattern similar to that of the 5% solution and had two major advantages: economically, since much less silver nitrate is used, and methodologically, since low background resulted with tissue of those species (rat, cat and rabbit) that required unusually long incubation. The staining of melanocytes was similar for all dilutions at the usual staining time (15-30 min).

A regulatory instead of an IL-17 T response predominates in Helicobacter pylori-associated gastritis in children

Th17 cells seem to have an important role in the efficacy of vaccines against Helicobacter pylori. Because children are a target group for human vaccination and Th17/T(reg) cells have intrinsically linked and antagonic commitments, we compared the gastric levels of Th17- and T(reg)-associated cytokines of children and adults. IL-6, IL-10 and TGF-β1 levels and Foxp3(+) cell numbers were higher, but IL-1β, IL-17A and IL-23 were lower in infected children than in infected adults. In conclusion T(reg) instead of Th17 cell response to H. pylori-infection predominates in children.

Iron Status and Helicobacter pylori Infection in Symptomatic Children: An International Multi-Centered Study

Objective Iron deficiency (ID) and iron deficiency anaemia (IDA) are global major public health problems, particularly in developing countries. Whilst an association between H. pylori infection and ID/IDA has been proposed in the literature, currently there is no consensus. We studied the effects of H. pylori infection on ID/IDA in a cohort of children undergoing upper gastrointestinal endoscopy for upper abdominal pain in two developing and one developed country. Methods In total 311 children (mean age 10.7±3.2 years) from Latin America - Belo Horizonte/Brazil (n = 125), Santiago/Chile (n = 105) - and London/UK (n = 81), were studied. Gastric and duodenal biopsies were obtained for evaluation of histology and H. pylori status and blood samples for parameters of ID/IDA. Results The prevalence of H. pylori infection was 27.7% being significantly higher (p<0.001) in Latin America (35%) than in UK (7%). Multiple linear regression models revealed H. pylori infection as a significant predictor of low ferritin and haemoglobin concentrations in children from Latin-America. A negative correlation was observed between MCV (r = −0.26; p = 0.01) and MCH (r = −0.27; p = 0.01) values and the degree of antral chronic inflammation, and between MCH and the degree of corpus chronic (r = −0.29, p = 0.008) and active (r = −0.27, p = 0.002) inflammation. Conclusions This study demonstrates that H. pylori infection in children influences the serum ferritin and haemoglobin concentrations, markers of early depletion of iron stores and anaemia respectively.

Immune Response and Gene Polymorphism Profiles in Crohn's Disease and Ulcerative Colitis

Background: Polymorphisms in genes linked to the innate and adaptive immune response may be involved in inflammatory bowel disease pathogenesis. Our aim was to investigate associations among IL1B‐511, IL1B‐31, IL1RN, TNFA‐307, TLR‐2, TLR‐4, IL2‐330, NOD2 G908R, NOD2 L1007fsinsC polymorphisms and both Crohns disease (CD) and ulcerative colitis (UC) in a Brazilian population. Methods: We studied 43 patients with CD, 42 with UC, and 541 blood donors. Polymorphisms were evaluated by PCR, PCR‐CTPP, or PCR‐RFLP. Data were analyzed in multivariate models adjusting for confounding factors. Results: IL1RN VNTR (P = 0.00, odds ratio [OR] = 2.43, 95% confidence interval [CI] = 1.50–3.90), as well as TNFA‐307 polymorphic allele (P = 0.05, OR = 1.70, 95% CI = 1.00–2.94) were associated with UC. Both NOD2 mutations (G908R, P = 0.02, OR = 6.83, 95% CI = 1.62–25.45, and L1007fsinsC, P = 0.00, OR = 20.00, 95% CI = 3.21–124.69) were associated with CD. Conclusions: Our analyses showed positive associations between proinflammatory polymorphisms at IL1RN and TNFA‐307 loci and UC, as well as polymorphisms in the NOD2 gene and CD. These results highlight the importance of different genetic profiles associated with CD and UC.

Helicobacter Species in the Intestinal Mucosa of Patients with Ulcerative Colitis

ABSTRACT In a search for Helicobacter species in the intestinal mucosae of 42 patients with ulcerative colitis (UC) and 74 without UC, only H. pylori was found. Although the bacterium was detected in UC patients by culture (7.1%) and nested PCR (19.0%), its presence was not associated with the disease (P = 0.13).

Primary hepatic non-Hodgkin's lymphoma in children: a case report and review of the literature.

Non-Hodgkins lymphomas presenting exclusively in the liver are rather uncommon in adults and extremely rare in children. We describe a six-year-old white boy with jaundice, abdominal pain, and weight loss of two weeks duration. Physical examination disclosed asthenia, jaundice, abdominal swelling, large hepatomegaly, and ascitis. Aminotransferases bilirubin, and alkaline phosphatase were significantly elevated. Bone marrow aspiration, cerebrospinal fluid, chest x-ray, renal function tests, and uric acid were normal. Abdominal ultrasound showed liver enlargement with irregular regular borders, many parenchymal nodules in both liver lobes, a large hypoechogenic mass in the inferior segment of the liver, normal biliary ducts and two pancreatic nodules resembling those in the liver. Liver needle biopsy disclosed diffuse lymphomatous infiltration. Blast cells were positive for leukocyte common antigen (CD 45). Immunohistochemistry study for T or B cell lineage differentiation was not done. The child showed an excellent response to chemotherapy based on the BFM-83 protocol for B cell non-Hodgkins lymphomas. The patient had his therapy discontinued in June 1995 and remains in first complete remission as of May 20th, 1996.

Accuracy of echogenic periportal enlargement image in ultrasonographic exams and histopathology in differential diagnosis of biliary atresia

OBJECTIVES To define the sensitivity, specificity and accuracy of the ultrasound triangular cord sign and hepatic histopathology, in isolation or in combination, for diagnostic differentiation between biliary atresia and intrahepatic cholestasis. METHODS This was a retrospective study carried out between January 1990 and December 2004. Fifty-one cases of biliary atresia and 45 of intrahepatic cholestasis were analyzed. Histopathology was performed blind by a pathologist. The triangular cord sign was identified in ultrasound reports as the only diagnostic sign of biliary atresia. Sensitivity, specificity and accuracy were calculated for the triangular cord sign and histology both in isolation and in combination. The gold standard for diagnosis of biliary atresia was the appearance of the extrahepatic biliary tree via laparotomy. RESULTS The triangular cord sign alone had sensitivity of 49%, specificity of 100% and accuracy of 72.5%. Histopathology compatible with extrahepatic biliary obstruction alone had 90.2% sensitivity, 84.6% specificity and 87.8% accuracy. The triangular cord sign and histopathology in isolation or combination resulted in sensitivity of 93.2%, specificity of 85.7% and accuracy of 90.3%. CONCLUSIONS Finding the triangular cord sign on ultrasound is an indication for laparotomy. If the triangular cord sign is negative, liver biopsy is indicated; if histopathology reveals signs of biliary atresia, explorative laparotomy is indicated. In cases where the triangular cord sign is absent and histopathology indicates neonatal hepatitis or other intrahepatic cholestasis, clinical treatment or observation are recommended in accordance with the diagnosis.

Associação entre a contagem de linfócitos T CD4+ e a gravidade da neoplasia intra-epitelial cervical diagnosticada pela histopatologia em mulheres infectadas pelo HIV

OBJETIVO: avaliar a associacao entre a contagem de linfocitos T CD4+ e a gravidade da neoplasia intra-epitelial cervical em pacientes HIV positivas. METODOS: estudo transversal no qual foram incluidas 87 pacientes infectadas pelo HIV, confirmado por testes sorologicos previos. Todas eram portadoras do HPV cervical, diagnosticado por meio da reacao em cadeia da polimerase. Foram realizados anamnese, exame fisico e colposcopia de todas em pacientes. A biopsia do colo uterino foi realizada quando indicada pelo exame colposcopico. Os resultados histopatologicos foram classificados com neoplasia intra-epitelial de baixo grau (NIC I) ou de alto grau (NIC II e II). A associacao entre a contagem de linfocitos T CD4+ e a gravidade da lesao foi verificada por meio da comparacao de medias utilizando a analise da variância (ANOVA). RESULTADOS: entre as 60 pacientes biopsiadas foram encontrados 24 casos (40,0%) com NIC I, oito (13,3%) NIC II, tres (5%) NIC III, 14 (23,3%) pacientes somente com cervicite cronica e 11 (18,3%) apresentando efeito citopatico produzido pelo HPV, mas sem perda da polaridade celular. Isso equivale a 35 mulheres com lesao intra-epitelial de baixo grau (NIC I + HPV) (58,3%) e 11 (18,3%) com lesao intra-epitelial de alto grau (NIC II + NIC III). A associacao entre a media da contagem de linfocitos T CD4+ e a gravidade da lesao intra-epitelial cervical nao foi significativa (p=0,901). CONCLUSOES: nao houve associacao entre a contagem de linfocitos T CD4+ e a gravidade da lesao intra-epitelial do colo uterino, diagnosticada pelo exame histopatologico.