Maria Aparecida Barone Teixeira

Trypanosoma cruzi: parasite persistence in tissues in chronic chagasic Brazilian patients

Chagas disease in the chronic phase may develop into cardiac and/or digestive forms. The pathogenesis of the disease is not yet clear and studies have been carried out to elucidate the role of parasite persistence in affected organs. The aim of this study was to detect and quantify Trypanosoma cruzi in paraffin-embedded tissue samples from chronic patients using NPCR (nested polymerase chain reaction) and QPCR (quantitative polymerase chain reaction) methods. These results were correlated to anatomopathological alterations in the heart and gastrointestinal tract (GIT). Of the 23 patients studied, 18 presented the cardiac form and five presented the cardiodigestive form of Chagas disease. DNA samples were randomly isolated from formalin-fixed paraffin-embedded sections of heart and GIT tissue of 23 necropsies and were analyzed through NPCR amplification. T. cruzi DNA was detected by NPCR in 48/56 (85.7%) heart and 35/42 (83.3%) GIT samples from patients with the cardiac form. For patients with the cardiodigestive form, NPCR was positive in 12/14 (85.7%) heart and in 14/14 (100%) GIT samples. QPCR, with an efficiency of 97.6%, was performed in 13 samples (11 from cardiac and 2 from cardiodigestive form) identified previously as positive by NPCR. The number of T. cruzi copies was compared to heart weight and no statistical significance was observed. Additionally, we compared the number of copies in different tissues (both heart and GIT) in six samples from the cardiac form and two samples from the cardiodigestive form. The parasite load observed was proportionally higher in heart tissues from patients with the cardiac form. These results show that the presence of the parasite in tissues is essential to Chagas disease pathogenesis.

Ascite por peritonite lúpica: uma forma rara de início do lúpus eritematoso sistêmico

Serositis is commonly seen in systemic lupus erythematosus (SLE). Approximately 16% of patients with SLE have pleural or pericardial involvement. However, peritoneal involvement is extremely rare, and clinically seen in a small group of patients. This is the case report of a 47-year old female with discoid lupus who evolved with systemic manifestations of the disease, characterized by significant abdominal distension and pain, asthenia, weight loss, signs of ascites, and acute non-invasive diarrhea. Exhaustive diagnostic investigation was performed and included laboratory and imaging tests, colonoscopy, and analysis of the ascitic fluid. Besides ruling out the possibility of an infectious, neoplastic, and hemodynamic etiology, the investigation also allowed the confirmation of SLE. Thus, the hypothesis of lupus peritonitis with ascites became viable. The patient was treated with prednisone and chloroquine, with substantial improvement of her condition

Associação de osteomielite tibial e pneumonite por tuberculose miliar em paciente com lúpus eritematoso sistêmico

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, which has great prevalence and uncommon manifestations of opportunistic infectious diseases, mainly due to the multiple abnormalities of the immune system and the immunosuppressive effect of the medications used in its treatment. Patients whit SLE have an increased incidence of tuberculosis, and osteoarticular involvement occurs in 1%-3% of the cases, manifesting as pain, reduction in mobility, and increased osteoarticular volume. The radiographic findings are often nonspecific. Magnetic resonance imaging (MRI) is an useful test to define the severity of bone involvement; however, the etiological diagnosis can only be established by use of synovial fluid or bone cultures or the histological study of the affected areas. Due to the lack of specificity of the findings, there is usually a mean diagnosis delay of 11 months. We report the case of a female patient with SLE and predisposing factors for tuberculosis infection/reactivation. The MRI was important to define bone involvement, and the etiological diagnosis was established by use of bone biopsy. The patient also had lung involvement due to miliary tuberculosis, shown on plain chest radiography and CT scan and confirmed on culture of Mycobacterium tuberculosis in the sputum. There was a 1.5-month delay in beginning therapy, which is considered a short time when compared to the reports in the literature. In conclusion, bone tuberculosis, although rare, should always be remembered as a differential diagnosis of patients with SLE and osteomyelitis, mainly those with history of pulmonary tuberculosis.

Occult esophageal squamous cell carcinoma with metastases to the spine and central nervous system

Esophageal malignancy encompasses a group of diseases that are mostly represented by the squamous cell carcinoma and the adenocarcinoma. Quite frequently, these neoplasms present aggressive behavior; therefore, the diagnosis is often made when the condition is in advanced stages. Dysphagia is the typical clinical complaint, although it is present only when most of the lumen is obstructed. Therefore, quite often, the metastatic disease is first diagnosed, which contributes to the patients poor survival expectancy. The authors report the case of a 58-year-old man who looked for medical care complaining of a long-term history of scapular pain. The diagnostic work-up disclosed a cervical spine lytic lesion surrounded by a tumoral mass shown by computed tomography. The cervical tumor was sampled by fine needle aspiration, revealing an undifferentiated carcinoma. The outcome was unfavorable and the patient died. The autopsy findings revealed metastatic disease to the spine and central nervous system, and the primary tumor was found to be an esophageal squamous cell carcinoma, which had progressed without typical dysphagia.

Supersensitivity of muscarinic receptors in rat isolated detrusor smooth muscle (DSM) after chronic nitric oxide inhibition

Address: 1Department of Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas (SP), Brazil, 2Department of Pharmacology, Pontifical Catholic University of Campinas, Campinas (SP), Brazil, 3Department of Physical Education; Institute of Bioscience, Paulista State University, Rio Claro (SP), Brazil, 4Section of Experimental Endocrinology, Department of Pharmacology, UNIFESP (SP), Sao Paulo, Brazil, 5Pharmacology Laboratory, Butanta Institute (SP), Sao Paulo, Brazil, 6Departament of Clinical Pathology, University of Campinas, Campinas (SP), Brazil and 7Faculty of Medicine, Pontifical Catholic University of Campinas, Campinas (SP), Brazil

Caso 5/03 - Paciente de 68 anos, sexo feminino, tabagista crônica, com tosse há 20 anos e dispnéia ao repouso há dois meses (Faculdade de Medicina da Pontifícia Universidade Católica, Campinas, SP)

Paciente do sexo feminino, 68 anos, branca, referindotosse produtiva com escarro hialino e dispnOia aos mOdios es-forcos hAE mais de 20 anos. HAE 2 meses apresentou piora dadispnOia, manifestando-a ao repouso e em posicao ortostAE-tica. Negava febre e alteracao da tosse. Tabagista de um macopor dia hAE 60 anos; referia dois episodios de pneumonia, sen-do o œltimo hAE 2 semanas (com tratamento domiciliar). Negavahipertensao arterial sistŒmica e uso de medicamentos.Ao exame fisico, apresentou-se cianotica ++/+++, desco-rada +, com pressao arterial de 90x50mmHg, pulso de 100 bpm,taquidispnOica (frequŒncia respiratoria de 37 movimentos/min), afebril (36,5°C) e com estase jugular a 45°. O