Vânia Glória Silami Lopes

Perinatal Transmission of Dengue: A Report of 7 Cases

Perinatal transmission of dengue virus was confirmed by the evidence of virus in fetal tissue, newborn serum, and placenta of pregnant women. Abortion, several different clinical findings, and placental inflammatory findings were documented. No association was seen between severity of maternal dengue and disease of the newborn.

Malignant peripheral nerve sheath tumors: clinicopathological aspects, expression of p53 and survival

Malignant peripheral nerve sheath tumors (MPNSTs) arerare and highly aggressive neoplasms, representing only 5%of soft tissue sarcomas (1,2). Approximately half of MPNSTcases occur in association with neurofibromatosis type 1(NF1) (3). MPNSTs may appear de novo or develop from themalignant transformation of a benign neural neoplasm,generally a plexiform neurofibroma (1). Solitary (unasso-ciated with NF1) and localized (or discrete; multiple in NF1)neurofibromas do not have malignant transformationpotential (1,3). NF1 loss of heterozygosity (LOH) has beendemonstrated in NF1-associated and sporadic MPNSTs.Although NF1 LOH is believed to be sufficient for neu-rofibroma development, MPNST pathogenesis has beensuggested to be a multistage process that includes othermolecular alterations (4,5). TP53 mutations have been foundin a subgroup of MPNSTs, indicating that a p53-mediatedpathway is involved in their development (5,6).Some clinicopathological features (e.g., the presence ofNF1,high histologicalgrade,necrosis,andrhabdomyoblasticdifferentiation) have been indicated to be important factorsforlower survival in MPNST cases in some studies butnotinothers (2,7–10). The clinical significance of p53 expression inMPNSTs is also a controversial issue. We aimed to study p53expression in MPNSTs and investigate its impact, as well astheimpactsoftheclinicopathologicalfeaturesofMPNSTs,onthe survival rates. We also compared p53 expression inMPNSTswith theirclinicopathological features and with p53expression in neurofibromas.

Dengue infection in pregnancy and its impact on the placenta

A histopathological and immunohistochemical study was conducted in placental tissues and retained products of conception from 24 patients with confirmed dengue infection during pregnancy. The immunohistochemical assay was positive for dengue virus in 19 placental and three ovular remnants analyzed. The light microscopic findings were signs of hypoxia, choriodeciduitis, deciduitis and intervillositis and the viral antigens were found in cytoplasmic of the trophoblast, villous stroma and decidua. Our results suggest that immunohistochemistry could be used as a laboratory confirmation method for dengue in pregnant women, especially in endemic areas when embedded material is the only material available.

Evaluation of Bcl-2, Bcl-x and cleaved caspase-3 in malignant peripheral nerve sheath tumors and neurofibromas.

AIMS To study the expression of Bcl-2, Bcl-x, as well the presence of cleaved caspase-3 in neurofibromas and malignant peripheral nerve sheath tumors. The expression of Bcl-2 and Bcl-x and the presence of cleaved caspase 3 were compared to clinicopathological features of malignant peripheral nerve sheath tumors and their impact on survival rates were also investigated. MATERIALS AND METHODS The evaluation of Bcl-2, Bcl-x and cleaved caspase-3 was performed by immunohistochemistry using tissue microarrays in 28 malignant peripheral nerve sheath tumors and 38 neurofibromas. Immunoquantification was performed by computerized digital image analysis. CONCLUSIONS Apoptosis is altered in neurofibromas and mainly in malignant peripheral nerve sheath tumors. High levels of cleaved caspase-3 are more common in tumors with more aggressive histological features and it is associated with lower disease free survival of patients with malignant peripheral nerve sheath tumors.

Immunoblastic morphology in diffuse large B-cell lymphoma is associated with a nongerminal center immunophenotypic profile

Diffuse large B cell lymphomas (DLCBL) are a group of lymphomas whose biologic and prognostic diversity has been recently well characterized. There is also morphologic heterogeneity, but the relevance of subclassification remains uncertain. The World Health Organization Classification states that pathologists have the choice to use only the term diffuse large B-cell lymphoma or to use one of the specific morphologic variants. The aim of the present study was to evaluate if there is an association between immunoblastic morphology and the immunophenotypic profile in DLBCL. Two observers reviewed 117 DLBCL cases. Cases of immunoblastic lymphoma and cases of centroblastic polymorphic lymphoma with more than 50% immunoblasts were defined as having immunoblastic morphology. Immunohistochemistry was performed on tissue microarray slides to establish the immunophenotypic profile. Patients with immunoblastic morphology more frequently had a non-GCB phenotype (94%vs 6%). This finding suggests that the morphological subclassification of DLBCL does have biological meaning, in line with recent evidence indicating that the immunoblastic morphology should not be overlooked in lymphoma classification.

Asfixia perinatal e problemas cardíacos

Objetivo - Avaliar a gravidade das complicacoes cardiacas na asfixia neonatal, sua evolucao e correlacionalas com o grau e duracao do processo hipoxico. Metodos - Foram estudados 90 bebes nos ultimos 7 anos com grau de Apgar <6 no 5°min de vida. Pelo protocolo, apos o exame fisico e os cuidados intensivos, eram submetidos a dosagem do pH arterial, CPK-MB, DHL, glicemia, alem da realizacao de radiografia de torax, eletrocardiograma (ECG), ecocardiograma, seriados e repetidos a cada semana. Aqueles que faleceram eram levados a necropsia. Resultados - Dos 90, 73 (81%) eram prematuros, 30 (41%) eram apropriados para a idade gestacional (AIG) e 43 (59%) eram pequenos(PIG). Em 21 (23%) casos havia pH arterial <7,2. Os quadros clinicos mais observados foram: pneumonia em 28 (31%), anemia 24 (26%) e ictericia moderada 12 (5%), entre outros. Ao exame fisico observaram-se: sopro sistolico em 46 (50%), ictus propulsivo 18 (20%) e ICC em 8 (9%). No ECG, os sinais mais frequentes foram alteracoes de repolarizacao (ST e T) em 44 (49%). No ecocardiograma, observou-se persistencia do canal arterial (PCA) em 20 (22%), regurgitacao tricuspide em 6 (7%), hipertensao pulmonar em 6 (8%), hipocontratilidade de VE e dilatacao de VD em 4 (5%). Dos 23 obitos, 14 foram estudados e as alteracoes mais frequentes foram necrose de fibras em 8 (68%) casos e em 4 (29%) congestao, vacuolizacao e perda de estriacao. Conclusao - A maioria teve evolucao favoravel mesmo naqueles que tiveram acidemia importante. Muitas alteracoes de ECG e ecocardiograma se normalizaram. Daqueles que evoluiram para o obito, as lesoes mais graves ocorreram nos que sofreram, por mais tempo, processo anoxico.

Follow-up of rheumatic carditis treated with steroids.

OBJECTIVE To present the long-term follow-up of children hospitalised for severe rheumatic carditis who were treated with corticosteroids. METHODS This is a retrospective analysis of the outcome of 242 patients with severe rheumatic carditis after discharge from two public hospitals in Niteroi, Brazil. We followed up 118 patients for 4 years or more, with an average of 7.7 years. They were treated with antibiotics to accomplish bacterial eradication and either intravenous methylprednisolone - 40 cases - or oral prednisone - 78 patients - to treat carditis. They were followed up in outpatient clinic. RESULTS Cardiac failure was categorised as classes III and IV according to the New York Heart Association classification. In the intravenous corticosteroid group, 21 cases (52.5%) had isolated mitral valve regurgitation, 12 (30%) had mitral plus aortic involvement, and seven (17.5%) had aortic lesion only. In the oral prednisone group, 45 (58%) had mitral valve regurgitation only, 27 (34%) had mitral plus aortic involvement, and six (8%) had aortic lesion only. A total of 28 children were in their first disease attack, of whom 19 (68%) had a rupture of chordae tendineae. A total of 58 patients (49%) sustained recurrence of carditis because of neglected secondary prophylaxis. In all, 19 cases (16%) underwent cardiac surgery - valve replacement or valvuloplasty. In 33% of the cases, the outcome was favourable - asymptomatic at follow-up. The overall mortality rate was 6.8%. CONCLUSION Many critically ill patients who complied with secondary prophylaxis were left with minor injuries, whereas those who neglected it or abandoned it had serious sequelae. The rate of abandonment and loss to follow-up was very high. Many cases (49%) were re-hospitalised because of carditis recurrence.

Appendicitis in the premature newborn

OBJECTIVE: To present a case of acute appendicitis in a premature infant. METHODS: Retrospective review of the literature using Medline and Lilacs databases, as well as the necropsy report. CLINICAL REPORT: A white male preterm infant born at 34 weeks of gestation weighing 1,750g to a primiparous mother. The Apgar score was 4 and 8 at 1st and 5th minutes, respectively. The physical exam was normal until the 9th day of life when the child developed clinical features suggestive of acute abdomen, possibly due to necrotizing enterocolitis with perforation. He was submitted to exploratory laparotomy, which leaded to the diagnostic of acute appendicitis. CONCLUSION: Acute appendicitis must be discarded on the differential diagnostic when there is a suspicion of necrotizing enterocolitis with perforation, and risk factors are not present.

DENGUE DURING PREGNANCY: ASSOCIATION WITH LOW BIRTH WEIGHT AND PREMATURITY

The aim of this study was to evaluate the effects of dengue virus infection during pregnancy and its correlation with low birth weight, prematurity, and asphyxia. A non-concurrent cohort study reveals the association of dengue during pregnancy with prematurity and low birth weight, when birth occurred during the maternal-fetal viremia period (p = 0.016 and p < 0.0001, respectively).

O decréscimo vertiginoso das autópsias em um hospital universitário do Brasil nos últimos 20 anos

INTRODUCTION: The decline in the number of autopsies at hospitals and university hospitals has been widely reported, initially in developed countries and afterwards in several developing countries including Brazil. The causes for this trend are multiple and complex, encompassing religious, family and medical aspects. Among the latter, we highlight diagnostic reasons, which are characterized by major technological advances in clinical imaging associated with the underlying assumption that all diagnoses can currently be made before death. Furthermore, there is a growing concern about malpractice lawsuits. OBJECTIVE: To demonstrate the sharp decrease in the number of autopsies at a university hospital in Brazil. MATERIAL AND METHODS: We evaluated the number of autopsies conducted at the Pathology Department of Antonio Pedro University Hospital (HUAP), Niteroi, Rio de Janeiro, and a database spreadsheet was created at Microsoft Excel. RESULTS: From 1966 to 2009, 23,813 autopsies were performed, comprising 12,702 adults and 11,111 fetuses. The highest number of autopsies occurred from 1966 to 1998, when 23,321 autopsies were performed, comprising 12,482 adults and 10,839 fetuses. Whereas, there was a dramatic decline from 1999 to 2009, when 492 autopsies were performed, including 220 adults and 272 fetuses. CONCLUSION: We believe that the main cause of this reduction is the lack of information among laypeople and medical professionals, who have neglected the fact that knowledge is ultimately acquired through study, investigation and practice.