Virginia Hora Rios Leite

Hepatic Histopathology of Patients with Morbid Obesity Submitted to Gastric Bypass

BACKGROUND The authors analyze and describe the hepatic histopathology of patients with morbid obesity submitted to gastric bypass. METHODS A liver biopsy was performed in 112 patients at the beginning of gastric bypass, and clinical data (gender, age, BMI and associated diseases) were obtained from the patient records. RESULTS Among the patients, 74.1% (n=83) were females and 25.9% (n=29) were males, age 39.59+/-10.12 years, with BMI 48.79+/-7.54. Regarding the diseases associated with morbid obesity, arterial hypertension was observed in 67.9% (n=76) of the patients, joint diseases in 55.4% (n=62), dyslipidemia in 40.2% (n=45), and diabetes type 2 in 27.7% (n=31). 111 patients (99.1%) showed different types of non-alcoholic fatty liver disease (NAFLD) (types 1, 2, 3 and 4), with types 3 and 4 accounting for 57.7% (n=64). A significant association was observed between NAFLD type 4 and diabetes type 2 (P=0.018). The presence of glycogen nuclei was significantly correlated with steatosis (P=0.000), lobular inflammation (P=0.019) and perisinusoidal fibrosis (P=0.000). CONCLUSION 1) Liver biopsy taken at gastric bypass reveals different types of NAFLD; 2) Diabetes type 2 is associated with NAFLD type 4; 3) Glycogen nuclei are correlated with steatosis, lobular inflammation and perisinusoidal fibrosis; 4) Steatosis represents the basic injury in NAFLD and is associated with hepato-cellular ballooning. 5) In view of the frequency of hepatic alterations, a biopsy should be part of the surgical protocol of morbid obesity, this method being the only one able to determine the presence of lesions and to stage fibrosis.Background: The authors analyze and describe the hepatic histopathology of patients with morbid obesity submitted to gastric bypass. Methods: A liver biopsy was performed in 112 patients at the beginning of gastric bypass, and clinical data (gender, age, BMI and associated diseases) were obtained from the patient records. Results: Among the patients, 74.1% (n=83) were females and 25.9% (n=29) were males, age 39.59±10.12 years, with BMI 48.79±7.54. Regarding the diseases associated with morbid obesity, arterial hypertension was observed in 67.9% (n=76) of the patients, joint diseases in 55.4% (n=62), dyslipidemia in 40.2% (n=45), and diabetes type 2 in 27.7% (n=31). 111 patients (99.1%) showed different types of non-alcoholic fatty liver disease (NAFLD) (types 1, 2, 3 and 4), with types 3 and 4 accounting for 57.7% (n=64). A significant association was observed between NAFLD type 4 and diabetes type 2 (P=0.018). The presence of glycogen nuclei was significantly correlated with steatosis (P=0.000), lobular inflammation (P=0.019) and perisinusoidal fibrosis (P=0.000). Conclusion: 1) Liver biopsy taken at gastric bypass reveals different types of NAFLD; 2) Diabetes type 2 is associated with NAFLD type 4; 3) Glycogen nuclei are correlated with steatosis, lobular inflammation and perisinusoidal fibrosis; 4) Steatosis represents the basic injury in NAFLD and is associated with hepato-cellular ballooning. 5) In view of the frequency of hepatic alterations, a biopsy should be part of the surgical protocol of morbid obesity, this method being the only one able to determine the presence of lesions and to stage fibrosis.

Estudo, ao microscópio óptico e eletrônico, do rim de caes natural e experimentalmente infectados com Leishmania (Leishmania) chagasi

Two naturally infected dogs (male and fema lei from Teofilo Otoni (MG Brazili were maintained for 18 months in our laboratory. Two other dogs, two months old males were infected with 1 x 106 promastigotes of MHO BR 70 BH46 Leishinania (Leishmanial chagasi strain, endo venous route, and autopsied after 10 months and two years. The main findings concerning the kidney were: (1) focal or diffuse mesangial glomerulo nephritis with proliferative and enlargement of mesangial cells; (2) increase in thickness of basement membrane with electron dense deposits: (3) chronic interstitial nephritis with intense exudation of plasmocytes: (4) cloud swelling of renal tubules. The authors discuss the probable pathogenetic mechanisms.Two naturally infected dogs (male and female) from Teófilo Otoni (MG-Brazil) were maintained for 18 months in our laboratory. Two other dogs, two months old males were infected with 1 x 10(6) promastigotes of MHO/BR/70/BH46 Leishmania (Leishmania) chagasi strain, endovenous route, and autopsied after 10 months and two years. The main findings concerning the kidney were: (1) focal or diffuse mesangial glomerulonephritis with proliferative and enlargement of mesangial cells; (2) increase in thickness of basement membrane with electron-dense deposits; (3) chronic interstitial nephritis with intense exudation of plasmocytes; (4) cloud swelling of renal tubules. The authors discuss the probable pathogenetic mechanisms.

A Novel Wistar Rat Model of Obesity-Related Nonalcoholic Fatty Liver Disease Induced by Sucrose-Rich Diet

The pathogenesis of nonalcoholic fatty liver disease (NAFLD) is not fully understood, and experimental models are an alternative to study this issue. We investigated the effects of a simple carbohydrate-rich diet on the development of obesity-related NAFLD and the impact of physical training on the metabolic abnormalities associated with this disorder. Sixty Wistar rats were randomly separated into experimental and control groups, which were fed with sucrose-enriched (18% simple carbohydrates) and standard diet, respectively. At the end of each experimental period (5, 10, 20, and 30 weeks), 6 animals from each group were sacrificed for blood tests and liver histology and immunohistochemistry. From weeks 25 to 30, 6 animals from each group underwent physical training. The experimental group animals developed obesity and NAFLD, characterized histopathologically by steatosis and hepatocellular ballooning, clinically by increased thoracic circumference and body mass index associated with hyperleptinemia, and metabolically by hyperglycemia, hyperinsulinemia, hypertriglyceridemia, increased levels of very low-density lipoprotein- (VLDL-) cholesterol, depletion of the antioxidants liver enzymes superoxide dismutase and catalase, and increased hepatic levels of malondialdehyde, an oxidative stress marker. Rats that underwent physical training showed increased high-density lipoprotein- (HDL-) cholesterol levels. In conclusion, a sucrose-rich diet induced obesity, insulin resistance, oxidative stress, and NAFLD in rats.

Eficácia da confecção de válvulas colônicas após ressecção retoanal em ratos

BACKGROUND: The present study intend to test the efficacy of colonic valves construction after the anorectal resection in rats, in order to obtain retardation of the intestinal flow. METHOD: Clinical, radiological and anatomopathological analysis, ranging from 31 rats, submited to a series of two colonic transversal-circunferential seromiotomies, followed by serous-serous invagination and anorectal resection, and a perineal colostomy. RESULTS: Seven rats have died in the post-operatorium and, when necropsied, they presented faecal impactation. There was reduction in both body and faecal weight in the immediate post-operatorium period (statistically not significant), followed by an apparent normalization of the values. Small stool were found frequently joined together. In eight animals, from twenty-four which underwent radiograph, at least one valve was visible. After the necropsy of 21 rats, there was a major predominance of faeces above the valves. Macroscopically, the valves were not identified quite often. Microscopically, hipertroph in muscle fibers and interruption in muscle lay with alteration in fibers disposition and fibrosis in the places of seromiotomy, were commomly found. CONCLUSIONS: The operation can be considered as being tecnically viable. The presence of faeces above the valves, the elimination of joined stools, the hipertrophy and interruption of muscle layer, all emphasize the hypothesis that seromiotomy acts as a braking mechanism, retarding the intestinal flow. The experimental model adopted does not allow us to make any gauging regarding to faecal continence.

Whipple's disease. Report of five cases with different clinical features

Whipples disease (WD) is a rare systemic disease of infectious etiology which involves the small intestine but can virtually affect any organ. We present here five cases (four males and one female) ranging in age from 20 to 59 years. All patients had intestinal involvement associated or not with clinical manifestations linked to this organ. Vegetation in the tricuspid valve was observed in one patient, suggesting endocarditis caused by Tropheryma whippelii, with disappearance of the echocardiographic alterations after treatment. In one of the male patients the initial clinical manifestation was serologically negative spondylitis, with no diarrhea occurring at any time during follow-up. Ocular involvement associated with intestinal malabsorption and significant weight loss were observed in one case. In the other two cases, diarrhea was the major clinical manifestation. All patients were diagnosed by histological examination of the jejunal mucosa and, when indicated, of extraintestinal tissues by light and electron microscopy. After antibiotic treatment, full remission of symptoms occurred in all cases. A control examination of the intestinal mucosa performed after twelve months of treatment with sulfamethoxazole-trimethoprim revealed the disappearance of T. whippelii in four patients. The remaining patient was lost to follow-up.

Disseminated histoplasmosis and primary central nervous system lymphoma.

A 36-year-old man with a previous diagnosis of AIDS was admittedto hospital complaining of weakness, dry cough, high fever, weightloss and shortness of breath, with onset 10 days earlier. He wastreated for cerebral toxoplasmosis in 1995 and since then has beengiven anti-retroviral drugs, which he takes irregularly. His CD4 countwas 34 cells/µl and the viral load was 143,730 copies/ml. For6 months he was treated for pulmonary tuberculosis, a probablediagnosis, based on circumstantial evidence, without clinicalimprovement. In the present hospitalization, a chest x-ray showedcondensation in the right lung. Computed tomography revealed twocavitations with thick walls and the presence of multiple nodulesdisseminated in both lung fields, some with the aspect of a buddingtree, suggestive of pulmonary tuberculosis (Figure A). During clinicalexamination two small ulcers were noticed in his left arm, and abiopsy taken from one of them (Figure B) confirmed the diagnosis ofcutaneous histoplasmosis. In addition, a liver biopsy and a biopsy ofthe bone marrow also found the fungus

Envolvimento renal na associação salmonella-Schistosoma mansoni

The responses of Plasmodium falciparum to antimalarial drugs were evaluated through the in vitro test using blood sample collected from patients of 7 municipalities of the south of Para State. Sixty nine microtests for chloroquine and mefloquine, 62 for amodiaquine and 61 for quinine were pet formed. The results showed a high resistancefor chloroquine (71%), a relatively low resistance level for amodiaquine (25.8%) and little resistance to quinine (8.2%). For mefloquine 100% of sensitivity wasfound.

Encefalite herpética do tronco encefálico: relato de um caso autopsiado com estudo imuno-histoquímico e ao microscópio eletrônico

A post-mortem examined case of herpetic brainstem encephalitis is presented. Clinically, the patient had cephalalgia followed by ataxia, drowsiness and multiple palsies of some cranial nerves, developing into death in eight days. The pathologic examination of the brain showed necrotizing encephalitis in multiple foci limited to the brainstem, more distinctly in the pons and medulla oblongata. The technique of immunoperoxidase revealed rare glial cells with intranuclear immunoreactivity for herpes antigen. Rare viral particles with the morphological characteristics of the herpesvirus were identified in the nuclei of neurons in 10% formol fixed material. This is the second reported case of herpetic brainstem encephalitis confirmed by post-mortem examination. The pathway used by the virus to reach the central nervous system and its posterior dissemination to the oral cavity, the orbitofrontal region and the temporal lobes as well as to the brainstem, after a period of latency and reactivation, are discussed.A post-mortem examined case of herpetic brainstem encephalitis is presented. Clinically, the patient had cephalea followed by ataxia, drowsiness and multiple palsies of some cranial nerves, developing into death in eight days. The pathologic examination of the brain showed necrotizing encephalitis in multiple foci limited to the brainstem, more distinctly in the pons and medula oblongata. The technique of immunoperoxidase revealed rare glial cells with intranuclear immunoreactivity for herpes antigen. Rare viral particles with the morphological characteristics of the herpesvirus were identified in the nuclei of neurons in 10% formol fixed material. This is the second reported case of herpetic brainstem encephalitis confirmed by post-mortem examination. The pathway used by the virus to reach the central nervous system and its posterior dissemination to the oral cavity, the orbitofrontal region and the temporal lobes as well as to the brainstem, after a period of latency and reactivation, are discussed.

Histiocitose cutânea não-Langerhans como causa de diabetes insípido central

The histiocytoses are rare diseases caused by alterations in the monocyte-histiocytic series with several clinical findings. Among the cutaneous syndromes of non-Langerhans cells, xanthoma disseminatum is the only disease of this group that has been classically associated to the central diabetes insipidus (CDI). The case reported describes a 30-year-old man that two years after presenting with CDI developed non confluent disseminated cutaneous brown papular lesions throughout the body. The histopathology, immunohistochemistry, and electronic microscopy were compatible with the diagnosis of non-Langerhans histiocytoses, suggesting the diagnosis of juvenile xanthogranuloma. The endocrine-metabolic evaluation did not show other alterations besides CDI in a 10-year follow up. The magnetic resonance of hypophysis showed absence of the pituitary hyperintense sign (bright spot). The radiologic and scinthigraphic evaluation of the bones did not show the presence of osteolytic lesions. This case prints out the importance of skin examination in cases of CDI and its association with cutaneous non-Langerhans histiocytoses in a broader spectrum, rather then restricted to the cases of xanthoma disseminatum.

Cirrhotic liver explants: regenerative nodule, dysplasia and hepatocellular carcinoma occurrence

A deteccao de nodulos hepaticos por tecnicas de imagem em pacientes com cirrose tem aumentado, e o consenso de que essas lesoes podem ser pre-malignas aumenta sua importância clinica e demanda criterio diagnostico preciso. A prevalencia de nodulos hepaticos macroscopicamente suspeitos (NHMS) em figados com cirrose foi analisada para identificar macronodulo regenerativo (MNR), nodulo displasico e carcinoma hepatocelular (CHC) e para avaliar a associacao de NHMS e CHC. Nodulos hepaticos maiores que 1cm com cor e textura diferentes dos demais nodulos da cirrose em cada peca foram definidos como NHMS. Sessenta e um figados explantados por cirrose foram seccionados em fatias de 0,5 a 0,7cm e NHMS e amostras de areas aleatorias do figado foram examinadas histologicamente. Noventa e quatro NHMS foram identificados em 26 figados (a histologia 11 foram nodulos tipicos da cirrose; 61, MNR; 12, nodulos displasicos; e dez, CHC). O CHC foi identificado macroscopicamente em um figado e pela microscopia optica em NHMS em seis outros. A relacao entre CHC e NHMS, especificamente MNR, foi estatisticamente significante. Esses achados sugerem associacao entre MNR e NHMS com o CHC em figados com cirrose e reforcam a importância pratica da classificacao histologica dos nodulos na cirrose, com o proposito de orientar a conduta medica no manuseio de pacientes que estao a espera de transplante hepatico ou de tratamento cirurgico.