Histological outcome of acute cellular rejection in kidney transplantation after treatment with methylprednisolone

BACKGROUND: Several studies comparing the response of acute cellular rejection (ACR) episodes to different corticosteroid regimens have been conducted. However, in most of them, the histological evaluation of the infiltrate and its correlation with clinical response was not studied. The clinical and histological outcomes of 37 episodes of ACR treated with methylprednisolone (MP) were studied, with the aim to determine how long the infiltrate takes to be cleared after therapy. METHODS: A total of 37 patients with biopsy-proven ACR were treated with 8 or 16 mg of MP/kg/day. Allograft biopsies were repeated at 5 and 10 days after the end of corticotherapy. Clinical and histological outcomes were compared. RESULTS: Six patients were excluded; 15 (48.4%) patients responded to therapy; the mean serum creatinine of these patients reached normal levels in the 2 weeks that followed treatment. Nine patients (60%) of this group had signs of ACR on biopsies done 5 days after corticotherapy, and four (26.7%) maintained them on the 10th day. Among 16 patients with no clinical response, none reached normal serum creatinine levels; 15 (93.7%) had signs of rejection 5 days after treatment and maintained them on the 10th day. Histological signs of ACR disappeared in 73.3% of patients with clinical response 10 days after therapy, but in only 6.3% of patients with no response (P=0.001). CONCLUSIONS: Biopsies performed 5 days after treatment show a high incidence of features of ACR; such features take on average 10 days to disappear in nearly 75% of cases with successful therapy with MP.     

Evaluation of the diagnostic power of symptoms and signs in acute otitis media

The diagnosis of acute otitis media (AOM) is made on clinical basis. The gold-standard tests are invasive. There are few studies quantifying the diagnostic power of the signs and symptoms. A sample of 300 children were analyzed to establish the diagnostic power of isolated and combinated signs and symptoms in AOM. The most important diagnostic signs were bulging, fluid level, acute perforation, and change in color of the tympanic membrane. Fever was the single symptom with statistical significance. We concluded that we can do an accurate and noninvasive AOM diagnosis using otomicroscopic findings.     

Attempts to culturing triatominae in the laboratory using "in vitro" feeding]

In order to simplify breeding of triatominae in the laboratory, for performing xenodiagnosis and other biologic studies, we tried to feed the insects "in vitro" with citrated or defibrinated blood from commercially abated chicken. Two types of efficacy observations were carried out with Triatoma infestans: a) analysis of the chaining of successive nymphal stages, viability of satisfactory matching, fertile oviposition and adequate reproduction; b) assessment of viability and infectivity of Trypanosoma cruzi in the insects. As a conclusion, it became evident that, despite operational easiness, the objectives were not achieved, since the classical procedure used as the control, was always superior.     

Magnetic resonance imaging in the evaluation of patients with aseptic meningoencephalitis and connective tissue disorders

OBJECTIVE: To describe the role of magnetic resonance imaging (MRI) in the evaluation of patients with chronic and recurrent aseptic meningitis. METHOD: A retrospective study of five patients with aseptic meningoencefalitis diagnosed by clinical and CSF findings. CT scans showed without no relevant findings. RESULTS: MRI showed small multifocal lesions hyperintense on T2 weighted images and FLAIR, with mild or no gadolinium enhancement, mainly in periventricular and subcortical regions. Meningoencephalitis preceded the diagnosis of the underlying disease in four patients (Beh?et's disease or systemic lupus erythematosus). After the introduction of adequate treatment for the rheumatic disease, they did not present further symptoms of aseptic meningoencephalitis. CONCLUSION: Aseptic meningoencephalitis can be an early presentation of an autoimmune disease. It is important to emphasize the role of MRI in the diagnosis and follow-up of these patients.     

Coexistence of benign phyllodes tumor and invasive ductal carcinoma in distinct breasts: case report

This report describes a rare case of coexistence of benign phyllodes tumor, which measured 9 cm in the right breast, and invasive ductal carcinoma of 6 cm in the left breast, synchronous and independent, in a 66-year-old patient. The patient underwent a bilateral mastectomy due to the size of both lesions. Such situations are rare and usually refer to the occurrence of ductal or lobular carcinoma in situ when associated with malignant phyllodes tumors, and more often in ipsilateral breast or intra-lesional.