Description of gamontogonic and sporogonic stages of Hepatozoon spp. (Apicomplexa, Hepatozoidae) from Caudisoma durissa terrifica (Serpentes, Viperidae)

Three specimens of Caudisoma durissa terrifica infected with Hepatozoon spp. were studied. One was parasitized by one type of gamont and the other two were each infected by two morphologically different gamonts. Utilizing morphology and morphometry analysis, we concluded that three types of gamonts were very similar and may represent the same Hepatozoon species, but at least three different Hepatozoon species were infecting the C. durissa terrifica snakes in this study. Some of this species caused erythrocyte modifications. The sporogonic development of Hepatozoon sp. was observed from 12 h to the 20th day after female Culex quinquefasciatus blood meals.     

Assessment of calcinosis in Portuguese patients with systemic sclerosis — a multicenter study

Clinical Rheumatology - The study aims to define the clinical and subclinical calcinosis prevalence, the sensitivity of radiographed site and clinical method for its diagnosis, and the phenotype of...     

Primary hyperparathyroidism associated to slipped capital femoral epiphysis in a teenager

Primary hyperparathyroidism (PHP) is an uncommon disease in children and adolescents. The association between PHP and slipped capital femoral epiphysis is rare, and so far only four cases have been reported in the literature. Herein, we report a case of PHP due to a parathyroid adenoma, with several painful skeletal deformities and associated with slipped capital femoral epiphysis in an 18-year-old male patient. Laboratory evaluation showed: calcium of 13.6 mg/dL, parathyroid hormone of 1,524 pg/mL and alkaline phosphatase of 3,449 U/L. Deformities were caused by late diagnosis during the growth spurt, and this association is the result of combinations between metabolic and mechanical factors. The patient underwent parathyroidectomy and, in agreement with the literature, since the removal of the adenoma is followed by prompt resolution of the slipped capital femoral epiphysis we decided for a conservative approach. We observed improvement of the pain and normalization of calcium and parathyroid hormone levels.     

Positive Montenegro skin test among patients with sporotrichosis in Rio De Janeiro

Visceral leishmaniasis (VL) or kala-azar continues to persist as one of the major public health problems in many tropical countries. However, no effective treatment for radical cure of the disease is yet available. Miltefosine, an alkyl phospholipid compound, is the first orally effective drug, which has shown 98% cure rate of VL patients during phase III clinical trial in India. Since this drug requires long course of treatment and has long half-life, there are fairly good chances of emergence of resistance. Furthermore, this drug has produced severe side-effects in some of the cases.We therefore examined the possibility of minimizing these effects by applying miltefosine in lower doses in combination with picrloviv, an immunomodulator against Leishmania donovani in hamsters (Mesocricetus auratus). The picroliv per se showed no antileishmanaial potential. However, when given with suboptimal dose of miltefosine, it enhanced efficacy of the latter from 45 to 86% on day 7 post treatment and from 32 to 64% on day 28 post treatment. Interestingly, the efficacy of this combination was as good as the curative dose of miltefosine alone. Thus, this combination appears to offer a fruitful strategy for treatment of VL.     

Structural Reorganization in the Supraoptic Nucleus of Withdrawn Rats following Long-Term Alcohol Consumption

We have recently shown in the supraoptic nucleus (SON) of the rat that prolonged ethanol consumption induces cell degeneration and enlargement of the surviving neurons and of their subcellular organelles. We analyzed the SON of withdrawn rats to evaluate whether it displays any evidence of morphological reorganization following abstinence from ethanol, inasmuch as in this condition the ethanol-Induced changes in the plasma levels of neurohormones and plasma osmolality are no longer detectable. A group of 18 month-old withdrawn rats was compared with age-matched, pair-fed control and ethanol-treated rats. To differentiate between the effects of withdrawal and the effects of rehydration, a group of 18-month-old rehydrated rats was also included in this study and compared with age-matched, pair-fed control and dehydrated rats. We estimated the volume of SON, and the total number and mean volume of its neurons. The cross-sectional areas of the vasopressinergic and oxytocinergic populations were also evaluated. At the ultra-structural level, we determined the volumes and surface areas of the rough endoplasmic reticulum and Golgi apparatus, and the volumes of neurosecretory granules and nucleoli. In withdrawn animals, the total number of SON neurons was smaller than in controls, although the neuronal volume was greater. The number of SON neurons did not differ between withdrawn and ethanol-treated rats, despite the reduced volume of SON the former animals. The decrease of SON volume correlated with and was caused by a reduction in the volume of SON neurons and in the size of the organelles involved in neuro-hormone synthesis. Thus, withdrawal from ethanol stops the ethanol-Induced neuronal degeneration of the SON and partially reverses the ethanol-induced enlargement of SON neurons and their organelles. We suggest that the larger volume of SON neurons in with dawn animals relative to controls represents a compensatory mechanism, triggered by the reduced number of neurons, to allow the maintenance of adequate levels of circulating neurohormones.     

Síndrome coronária aguda em doente oncológico: um problema evitável?

5-Fluorouracil is a first‐line agent in several cancer‐therapy regimens. Cardiotoxicity is common, with coronary artery disease being an important risk factor. We report the case of an acute coronary syndrome presumably induced by 5‐FU, in a patient with previously unknown and asymptomatic coronary artery disease, with an estimated intermediate risk for cardiovascular events. Pre‐chemotherapy risk evaluation and optimal patient care are still not standardized in this clinical scenario.     

Prognostic factors in patients with endocrine tumours of the duodenopancreatic area

Background—Thedevelopment of endocrine tumours of the duodenopancreatic area (ETDP)is thought to be slow, but their natural history is not well known. Theaim of this study was to determine the factors that influence survivalof patients with ETDP.
Patients/Methods—Eightytwo patients with ETDP (44 non-functioning tumours, 23 gastrinomas,seven calcitonin-secreting tumours, four glucagonomas, threeinsulinomas, one somatostatinoma) followed from October 1991 to June1997 were included in the study. The following factors wereinvestigated: primary tumour size, hormonal clinical syndrome, livermetastases, lymph node metastases, extranodular/extrahepatic metastases, progression of liver metastases, local invasion, complete resection of the primary tumour, and degree of tumoral differentiation. The prognostic significance of these factors was investigated by uni-and multi-variate analysis.
Results—Twenty eightpatients (34%) died within a median of 17 months (range 1-110) fromdiagnosis. Liver metastases (p =0.001), lymph node metastases (p = 0.001), progression of liver metastases (p<0.00001), lack of completeresection of the primary tumour (p = 0.001), extranodular/extrahepaticmetastases (p =0.001), local invasion (p = 0.001), primary tumour size3 cm (p = 0.001), non-functioning tumours (p = 0.02), and poortumoral differentiation (p = 0.006) were associated with anunfavourable outcome by univariate analysis. Multivariate analysisidentified only liver metastases (risk ratio (RR) = 8.3; p<0.0001),poor tumoral cell differentiation (RR = 8.1; p = 0.0001), and lack ofcomplete resection of the primary tumour (RR = 4.8; p = 0.0007) asindependent risk factors. Five year survival rates were 40and 100% inpatients with and without liver metastases, 85 and 42% in patientswith and without complete resection of primary tumour, and 17 and 71%in patients with poor and good tumour cell differentiation respectively.
Conclusion—Livermetastases are a major prognostic factor in patients with ETDP.Progression of liver metastases is also an important factor which mustbe taken into account when deciding on the therapeutic approach. Theonly other independent prognostic factors are tumoral celldifferentiation and complete resection of the primary tumour.

Keywords:prognostic factors; survival; endocrine tumours; gastrinoma; cell differentiation; liver metastases

     

Evaluation of aortic stenosis severity: role of contrast echocardiography in comparison with conventional echocardiography and cardiac catheterization.

OBJECTIVES: To evaluate the role of contrast Doppler echocardiography in the assessment of aortic stenosis severity, in comparison with the conventional method and using the catheterization study as the gold standard. STUDY DESIGN: Prospective comparative study. SETTING: Echocardiography Laboratory of Cardiology Department. POPULATION: We included 36 consecutive patients, 20 male, aged 67 +/- 11 years, referred for catheterization study to evaluate aortic stenosis severity. METHODS: All patients underwent conventional and contrast Doppler echocardiography and catheterization study. For contrast Doppler, we used Levovist (300 mg/ml infusion). We analyzed the following echocardiographic parameters: a) left ventricle dimensions, wall thickness and function; b) aortic valve morphology; c) post-stenotic aortic valve flow--peak velocity, velocity-time integral, peak gradient, mean gradient; d) left ventricle outflow tract flow--peak velocity, velocity-time integral; e) aortic valve functional area; f) acquisition time and Doppler signal intensity for post-stenotic aortic valve flow. Catheterization parameters analyzed: a) peak aortic valve gradient; b) mean aortic valve gradient. RESULTS: Contrast Doppler yielded higher peak gradients than conventional Doppler (85.6 +/- 30.2 vs 72.6 +/- 26.1 mmHg, p < 0.001), as well as higher mean gradients (51.4 +/- 19.0 vs 44.2 +/- 15.9 mmHg, p < 0.001). Peak gradients obtained with contrast Doppler correlated with those obtained invasively (r = 0.88, p < 0.001), although the values were higher (85.6 +/- 30.2 vs 73.6 +/- 32.0 mmHg, p < 0.001). There was no difference between mean contrast Doppler gradients and mean catheterization gradients, which showed a high correlation (r = 0.89, p < 0.001). There was no difference between peak and mean gradients obtained by conventional Doppler and invasively, which yielded correlations of 0.73 and 0.75, respectively (p < 0.001). The sensitivity of contrast Doppler for detection of severe aortic stenosis was 100% for peak gradient and 84% for mean gradient, while for conventional Doppler it was 68% and 58%. The specificity of contrast Doppler was 65% for peak gradient and 88% for mean gradient, while for conventional Doppler it was, respectively, 58% and 88%. Acquisition time for aortic flow visualization was lower (p < 0.001) and flow intensity higher for contrast Doppler, in comparison with conventional Doppler. CONCLUSIONS: In this study, contrast Doppler yielded high correlations with invasive data and higher sensitivity and specificity for detection of severe aortic stenosis than conventional Doppler. It is a useful method for evaluation of aortic stenosis severity.