Profil clinique, biologique et traitement des drépanocytaires régulièrement suivis au Centre Hospitalier Universitaire de Libreville / Clinical, biological and treatment profile of sickle cell patients regularly followed at Libreville University Hospital Center

Introduction: La mise en place depuis Septembre 2016 au Centre Hospitalier Universitaire (CHUL) d'une consultation d'hématologie dédiée aux adultes drépanocytaires a été l'occasion de mener cette étude dont le but principal était d'établir les profils clinique et paraclinique de l'adulte drépanocytaire régulièrement suivi.Patients et méthodes : Il s'agissait d'une étude rétrospective. La population d'étude était constituée de patients drépanocytaires homozygotes de 18 ans et plus, qui avaient effectués au moins trois consultations d'hématologie sur une année. Les informations recueillies, après étude du dossier médical et entretien téléphonique avec le patient, concernaient les données socio-démographiques, l'histoire de la drépanocytose, les antécédents, les complications de la maladie, les examens biologiques et radiologiques et le traitement.Résultats : Au total 88 patients répondaient aux critères d'inclusion sur les 233 drépanocytaires vus durant la période de l'étude. L'âge moyen était de 30,4 ± 7,8 ans. L'interrogatoire révélait que la crise vaso-occlusive (CVO) était la principale complication aiguë et la lithiase vésiculaire (36,3%) la première complication chronique. L'hémoglobine moyenne était de 7,8 g/dl et pour 49,3% des patients elle se situait entre 7 et 9 g/dl. Les leucocytes étaient augmentés dans 65,7%. L'échographie cardiaque réalisée chez 35 patients retrouvait 11,1% d'hypertension artérielle pulmonaire et 22,8% d'hypertrophie ventriculaire gauche. L'intensité de la crise douloureuse motivait une consultation au service des urgences du CHU dans 81,6% des cas dont plus de 62% déploraient un retard dans l'exécution de cette prise en charge bien qu'ils en aient été satisfaits dans 54,9% des cas.Conclusion : Les drépanocytaires adultes régulièrement suivis au CHUL sont peu nombreux. La transition entre le suivi pédiatrique et adulte doit se faire avec une transmission des informations du dossier médical sur l'histoire de la drépanocytose.

Introduction: The establishment since September 2016 at the University Hospital Center (CHUL) of a hematology consultation dedicated to adults with sickle cell disease was an opportunity to conduct this study, the main purpose of which was to establish the clinical and paraclinical profiles of the adults with sickle cell disease regularly monitored. Patients and methods: This was a retrospective study. The study population consisted of homozygous sickle cell patients aged 18 and over, who had performed at least three hematology consultations over a year. The information collected, after studying the medical file and telephone interview with the patient, concerned socio-demographic data, history of sickle cell disease, history, complications of the disease, biological and radiological examinations and treatment. Results: A total of 88 patients met the inclusion criteria out of the 233 sickle cell patients seen during the study period. The mean age was 30.4 ± 7.8 years. The questioning revealed that vaso-occlusive crisis (VOC) was the main acute complication and cholelithiasis (36.3%) the first chronic complication. The average hemoglobin was 7.8 g/dl and for 49.3% of the patients it was between 7 and 9 g/dl. Leukocytes were increased in 65.7%. Cardiac ultrasound performed in 35 patients found 11.1% pulmonary arterial hypertension and 22.8% left ventricular hypertrophy. The intensity of the painful crisis motivated a consultation in the emergency department of the CHU in 81.6% of cases, of which more than 62% complained of a delay in the execution of this care although they were satisfied with it in 54 .9% of cases.Conclusion: Few adult sickle cell sufferers are regularly monitored at the CHUL. The transition between pediatric and adult follow-up must be made with a transmission of information from the medical file on the history of sickle cell disease

Utilidad del score de calcio ecocardiográfico como herramienta predictiva de enfermedad coronaria obstructiva / Usefulness of the Echocardiographic Calcium Score as Predictive Tool for Obstructive Coronary Artery Disease:

RESUMEN Objetivos: Evaluar el valor predictivo del score cálcico ecocardiográfico (SCE). Material y métodos: Se evaluaron 96 pacientes con indicación de coronariografía (CCG). Síndrome coronario sin supra ST 20 pacientes. Angina crónica 15 pacientes Síndrome coronario con supra ST 31 pacientes. Asintomáticos 30 pacientes. Se efectuó ecocardiograma con SCE y correlación con coronariopatía. Dos grupos: pacientes con SCE ≤ 1 y SCE ≥ 2. Resultados: Sobre 96 pacientes, 23 sin lesiones con SCE 0,61, y 73 con lesión SCE 2,63. Entre aquellos con lesión, 16 lesión única SCE 1,68, 57 lesión múltiple SCE 2,87. De 23 sin lesiones 20 tuvieron SCE ≤ 1, y 3 SCE ≥ 2, y de 73 con lesiones 13 tuvieron SCE ≤ 1, y 60 SCE ≥ 2; así, un SCE ≥ 2 presenta mayor frecuencia de coronariopatía vs. SCE ≤ 1 (p < 0,05), sensibilidad 82,2%, especificidad 87%, valor predictivo positivo: 95,2%, y negativo 60,6%. En lesión única vs. múltiple 16 presentaron lesión única, 9 tenían SCE ≥ 2, y 57 múltiple, 51 tenían SCE ≥ 2, sensibilidad: 89,5% y especificidad: 43,8% para identificar múltiples vasos, valor predictivo positivo 85%, y negativo: 53,8%. Conclusiones: El SCE tendría buen valor predictivo positivo para coronariopatía.

ABSTRACT Objectives: The aim of this study was to evaluate the predictive value of the echocardiographic calcium score (ECS). Methods: Ninety-six patients with coronary angiography indication were enrolled in the study: 20 with non-ST-segment elevation acute coronary syndrome, 15 with chronic angina, 31 with ST-segment elevation acute coronary syndrome and 30 asymptomatic patients. After echocardiography with ECS and correlation with coronary artery disease, patients were classified into 2 groups according to ECS ≤1 or ECS ≥2. Results: Among the total number of patients, 23 patients without lesions had ECS: 0.61 and 73 with lesions had ECS: 2.63. In patients presenting lesions, 16 had single lesion with ECS: 1.68 and 57 multiple lesions with ECS: 2.87. In the 23 patients without lesions, 20 had ECS ≤1 and 3 ECS ≥2, and among the 73 patients with lesions, 13 had ECS ≤1 and 60 ECS ≥2. Thus, ECS ≥2 presented a higher frequency of coronary artery disease vs. ECS ≤1 (p <0.05), with 82.2% sensitivity, 87% specificity, 95.2% positive predictive value and 60.6% negative predictive value. In single vs. multiple lesions, 9 out of 16 patients with single lesion had ECS ≥2 and 51 out of 57 patients with multiple lesions had ECS ≥2, with 89.5% sensitivity and 43.8% specificity to identify multivessel disease, and 85% positive predictive value and 53.8% negative predictive value. Conclusions: The ECS would have good positive predictive value to assess coronary artery disease.

Causes of mortality of seabirds stranded at the Northeastern coast of Brazil / Causas de mortalidade de aves marinhas encalhadas na costa do Nordeste do Brasil

The aim of this work was to determine the main species of stranded seabirds at the Northeastern coast of Brazil in addition to the most frequent causes of stranding and mortality. The study was conducted in a monitored area for three years (2012-2014), from the coastline of south Alagoas through north coast of Bahia encompassing 254km of coast. The seabirds found alive during the monitoring were sent to rehabilitation, clinically examined and the carcasses were removed, necropsied and histopathologically analyzed. A total of 1.347 seabirds were found stranded. Of these, 378 were found alive and sent to rehabilitation. From the 969 dead seabirds 806 were unsuitable for necropsy, being only 163 submitted to necropsy and histopathological analysis. Calonectris borealis, Puffinus gravis and Puffinus puffinus were the main seabirds stranded in the studied area. Most stranding occurred from March to June with an increase during April and May for the most species of seabirds. The main clinical signs of stranded seabirds consisted of inappetence, apathy, low body score, hypothermia, flying or movement difficulty and prolonged recumbency. Natural causes followed by infectious diseases and anthropogenic environmental factors were the main causes of death of seabirds stranded on the Northeastern coast of Brazil.(AU)

O objetivo deste trabalho foi determinar as principais espécies de aves marinhas encalhadas na costa do Nordeste do Brasil, bem como as mais frequentes causas de encalhe e mortalidade. O estudo foi desenvolvido em área monitorada durante três anos (2012-2014), entre o litoral sul de Alagoas e o litoral norte da Bahia, perfazendo um total de 254km de extensão da costa. As aves encontradas vivas foram encaminhadas para reabilitação e examinadas clinicamente; as carcaças foram removidas, necropsiadas e os órgãos foram analisados por meio da histopatologia. Um total de 1.347 aves foi encontrado, encalhadas. Dessas, 378 estavam vivas e foram encaminhadas para a reabilitação. Das 969 aves marinhas mortas, 806 estavam impróprias para realização de necropsia, sendo apenas 163 submetidas à necropsia e análise histopatológica. Calonectris borealis, Puffinus gravis e Puffinus puffinus foram as principais espécies encontradas na área estudada. A maioria dos encalhes para grande parte das aves marinhas ocorreram de março a junho, com um aumento durante abril e maio. Os principais sinais clínicos das aves marinhas consistiram em inapetência, apatia, baixo escore corporal, hipotermia, dificuldade de voo ou movimento e decúbito prolongado. Causas naturais, seguidas de doenças infecciosas e fatores antropogênicos, foram as principais causas de mortes de aves marinhas encalhadas na costa do Nordeste do Brasil.(AU)

Anethole reduces oxidative stress and improves in vitro survival and activation of primordial follicles

Primordial follicles, the main source of oocytes in the ovary, are essential for the maintenance of fertility throughout the reproductive lifespan. To the best of our knowledge, there are no reports describing the effect of anethole on this important ovarian follicle population. The aim of the study was to investigate the effect of different anethole concentrations on the in vitro culture of caprine preantral follicles enclosed in ovarian tissue. Randomized ovarian fragments were fixed immediately (non-cultured treatment) or distributed into five treatments: α-MEM+ (cultured control), α-MEM+ supplemented with ascorbic acid at 50 μg/mL (AA), and anethole at 30 (AN30), 300 (AN300), or 2000 µg/mL (AN2000), for 1 or 7 days. After 7 days of culture, a significantly higher percentage of morphologically normal follicles was observed when anethole at 2000 μg/mL was used. For both culture times, a greater percentage of growing follicles was observed with the AN30 treatment compared to AA and AN2000 treatments. Anethole at 30 and 2000 µg/mL concentrations at days 1 and 7 of culture resulted in significantly larger follicular diameter than in the cultured control treatment. Anethole at 30 µg/mL concentration at day 7 showed significantly greater oocyte diameter than the other treatments, except when compared to the AN2000 treatment. At day 7 of culture, levels of reactive oxygen species (ROS) were significantly lower in the AN30 treatment than the other treatments. In conclusion, supplementation of culture medium with anethole improves survival and early follicle development at different concentrations in the caprine species.

Virulence factors and biofilm production by isolates of Bacteroides fragilis recovered from dog intestinal tracts

Bacteroides fragilis colonizes dog guts both as a commensal and as an opportunistic pathogen. This study aims to evaluate virulence factors of 13 B. fragilis strains isolated from dog intestinal tracts and their ability for biofilm formation. Capsules were detected in all the evaluated strains. A total of 61.5% of all strains were biofilm producers. These attributes most likely play an important role in B. fragilis persistent colonization in the gut.

Palynological evidence of the replacement of the hygrophilous forest by field vegetation during the last 7,000 years B.P. in the northern coast of Rio de Janeiro, Brazil

Historians claim that European colonizers of the northern coast of Rio de Janeiro State found vast herbaceous fields when arrived in this region. Hypotheses about the origin of these fields include forest burning by the Goitacás indians and periodical floods by the Paraíba do Sul River and the lagoon system. The palynologycal analysis of two lake cores obtained in the municipality of Campos dos Goytacazes revealed opening episodes of hygrophilous forest and the establishment of field vegetation, recorded at ca. 6,500 and ca. 4,000 14C yr BP. The partial replacement of forest by field vegetation in the first episode was probably caused by floods of the lower areas during the development of the Holocene lagoon phase. During the second episode, successions of vegetational patterns occurred due to lowering of the sea level. Drying and enlarging of the coastal plain have allowed its colonization by herbs and heliophyte plants. The palynological analysis does not provide any evidence that sustains the theories of use of fire and agricultural activities by indigenous groups during these periods.

Os historiadores citam que os europeus colonizadores da costa norte do Estado do Rio de Janeiro encontraram vastos campos herbáceos quando chegaram a essa região. As hipóteses sobre a origem desses campos incluem aplicação de "queimada"pelos índios Goitacás e periódicas inundações do rio Paraíba do Sul e sistemas lagunares. A análise palinológica de dois testemunhos de sondagem obtidos no município de Campos dos Goytacazes revelou epsódios de abertura da floresta higrófila e o estabelecimento da vegetação campestre, datado sem ca. 6.500 e 4.000 14C anos AP. O primeiro epsódio de substituição parcial da floresta pela vegetação campestre se deu provavelmente pelas inundações das áreas baixas durante o desenvolvimento da fase lagunar holocênica. No segundo epsódio, os padrões de sucessão da vegetação ocorreram como consequência do abaixamento do nível do mar. O ressecamento e a progressão da planície costeira permitiram sua colonização pelas plantas herbáceas heliófitas. A análise palinológica não forneceu qualquer evidência que apoie as teorias do uso do fogo e da prática de atividades agrícolas por grupos indígenas durante esses períodos.

Effects of Myrcia ovata Cambess., essential oil on planktonic growth of gastrointestinal microorganisms and biofilm formation of Enterococcus faecalis

The essential oil from the leaves of Myrcia ovata Cambess., commonly used in Brazil for the treatment of gastric illnesses, was screened for antimicrobial activity and action in the formation of microbial biofilms by Enterococcus faecalis. The oil was obtained by hydrodistillation using a clevenger-type system. Its chemical composition was analyzed using GC and GC-MS. Both MIC and MBC of the essential oil were determined by broth microdilution techniques and agar dilution method. The essential oil showed antimicrobial activity against E. faecalis, Escherichia coli, Pseudomonas aeruginosa, Salmonella choleraesuis, Staphylococcus aureus, Streptococcus pneumoniae and Candida parapsilosis. The results showed that the essential oil of M. ovata Cambess. was effective against the formation of biofilm by E. faecalis when compared with the control. Four volatile compounds, representing 92.1 percent of the oil, were identified and geranial was the major component (50.4 percent). At the best of our knowledge, this is the first report of the chemical composition and antimicrobial activity of the essential oil from leaves of M. ovata.

Influence of ridge type on mandibular distal extension removable partial denture

The aim of this study was to use photoelastic models to analyze the distribution of stress caused by the incidence of loads on a mandibular distal extension removable partial denture, both on the abutment teeth and on differently shaped residual ridges: distal ascending, descending-ascending, horizontal and distal descending. The best type of retainer and location of the rest on the last abutment tooth were determined for the different types of ridge. Four models were made from photoelastic resin (PL-1 for the teeth and PL-2 for the alveolar ridge), one for each kind of ridge. For each model, 4 removable partial dentures (RPD) were made (16 RPD altogether): T-bar retainer and distal rest, T-bar retainer and mesial rest, circumferential retainer and distal rest, and circumferential retainer and mesial rest. The models were placed on a circular polariscope and a 100 N axial load (point load) was applied to premolars and molars of the RPD. The formation of photoelastic bands was photographed for qualitative analysis. Results showed that the horizontal ridge had better distribution of stress, while the distal descending ridge had greater concentration of stress. The circumferential retainer had greater areas of stress for all types of ridges except the horizontal ridge, where there was no influence related to retainer type. The distribution of stress was similar among the different types of ridges when the rest was mesial or distal to the last abutment tooth, except for the distal descending ridge, where there was greater concentration of stress when the rest was located distally to the last abutment tooth. Thus, it may be concluded that (1) the situation was least favorable for the distal descending ridge and most favorable for the horizontal ridge, (2) the T-bar retainer had more favorable stress distribution, except when the ridge was horizontal, in which case there was no influence in relation to the type of retainer, (3) the location of the rest showed similar behavior in all except the distal descending ridge.

O objetivo da pesquisa foi analisar, atraves de modelos fotoelasticos, a distribuicao das tensoes formadas pela incidencia de cargas sobre a protese parcial removivel de extremidade livre mandibular, nos dentes suporte e no rebordo residual nas formas: ascendente distal, descendente-ascendente, horizontal e descendente distal. Nos diferentes tipos de rebordo foi verificado o melhor tipo de grampo e a localizacao do apoio no ultimo dente suporte da extremidade livre. Foram construidos 4 modelos de resina fotoelastica (PL-1 para os dentes e PL-2 para o rebordo alveolar), um modelo para cada tipo de rebordo. Para cada modelo foram confeccionados 4 proteses parciais removiveis (PPR)(total de 16 PPR): com grampo em barra T e apoio na face distal, com grampo em barra T e conector na mesial, grampo circunferencial e apoio na face distal e grampo circunferencial e apoyo na face mesial. Os modelos foram posicionados em um polariscopio circular e aplicado carga pontuais e axiais de 100 N nos pre-molares e molares das proteses. As franjas formadas foram fotografadas para analise. Os resultados foram analisados de uma forma qualitativa e podemos observar que o rebordo horizontal apresentou uma melhor distribuicao das tensoes, enquanto o rebordo descendente distal apresentou as maiores concentracoes de tensoes. O grampo circunferencial apresentou as maiores formacoes de tensoes em todos os tipos de rebordo, exceto no rebordo horizontal, onde nao houve influencia quanto ao tipo de grampo. Nao houve diferenca significante entre os tipos de rebordo ao posicionar o apoio na mesial ou distal do ultimo dente suporte, com excecao feita ao rebordo descendente distal, onde se acentuou a concentracao de tensoes ao posicionar o apoio na distal do ultimo dente. Desse modo, podemos concluir que (1) o rebordo mais desfavoravel foi o descendente distal e o mais favoravel o horizontal, (2) o grampo em barra T apresentou distribuicao de tensoes mais favoraveis, com excecao do rebordo horizontal, onde nao houve influencia quanto ao tipo de grampo, (3) e que a localizacao do apoio apresentou comportamentos semelhantes, a nao ser no rebordo descendente distal.

Effects of alpha-tocopherol and ternatin antioxidants on morphology and activation of goat preantral follicles in vitro cultured / Efeitos dos antioxidantes alpha-tocoferol e ternatina na morfologia e na ativação de folículos pré-antrais caprinos cultivados in vitro

The effects of α-tocopherol and ternatin on the morphology, activation, and growth of goat preantral follicles in vitro cultured, for one or five days, were evaluated. Ovarian fragments were immediately fixed (non-cultured control) or in vitro cultured for one or five days in Minimum Essential Medium (MEM) with or without α-tocopherol or ternatin supplementation, both at concentrations of 5, 10, or 15µM, corresponding to the following treatments: MEM, TOC5, TOC10, TOC 15, TER5, TER10, and TER15. The percentages of morphologically normal preantral follicles in non-cultured ovarian tissue (control) was 73.2 percent and after five days of culture, there was a decrease on these percentages in all treatments (P<0.05) when compared with non-cultured control. Culture of ovarian cortex for five days increased the percentages of follicular activation in all treatments (P<0.05). Ultrastructural analysis did not confirm the integrity of caprine preantral follicles cultured for five days in medium containing antioxidants. This study demonstrated that α-tocopherol and ternatin can promote follicular activation; however, addition of these antioxidants in the tested concentrations reduced the follicular viability after in vitro culture.

Os efeitos do α-tocoferol e da ternatina sobre morfologia, ativação e crescimento de folículos pré-antrais caprinos cultivados in vitro, por um ou cinco dias, foram avaliados. Os fragmentos ovarianos foram imediatamente fixados (controle não-cultivado) ou cultivados in vitro, por um ou cinco dias, em Meio Essencial Mínimo (MEM) com ou sem suplementação com α-tocoferol ou ternatina nas concentrações de 5, 10 ou 15µM, formando os tratamentos MEM, TOC5, TOC10, TOC 15, TER5, TER10, TER15. O percentual de folículos pré-antrais normais no controle não-cultivado foi de 73,2 por cento, depois de cinco dias de cultivo, houve redução desse percentual em todos os tratamentos, quando comparados com o controle não-cultivado (P<0,05). O cultivo por cinco dias aumentou a ativação folicular em todos os tratamentos (P<0,05). A análise ultra-estrutural não mostrou folículos pré-antrais íntegros após cinco dias de cultivo em meio contendo antioxidantes. Concluiu-se que o α-tocoferol e a ternatina podem promover a ativação folicular, no entanto a adição desses antioxidantes nas concentrações testadas reduziu a viabilidade folicular após o cultivo in vitro.

Característica histológica, ultra-estrutural e produção de nitrito de folículos pré-antrais caprinos cultivados in vitro na ausência ou presença de soro / Histological and ultrastructural feature and nitrite production of caprine preantral follicles in vitro cultured in the presence or absence of serum

Avaliou-se o efeito da adição de diferentes tipos e concentrações de soro sobre o desenvolvimento e a sobrevivência de folículos ovarianos pré-antrais (FOPA) caprinos in vitro. Além disso, verificou-se a relação entre as concentrações de nitrito presentes no meio de cultivo e a viabilidade folicular. Cada par ovariano foi dividido em 29 fragmentos, sendo um destinado ao controle. Os fragmentos foram cultivados por um ou sete dias em meio essencial mínimo suplementado (MEM+) ou MEM+ com diferentes concentrações (10 ou 20 por cento) de soro fetal bovino (SFB), soro de cabra em estro (SCE) ou soro de cabra em diestro (SCD). Na análise morfológica após sete dias, apenas o tratamento com 10 por cento de SFB apresentou percentual de FOPA normais similar ao MEM+ (P>0,05). A análise ultra-estrutural dos folículos cultivados por sete dias com MEM+ ou MEM+ com 10 por cento de SFB mostrou danos oocitários, porém células da granulosa normais. A análise do meio de cultivo revelou correlação positiva entre a viabilidade folicular e a produção de nitrito. A suplementação com soro não melhorou a viabilidade de FOPA e a concentração de nitrito no meio de cultivo funcionou como um indicador da viabilidade das células da granulosa de FOPA caprinos cultivados in vitro.

The effect of the addition of different types and concentrations of sera on the viability and development of caprine preantal follicles (PAF) in vitro cultured was analyzed. In addition, it was evaluated the correlation between nitrite concentrations in culture medium and folicular viability. Each ovarian pair was divided in 29 fragments and one was used as control. The fragments were cultured for one or seven days in minimal essential medium (MEM+) or MEM+ with different concentrations of (10 or 20 percent) bovine fetal serum (BFS), estrous goat serum (EGS), or diestrous goat serum (DGS). After seven days, the morphological analysis showed that only the treatment with 10 percent BFS maintained the percentage of normal PAF similar to MEM+ (P>0.05). The ultrastructural analysis of follicles cultured for seven days in MEM+ or MEM+ with 10 percent BFS showed some oocyte damage, although the granulosa cells were normal. Analysis of culture medium revealed a positive correlation between follicular viability and nitrite production. Supplementation with serum did not improve the viability of PAF and nitrite levels in culture medium served as an indicator of viability of granulose cells from caprine PAF in vitro cultured.

Investigação de áreas de risco como metodologia complementar ao controle da leishmaniose visceral canina / Investigation of risk areas as complemental methodology for the control of canine visceral leishmaniasis

Foram investigadas áreas de risco de leishmaniose visceral canina no município de Camaçari, Bahia. Um total de 278 cães distribuídos em 141 residências, pertencentes a 20 áreas de risco investigadas, foi examinado sorologicamente (ELISA). A soroprevalência geral foi 21,7 por cento (56/258) depois da exclusão dos 20 cães usados no início do estudo para delimitar a área. Os resultados respectivos das análises univariada e multivariada dos fatores relacionados à infecção do cão por Leishmania chagasi, a captura e distribuição do vetor na área e a metodologia usada para localizar os focos caninos são discutidos.

Risk areas of canine visceral leishmaniasis in the city of Camaçari, Bahia, Brazil, were investigated. A total of 278 dogs from 141 homes pertaining to 20 investigated risk areas was serologically screened (ELISA). The general seroprevalence was 21.7 percent (56/258) after exclusion of 20 dogs used at the beginning of the survey to limit the study area. The respective results of the univariated and multivariated analysis of factors related to infection of dogs by Leishmania chagasi, to vector distribu-tion pattern in the area and to the methodology used to localize the canine focuses are discussed.

Marcadores de prognóstico no abscesso hepático piogênico / Pyogenic liver abscess: analysis of prognostic factors

Objetivo:Analisar os marcadores de prognóstico no abscesso hepático piogênico. Casuística e método: Foram estudados retrospectivamente 26 pacientes admitidos na Unidade de Emergência Armando Lages-Maceió e no Hospital Universitário Prof. Alberto Antunes, da Universidade Federal de Alagoas, com diagnóstico de abscesso hepático piogênico confirmado à laparotomia exploradora, período 1993-99. Foram estudadas as seguintes variáveis: idade, sexo, icterícia, número de abscessos, localização, choque, rotura, diâmetro, hematócrito e número de leucócitos. A análise estatística foi feita pelos testes de Fisher e Mann-Whitney, sendo considerados significantes respectivamente os valores de p<0,01 e p<0,05. Métodos: Dezenove pacientes eram do sexo masculino e sete do feminino. A idade média foi de 31 anos e variou de três a 92 anos. Resultados: as manifestações clínicas principais foram dor abdominal e febre. O abscesso com lesão única no lobo direito foi a apresentação mais frequente. A drenagem cirúrgica com antimicrobianos foi a terapêutica predominante e a mortalidade global doi de 26,9por cento. Os marcadores idade, sexo, número de abscessos, localização, hematócrito e o número de leucócitos não foram significantes, icterícia, rotura, choque séptico e o diâmetro do abscesso foram os marcadores de prognóstico significantes para mortalidade. Conclusão: Os marcadores de prognóstico para evolução desfavorável foram: presença de icterícia, choque séptico, rotura e o diâmetro do abscesso

Estudo histopatológico do pâncreas de ratos intoxicados pelo veneno bruto do escorpião Tityus serrulatus / Histopathologic study in rats’pancreas after injection of venom from the scorpion Tityus serrulatus

Modificações no teor de vários componentes da secreção pancreática e alterações histopatológicas desse órgão são verificadas após injeção de veneno do escorpião Tityus serrulatus em ratos. Entre essas alterações, podem ser citadas pancreatite aguda e crônica após uma única injeção de veneno. Os achados compatíveis com pancreatite aguda foram encontrados a partir de 10 minutos após a intoxicação e, 20 dias após, a maioria dos animais exibiu achados histológicos típicos de pancreatite crônica. O objetivo do presente trabalho foi determinar a cinética das alterações pancreáticas que ocorrem ao longo do tempo, após injeção endovenosa de veneno bruto de escorpião em ratos. Os animais, após jejum de 24-48 horas, receberam uma injeção venosa, pela veia peniana, de 0,2 ml de uma solução de cloreto de sódio (grupo controle) ou de 0,2 ml de uma solução contendo 300 mg/ml de veneno bruto do escorpião Tityus serrulatus (60 mg/animal). Os animais foram sacrificados em grupos de 5 a 10 cada, aos 10, 20 e 40 minutos e 1, 2, 3, 4, 6, 8, 10, 12, 14, 16, 18 e 20 dias após a injeção. O pâncreas foi retirado e processado para estudo histológico. Pancreatite aguda (PA) foi observada nos grupos sacrificados após 10, 20 e 40 minutos, 24 e 48 horas após a injeção. Achados compatíveis com pancreatite crônica (PC) foram detectados nos animais sacrificados entre 4 a 20 dias após a injeção. No grupo de animais sacrificados 3 dias após, observaram-se, no mesmo animal e, às vezes, no mesmo corte histológico, alterações características de PA (degranulação, vacuolização acinar, infiltração difusa de linfócitos e lesões granulomatosas) e, surpreendentemente, de PC (dilatação ductal com rolhas protéicas, hiperplasia ductal e hiperplasia dos linfonodos peripancreáticos), caracterizando a fase de transição da pancreatite aguda para pancreatite crônica. Todos os grupos apresentaram mobilização e degranulação de mastócitos, sugerindo a participação dessas células na etiopatogênese dessas lesões...

Muscarinic receptors and acetylcholinesterase activity in brain of patients with dementia

The present paper describes the determination of muscarinic receptor number ([3H]-N-methylscopolamine binding) and acetylcholinesterase activity in six brain areas (pre-central gyrus, post-central gyrus, hippocampus, caudate nucleus,lentiform nucleus and substantia inominata) of demented patients (diagnosed by screening tests and neurological evaluation) and age-matched controls.These was a significant increase in muscarinic receptors in the hippocampus and substanctia inominata (171.2 and 359.4fmol/mg protein, respectively) of the demented group as compared with controls (123.9 and 219.0 fmol/mg protein, respectively). No changes were observed in pre-and post-central gyrus, while a tendency towards decreased binding was detected in the caudate nucleus and lentiform nucleus of the demented group. Lower acetylcholinesterase activity was also detected in the demented group in all areas studied although the differences were significant only in the post-central gyrus, caudate nucleus and substantia inominata which showed a 49.21 and 25% decrease in enzyme activity respectively. The results are discussed in terms of a compensatory mechanism of presynaptic deficiency such as that occurring in Parkinson's disease

Adenocarcinoma mucinoso primario del piel / Primary mucious adenocarcinma of skin

Se presenta el caso de un adenocarcinoma mucionoso primitivo de piel, ubicado en la mejilla, con historia de 9 años de evolución signada por la recidiva lesional. Se hace una consideración y análisis de la literatura. La negatividad del antígeno carcino embrionario sugiere una línea de diferenciación más primitiva, quizás de una etapa precoz del germen epitelial

Sindrome de Gorham: presentación de un caso con linfangiomatosis y osteolisis progresiva / Gorham syndrome: presentation of a case with lymphangiomatosis and progressive osteolysis

En definitiva se trata de un Síndrome de Gorham, con osteolisis masiva de cintura pelviana y lesiones de piel características. Desde el punto de vista histopatológico, se trata de un tumor vascular linfático sin malignidad citológica, pero arquitecturalmente de carácter disecante e infiltrante, biológicamente maligno, originado en restos embrionários. Actuarían eventualmente como factores inductores de su desarrollo el traumatismo y estímulos de carácter hormonal