ABSTRACT
Os autores apresentam caso clínico de infarto esplênico em paciente com lúpus eritematoso sistêmico. Trata-se de comprometimento raro, sendo descritos apenas quatro casos na literatura, nenhum no Brasil. Discutem os achados clínicos e laboratoriais, incluindo ultra-sonografia e tomografia computadorizada, comparando-se com a literatura
Subject(s)
Humans , Male , Adult , Infarction , Lupus Erythematosus, SystemicABSTRACT
Anticorpos anti-Ro/SS-A sao observados no soro de pacien tes com diferentes doenças reumáticas, com maior prevalência no lúpus eritemato so sistêmico, síndrome de SjÖgren primária e lúpus neonatal com bloqueio cardía co congênito. Várias técnicas com diferentes níveis de sensibilidade e especifi cidade têm sido utilizadas para detecçao de anticorpos anti-Ro/SS-A. O objetivo deste estudo foi desenvolver um ensaio imunoenzimático (ELISA) para detecçao e semiquantificaçao de anticorpos anti-Ro/SS-A. Cromatografia de imunoafinidade anti-Ro/SS-A foi utilizada para purificar o antígeno Ro/SS-A de baço de vitelo. Na eletroforese em gel de poliacrilamida, o antígeno purificado migrou como bandas de 60 e 52 kDa e foi utilizado como substrato no ELISA. Por este período, anti corpos anti-Ro/SS-A foram detectados em 35,8 por cento (43/120) dos pacientes com diferentes doenças reumáticas, em contraste com 29,2 por cento quando utili zada imunodifusao dupla (IDD). Anticorpos anti Ro/SS-A nao foram detectados nos 30 controles normais, tanto no ELISA como na IDD. ELISA para detecçao de anticorpos anti-RO/SS-A mostrou ser mais vantajoso que a IDD, devido à sua maior sensi bilidade, sua capacidade de fornecer resultados semiquantitativos e a possibili dade de ser adaptado como procedimento semi-autorizado
Subject(s)
Humans , Antibodies, Antinuclear , Autoantigens , Chromatography, Affinity , Enzyme-Linked Immunosorbent Assay , Rheumatic DiseasesABSTRACT
In order to evaluate the pattern of ANA testing solicitation, 506 patients with ANA testing requested from July 1st. 1988 to December, had their charts reviewed. These patients, randomly selected, were regularly attending the outpatient clinic at the "Escola Paulista de Medicina" (EPM). 289 patients were followed up at the Rheumatology Division (group A) and 217 patients at other clincial divisions at EPM (group B). The disease that most frequently motivated the request for ANA test were: group A - SLE (22.5 per cents), RA (18.1 per cents), undefined arthropathies (6.2 per cents), PSS and CREST (5.9 per cents) and Raynaud phenomena (5.5 per cents); and group B - rheumatic diseases (24.4 per cents), nephropathies (17.1 per cents), neuropathies (16.6 per cents), dermopathies (7.8 per cents), hemopathies (4.6 per cents), pneumopathies (4.2 per cents) and ophtalmopathies (3.7 per cents). The positivity of ANA test in groups A and B was 32.9 per cents and 17.5 per cents respectively. 92 SLE patients were clinically diagnosed. The positivity of Ana and anti-dsDNA tests in this group was respectively 85.1 per cents and 26.6 per cents. The sensitivity and specificity of 1982 ARA revised criteria were 94.7 per cents and 99 per cents respectively. The likelihood ratio (LR) of a positive or a negative test was established for this population. LR of a positive test was 6.5 while for a negative test it was 0.17. The ANA test, although lacking specificity, has been commonly requested by different specialities in order to practically rule-out the diagnosis of some connective rheumatic diseases. Immunofluorescence technique (IF) using antibodies conjugated with fluorchromes was first described by Coons et al. in 1941 (4). This method has been used as an important diagnostic tool in routine laboratory tests ever since. Anew technique using indirect immunofluorescence for detection of antinuclear antibodies (ANA) was developed by Friou in 1957 (5). This method has been gaing importance since then, due to the presence of antoantibodies in a variety of neoplastic, infectious, autoimmune and, particularly, connective tissue diseases. In 1960, the study of Anderson (1) led to the description of a new set of autoantibodies, which recognized extractable nuclear and citoplasmatic antigens in a great percentage of cases, but were not detected by indirect IF. Nowadays, these autoantibodies can be identified by immunodifusion, immunoenzymatic, radioimmune or immunoblot techniques...
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Antibodies, Antinuclear/analysis , Lupus Erythematosus, Systemic/immunology , Time Factors , Aged, 80 and over , Brazil , Retrospective Studies , Sensitivity and Specificity , Hospitals, UniversityABSTRACT
Os autores relatam um caso rabdomiossarcoma embrionário com vários aspectos interessantes que contribuíram para dificultar o diagnóstico
Subject(s)
Adult , Humans , Male , Pelvic Neoplasms/diagnosis , Rhabdomyosarcoma/diagnosisABSTRACT
Os autores relatam um caso de dermatopolimiosite (DPM) infantil, em que a biópsia muscular revelou-se absolutamente normal, apesar da nova metodologia utilizada e do emprego de técnicas histoquímicas de coloraçäo