Enfermedad de Paget extramamaria perianal, tratada con imiquimod tópico / Atypical presentation of perianal extramammary Paget's disease, treated with topical imiquimod

RESUMEN La enfermedad de Paget extramamaria (EPEM) perianal es un adenocarcinoma intraepitelial del margen anal de muy baja frecuencia. La forma primaria representa una neoplasia de origen apocrino, mientras que la forma secundaria representa una diseminación pagetoide de una neoplasia maligna en general anorectal. Debido a su similitud clínica con otras patologías de presentación frecuente, se requiere de un alto índice de sospecha para diagnosticarla. La resección quirúrgica amplia o la cirugía micrográfica de Mohs se considera comúnmente el pilar del tratamiento con altas tasas de recurrencia. Estudios previos han demostrado buena respuesta en la EPEM vulvar con imiquimod 5% en crema, pero su eficacia no ha sido bien descrita en la afectación perianal. En este artículo presentamos un caso de EPEM perianal primario con sobreinfección con HPV, al que se le indicó tratamiento tópico con imiquimod.

ABSTRACT Perianal extramammary Paget disease is a very low frequency intraepithelial adenocarcinoma of the anal margin. The primary form represents a neoplasm of apocrine origin, while the secondary form represents a pagetoid spread of a generally anorectal malignant neoplasm. Due to its clinical similarity with other pathologies with frequent presentation, a high index of suspicion is required to diagnose it. Wide surgical resection or Mohs micrographic surgery is commonly considered the mainstay of treatment with high recurrence rates. Previous studies have shown a good response in vulvar extramammary Paget disease with imiquimod 5% cream, but its efficacy has not been well described in perianal involvement. In this article we present a case of primary perianal extramammary Paget disease with HPV superinfection, which received topical treatment with imiquimod.

Isolation and characterization of Flavobacterium columnare (Bernardet et al. 2002) from four tropical fish species in Brazil / Isolamento e caracterização de Flavobacterium columnare de quatro espécies de peixes tropicais no Brasil

Flavobacterium columnare is the causative agent of columnaris disease in freshwater fish, implicated in skin and gill disease, often causing high mortality. The aim of this study was the isolation and characterization of Flavobacterium columnare in tropical fish in Brazil. Piracanjuba (Brycon orbignyanus), pacu (Piaractus mesopotamicus), tambaqui (Colossoma macropomum) and cascudo (Hypostomus plecostomus) were examined for external lesions showing signs of colunmaris disease such as greyish white spots, especially on the head, dorsal part and caudal fin of the fish. The sampling comprised 50 samples representing four different fish species selected for study. Samples for culture were obtained by skin and kidney scrapes with a sterile cotton swabs of columnaris disease fish and streaked onto Carlson and Pacha (1968) artificial culture medium (broth and solid) which were used for isolation. The strains in the liquid medium were Gram negative, long, filamentous, exhibited flexing movements (gliding motility), contained a large number of long slender bacteria and gathered into ‘columns'. Strains on the agar produced yellow-pale colonies, rather small, flat that had rhizoid edges. A total of four Flavobacterium columnare were isolated: 01 Brycon orbignyanus strain, 01 Piaractus mesopotamicus strain, 01 Colossoma macropomum strain, and 01 Hypostomus plecostomus strain. Biochemical characterization, with its absorption of Congo red dye, production of flexirubin-type pigments, H2S production and reduction of nitrates proved that the isolate could be classified as Flavobacterium columnare.

Flavobacterium columnare é o agente etiológico da columnariose em peixes de água doce, ocasionando enfermidade na pele e nas brânquias, provocando freqüentemente um grande número de mortalidade. O objetivo deste estudo foi o isolamento e a caracterização de Flavobacterium columnare em peixes tropicais no Brasil. Piracanjuba (Brycon orbignyanus), pacu (Piaractus mesopotamicus), tambaqui (Colossoma macropomum) e cascudo (Hypostomus plecostomus) foram examinados externamente com relação a sinais característicos de columnariose, como manchas acinzentadas na cabeça, região dorsal e pedúnculo caudal dos peixes. A amostragem compreendeu a coleta de 50 exemplares de peixes, representando as quatro diferentes espécies escolhidas para este estudo. Amostras para o isolamento foram obtidas através de raspado com swab estéril das lesões e do rim dos peixes clinicamente diagnosticados como acometidos por columnarios e imediatamente semeados em meios de culturas artificiais (líquido e sólido) próprios para o estudo de Flavobacterium segundo Carlson e Pacha (1968). No meio líquido, houve o desenvolvimento de microrganismos que observados em gota pendente apresentaram a forma de bacilos finos, longos, móveis por deslizamento. Através da coloração de Gram, apresentaram morfologia de bacilos finos, Gram negativos, agrupados em colunas. Em meio sólido, as colônias eram pequenas, cinza-amareladas, com borda em forma de raiz. No total, foram obtidos quatro isolamentos: 01 cepa de Brycon orbignyanus; 01 cepa de Piaractus mesopotamicus; 01 cepa de Colossoma macropomum; e 01 cepa de Hypostomus plecostomus. A caracterização bioquímica das amostras, como absorção do vermelho Congo, produção de flexirrubina, produção de H2S e redução do nitrato, sugere que os isolamentos poderiam ser classificados como Flavobacterium columnare.

CYP2A6 and CYP2E1 polymorphisms in a Brazilian population living in Rio de Janeiro

Cytochrome P450 (CYP) is a superfamily of enzymes involved in the metabolism of endogenous compounds and xenobiotics. CYP2A6 catalyzes the oxidation of nicotine and the activation of carcinogens such as aflatoxin B1 and nitrosamines. CYP2E1 metabolizes ethanol and other low-molecular weight compounds and can also activate nitrosamines. The CYP2A6 and CYP2E1 genes are polymorphic, altering their catalytic activities and susceptibility to cancer and other diseases. A number of polymorphisms described are ethnic-dependent. In the present study, we determined the genotype and allele frequencies of the main CYP2A6 and CYP2E1 polymorphisms in a group of 289 volunteers recruited at the Central Laboratory of Hospital Universitário Pedro Ernesto. They had been residing in the city of Rio de Janeiro for at least 6 months and were divided into two groups according to skin color (white and non-white). The alleles were determined by allele specific PCR (CYP2A6) or by PCR-RFLP (CYP2E1). The frequencies of the CYP2A6*1B and CYP2A6*2 alleles were 0.29 and 0.02 for white individuals and 0.24 and 0.01 for non-white individuals, respectively. The CYP2A6*5 allele was not found in the population studied. Regarding the CYP2E1*5B allele, we found a frequency of 0.07 in white individuals, which was statistically different (P < 0.05) from that present in non-white individuals (0.03). CYP2E1*6 allele frequency was the same (0.08) in both groups. The frequencies of CYP2A6*1B, CYP2A6*2 and CYP2E1*6 alleles in Brazilians are similar to those found in Caucasians and African-Americans, but the frequency of the CYP2E1*5B allele is higher in Brazilians.

Requests of medical examinations after pneumococcal & influenza vaccination in the elderly.

BACKGROUND & OBJECTIVES: There are no specific recommendations about pneumococcal vaccination (PV) in Italy. There are limited data on the requests of medical examination or hospitalization due to side effects of pneumococcal vaccination. In the present study we present our analyses on the requests of medical examination due to side effects of pneumococcal vaccination (PV) in 29,086 elderly aged >/=65 yr. METHODS: Vaccination with influenza vaccine (IV) alone or in association with PV was offered during the IV campaign in the winter 1999-2000 in 8 counties of Sicily. General practitioners (GPs) provided the vaccination and, 72 h later, recorded local and systemic side effects by a telephonic interview with the waccinees. GPs recorded also the requests of medical treatments. RESULTS: A total of 16,601 subjects (57.1%) were vaccinated with IV alone and 12,485 (42.9%) with the association IV+PV. Adverse effects were reported by 14.7 per cent of vaccinees. Out of 4,289 subjects with side effects, 305 (7.1%) looked for a medical examination. The factors associated with a significantly increased risk for medical examination after vaccination were symptoms duration >72 h (OR 2.04; 95% CI 1.38-3.01; P=0.0002); local induration (OR 3.26; 95% CI 2.07-5.13; P<0.0001); general malaise (OR 2.05; 95% CI 1.34-3.13; P=0.0009); fever >/=38 degrees C (OR 3.34; 95% CI 1.90-5.86; P<0.0001); myalgia (OR 2.80; 95% CI 1.46-5.37; P=0.0018) and dyspnea (OR 37.86; 95% CI 9.65-148.60; P=0.0001). INTERPRETATION & CONCLUSION: The few requests for medical examination and the low rate of adverse effects confirmed the tolerability and safety of PV+IV; GPs consultation were related to the severity and duration of symptoms, but independent of the type of vaccine administered.

Indice clínico no diagnóstico e profilaxia da artrite-encefalite caprina (AEC) / Clinical index for diagnosis and prophylaxis of caprine arthritis-encephaliytis (CAE)

Em amostras de sangue colhidas de 60 fêmeas adultas, criadas no Estado de Säo Paulo, realizou-se o exame sorológico visando a detecçäo de anticorpos contra o vírus da Artrite-Encefalite Caprina (VAEC) e Mycoplasma mycoides. O índice clínico (IC) foi obtido pelo uso de uma fita métrica. Näo foram encontradas diferenças estatísticas significativas entre as médias dos IC encontrados em animais sorologicamente positivos e negativos. Considerando-se como 6,0 cm o valor crítico do IC, encontrou-se uma sensibilidade relativa de 57 por cento e uma especificidade relativa de 61 por cento no emprego do IC para o diagnóstico da infecçäo pelo VAEC e Mycoplasma mycoides. Os resultados encontrados mostram que o IC, isoladamente, näo é um critério satisfatório para o diagnóstico da infecçäo pelo VAEC

Micoplasmose bovina: isolamento de Mycoplasma bovis de bezerros acometidos de pneumonia. / Bovine mycoplasmosis: isolation of Mycoplasma bovis from feedlot calves with pneumonia

Os autores analisaram um lote de oito bezerros da raca Holandesa preta e branca, pertencentes a um mesmo plantel e criados em sistema de confinamento, que apresentavam um quadro de pneumonia. De quatro deles, foram isolados e caracterizados microrganismos do genero Mycoplasma atraves do cultivo "in vitro" e estudo da ultra estrutura eletronica, sendo uma das especies identificada como Mycoplasma bovis pelo "Mycoplasma Reference Laboratory-Colindale, England"