Absence of Wharton's jelly: case report / Ausência da geleia de Wharton: relato de caso

There are few reports in the literature of the absence of Wharton's Jelly. Here we report the seventh case in a primigravida, 22 years old, admitted after vaginal delivery of stillborn. The umbilical cord have a long segment with disruption of cord structures and the three blood vessels were completely separated from each other, with a minimum amount of Wharton's jelly remaining around each vessel. The absence of Wharton' jelly is associated with fetal distress, intrauterine growth restriction, and fetal death. Quantitative/qualitative studies of Wharton's jelly represent an open field of research for possible correlations with obstetric conditions and fetal deaths.

Na literatura, há poucos relatos sobre a ausência de geleia de Wharton. Relatamos o sétimo caso em uma primigesta de 22 anos, admitida após parto vaginal de feto natimorto. O cordão umbilical apresentava longo segmento com esfacelo da geleia e três vasos sanguíneos completamente separados uns dos outros, com mínima quantidade de geleia de Wharton remanescente ao redor de cada vaso. Ausência de geleia de Wharton associa-se a estresse, restrição de crescimento e óbitos fetais. Estudos quantitativos/ qualitativos sobre a geleia de Wharton representam campo de pesquisa aberto para possíveis correlações com condições e doenças obstétricas e óbitos fetais.

Using pegylated interferon alfa-2b and ribavirin to treat chronic hepatitis patients infected with hepatitis c virus genotype 1: are nonresponders and relapsers different populations?

The combination of pegylated interferon (PEG-INF) and ribavirin is currently the best treatment for chronic hepatitis C, providing a sustained virological response (SVR) in 54 percent-63 percent of patients. In patients infected with hepatitis C virus (HCV) genotype 1, the SVR rate is 42 percent-52 percent. To evaluate the treatment efficacy of this drug combination, we conducted an open, prospective study of 58 consecutive treatment-naïve patients infected with HCV genotype 1 and treated at a university hospital, comparing those presenting an SVR (SVRs), nonresponders (NRs), and relapsers (RELs). Among the intent-to-treat patients, an end-of-treatment virological response was achieved in 69 percent of the sample as a whole and in 52 percent of the SVRs. We found that being an SVR was significantly associated with mild fibrosis (p = 0.04) and with undetectable HCV RNA at weeks 12 and 24 of treatment (p < 0.0001). Comparing the SVR and REL groups, we observed that being older than 40 was significantly associated with being a REL (p = 0.04). Being an NR was found to be associated with severe fibrosis and moderate inflammatory infiltrates (portal or periportal). In the polytomous logistic regression, no independent factors were associated with the REL group when compared with the SVR group. We conclude that RELs and NRs differ in comparison with SVRs. The RELs accounted for 17 percent of the sample. The HCV RNA test results at weeks 12 and 24 of treatment, although independent predictors of non-response (OR: 4.8 and 8.2, respectively), did not differ between SVRs and RELs.

Sociodemographic and clinical characteristics, causal factors and evolution of a group of patients with chronic urticaria-angioedema

CONTEXT AND OBJECTIVE: Chronic urticaria-angioedema is a common, multiple-cause complaint. The aim was to investigate the sociodemographic and clinical characteristics, causal and aggravating factors and evolution of urticaria-angioedema. DESIGN AND SETTING: This was a descriptive prospective study carried out at the Dermatology outpatient clinic of Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp). METHODS: A total of 125 patients with chronic urticaria-angioedema were evaluated to obtain sociodemographic data, anamnesis, dermatological and general clinical data and laboratory data, emphasizing causal and aggravating factors and complaint evolution. RESULTS: Chronic urticaria-angioedema occurred mainly in females (mean age: 35 years), but also in men (mean age: 32 years). White color and living in urban areas also predominated. There was no preferential time for symptoms to appear, and nighttime was the most commonly reported time for clinical worsening. Around half of the patients had urticaria associated with angioedema. There were no associated factors in most of the cases, and stress was the most commonly reported aggravating factor. The cause was ascertained in 37.6 percent of our cases. The mean duration of follow-up was 11.7 months. Around 60 percent of the patients evolved with the problem under control, 32 percent improved, 9 percent had no change in dermatological condition and only one patient worsened. CONCLUSIONS: Chronic urticaria-angioedema was more common among middle-aged women. It is a long-term disease, and its cause was explained in about one-third of the patients. Half of the patients presented disease control after treatment lasting an average of approximately one year.

CONTEXTO E OBJETIVO: Urticária-angioedema crônico é enfermidade freqüente, complexa e multicausal. O objetivo foi estudar as características sociodemográficas, clínicas, os fatores causais, agravantes e a evolução da enfermidade. TIPO DE ESTUDO E LOCAL: Descritivo e prospectivo, realizado no ambulatório de Dermatologia da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp). MÉTODOS: Foram avaliados pacientes com diagnóstico de urticária-angioedema crônico através de dados sociodemográficos, anamnese, exames dermatológico, clínico e laboratorial, com ênfase nos fatores causais, agravantes e na evolução da enfermidade. RESULTADOS: 125 pacientes foram incluídos, 95 mulheres e 30 homens. Predominaram mulheres de 30 a 40 anos e homens de 10 a 20 anos. A idade média foi de 35 anos para as mulheres e 32 anos para os homens. Predominaram pacientes de raça branca, residentes em zona urbana e casados. O tempo médio de doença foi de 45,6 meses e de cada lesão foi de 5,6 horas. A metade dos casos tinha surtos diariamente e associação de urticária com angioedema. Não houve horário preferencial de aparecimento dos surtos, mas o noturno foi o horário de piora mais citado. A causa foi esclarecida em 37,6 por cento, predominando as infecções. O estresse foi o agravante mais referido. O tempo médio de acompanhamento foi de 11,7 meses e 60 por cento evoluíram para o controle, 32 por cento melhoraram, 9 por cento mantiveram-se inalterados e um caso piorou. CONCLUSÕES: Urticária-angioedema ocorreu mais em mulheres de meia-idade. A causa foi esclarecida em um terço dos pacientes e metade deles teve controle da doença em aproximadamente um ano.

Hiperplasia nodular focal do fígado: apresentação de um caso e revisão da literatura / Focal nodular hyperplasia of the liver: a case report and review of the literature

Neste trabalho apresentamos um caso de hiperplasia nodular focal que foi diagnosticado aos seis anos de idade e que está sendo acompanhado até o momento presente. Para o diagnóstico foram imprescindíveis as técnicas de imagem, tendo importância de realce a cintilografia hepatoesplênica e a tomografia computadorizada. Apresentamos, também, revisão da literatura sobre o assunto.

In this case report we discuss a focal nodular hyperplasia diagnosed in a female, six-year old patient, as well as her follow-up from the diagnosis to the present time. Imaging techniques, particularly hepatosplenic scintigraphy and computed tomography, are essential for the diagnosis. Also, a literature review is presented.

Grading and staging chronic hepatitis C and its relation to genotypes and epidemiological factors in brazilian blood donors

Progression of chronic hepatitis C is known to be associated with some factors, but influence of HCV genotypes is still controversial. Association between HCV genotypes and other risk factors was examined to determine which factors are associated with progression of infection. One hundred consecutive anti-HCV positive volunteer blood donors were evaluated for several risk factors, examined for HCV genotypes, and submitted to hepatic biopsy and biochemical exams.HCV genotyping were carried out in 89 patients and hepatic biopsy in 78. Transmission routes were found to be illicit intravenous drug use (26 percent), Gluconergan® use in a non-safe manner (48 percent) and blood transfusion (15 percent). HCV genotype was 1 in 45 percent, 3 in 40 percent, and it was not associated with the stage of fibrosis or with inflammatory activity. There was no significant association of factors related to infection, chronic alcohol use, or duration of illness, with progression of the lesion. There was a significant association of aminotransferase levels and the fibrosis stage. Univariate analysis showed that the age at contamination, patient's age, GT-gamma, and aminotransferase levels over three times the upper normal limits, were associated with fibrosis stages 2 to 4. Multivariate analysis detected age (odds ratio=1.19), and GT-gamma (odds ratio=2.02) as independent factors.

Isolation of Paracoccidoides brasiliensis from armadillos (Dasypus novemcinctus) captured in an endemic area of paracoccidioidomycosis

Paracoccidioides brasiliensis, the causative agent of paracoccidioidomycosis (PCM), was first isolated from the Amazonian gerion where the mycosis is uncommon. In the present study, we report on the high incidence of PCM infection in armadillos from a hyperendemic region of the disease. Four nine-banded armadillos (Dasypus novemcinctus) were captured in the endemic area of Botucatu, Sao Paulo, Brazil, killed by manual cervical dislocation and autopsied under sterile conditions. Fragments of lung, spleen, liver and mesenteric lymph nodes were precessed for histology, cultured on Mycosel agar at 37ºC, and homogenized for inoculation into the testis and peritoneum of hamster. The animals were killed from week 6 to week 20 postinoculation and fragments of liver, lung, spleen, testis, and lymph nodes were cultured on brain heart infusion agar at 37ºC. Paracoccidioides brasiliensis was isolated from three armadillos both by direct organ culture and from the liver, spleen, lung, and mesenteric lymph node hamster. In addition, one positive armadillo presented histologically proven PCM disease in a mesenteric lymph node. The three aramdillos isolates (Pb-A1, Pb-A2, and Pb-A4) presented thermodependent dimorphism, urease activity, and casein assimilation, showed amplification of the gp43 gene, and were highly virulent in intratesticulary inoculation hamster. The isolates expressed the gp43 glycoprotein, the immunodominant antigen of the fungus, and reacted with a pool of sera from PCM patients. Taken together, the present data confirm that armadillos are a natural reservoir of P. brasiliensis and demonstrate that the animal is a sylvan host to the fungus

Adenocarcinoma de cólon com diferenciaçäo neuro-endócrina e escamosa: relato de caso / Colon adenocarcinoma with differentiation neuroendocrine and squamous cell

O presente trabalho relata um caso de adenocarcinoma tubular de cólon com áreas sólidas compostas por pequenas células, de diferenciaçäo neuro-endócrina, demonstrada por estudo imunohistoquímico, usando-se como marcador enolase neural específica. Em outras áreas do tumor foram visualizadas células escamosas com tendência a ceratinizaçäo. A presença de características neuroendócrinas e escamosa fornece evidência da capacidade de diferenciaçäo multi-direcional das células neoplásicas colônicas. As implicaçöes desta combinaçäo em relaçäo com as teorias sobre origem e diferenciaçäo tumoral e a significância prognóstica das células neuro-endócrinas em neoplasias malignas do trato gastrointestinal, säo discutidas

Hipertensäo portal em cäes por injeçäo de sílica na veia porta: estudos manométricos e histológicos / Portal Hypertension in dogs after injection of silica in the portal vein: manometric and histologic studies

Injeçöes de sílica sob diferentes formas e por vias diversas tem sido utilizadas para a produçäo experimental de hipertensäo portal. Neste trabalho foi utilizada a sílica na forma de talco comercial e procurou-se padronizar uma dose capaz de produzir hipertensäo portal em cäes com níveis compatíveis com a sobrevida dos animais. Procurou-se ainda produzir hipertensäo portal crônica por injeçöes repetidas de sílica na veia porta. A dose de sílica, 50 mg/Kg de peso corpóreo resultou em aumento de cerca de duas vezes a pressäo normal e morte espontânea de 20% dos animais: a dose de 100 mg/Kg levou todos os animais a óbito em menos de 24 horas. Injeçöes repetidas de sílica com acompanhamento por 4 meses levaram a hipertensäo portal sem repercusäo para a circulaçöa colateral e o modelo näo foi considerado válido, para os fins desejados. Além desse resultado hemodinâmico näo satisfatório houve também problema técnico porque depois de várias laparotomias houve intensa fibrose periportal dificultando o isolamento da veia

Intestinal cryptosporidiosis: association with Pneumocystis carinii, cytomegalovirus and Candida sp. infections

Trata-se de apresentaçäo de um caso de criptosporidiose intestinal diagnosticada histologicamente em material de autópsia. A paciente era uma criança de 5 meses, internada com diarréia aguda grave, associada a pneumonia por Pneumocystis carinii, sialadenite citomegálica e candidíase oral e cutánea. A presença de infecçöes oportunísticas múltiplas indicaram o diagnóstico de imunodeficiência. Cryptosporidium sp é uma possibilidade etiológica para diarréias agudas em pacientes imunodeprimidos ou imunocompetentes e deve ser procurado em material de autópsia quando näo diagnosticado "in vivo"