An elderly man with gastric cancer, Saint's triad and Heyde's syndrome / Un anciano con cáncer gástrico, tríada de Saint y síndrome de Heyde

This case study describes a 71-year-old man with signet-ring cell gastric adenocarcinoma and malignant sigmoidal polyp; and typical features of Saint's triad and Heyde syndrome. He had digestive bleeding, two types of hernia, diverticulosis, arterial hypertension, malignant polyp, and antecedent of smoking, lung tuberculosis, and surgical correction of aortic valve stenosis. There is a hypothetical inverse relationship between herniosis and development of malignancy; however, the patient herein described presented gastric and sigmoidal cancers. Gastrointestinal malignancies are sometimes associated with paraneoplastic entities, isolated or manifested as syndromes, but neither Saint's triad or Heyde syndrome have been included. This patient persisted clinically stable during the preoperative period, but suddenly died; Trousseau's syndrome would be the most probable mechanism of sudden death in this setting. Case reports can stimulate further studies to get additional knowledge about unusual entities.

Este estudio de caso describe un hombre de 71 años de edad, con adenocarcinoma gástrico con células en anillo de sello y un pólipo maligno sigmoideo; y características típicas de la tríada de Saint y del síndrome de Heyde. Tuvo una hemorragia digestiva, dos tipos de hernias, divertículos, hipertensión arterial, y pólipo maligno; con antecedente de tabaquismo, tuberculosis pulmonar, y corrección quirúrgica de estenosis de la válvula aórtica. Hay una hipotética relación inversa entre hernioses y el desarrollo de malignidades; sin embargo, el paciente que se describe en el presente documento presentó cánceres gástrico y sigmoideo. Neoplasias gastrointestinales se asocian a veces con entidades para neoplásicas aisladas o manifiestan síndromes, pero ni la tríada de Saint ni el síndrome de Heyde se ha incluido. Este paciente persistió clínicamente estable durante el período preoperatorio, pero de repente murió; síndrome de Trousseau sería el mecanismo más probable de muerte súbita en esta situación. Los informes de casos pueden estimular más estudios para obtener un conocimiento adicional sobre esas entidades inusuales.

Late diagnosis of nodular melanoma of the foot in a 74-year-old Brazilian man / Diagnóstico tardío de melanoma nodular del pie en un varón con 74 años

The incidence and mortality of malignant melanoma is increasing. Its early diagnosis can contribute to a favorable prognosis. We report a 74-year-old black man with a dark brown mole in the right plantar area, that grew slowly in the last decade. A biopsy of the lesion revealed a nodular malignant melanoma. A wide excision of the tumor was performed 18 months ago, followed by chemotherapy for nine months. At admission, the patient was debilitated, and presented with numerous nodules in the lower limb and suprapubic area. Imaging studies disclosed chest and abdominal nodules. The patient died 13 days after admission.

Melanoma maligno constituye una importante preocupación debido al incremento de la incidencia y mortalidad. El diagnóstico precoz de esta malignidad puede contribuir para prognósticos favorables. Se describe el diagnóstico tardío de melanoma nodular del pie en un varón afro-brasileño con 74 años de edad. El propósito es aumentar el índice de sospecha acerca de esta infrecuente localización del tumor de la piel, y estimular a los médicos de cuidado primario para realizar examen minucioso del cuerpo entero, contribuyendo a la detección temprana de los cánceres de piel.

Microbiota associated with tramp ants in a Brazilian University Hospital / Microbiota associada às formigas urbanas em um Hospital Universitário Brasileiro

Our aim was to study the fauna of ants in the Hospital Universitário of the Universidade Federal do Triângulo Mineiro, municipality of Uberaba, Minas Gerais State, Brazil, as well as to identify the microorganisms the ants carry and their patterns of resistance to antibiotics. Sterile tubes (traps) containing honey were used to attract the ants. Traps were exposed for 3h, and those which attracted ants were considered the test group, while the ones that did not attract the insects constituted the control group. Only the ant species Tapinoma melanocephalum (Fabricius) was sampled. Sixty microorganisms were isolated from the sampled ants, including seven Gram-positive bacilli, 14 Gram-negative bacilli, 22 Gram-positive cocci and 17 filamentous fungi. Pseudomonas, Staphylococcus and Group D Streptococcus were the microorganisms with the highest resistance to the tested antibiotics. The ants should be considered an important vector of infections as they carry several pathogenic microorganisms, spreading them on the surface of sterile materials, equipments and uncontaminated food. It is impossible to define the exact role of ants in nosocomial infections at this moment; however, this issue must be better studied and special attention must be given by the commissions of Nosocomial Infection Control.

O objetivo deste estudo foi conhecer a fauna de formigas existente no Hospital Universitário da Universidade Federal do Triângulo Mineiro, Uberaba, MG, bem como as espécies de microrganismos transportadas por elas, além de identificar o padrão de resistência destes microrganismos a antimicrobianos. Para atrair as formigas, utilizaram-se tubos estéreis contendo mel. Após período de exposição de 3h, os mesmos foram tampados. Os tubos que atraíram formigas foram considerados o grupo teste e os que não atraíram o controle. Apenas Tapinoma melanocephalum (Fabricius) foi amostrada. O isolamento de microrganismos dos exemplares de T. melanocephalum apontou 60 espécies, entre as quais sete eram bacilos Gram positivo, 14 bacilos Gram negativo, 22 cocos Gram positivo e 17 fungos filamentosos. Pseudomonas, Staphylococcus e Streptococcus do grupo D foram os microrganismos que apresentaram maior resistência aos antibióticos. As formigas devem ser consideradas um importante vetor de infecções, pois são carreadoras de microrganismos, levando-os na superfície de seu corpo para materiais estéreis, equipamentos e alimentos não-contaminados. Não é possível definir o papel exato das formigas em infecções nosocomiais. No entanto, este deve ser melhor avaliado e atenção especial deve ser dada pelas comissões de Controle de Infecções Hospitalares.

Budd-chiari syndrome and unsuspected gastric adenocarcinoma

The Budd-Chiari syndrome has not been described in young patients with gastric cancer. A case of Budd-Chiari syndrome and carcinomatous Iymphangitis is reported in a 28 years-old white man with unsuspected gastric cancer, presenting jaundice, hematemesis and dyspnea. Autopsy disciosed gastric adenocarcinoma invading vessels of the submucous and serous layers, with gastric and intestinal bleeding, liver and lung metastases. Multiple mixed (fibrin, platelets and tumor cells) microthrombi were observed in small pulmonary blood vessels, and both subpleural Iymph vessels and lung interstitium contained metastatic tumor cells.

C-cells in colloid goiter

PURPOSE: The aim of this investigation was to quantitatively evaluate C-cells in colloid goiters, analyzing 36 thyroids that were obtained through thyroidectomy from 24 patients with goiter and 12 normal glands from adult patients without thyroid disease, which were used as the control group. MATERIAL AND METHODS: On average, 6 different thyroid areas were sampled and labeled by immunohistochemistry with a monoclonal anticalcitonin antibody, utilizing the avidin-biotin-peroxidase complex. C-cells were counted in fields measuring 1 square centimeter, and the mean number of cells per field was then calculated. Data were statistically analyzed using the Mann-Whitney test. RESULTS: In the colloid goiter group, the number of C-cells ranged from 0 to 23 per field, while in normal controls they ranged from 20 to 148 per field. CONCLUSIONS: These results demonstrate a significant decrease of C-cell number in the colloid goiter group compared with control group, indicating that the hyperplastic process is restricted to follicular cells, to the detriment of C-cells, which probably cease to receive trophic stimuli

Spontaneous B-cell lymphoma in hamster

During anatomopathologic study, including immunohistochemistry, about chagasic pancreatitis experimentally induced in four month aged male non-isogenic hamsters, weighing 107.8 ±: 10.9g, lymphoma infiltration was observed in a 15 month-aged normal control animal. The neoplasia was disclosed on the occasion of necropsy studies, 330 days after the beginning of experiment. Similar lymphoma was not found in the remainder normal controls (n=73), nor in the group of infected hamsters age and weight matched (n=94). The neoplasia histopathologic and immunohistochemical changes were consistent with non-Hodgkin diffuse large B-cell lymphoma; nevertheless, the hypothesis of eventual leukemic origin was not entirely excluded. Experimentally induced lymphomas have been related in laboratory animals; however, cases of spontaneously occurring lymphoma have been infrequently described in hamsters. In the present case, the development of the disease could have some relation with the animal aging process

Chylothorax in hairy cell leukemia

A case of postoperative left chylothorax in a 43-year-old black woman with hairy cell leukemia is reported. First submitted to pleural drainage, she was successfully treated with a combination of chemotherapy and elemental enteral diet enriched with medium-chain triglycerides.