Dioctophymosis in a free-ranging maned wolf (Chrysocyon brachyurus): clinical-therapeutic, ultrasonographic and pathological aspects - case report / [Dioctofimose em um lobo guará (Chrysocyon brachyurus) de vida livre: aspectos clínico-terapêuticos, ultrassonográficos e patológicos - relato de caso]

Dioctophymosis is the disease caused by Dioctophyma renale, a large nematode, popularly known as giant kidney worm, and whose definitive hosts are the domestic dog and many wild mammal species. There are some reports of maned wolf parasitism by D. renale, however, in most cases the reports are restricted to the finding of the parasite during necropsy, without clinical assessment. The present report aimed to describe the clinical-therapeutic, ultrasonographic and pathological aspects of D. renale parasitism in a free-ranging maned wolf, emphasizing the treatment with an association of doramectin, praziquantel, pyrantel pamoate, and febantel that resulted in complete elimination of the parasite.(AU)

A dioctofimose é a doença causada pelo Dioctophyma renale, um nemátodo grande, popularmente chamado de verme gigante do rim e que tem como hospedeiro definitivo o cão doméstico e inúmeras espécies de mamíferos silvestres. Existem alguns relatos do parasitismo do lobo-guará por D. renale, contudo, na maioria das vezes, os relatos se restringem apenas ao achado do parasita durante a necropsia, sem a correlação clínica. O presente relato objetiva descrever os aspectos clínico-terapêuticos, ultrassonográficos e patológicos do parasitismo por D. renale em um lobo-guará de vida livre, enfatizando o tratamento com uma associação de doramectina, praziquantel, pamoato de pirantel e febantel, o que resultou na eliminação completa do parasita.(AU)

Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients?

Non-alcoholic steatohepatitis (NASH) has been associated with hepatocellular carcinoma (HCC) often arising in histologically advanced disease when steatohepatitis is not active (cryptogenic cirrhosis). Our objective was to characterize patients with HCC and active, histologically defined steatohepatitis. Among 394 patients with HCC detected by ultrasound imaging over 8 years and staged by the Barcelona Clinic Liver Cancer (BCLC) criteria, we identified 7 cases (1.7 percent) with HCC occurring in the setting of active biopsy-proven NASH. All were negative for other liver diseases such as hepatitis C, hepatitis B, autoimmune hepatitis, Wilson disease, and hemochromatosis. The patients (4 males and 3 females, age 63 ± 13 years) were either overweight (4) or obese (3); 57 percent were diabetic and 28.5 percent had dyslipidemia. Cirrhosis was present in 6 of 7 patients, but 1 patient had well-differentiated HCC in the setting of NASH without cirrhosis (fibrosis stage 1) based on repeated liver biopsies, the absence of portal hypertension by clinical and radiographic evaluations and by direct surgical inspection. Among the cirrhotic patients, 71.4 percent were clinically staged as Child A and 14.2 percent as Child B. Tumor size ranged from 1.0 to 5.2 cm and 5 of 7 patients were classified as early stage; 46 percent of all nodules were hyper-echoic and 57 percent were <3 cm. HCC was well differentiated in 1/6 and moderately differentiated in 5/6. Alpha-fetoprotein was <100 ng/mL in all patients. HCC in patients with active steatohepatitis is often multifocal, may precede clinically advanced disease and occurs without diagnostic levels of alpha-fetoprotein. Importantly, HCC may occur in NASH in the absence of cirrhosis. More aggressive screening of NASH patients may be warranted.

Low occurrence of occult hepatitis B virus infection and high frequency of hepatitis C virus genotype 3 in hepatocellular carcinoma in Brazil

Occult hepatitis B virus (HBV) infection has been reported among patients with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC). Our aim was to evaluate the presence of occult HBV infection in patients with HCV-related liver cirrhosis (LC) with or without HCC in São Paulo, Brazil. Serum and liver tissue samples from 50 hepatitis B surface antigen-negative patients with HCV-related LC who underwent liver transplantation at the University of São Paulo School of Medicine Hospital from 1993 to 2004 were divided into groups with LC only (N = 33) and with LC plus HCC (N = 17). HBV DNA was assayed for serum and paraffin-embedded liver tissue (tumoral and non-tumoral) using real time PCR and only 1 case with HCC had HBV DNA-positive serum. All liver samples were negative. HCV genotype 3 was detected in 17/39 (43.7 percent) cases. In conclusion, using a sensitive real time PCR directed to detect HBV variants circulating in Brazil, occult hepatitis B infection was not found among HCV-positive cirrhotic patients and was rarely found among HCV-positive HCC patients. These results are probably related to the low prevalence of HBV infection in our population. Furthermore, we have also shown that HCV genotype 3 is frequently found in Brazilian cirrhotic patients, particularly when they also have HCC. More studies involving a large number of cases should be carried out to confirm these data and to further characterize Brazilian HCV genotype isolates to elucidate genetic features that might be related to its carcinogenic potential.

Tumores neuro-endocrinos do estomago e duodeno: estudo morfologico e imunohistoquimico das suas diferentes formas de apresentacao clinico-patologicas / Neuroendocrine tumors of the stomach and duodenum: a morphologic and imunohistochemical study of the different clinical and pathological presentations

Apos o advento da endoscopia digestiva alta, o numero de casos diagnosticados com tumores neuroendocrinos (TNE) gastricos e duodenais tem aumentado consideravelmente. Novas classificacoes tem sido propostas, entretanto ha escassez de conhecimento em nosso meio, motivando o presente estudo...