Granulomas do pênis: uma complicação rara da terapia intravesical com Bacilo Calmette-Guérin / Granulomas of the penis: a rare complication of intravesical therapy with Bacillus Calmette-Guerin

A imunoterapia com o Bacilo Calmette-Guérin é amplamente usada no tratamento e profilaxia da neoplasia urotelial superficial. As complicações associadas ao tratamento são comuns. Os autores relatam um caso de inflamação granulomatosa do pênis, associada à terapia intravesical com Bacilo Calmette-Guérin, com múltiplos nódulos eritematosos indolores localizados na glande. É também efetuada uma revisão da literatura. A balanopostite granulomatosa é uma complicação rara associada à imunoterapia com Bacilo Calmette-Guérin, com uma apresentação clinicamente heterogênea que pode dificultar o diagnóstico. O seu reconhecimento clínico é essencial para o início precoce de tuberculostáticos e interrupção de Bacilo Calmette-Guérin.

Immunotherapy with Bacillus Calmette-Guérin is widely used for treatment and prophylaxis of superficial urothelial cancer. Complications associated with Bacillus Calmette-Guérin treatment are common. The authors describe a case of granulomatous inflammation of the penis associated with intravesical Bacillus Calmette-Guérin therapy, presenting with multiple erythematous and painless nodules located on the glans. A review of the literature is also performed. Granulomatous balanoposthitis is a rare complication of Bacillus Calmette-Guérin immunotherapy, with heterogeneous clinical presentation, which can make the diagnosis difficult. Its clinical recognition is essential for early start of therapy with antitubercular agents and interruption of Bacillus Calmette-Guérin.

A case of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis / 대한간학회지

Allopurinol-induced hypersensitivity syndrome is characterized by an idiosyncratic reaction involving multiple-organs, which usually begins 2 to 6 weeks after starting allopurinol. In rare cases, the adverse reactions to allopurinol are accompanied by a variety of liver injury, such as reactive hepatitis, granulomatous hepatitis, vanishing bile duct syndrome, or fulminant hepatic failure. Here we report a case with granulomatous hepatitis and ductopenia. A 69-year-old man with chronic renal failure, hyperuricemia, and previously normal liver function presented with jaundice, skin rash, and fever 2 weeks after taking allopurinol (200 mg/day). In histopathology, a liver biopsy specimen showed mild spotty necrosis of hepatocytes, marked cholestasis in parenchyma, and some granulomas in the portal area. There were vacuolar degeneration in the interlobular bile ducts and ductopenia in the portal tracts. Pathologic criteria strongly suggested the presence of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis. The patient fully recovered following the early administration of systemic corticosteroid therapy.

Accidental self-injection with Freund's complete adjuvant.

The case of a research worker who accidentally injected herself with Freund's Complete Adjuvant (FCA) in the right forearm is reported. This resulted in a serious granulomatous inflammation of the hand an forearm. She was treated with corticosteroids and chloroquine with good result. The course of this reaction and the hazards of injection with FCA are emphasised and the relevant literature reviewed.

Pterigium con mitomicina-C al 0, 02 por ciento: resultados y complicaciones / Pterygium with mytomicin-C to 0, 02 percent: results and complications

Objetivos: la finalidad de este trabajo es determinar la efectividad y las complicaciones asociadas al uso de mitomicina-C al 0,02 por ciento, intraoperatoria en la cirugía del pterigium. Pacientes y método: un total de 23 ojos en 23 pacientes fueron intervenidos por el mismo cirujano. Los criterios de inclusión consideraban pterigium uni o bilateral en pacientes menores de 40 años, o recidivantes en cualquier edad, que comprometían al menos 1,5 mm de la córnea desde el limbo, sin patología corneal concomitante. Como grupo control se consideraron 20 pacientes operados sin el antimitótico, con la misma técnica y por el mismo cirujano. Los pacientes fueron controlados a los 7, 30, 90 días y al año. Resultados: del total de pacientes operados con mitomicina al año, 4 pacientes de 23 presentaron recidivas (17,39 por ciento), entendidas como formaciones de 1,5 o más mm en la córnea, frente a 10 sobre 20 de los controles (50 por ciento). Las complicaciones fueron 1 caso de escleromalacia (4,35 por ciento), 5 casos de dehiscencias de sutura con formación de granuloma (21,74 por ciento), y 1 caso de quiste conjuntival tratado con reintervención a los 6 meses. Conclusiones: el uso de mitomicina al 0,02 por ciento en dosis única reduce la tasa de recidivas del pterigium con la técnica empleada, pero se asocia a una mayor incidencia de dehiscencias de sutura y granulomas

Jelly petrolatum conjunctival granuloma: a case report

Os autores relatam um caso de granuloma da conjuntiva que ocorreu em consequência de uma complicaçäo de uma cirurgia dos seios para-nasais. Fraturas bilaterais dos ossos etmoidais possibilitaram a infiltraçäo subconjuntival da vaselina comumente utilizada ao final dessas cirurgias

Acute granulomatous iritis following 5 fluorouracil therapy for failed trabeculectomy.

We are reporting a case which developed idiosyncratic anterior granulomatous uveitis following a single dose of subconjunctival 5 Fluorouracil. This has not been previously reported anywhere in the world.

Central modulation of croton oil induced subacute inflammation in rats.

Earlier studies from this laboratory have indicated that CNS exerts a modulatory influence over acute inflammation in rats. The present study examines the existence of a similar modulatory effect of CNS on a subacute inflammatory paradigm, the croton oil-induced granuloma pouch in rats. The inflammatory exudate, collected on 6th day after croton oil administration, was found to be substantially less in intracerebroventricular (icv) cannulated and artificial cerebrospinal fluid administered rats as compared to their uncannulated saline (ip) administered counterparts. This effect may be due to stress induced by cannulation. Centrally administered pharmacological agents which attenuate central monoaminergic, cholinergic or prostaglandin systems had insignificant effects on the inflammatory exudate. However, induced increase in central noradrenergic activity was found to attenuate the inflammation when the treatment was done before, but not 48 hr after, the induction of the inflammation. In contrast, induced increase in central serotonergic activity had no effect on the volume of the inflammatory exudate at either time period. Steady state levels of rat brain noradrenaline and serotonin, but not dopamine, were enhanced by the inflammatory procedure. However, these effects may be attributed to the stress induced by croton oil inflammation. The investigation indicates that the modulatory influence of CNS remains limited to the acute phase of inflammation, being exerted mainly by the central noradrenergic system. Once the inflammation has progressed, this modulatory influence of CNS is no longer apparent.

Estudio comparativo con dos tipos de mallas sintéticas en plásticas intraabdominales en la rata / Comparative study with 2 synthetic mesh types in intraabdominal surgery on the rat

A 20 ratas se les realizó una plástica de la pared abdominal mediante prótesis colocadas intraperitonealmente. En 10 se empleó una malla de polipropileno y en las restantes prótesis de poliglactina 370. Luego de 45 días todos los animales habían sido sacrificados. El examen histológico demostró escasa reacción inflamatoria en los preparados con mallas absorbibles, mientras que aquellos con materiales no absorbibles desarrollaron una gran respuesta inflamatoria con la formación de bridas y granulomas. Estos hallazgos inducen, a través de un modelo experimental, a continuar evaluando y preferir en la práctica, la utilización de mallas sintéticas absorbibles, en aquellos procedimientos de reemplazo de la pared abdominal, que necesitan una prótesis en posición intraperitoneal.

Morphology and collagen isotypes of carrageenin granuloma

1. Injection of carrageenin into the liver of rats provoked a focal necrotic-hemorrhagic lesion that evolved through acute inflammation, accumulation of macrophages and fibroblasts and the formation of a relatively large amount of fibrous tissue that underwent resorption. The entire lesion disappeared within15-18 days of the beginning of incolulation. 2. Ultrastructural analysis revealed that carrageenin granules were taken up by macrophages, fibroblasts and myofibroblasts and that signs of formation and degradation of collagen were constant features, the former predominating early and the latter being evident to ward the second half of the evolution of the lesion. 3. The presence of fibronection was prominent during the first days and Type I and type III collagens were present in the extracellular matrix soon after induction of the carrageenin lesion. Both collagen isotypes subsequently underwent progressive and simultaneous resorption. 4. The rapid formation and degradation of both collagen isotypes during the evolution of carrageenin granuloma indicates that collagen stability is not fundamentally dependent on genetic isotype

Tecido de granulaçäo exuberante: efeito colateral da terapêutica com isotretinoína / Excess granulation tissue: side-effect of isotretinoin therapy

Aresentam-se três casos de tecido de granulaçäo excessivo conseqüentes a terapia pela isotretinoína para o acne cístico severo. Sugere-se que, de acordo com as características do grupo sob tratamento, tal evento poderá näo ser täo raro como anteriormente pensado. Aspectos da incidência, patogênese, patologia, epidemiologia e tratamento säo discutidos. Acredita-se que pacientes que apresentaram lesöes tipo granuloma piogênico anteriores à terapia estejam mais propensos ao desenvolvimento de tecido de granulaçao excessivo durante a mesma. Acredita-se que o tratamento de escolha para o mesmo seja o uso de corticóide oclusivo por ser um método eficaz, simples, seguro e indolor. É a primeira publicaçäo brasileira sobre o assunto

Formaçao do granuloma induzido pelo BCG no hamster: influência da hipersensibilidade tardia e da administração do "PPD" na evolução e no número de bactérias das lesões

No presente trabalho foi analisada a influência da hipersensibilidade do tipo tardio sobre a formaçao do granuloma induzido pelo BCG no hamster, bem como o efeito do PPD sobre a evoluçao e o número de bacilos das lesoes. Inicialmente, pode-se confirmar que o sub-epitelial da bolsa cervical do hamster é desprovido, induz a formaçao de lesao granulomatosa e nao sensibiliza o animal ap PPD. Por outro lado, a inoculaçao da bacteria no coxim plantar dos animais provocou lesao granulomatosa significantemente mais exuberante que aquela induzida na bolsa e determinou inequivoca reaçao de hipersensibilidade do tipo tardio ao PPD. Demonstrou-se ainda que a inoculaçao do PPD pelas vias sub-epitelial na bolsa, intravenosa ou intraperitoneal, determinou, em 48 horas, a reativaçao de lesoes induzidas pelo BCG na bolsa, caracterizada por necrose, infiltraçao celular e marcado aumento do número de bactérias na lesao. Demonstrou-se também que o efeito do PPD se dá por açao direta da droga sobre o granuloma, nao tendo o mesmo sido observado em lesoes induzidas na pata dos animais