Detecting p53 immunoexpression in esophageal mucosa with exfoliative cytology in individuals at risk for squamous cell carcinoma of the esophagus.

OBJECTIVE: To determine the prevalence of p53 expression in cytologic smear collected by the RS Balloon in high-risk individuals, and test its yield in the cytologic screening of squamous cell carcinoma of the esophagus (SCCE). STUDY DESIGN: Asymptomatic individuals at risk for SCCE underwent esophageal exfoliative cytology with the RS Balloon immediately followed by upper gastrointestinal endoscopy with biopsies of unstained areas after iodine mucosal staining of the esophagus. For each patient, cytologic expression of p53 was compared with the worst endoscopic biopsy diagnosis and the histologic expression of p53. RESULTS: One hundred seventy-one individuals were submitted to the study's protocol. There were 8 lost cases (4.7%) due to inadequate cytologic samples. The final sample consisted of 163 individuals where 150 were male (92%), mean age of 52.6 +/- 12.0 years old. There were 3 cases of dysplasia/SCCE. Immunohistochemical expression of p53 protein was positive in 38 patients (23.6%), with basal layer expression in 29 (76.3%), middle layer expression in 8 (21.1%) and superficial layer in 1 (2.6%). All patients with dysplasia/SCCE had positive immunohistochemical expression of p53 protein. Immunocytochemical expression of p53 protein in cytologic smear was negative in all cytology samples. CONCLUSION: The negative results of immunocytochemical expression of p53 protein suggest that its use does not contribute to improving the performance of conventional cytology of the esophagus in the screening for SCCE and its precursor lesions.

Sensitivity and specificity of nested and real-time PCR for the detection of Pneumocystis jiroveci in clinical specimens.

A polymerase chain reaction (PCR)-based test for Pneumocystis jiroveci (formerly Pneumocystis carinii f. sp. hominis) might be an alternative to histologic diagnoses of P. jiroveci pneumonia (PCP). However, previously developed nested PCR methods tend to have low specificities (high false-positive rates). In this study, nested and quantitative real-time PCR methods for the amplification of the P. jiroveci DHPS (dihydropteroate synthase) gene were evaluated in a variety of stored clinical samples from Spain, South Africa, and Brazil. The sensitivities of both assays were high, ranging from 62.5% to 100% depending on the type of specimen. In a subset of 71 microscopically confirmed PCP cases and 70 negative cases, the sensitivities and specificities were 94% and 81% for nested PCR and 94% and 96% for real-time PCR, respectively. Real-time PCR has a statistically significantly better specificity than nested PCR (P = .015) and is likely to generate fewer false positives.

Citopatologia de tumores raros do pulmão e da parede torácica: relato de seis casos / Cytological characteristics of rare thoracic tumors: report of six cases

Sob o ponto de vista citopatológico, existem três grandes tipos de tumores brônquicos: carcinoma de células escamosas, adenocarcinoma e carcinoma de pequenas células, que correspondem em nossa experiência, a mais de 95 dos casos. Os demais tipos citológicos são muito raros, mas sua eventual ocorrência deve ser sempre buscada, pois seu comportamento biológico e respectivo tratamento costumam diferir e necessitam individualização. Neste trabalho, relatamos seis casos de tumores torácicos relativamente raros, com sua respectiva apresentação citopatológica: oncocitoma pulmonar, fibrossarcoma pulmonar, tumor de Askin, mieloma da parede torácica, envolvimento pleuro-pulmonar por linfoma de células T e metástase endobrônquica de carcinoma de endométrio

Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: a double-blind randomized trial.

BACKGROUND: the study was designed to test whether vitamin E (VE) provides oral mucosal protection in patients with irradiated cancers of the head and neck. METHODS: Fifty-four patients with cancer of the oral cavity and oropharynx were randomly assigned to rinse the oral cavity in an oil solution containing either VE or placebo before every conventional fraction of 2 Gy and again 8 to 12 hours later during the 5 to 7 weeks of radiotherapy (RT). RESULTS: Thirty-six events/167 patient-weeks (21.6%) and 54 events/161 patient-weeks (33.5%) of symptomatic mucositis were observed in VE and placebo groups, respectively (p =.038). VE reduced the risk by 36%. Subjective data at the end of the treatment revealed that VE decreased pain grades 2 to 3 during RT (3 of 28 patients vs 14 of 26 patients, p =.0001). No significant influence was detected in survival. CONCLUSION: VE decreased the incidence of symptomatic oral radio-induced mucositis in patients with cancer of the oropharynx and oral cavity.

Microscopy and polymerase chain reaction detection of Leishmania chagasi in the pleural and ascitic fluid of a patient with AIDS: Case report and review of diagnosis and therapy of visceral leishmaniasis.

Atypical visceral leishmaniasis is increasingly reported in immunocompromised patients, including patients with AIDS. A case of visceral leishmaniasis in an HIV-infected Brazilian patient with pulmonary and peritoneal involvement is reported. Histological evaluation of pleural fluid and ascites aspirate revealed macrophages with intracellular Leishmania. Polymerase chain reaction analysis was positive for Leishmania in the pleural and ascitic fluid with use of primers specific for Leishmania chagasi. In addition to classical methods for diagnosing leishmaniasis, such as microscopy and culture, polymerase chain reaction detection and identification of Leishmania species in pleural effusions and ascites are important diagnostic tools that should be considered by clinicians evaluating HIV-infected patients from endemic areas of visceral leishmaniasis. The authors review the clinical manifestations, diagnostic and therapeutic aspects of visceral leishmaniasis in immunocompetent and HIV-infected patients.

Dados epidemiológicos do câncer de colo uterino no Rio Grande do Sul / Epidemiological data of cervix neoplasies in Rio Grande do Sul, Brazil

O objetivo deste trabalho foi estudar a epidemiologia descritiva do câncer do colo uterino no Rio Grande do Sul, no período de 1980/94 e verificar a situação da prevenção secundária dessa neoplasia pela citologia. Foram construidas séries históricas com índices de mortalidade padronizados pela população mundial, a partir dos dados da Secretaria de Saúde e Meio Ambiente do Rio Grande do Sul e analisadas pelo coeficiente de correlação de Pearson para séries históricas. Os resultados foram comparados com séries anteriores publicadas na literatura e com dados do Instituto Nacional do Câncer do Brasil. Concluiu-se que a mortalidade por câncer de colo uterino no Rio Grande do Sul continua ascendente, apesar dos esforços da SSMA para sua prevenção pela citologia. São apresentadas sugestões para remediar essa situação no Rio Grande do Sul

Papel do papilomavirus humano (HPV) na genese do carcinoma de colo de utero: suas implicacoes atuais no rastreio / Role of human papillomavirus (HPV) in the pathogenesis of uterine cervical cancer; implications for screening

Neste trabalho a literatura recente em relacao as seguintes questoes e revisada: 1) qual e a prevalencia HPV, em mulheres cujo exame citopatologico foi normal? 2) existe correlacao entre a morfologia citologica ou histologica e o tipo de HPV? 3) qual e a historia natural da infeccao pelo HPV do colo uterino? 4) quando determinar o tipo de HPV por biologia molecular? 5) que alteracoes nas estrategias de rastreamento populacional esses novos conhecimentos estao a exigir? e 6) que expectativa devemos ter em relacao as vacinas profilaticas e curativas em estudo?

Derrames seroso: citopatology / Serous effusions: cytopathology

Os mecanismos de formação dos derrames serosos, transudatos e exsudatos são brevemente mencionados. A citologia dos derrames é discutida, com ênfase nas principais aplicações clínicas: diagnóstico dos derrames infecciosos piogênicos, derrames por neoplasias primárias (Mesoteliomas) e metastáticas (carcinomas e linfomas). As distinções entre células mesoteliais "reativas" e mesoteliomas e adenocarcinomas metastáticos são discutidas e ilustradas

Insuficiência respiratória aguda causada por hiperinfecçäo pelo "Strongyloides Stercoralis": relato de um caso / Acute respiratory failure due to hyperinfection by \"Strongyloides Stercoralis\": a case report

O presente trabalho aborda um caso de hiperinfecçäo por Strongyloides stercoralis em um paciente idoso, com DPOC e Cor Pulmonale. Descrevem-se as manifestaçöes clínicas atuais, relacionadas à infecçäo respiratória aguda grave que segue curso inusitado, apontam-se aspectos diagnósticos e terapêuticos relevantes para o sucesso da intervençäo médica. É ressaltada a importância das informaçöes fornecidas pela radiologia, fibrobroncoscopia e microbiologia do lavado broncoalveolar, para a elucidaçäo diagnóstica. Enfatiza-se que, sendo uma doença curável, de terapêutica simples e pouco dispendiosa, näo haja retardo no início do tratamento pois, uma vez estabelecida, a hiperinfecçäo pelo S. Stercoralis apresenta alto risco de mortalidade