Vascular dysfunction by myofibroblast activation in patients with idiopathic pulmonary fibrosis and prognostic significance

In this study, we demonstrated the importance of telomerase protein expression and determined the relationships among telomerase, endothelin-1 (ET-1) and myofibroblasts during early and late remodeling of parenchymal and vascular areas in usual interstitial pneumonia (UIP) using 27 surgical lung biopsies from patients with idiopathic pulmonary fibrosis (IPF). Telomerase+, myofibroblasts α-SMA+, smooth muscle cells caldesmon+, endothelium ET-1+ cellularity, and fibrosis severity were evaluated in 30 fields covering normal lung parenchyma, minimal fibrosis (fibroblastic foci), severe (mural) fibrosis, and vascular areas of UIP by the point-counting technique and a semiquantitative score. The impact of these markers was determined in pulmonary functional tests and follow-up until death from IPF. Telomerase and ET-1 expression was significantly increased in normal and vascular areas compared to areas of fibroblast foci. Telomerase and ET-1 expression was inversely correlated with minimal fibrosis in areas of fibroblast foci and directly associated with severe fibrosis in vascular areas. Telomerase activity in minimal fibrosis areas was directly associated with diffusing capacity of the lung for oxygen/alveolar volume and ET-1 expression and indirectly associated with diffusing capacity of the lungs for carbon monoxide and severe fibrosis in vascular areas. Cox proportional hazards regression revealed a low risk of death for females with minimal fibrosis displaying high telomerase and ET-1 expression in normal areas. Vascular dysfunction by telomerase/ET-1 expression was found earlier than vascular remodeling by myofibroblast activation in UIP with impact on IPF evolution, suggesting that strategies aimed at preventing the effect of these mediators may have a greater impact on patient outcome.

Vascular dysfunction by myofibroblast activation in patients with idiopathic pulmonary fibrosis and prognostic significance.

In this study, we demonstrated the importance of telomerase protein expression and determined the relationships among telomerase, endothelin-1 (ET-1) and myofibroblasts during early and late remodeling of parenchymal and vascular areas in usual interstitial pneumonia (UIP) using 27 surgical lung biopsies from patients with idiopathic pulmonary fibrosis (IPF). Telomerase+, myofibroblasts α-SMA+, smooth muscle cells caldesmon+, endothelium ET-1+ cellularity, and fibrosis severity were evaluated in 30 fields covering normal lung parenchyma, minimal fibrosis (fibroblastic foci), severe (mural) fibrosis, and vascular areas of UIP by the point-counting technique and a semiquantitative score. The impact of these markers was determined in pulmonary functional tests and follow-up until death from IPF. Telomerase and ET-1 expression was significantly increased in normal and vascular areas compared to areas of fibroblast foci. Telomerase and ET-1 expression was inversely correlated with minimal fibrosis in areas of fibroblast foci and directly associated with severe fibrosis in vascular areas. Telomerase activity in minimal fibrosis areas was directly associated with diffusing capacity of the lung for oxygen/alveolar volume and ET-1 expression and indirectly associated with diffusing capacity of the lungs for carbon monoxide and severe fibrosis in vascular areas. Cox proportional hazards regression revealed a low risk of death for females with minimal fibrosis displaying high telomerase and ET-1 expression in normal areas. Vascular dysfunction by telomerase/ET-1 expression was found earlier than vascular remodeling by myofibroblast activation in UIP with impact on IPF evolution, suggesting that strategies aimed at preventing the effect of these mediators may have a greater impact on patient outcome.

Analysis of human mammary fibroadenoma by Ki-67 index in the follicular and luteal phases of menstrual cycle.

OBJECTIVES: Fibroadenoma is the most common benign mammary condition among women aged 35 or younger. Expression of Ki-67 antigen has been used to compare proliferative activity of mammary fibroadenoma epithelium in the follicular and luteal phases of the menstrual cycle. MATERIALS AND METHODS: Ninety eumenorrheic women were selected for tumour excision; they were assigned to either of the two groups, according to their phase of menstrual cycle. At the end of the study, 75 patients with 87 masses were evaluated by epithelial cell Ki-67 expression, blind (no information given concerning group to which any lesion belonged). RESULTS: Both groups were found to be homogeneous relative to age, menarche, body mass index, previous gestation, parity, breastfeeding, number of fibroadenomas, family history of breast cancer and tabagism. Median tumour size was 2.0 cm and no relationship between proliferative activity and nodule diameter was observed. No typical pattern was observed in the expression of Ki-67 in distinct nodules of the same patient. Average values for expression of Ki-67 (per 1000 epithelial cells) in follicular and luteal phases were 27.88 and 37.88, respectively (P = 0.116). CONCLUSION: Our findings revealed that proliferative activities in the mammary fibroadenoma epithelium did not present a statistically significant difference in the follicular and luteal phases. The present study contributes to clarifying that fibroadenoma is a neoplasm and does not undergo any change in the proliferative activity during the menstrual cycle.

Lipomas of the oral cavity: clinical findings, histological classification and proliferative activity of 46 cases.

Lipomas represent about 1 to 5% of all neoplasms of the oral cavity. Although relatively common, few large series of intraoral lipomas and its variants are seen in the literature. Therefore, the authors present the clinical, histological and immunohistochemical features of 46 cases of intraoral lipomas reviewed from the files of the University of Campinas Dental School from 1970 to 2001. Most of the cases affected adults, without gender predilection, and the main involved sites were the buccal mucosa (21 cases), tongue (six cases), lips (six cases) and floor of mouth (five cases). The histological analysis revealed 21 cases of lipoma, 18 fibrolipomas, four intramuscular lipomas, two minor salivary gland lipomas and one spindle cell lipoma. PCNA and ki-67 expression indexes were higher in spindle cell lipoma, intramuscular lipomas and fibrolipomas compared to common lipomas, but the differences were not statistically significant. All lesions were removed surgically and none showed recurrence, regardless of the various proliferative activities.

[Cystic neoplasm diagnosed as pancreatic pseudocyst: report of 5 cases and review of the literature]. / Neoplasia cística diagnosticada como pseudocisto de pancrêas: estudo de cinco casos e revisão da literatura.

The majority of cystic lesions of the pancreas are pseudocysts. Nine to thirteen per cent of pancreatic cyst are neoplastic, benign or malignant. Failure to recognize neoplastic nature of a cyst leads to an improper management. The authors present five cases of cystic tumors mistaken for pancreatic pseudocysts, including three mucinous cystadenomas and two mucinous cystadenocarcinomas. Four were drained by cystojejunostomy and one cystogastrostomy. One patient with no metastases at first operation had metastatic spread at reoperation. In the other four cases, subsequent resection was possible and probably curative. Review of the literature and guidelines are given for the purpose of differential diagnosis between theses entities.

[Multicentric myxoid, metachronous and synchronous and multifocal liposarcoma: report of a case]. / Lipossarcomas mixoides multicêntricos e multifocais sincrônicos e metacrônicos: relato de caso.

A case of a male patient, 66 years old, who exhibited in a period of six years many multicentric and multifocal synchronic and metachronic myxoid liposarcomas is reported. The authors made a revision of cytogenetics and DNA alterations recently identified in this type of tumor. The chromosomic alterations are represented by the translocation t(12;16) (q13;p11) and trisomy of the chromosome 8. The genic analysis revealed the presence of altered restriction fragments due to highly specific and reproducible methylation differences. In conclusion the authors suggest that the presence of the multiple tumors of this type in the same patient could be due to a common etiologic factor, not yet known, as being the initiator of this systemic illness of the fat tissue.

[Cystic neoplasm of the pancreas: analysis of 24 cases]. / Neoplasia cística do pâncreas: análise de 24 casos.

Cystic neoplasms are an uncommon group among pancreatic tumors. These lesions are seen more frequently in recent surgical practice, probably because of advances in diagnostic and surgical techniques. We report 24 patients with cystic tumors of the pancreas, including twelve patients with serous cystadenoma, ten with mucinous cystadenoma and two patients with mucinous cystadenocarcinoma. Twenty-two patients were women and two were man. The median age of patients was 53.5 years (range, 21 to 80 years). Mild abdominal pain was the main symptom; in 71% of patients and weight loss in 29% of patients. The lesions were incidental findings 8% of patients. The mean size of the cysts was 7.8 cm (range, 2.3 to 15cm). Eleven cystic neoplasms were located in the head, three in the neck, five in the body, two in the tail of pancreas and three in the body and tail. All patients underwent surgical exploration. There was no perioperative mortality. Total tumor resection provides the best chance of cure and may remove the risk of malignant transformation of the cystadenomas, particularly of the mucinous type.

[Gastric epithelioid leiomyosarcoma simulating pancreatic pseudocyst. Report of a case and review of the literature]. / Leiomiossarcoma epitelióide gástrico simulando pseudocisto de pâncreas. Relato de um caso e revisão da literatura.

The authors report a case of malignant gastric leiomyoblastoma (epithelioid leiomyosarcoma) which was mistaken for a pseudocyst of the pancreas. The patient was operated several times in another hospital. At one of the operations a cystogastrostomy was performed. In november, 1989, when operated again by us, a large tumoral mass arising from the posterior gastric wall was found. The histopathological diagnosis was leiomyoblastoma of the stomach. It is concluded that the wall of a pancreatic cystic lesion should always be submitted to histologic examination in order to be excluded the possibility of a malignant neoplasm.

[Value of lamellar body quantification in leukocytes in amiodarone toxicity]. / Valor da quantificação dos corpos lamelares em leucócitos na toxicidade por amiodarona.

Amiodarone is an amphiphilic drug that penetrates easily through the plasmatic membrane and can induce the production of lysosome lamellar bodies in virtually all cells of the organism, independently of toxic effects. This study determines the value of searching for lamellar bodies in peripheric leucocytes as a method of prevention of pulmonary toxic effects in long term amiodarone treated patients. The rate of leucocytes with lamellar bodies was determined in three groups of patients. The group I was composed of 8 patients with amiodarone induced pneumonia who were taking the drug for an average of 16.88 months (average of 386.60 mg a day). The group II was composed of 19 patients not presenting any toxic effects, and who were taking amiodarone for an average of 38.32 months (average of 260.62 mg a day). The group III consisted by 8 healthy volunteers. The leucocyte layer was sampled from centrifuged peripheric blood and examined by transmission electron microscopy. The average percentage of leucocytes with lamellar bodies was 1.82 in group I, 1.65 in group II and 3.47 in group III. The lamellar inclusions were seen in all groups. There were no significant qualitative or quantitative differences between the groups. The inclusions couldn't be differentiated from other previously described non amiodarone lamellar bodies, such as artifacts and those produced by cellular degeneration. Although lamellar bodies can be observed in leucocytes of patients taking amiodarone, the determination of the rate of affected leucocytes is of no help for predicting amiodarone pulmonary toxicity.

[Postoperative jaundice syndrome after mitral valve replacement. A case report]. / Síndrome de icterícia pós-operatória após substituição valvar mitral. Relato de caso.

A 52-year old woman was submitted to mitral valve replacement. The operation proceeded without complications. Jaundice had been noted since the first postoperative (po) day and increased progressively due to conjugated bilirubin. Abdominal examination was normal and no signs of infection or circulatory failure were noted. Conjugated bilirubin levels increased from 6 mg/dl on the second po day to 20.4 mg/dl on the sixth po day and to 32 mg/dl on the tenth po day. Gammaglutamyl transferase levels were 600 U/L (normal up to 18 U/L) and lactate dehydrogenase levels were 396 U/L (normal) up to 240 U/L) on the seventh po day. Alkaline phosphatase levels were 1880 U/L (normal up to 170 U/L) whereas glutamic oxalacetic transaminase levels were 60 U/L (normal up to 15 U/L) and glutamic pyruvic transaminase levels were 66 U/L (normal up to 17 U/L) on the tenth po day. Abdominal ultrasonography did not disclose dilatation of intra and extra-hepatic biliary system. The patient died after a percutaneous hepatic biopsy procedure. The jaundice was attributed to a cholestatic syndrome after cardiac surgery and cardiopulmonary bypass, due to an impairment of the excretory function of the hepatocyte.

[Primary rhabdomyosarcoma of the heart in children. A case report]. / Rabdomiosarcoma primário do coração em criança. Relato de caso.

The authors report a case of a child, 10 years old with a primary rhabdomyosarcoma of the heart that obstructed both caval veins. The clinical picture that lasted just three months before the admission was characterized by persistent fever, accentuated loss of weight and a very deteriorated general aspect. We emphasize the clinical aspects and other subsidiary elements that easily allowed to make the precise diagnosis in life as well as the therapeutic measures and follow up, besides a review of the literature, where it was confirmed the rarity of this pathological entity.

Myocardial infarct due to a unique atrial myxoma with epithelial-like cells and systemic metastases.

A 73-year-old man had myocardial infarct and coronary emboli from a left atrial myxoma diagnosed at necropsy. The tumor was attached to the atrial roof and showed no local myocardial infiltration. Transmission electron microscopic (TEM), light microscopic, and immunoperoxidase (IPX) studies confirmed the neoplastic character of this lesion and pointed to undifferentiated mesenchymal cells as the origin of the atrial myxoma cells. This case emphasizes two aspects: (1) glandlike structures were also found in the myxoma, and their epithelial-like nature was supported by TEM and IPX studies, which showed positivity for carcinoembryonic antigen and H blood substance; (2) many systemic tumor masses were found, and their metastatic nature was evidenced by the markedly infiltrative and destructive character; the only cytologic marker that could discriminate this case from other usual, noninfiltrative cardiac myxomas was the epithelial-like cells.

Adesivos teciduais no tratamento de perfuracao corneana. Estudo comparativo em cobaios. / Adhesive tissues in treatment of corneal perfuration.Comparative study in guinea pigs

Foi realizada comparacao da acao entre dois adesivos: Histoacryl e Super Bonder sobre cornea. Dezesseis olhos de cobaios foram perfurados e a perfuracao selada com os adesivos citados, seguido de tarsorrafia. Exame biomicroscopico e histologico realizado no 7o. dia revelou acao semelhante dos dois produtos, apesar da cola Super Bonder ter provocado mais edema e infiltrado inflamatorio na observacao clinica e a Histoacryl ter levado a maior acantose

Reuniao anatomo-clinica do Instituto da Crianca. / Anatomo-clinical meeting of the Instituto da Crianca

Os autores descrevem o caso de uma crianca de 3 anos e 8 meses de idade com sinais e sintomas de hipertensao portal. A necropsia revelou ser a causa uma doenca veno-oclusiva hepatica com comprometimentos, em extensao, das veias supra-hepaticas. A crianca faleceu 7 meses apos a internacao. E comentado o diagnostico diferencial com a Sindrome de Budd-Chiari, bem como os aspectos rediologicos dos quadros com hipertensao portal