Solid pseudopapillary tumor of the pancreas: Clinical features, diagnosis and treatment / Tumor sólido pseudopapilífero do pâncreas: características clínicas, diagnóstico e tratamento

Summary Introduction: Solid pseudopapillary tumor of the pancreas (SPTP) is a rare neoplasm of low malignant potential with uncertain behavior, diagnosed mainly in young women. Method: Our report comprises a series of cases of SPTP reviewed retrospectively, highlighting clinical, tomographic and immunohistochemical features, treatment performed and outcomes. Results: Thirteen patients were found to have pancreatic [solid] masses on computed tomography scan measuring a mean diameter of 8.8 cm. All patients underwent complete surgical excision. Immunohistochemistry confirmed diagnosis in all cases. Conclusion: SPTP occurs more frequently in young women. Diagnostic suspicion lies on the finding of a bulky, solid and cystic pancreatic mass. Imaging findings might provide diagnostic information before resection. Conservative approaches can be used in selected cases and survival rates are usually excellent following complete resection.

Resumo Introdução: O tumor sólido pseudopapilífero do pâncreas é uma neoplasia rara de baixo potencial de malignidade e com comportamento incerto, diagnosticado principalmente em mulheres jovens. Método: Uma série de casos dessa patologia é revisada retrospectivamente, focalizando os aspectos clínicos, tomográficos e imuno-histoquímicos, o tratamento realizado e o desfecho. Resultados: Foram avaliadas 13 pacientes com massas pancreáticas, por meio de tomografia computadorizada, com diâmetro médio de 8,8 cm. Todas as pacientes submeteram-se a ressecção cirúrgica completa. A imuno-histoquímica confirmou o diagnóstico em todos os casos. Conclusão: Esses tumores ocorrem frequentemente em mulheres jovens. Suspeita-se do diagnóstico ao encontrar uma volumosa tumoração sólido-cística no pâncreas. As imagens podem fornecer informações diagnósticas antes da ressecção. Podem-se empregar abordagens conservadoras em pacientes selecionados, e a sobrevida geralmente é excelente com a ressecção completa.

Inflammatory and oxidative stress airway markers in premature newborns of hypertensive mothers.

Although oxidative stress and inflammation are important mechanisms in the pathophysiology of preeclampsia and preterm diseases, their contribution to the respiratory prognosis of premature infants of hypertensive mothers is not known. Our objective was to determine the levels of oxidative stress and inflammation markers in the airways of premature infants born to hypertensive and normotensive mothers, in the first 72 h of life, and to investigate whether they are predictors of bronchopulmonary dysplasia (BPD)/death. This was a prospective study with premature infants less than 34 weeks' gestation on respiratory support who were stratified into 2 groups: 32 premature infants of hypertensive mothers and 41 of normotensive women, with a mean gestational age of 29 weeks. Exclusion criteria were as follows: diabetes mellitus, chorioamnionitis, malformation, congenital infection, and death within 24 h after birth. The outcome of interest was BPD/death. Malondialdehyde (MDA), nitric oxide (NO), and interleukin 8 (IL-8) were measured in airway aspirates from the first and third days of life and did not differ between the groups. Univariate and multivariate statistical analyses were performed. The concentrations of MDA, NO, and IL-8 were not predictors of BPD/death. Premature infants who developed BPD/death had higher levels of IL-8 in the first days of life. The gestational age, mechanical ventilation, and a small size for gestational age were risk factors for BPD/death. In conclusion, the biomarkers evaluated were not increased in premature infants of hypertensive mothers and were not predictors of BPD/death.

Inflammatory and oxidative stress airway markers in premature newborns of hypertensive mothers

Although oxidative stress and inflammation are important mechanisms in the pathophysiology of preeclampsia and preterm diseases, their contribution to the respiratory prognosis of premature infants of hypertensive mothers is not known. Our objective was to determine the levels of oxidative stress and inflammation markers in the airways of premature infants born to hypertensive and normotensive mothers, in the first 72 h of life, and to investigate whether they are predictors of bronchopulmonary dysplasia (BPD)/death. This was a prospective study with premature infants less than 34 weeks’ gestation on respiratory support who were stratified into 2 groups: 32 premature infants of hypertensive mothers and 41 of normotensive women, with a mean gestational age of 29 weeks. Exclusion criteria were as follows: diabetes mellitus, chorioamnionitis, malformation, congenital infection, and death within 24 h after birth. The outcome of interest was BPD/death. Malondialdehyde (MDA), nitric oxide (NO), and interleukin 8 (IL-8) were measured in airway aspirates from the first and third days of life and did not differ between the groups. Univariate and multivariate statistical analyses were performed. The concentrations of MDA, NO, and IL-8 were not predictors of BPD/death. Premature infants who developed BPD/death had higher levels of IL-8 in the first days of life. The gestational age, mechanical ventilation, and a small size for gestational age were risk factors for BPD/death. In conclusion, the biomarkers evaluated were not increased in premature infants of hypertensive mothers and were not predictors of BPD/death.

Evaluation of multiplex PCR in first episodes of febrile neutropenia as a tool to improve early yeast diagnosis in leukemic/preleukemic patients.

In febrile neutropenic onco-hematological patients, delayed microbiological diagnosis leads to an increase in morbidity and mortality. Identification of the microorganism changes antibiotic therapy in more than half of cases; however, in only 20-30 % of such cases pathogen isolation is achieved. This study evaluates the frequency of fungus infection and its etiology in onco-hematological patients with febrile neutropenia utilizing blood cultures and non-commercial multiplex polymerase chain reaction (MT-PCR) primers. Fifty-three febrile neutropenia episodes in 35 onco-hematological patients were observed, and the results for the first unique 30 episodes are presented. Blood cultures were positive for Candida tropicalis (one case), gram-positive bacteria (two cases), and gram-negative bacteria (four cases), showing a 23.3 % microbiological isolation rate. Multiplex-PCR pan-fungal sequence was positive in 18 cases (60 %), and further sequencing identified fugal pathogens in 11 cases (Candida glabrata and Candida parapsilosis being the most common). MT-PCR pan-fungal sequence amplification was detected in 13 of 16 patients that later received antifungal treatment for clinical reasons only, while positivity was found in 5 out of 14 patients that did not receive antifungal treatment (p = 0.02). These results show that performing in-house non-commercial MT-PCR is feasible and may provide additional information about fungal infection without the need to wait for culture results. Further research is necessary to incorporate this technology into the decision-making process.

[The making of AIDS news]. / A construção da AIDS-notícia.

This study is part of the overall research effort on the role of the media in making sense of events in late modernity. The main objective is to investigate the context in which news about AIDS is produced at the interface between norms for producing news (as expressed by professional journalists) and an analysis of news stories published in four mainstream Brazilian newspapers. The results are organized in three broad topics: (a) the construction of news about AIDS; (b) the visibility of AIDS news during the study period; and (c) factors that facilitate or hinder the production of AIDS news. Important factors include exclusiveness of the story and/or novelty of the content, the notion of hot (or cold) news, and the specific contents. The authors also emphasize the inevitable chance elements associated with organizational characteristics and daily journalism. They conclude by pointing to recent changes in both the shape of the AIDS epidemic and the communications dynamics resulting from recent developments in the electronic media.

In vivo and in vitro expression of tenascin by human thymic microenvironmental cells.

Increasing evidence reveals that extracellular matrix components can be regarded as a group of mediators in intrathymic T-cell migration and/or differentiation. Yet, little is known about the expression and putative function of one particular extracellular matrix protein, namely, tenascin in the thymus. Herein we investigated, by means of immunocytochemistry, tenascin expression in normal infant and fetal human thymuses, as well as in cultures of thymic microenvironmental cells. In situ, tenascin distribution is restricted to the medulla and cortico-medullary regions of normal thymuses. This pattern thus differed from that of fibronectin, laminin and type IV collagen, in which subseptal basement membranes were strongly labeled. Interestingly, tenascin did not co-localize with the cytokeratin-defined thymic epithelial cell network. This was in keeping with the in vitro data showing that tenascin-bearing cells were nonepithelial (and probably nonfibroblastic) microenvironmental elements. Studies with fetal thymuses revealed a developmentally regulated expression of tenascin, with a faint but consistent network labeling, in thymic rudiments as early as 12 weeks of gestational age, that progressed to a strong TN expression at 18 weeks of fetal development, which was similar to the distribution pattern observed thereafter, including postnatally. Our results clearly indicated that tenascin is constitutively expressed in the human thymus, since early stages of thymic ontogeny, and suggest that the cell type responsible for its secretion is a nonepithelial microenvironmental cell.

Thymic extracellular matrix in human malnutrition.

Previous studies have shown that malnutrition severely affects both lymphoid and epithelial components of the thymus. Yet, few data are available concerning the extracellular matrix (ECM) of the thymic microenvironment in malnutrition. We studied by histological, ultrastructural, and immunohistochemical means thymuses obtained in necropsies from 19 malnourished children. We observed a consistent increase in the intralobular ECM-containing network which could be ascertained histologically by the dense reticulin staining. This abnormally dense ECM network contained fibronectin, laminin, and type IV collagen. Importantly, the enhancement of thymic ECM in malnourished individuals positively correlated with the degree of thymocyte depletion. This correlation may represent a cause-effect relationship in which the contact of thymocytes with abnormally high amounts of thymic ECM triggers and/or enhances programmed cell death.