An experimental study of tissue reaction to hyaluronic acid (Restylane) and polymethylmethacrylate (Metacrill) in the mouse.

The aging skin is a challenge for medical science. Plastic surgeons and dermatologists are called every day to solve problems like filling wrinkles or folds. The material used must be biocompatible because abnormal reactions may cause catastrophic results. This study analyzes the biological behavior of polymethylmethacrylate (Metacrill) and hyaluronic acid (Restylane), using a histopathologic study in mice. A prospective study was performed using 40 mice for each substance: polymethylmethacrylate or hyaluronic acid was injected into the right ear, the left ear been used as a control. Histopathologic analyses of the right ear, liver, and kidney were performed at intervals during the study and revealed the development of a granulomatous reaction with fibrosis and absorption of spheres and signs of liver and kidney sistematization for polymethylmethacrylate. A discrete cellular reaction, with less formation of fibrosis, and no giant cells were seen in the mice injected with hyaluronic acid.

Expression of laminin-5 γ2 chain in cutaneous pseudocarcinomatous hyperplasia.

BACKGROUND: Since the use of laminin-5 as a marker of invasiveness has been proposed by several authors, our objective was to compare the expression of this protein in pseudocarcinomatous hyperplasia and squamous cell carcinoma (SCC). METHODS: Sixty-four paraffin-embedded skin biopsy samples with diagnosis of epidermal hyperplasia (non-pseudocarcinomatous), pseudocarcinomatous hyperplasia, actinic keratosis/carcinoma in situ, microinvasive and frankly invasive SCC were obtained for immunohistochemical study. RESULTS: Adjacent normal epithelium and epidermal hyperplasia (non-pseudocarcinomatous) showed no staining. In pseudocarcinomatous hyperplasia, laminin-5 was positive, at least focally, in 14 of 16 (87.5%) samples and was concentrated in peripheral cells of elongated rete pegs and in migrating cells in dermis. In samples of microinvasive carcinoma (n = 7), the expression was observed in all cases and was concentrated in the leading edge of the tumor. All cases (n = 21) of frankly invasive SCC showed cells expressing laminin-5, at least focally. Well-differentiated areas of the tumor presented a pattern of expression in peripheral cells of tumor nests while a diffuse pattern of expression was observed in less differentiated areas. CONCLUSION: We showed that cytoplasmic laminin-5 expression should not be used as a criterion of malignancy and is not useful in distinguishing pseudocarcinomatous hyperplasia from microinvasive and well-differentiated SCC.

Can we tell the site of origin of metastatic squamous cell carcinoma? An immunohistochemical tissue microarray study of 194 cases.

To the workup of metastatic squamous cell carcinoma (SCC) of unknown primary, we studied an immunohistochemical panel including thyroid transcription factor (TTF-1), napsin A, villin, CDX-2, K903, CK5/6, p63, p16, CK7, and CK20. Using tissue microarray, we compared 194 SCC cases from the following sites: 35 lung, 34 skin, 14 cervix, 4 vagina, 16 vulva, 8 penis, 9 anus, 3 rectum, 10 esophagus, 4 bladder/urethra, and 57 SCC from various head and neck sites. p63 and K903 stained positively in 100% of cases, and CK5/6 in nearly 100% of cases, with the exception of 1 lung. CK7 was positive in 31.6% of all cases, with varying positivity according to the site. CK20 was negative in all cases except 1 lung. Napsin A was positive in 25.8% of lung, 7.7% of skin, 37.5% of penis, and 13.3% of tongue, and negative in all other sites. TTF-1 was positive only in 1 lung. p16 positivity ranged from 21.43% in vulva, to 75% in vagina and anus, and it was negative in lung, penis, bladder/urethra, and some head and neck. CDX-2 was negative in all cases except 1 vulva. Villin was negative in all cases. We conclude that immunohistochemistry has very limited value in determining the primary site of metastatic SCC. If lung is in the differential versus head and neck, esophagus, anorectal, or genital SCC, a panel including TTF-1, napsin A and p16 may be helpful, since positive TTF-1 and/or napsin A would favor lung primary, and positive p16 would favor an extrapulmonary site.

Variable pathological and clinical features of a large Brazilian family harboring a mutation in the aryl hydrocarbon receptor-interacting protein gene.

BACKGROUND: Germline aryl hydrocarbon receptor-interacting protein (AIP) mutations occur in 15% of familial isolated pituitary adenoma (FIPA) cases. To date, studies have focused on the identification of such mutations in large international cohorts. Detailed genetic and clinical studies within AIP mutation-positive families have been limited. AIM: To undertake a comprehensive study of a large Brazilian FIPA kindred with an E174 frameshift (E174fs) AIP mutation to assess clinical, hormonal, and radiological features in mutation carriers. METHODS: The kindred included 122 subjects across six generations; all underwent clinical examination. Genetic studies were performed to identify E174fs mutation carriers. E174fs-positive subjects underwent magnetic resonance imaging (MRI) and hormonal assessments. RESULTS: Of the ten germline AIP mutation carriers, three had pituitary tumors, while seven were asymptomatic carriers. Three patients with pituitary tumors showed variability in terms of tumor phenotype (two with acromegaly, one with prolactinoma, or mixed prolactin/GH-secreting tumor) and age at diagnosis; both patients with acromegaly had poor responses to octreotide. Tumor AIP immunohistochemistry from the operated patient showed decreased expression when compared with normal tissue. Two adult subjects with normal MRI had elevated IGF-I in the absence of other causes. A 2-year-old child with the E174fs mutation and a normal MRI had premature thelarche, ovarian development, and advanced bone age in the absence of other underlying causes. CONCLUSIONS: The penetrance of pituitary tumors in AIP mutation-positive adult subjects was 33.3%, while clinical/hormonal features were variable. The features noted in AIP-mutation carriers in this kindred suggest that clinical characteristics of such carriers may extend beyond pituitary tumors.

Câncer de boca: expressão imuno-histoquímica de c-erbB-2, Bcl-2 e EGFR - estudo comparativo com leucoplasia e hiperplasia inflamatória / Oral cancer: immunohistochemical expression of c-erbB-2, Bcl-2 and EGFR - study with leukoplakia and inflammatory hyperplasia

Anormalidades em genes que regulam a proliferação e morte celular podem provocar inúmeras doenças entre elas o carcinoma epidermóide de boca. Tem sido relatado que alterações genéticas nas células tumorais predizem a agressividade biológica dos tumores. Marcadores genéticos como c-erbB-2, Bcl-2 e EGFR são considerados indicadores promissores de prognósticos para as lesões cancerizáveis e as neoplasias. Objetivo: Avaliar a expressão imuno-histoquímica das proteínas c-erbB-2, Bcl-2 e EGFR (oncoproteínas envolvidas na vias de proliferação celular). Material e Métodos: cento e cinco blocos de parafina contendo fragmentos de biopsias incisionais, sendo 54 de carcinomas epidermóides, 25 blocos de leucoplasias e 26 blocos de hiperlasias obtidos do Laboratório de Patologia de Boca da Universidade Federal de Mato Grosso do Sul (UFMS). A expressão das proteínas foi verificada através da técnica imuno-histoquímica utilizando a estreptoavidina-biotina-peroxidase no Laboratório de Patologia da Universidade de Brasília (UNB). Resultados: Os resultados revelaram diferença estatisticamente significante da proteína EGFR para os carcinomas epidermóides de boca e para as demais proteínas não houve diferença estatisticamente significante entre as lesões. Conclusões: Os resultados sugerem que o EGFR pode ser utilizado como marcador em carcinoma de boca podendo contribuir para a progressão da neoplasia, porém, sendo insuficiente na predição da carcinogênese

Mefloquina no tratamento da leishmaniose cutânea em uma área endêmica de Leishmania (Viannia) braziliensis / Efficacy of mefloquine in the treatment of skin leishmaniasis in an endemic area of Leishmania (Viannia) braziliensis

O objetivo deste trabalho foi avaliara eficácia da mefloquina numa regiäo endêmica de leishmaniose cutânea por Leishmania (Viannia) braziliensis, considerando que esta droga de administraçäo oral, eficaz no tratamento da malária, com meia vida prolongada e efeitos colaterais pouco freqüentes poderia ser menos tóxica e de mais fácil administraçäo, quando comparadas com os antimoniais pentavalentes. Em Corte de Pedra, no litoral sul do Estado da Bahia, foram tratados, aleatoriamente, dez pacientes portadores de lesöes leishmanióticas, subdivididos em dois grupos. O primeiro grupo recebeu mefloquina pela via oral, dose de 250mg/dia, durante seis dias, repetindo-se o mesmo esquema após intervalo de três semanas. O segundo grupo recebeu antimoniato de meglumina (Glucantime©) diariamente, pela via endovenosa, na dose de 20mg/kg por20 dias. Do grupo da mefloquina só um paciente apresentou cicatrizaçäo depois do segundo ciclo. Um desses, com quatro lesöes apresentou nova lesöo durante o primeiro ciclo de tratamento. A evoluçäo dos outros três foi lenta sendo que em nove semanas nenhum deles tinha cicatrizado as úlceras que permaneciam com grande infiltraçäo e sinais evidentes de atividade. O grupo tratado com Glucantime© apresentou evidente melhora

Estudo terapêutico aberto com sulfato de aminosidine na leishmaniose mucosa causada por Leishmania (Viannia) braziliensis / Open therapeutic study with aminosidine sulfate in mucosal leishmaniasis due to Leismania (Viannia) braziliensis

From September to November 1994. 21 patients with active mucosal leishmaniasis were treated with aminosidine sulphate 16 mg/kg/day by intramuscular injection for 20 days. They were principally adult male agricultural workers. Thirteen patients had not received specific treatment and eight had failed to respond to Glucantime therapy. Diagnosis was based on clinical and epidemiological observations, a search for the parasite, leishmanin skin sensitivity and indirect fluorescent antibody serological tests. Sixty seven percent of patients had leishmania parasites isolated from inoculated hamsters or visualized in imprints or histopathological sections. The mean follow-up period was 12.6 months. All patients completed treatment. Side effects were pain at the injection site (86 per cent); mild proteinuria (24 per cent), elevated serum creatinine (.5 per cent) and subclinical bearing loss in one of two patients who did audiometric tests. Clinical cure was achieved in 48 per cent and the accumulated relapse rate was 29 per cent(4/14).

Estudo comparativo entre antimoniato de meglumina, isotianato de pentamidina e sulfato de aminosidine, no tratamento de lesöes cutâneas primárias causadas por Leishmania (Viannia) braziliensis / Comparative study between meglumine antimoniato, pentamidine isothianate and aminosidine sulphate, in the treatment of cutaneous primary lesions, caused by Leishmania (Viannia) braziliensis (L(V)b)

With the aim of comparing the therapeutic efficacy, tolerability and toxicity of meglumine antimoniate, aminosidine sulphate and pentamidine isethionate, a field study was conducted on randomized treatment of patients with primary cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis (L(V)b), in Corte de Pedra, BA, from October 1992 up to January 1993. Forty six patients were treated and distributed into three groups, two with 15 and one with 16 subjects. All patients were submitted to clinical examination, histopathological and immunological investigations, as diagnostic criterium. All patients were treated by intramuscular route. Group 1 received pentamidine 4 mg/kg/every 2 days, for 8 applications; Group 2 received aminosidine 20 mg/kg/day, for 20 days, and Group 3 received meglumine 10 mg Sbv/kg/day, for 20 days. Failure of therapy was defined as ulceration of the skin lesion four months after treatment. Such failure occurred in five cases as follows: two cases in patients of group 1 one case in patients of group 2, and two cases in group 3, after the first year of follow up. In the evaluation after three years we reviewed fifteen patients, five in each group; except for one in Group 3, all of them were cured. Statistical significance of the results between the three schedules used was not verified.

Cura espontânea da leishmaniose causada por leishmania viannia braziliensis em lesöes cutâneas / Spontaneous healing of leishmaniasis caused by leishmania viannia braziliensis in cutaneous lesions

Os autores relatam que durante 14 anos de trabalho clínico em campo, realizado nas comunidades de Três Braços e Corte de Pedra, bahia, acompanharam 1.416 pacientes portadores de Leishmaniose Tegumentar Americana, cuja espécie envolvida na transmissäo, é predominamente a Leishmania Viannia brasilienses. A terapêutica utilizada rotineiramente nos casos é o antimoniato-N-metilglucamina (Glucantime). Contudo, 16 pacientes do sexo masculino recusaram-se a utilizar a medicaçäo e 6 do sexo feminino encontravam-se em período gestacional, portanto näo utilizaram o medicamento. Estes pacientes foram acompanhados por um período entre 4 a 12 anos, a partir do diagnóstico. observou-se que em 9 pacientes (40.9%) desta casuística, o tempo de cicatrizaçäo após o aparecimento da lesäo, pode ser calculado em 6 meses de evoluçäo. Quando se eleva a observaçäo para 12 meses, temos que 19 pacientes (86,3%) cicatrizaram suas lesöes neste período. Em 3 casos (13.6%) as lesöes permaneceram ativas por mais de 12 meses. Conclui-se que os determinantes da cicatrizaçäo natural das lesöes produzidas por Leishmania Viannia brasiliensis permanecem desconhecidos, dificultando para nós entedermos e compararmos aos efeitos das drogas utilizadas no tratamento da leishmaniose tegumentar

Mudança do componente cognitivo da atitude de uma populaçäo de regiäo endêmica do sul da Bahia diante da leishmaniose tegumentar / Information-related changes in attitude to mucocutaneous leishmaniasis of a population from an endemic region of the south of Bahia

O caráter mutilante da forma mucosa da leishmaniose tegumentar pode provocar alteraçöes no relacionamento interpessoal. Para identificar o nivel de informaçäo dos portadores da doença e a reaçäo psicológica dos moradores aos doentes de leishmaniose e seu nivel de informaçäo quanto à doença, foi aplicado um questionário na regiäo endêmica do sul da Bahia. Foram identificadas diversas crenças falsas e um nível de rejeiçäo da populaçäo bastante forte que admitiu a existência de relaçäo entre o medo do contágio e a atitude de rejeiçäo. Presume-se que a Comunicaçäo da Informaçäo Persuasiva à populaçäo provocara uma mudança da atitude através da alteraçäo do seu componente cognitivo

Leishmaniose causada por Leishmania viannia braziliensis (Lvb): um caso de evoluçäo atípica / Leishmania caused by Leishmania viannia braziliensis (Lvb): atypic evolution of a case

Os autores relatam o caso de uma criança portadora de Leishmaniose Tegumentar Americana causada por Leishmania braziliensis braziliensis que foi infectada durante a amamentaçäo, desenvolvendo lesäo infiltrativa e nodular nos lábios, com posterior disseminaçäo para os seis da face, fossas nasais e pavilhäo auricular e cuja evoluçäo clinica pós-terapêutica caracterizou-se por períodos sucessivos de regressäo e de reativaçäo da lesäo. Enfatizam a gravidade do caso, e as dificuldades terapêuticas com a utilizaçäo dos antimoniais pentavalentes, antimoniato-N-metil flucamina (Glucantime e o stibogluconato de sódio (Pentostam)