Alterações anatomopatológicas de corações de pacientes chagásicos portadores de marcapasso definitivo endocárdico / Anatomopathological changes in hearts of Chagas disease patients with permanent endocardial pacemakers

OBJETIVO: Descrever as lesões morfológicas, macro e microscópicas, associadas ao marcapasso definitivo (MP) em corações de pacientes falecidos com cardiopatia chagásica crônica e compará-las com as descritas em outras cardiopatias. MÉTODO: Foram estudados 22 corações de pacientes chagásicos crônicos (16 homens e seis mulheres) de 26 a 86 anos de idade (média de 54 anos) portadores de MP definitivo endocárdico. Foram retirados fragmentos das paredes das quatro câmaras, do septo interventricular e da ponta cardíaca, bem como de tecidos que envolviam os cabos-eletrodos e de áreas de aderências para processamento histológico. As características do exsudato leucocitário nos sítios de implante e no miocárdio ventricular foram analisadas por meio da técnica de imuno-histoquímica. RESULTADOS: Inflamação e trombose nos sítios de implante resultaram em encapsulamento fibroso das pontas dos cabos-eletrodos que permaneceram firmemente aderidos ao endocárdio adjacente. Nos sítios de implante, linfócitos B e T ocorreram em proporções semelhantes, diferentemente dos focos da miocardite chagásica ventricular, na qual foi observado marcante predomínio de linfócitos T. CONCLUSÃO: Os cabos-eletrodos não são estruturas biologicamente inertes; sua permanência produz constante estímulo trombogênico, assim como processo inflamatório e fibrogênico nos sítios dos implantes. A organização de trombos vermelhos e/ou de fibrina que se formam em torno dos cabos-eletrodos parece responsável por seu encapsulamento e por frequentes aderências às estruturas adjacentes. As lesões cardíacas associadas aos MP na cardiopatia chagásica crônica dos casos estudados foram semelhantes às descritas em outras cardiopatias.

Objective: Describe morphologic, macro and microscopic lesions associated with permanentpacemaker (PM) in hearts of patients who died with chronic Chagas disease and compare them with those reportedin other heart diseases. Methods: Twenty-two hearts of chronic chagasic patients (16 mean and six women) from26 to 86 years of age (mean 54 years) with a permanent endocardial PM were studied. Fragments representing thewalls of four the chambers, the ventricular septum and the tip of the heart as well as tissue involving the leads and areas of adhesions were obtained for histological processing. The characteristics of leukocyte exudates leukocyte inimplant sites and the ventricular myocardium were analyzed by immunohistochemistry. Results: Inflammationand thrombosis at the site of implantation resulted in fibrous encapsulation of the tips of the electrode leadsthat remained firmly adhered to the adjacent endocardium. At the site of implantation, B and T lymphocytesoccurred in similar proportions, unlike ventricular chagasic myocarditis areas, where a large predominance ofT lymphocytes was observed. Conclusion: The leads are not biologically inert structures, their permanenceproduces constant thrombogenic stimulation, as well as thrombogenic and fibrogenic inflammatory process in thesites of the implants. The organization of red thrombi and/or fibrin formed around the electrode leads seems to beresponsible for the encapsulation and frequent adhesions to adjacent structures. Cardiac lesions associated PM inchronic Chagas disease in the studied cases were similar to those described in other heart diseases.

Objetivo: Describir las lesiones morfológicas, macro y microscópicas, asociadas con marcapasosdefinitivo (MP) en corazones de pacientes fallecidos con cardiopatía chagásica crónica y compararlas con lasdescritas en otras cardiopatías. Métodos: Fueron estudiados 22 corazones de pacientes chagásicos crónicos (16hombres y seis mujeres) de 26 a 86 años de edad (promedio de 54 años) portadores de MP definitivo endocárdico.Fueron retirados fragmentos de las paredes de las cuatro cámaras, del tabique interventricular y la punta cardiaca,así como de tejidos que envolvían los cables-electrodos y de áreas de adherencias para procesamiento histológico.Las características del exudado leucocitario en los sitios de implante y el miocardio ventricular fueron analizadaspor medio de la técnica de inmunohistoquímica. Resultados: Inflamación y trombosis en los sitios de implanteresultaron en encapsulamiento fibroso de las puntas de los cables-electrodos que permanecieron firmementeadheridos al endocardio adyacente. En los sitios de implante, linfocitos B y T ocurrieron en proporcionessemejantes, diferentemente de los focos de la miocarditis chagásica ventricular en la que se observó distintivopredominio de linfocitos T. Conclusión: Los cables-electrodos no son estructuras biológicamente inertes; supermanencia produce constante estímulo trombogénico, así como proceso inflamatorio y fibrogénico en los sitiosde los implantes. La organización de trombos rojos y/o fibrina que se forman alrededor de los cables-electrodosparece responsable de su encapsulamiento y las frecuentes adherencias a las estructuras adyacentes. Las lesionescardiacas asociadas con los MP en la cardiopatía chagásica crónica de los casos estudiados fueron semejantes a lasdescritas en otras cardiopatías.

Keratosis follicularis spinulosa decalvans: case report.

Keratosis follicularis spinulosa decalvans is a rare disease, with genetic transmission either X-linked or sporadic, characterized by follicular hyperkeratosis and cicatricial alopecia. The disease usually begins in early childhood exacerbating throughout adolescence. The therapies are somewhat effective, with frustrating treatment when there are changes which are predominantly cicatricial. It is reported a case of child with intense cicatricial alopecia, with precocious changes (already present at birth) that rapidly evolved to diffuse cicatricial alopecia on the scalp, which has limited the treatment, with disappointing results.

Queratose folicular espinulosa decalvante: relato de caso / Keratosis follicularis spinulosa decalvans: case report

A queratose folicular espinulosa decalvante é afecção rara, de transmissão genética ligada ao X ou esporádica, caracterizada por hiperqueratose folicular e alopecia cicatricial. Inicia-se, geralmente, na primeira infância, exacerbando-se na adolescência. As terapias são pouco efetivas, com tratamento frustrante, quando já há alterações predominantemente cicatriciais. Relata-se caso de criança com quadro de alopecia cicatricial intensa, com alterações precoces (já ao nascimento) e rápida evolução para alopecia difusa cicatricial do couro cabeludo, o que tornou o tratamento limitado e desapontador.

Keratosis follicularis spinulosa decalvans is a rare disease, with genetic transmission either X-linked or sporadic, characterized by follicular hyperkeratosis and cicatricial alopecia. The disease usually begins in early childhood exacerbating throughout adolescence. The therapies are somewhat effective, with frustrating treatment when there are changes which are predominantly cicatricial. It is reported a case of child with intense cicatricial alopecia, with precocious changes (already present at birth) that rapidly evolved to diffuse cicatricial alopecia on the scalp, which has limited the treatment, with disappointing results.

Cutaneous horn: a retrospective histopathological study of 222 cases.

BACKGROUND: Cutaneous horn is a keratotic, conical and circumscribed lesion that can hide both benign or malignant lesions. OBJECTIVE: To identify,from a histopathological point of view, the main clinical dermatoses that are presented ,from a clinical point of view, as cutaneous horn. METHODS: RETROSPECTIVE HISTOPATHOLOGICAL STUDY OF 222 CASES OF CUTANEOUS HORNS THAT WERE CLASSIFIED AS SUCH BY ANATOMICAL-PATHOLOGICAL REPORTS OF THE UNIVERSITY HOSPITAL (HOSPITAL DE CLINICAS DE UBERLANDIA) FROM 1990 TO 2006. RESULTS: The average age of patients was 67,42. The female sex was more affected (64,86%). The average time of clinical evolution was 16,92 months. Lesions were mostly frequent located on the head (35,14%) and upper limbs (31,08%). Histopathological analysis considered 41,44 % of the lesions as benign and 58,56% as pre-malignant or malignant among the 222 cases of cutaneous horns studied. Within the group of pre-malignant lesions, actinic keratosis was found in 83,84% of the cases; within the group of malignant lesions, squamous cell carcinoma was found in 93,75% of the cases. CONCLUSIONS: This study showed that the majority of cutaneosus horns occured in areas of the body that are exposed to the sun, predominantly head and upper limbs. Considering the high frequency of pre-malignant lesions and also the presence of malignant lesions it is suggested surgical exeresis followed by histopathological study of the cutaneous horns for confirmation of specific diagnosis.

Corno cutâneo: estudo histopatológico retrospectivo de 222 casos / Cutaneous horn: a retrospective histopathological study of 222 cases

FUNDAMENTOS: O corno cutâneo é lesão acentuadamente hiperqueratótica, cônica e circunscrita, que pode ocultar tanto lesões benignas como malignas. OBJETIVO: Identificar histopatologicamente as principais dermatoses que se apresentam clinicamente como corno cutâneo. MÉTODOS: Estudo histopatológico retrospectivo de 222 cornos cutâneos, a partir de laudos anatomopatológicos do Hospital de Clínicas de Uberlândia entre os anos de 1990 e 2006. RESULTADOS: A média de idade dos pacientes foi de 67,42 anos. O sexo feminino foi mais acometido (64,86 por cento). O tempo médio de evolução foi de 16,92 meses. As localizações mais frequentes das lesões foram: cabeça (35,14 por cento) e membros superiores (31,08 por cento). Observaram-se lesões histopatologicamente benignas em 41,44 por cento e lesões prémalignas ou malignas em 58,56 por cento dos cornos cutâneos estudados. Entre as lesões pré-malignas, a queratose actínica foi encontrada em 83,84 por cento dos casos; entre as malignas, o carcinoma espinocelular correspondeu a 93,75 por cento dos casos. CONCLUSÕES: Este estudo mostrou que a maioria dos cornos cutâneos surgiu sobre áreas do corpo expostas à luz solar, predominantemente, cabeça e membros superiores. Considerando-se a elevada frequência de lesões prémalignas e também a presença de lesões malignas, sugere-se exérese cirúrgica seguida de estudo histopatológico dos cornos cutâneos, para confirmação de diagnóstico específico.

BACKGROUND: Cutaneous horn is a keratotic, conical and circumscribed lesion that can hide both benign or malignant lesions. OBJECTIVE: To identify,from a histopathological point of view, the main clinical dermatoses that are presented ,from a clinical point of view, as cutaneous horn. METHODS: RETROSPECTIVE HISTOPATHOLOGICAL STUDY OF 222 CASES OF CUTANEOUS HORNS THAT WERE CLASSIFIED AS SUCH BY ANATOMICAL-PATHOLOGICAL REPORTS OF THE UNIVERSITY HOSPITAL (HOSPITAL DE CLÍNICAS DE UBERLÂNDIA) FROM 1990 TO 2006. RESULTS: The average age of patients was 67,42. The female sex was more affected (64,86 percent). The average time of clinical evolution was 16,92 months. Lesions were mostly frequent located on the head (35,14 percent) and upper limbs (31,08 percent). Histopathological analysis considered 41,44 percent of the lesions as benign and 58,56 percent as pre-malignant or malignant among the 222 cases of cutaneous horns studied. Within the group of pre-malignant lesions, actinic keratosis was found in 83,84 percent of the cases; within the group of malignant lesions, squamous cell carcinoma was found in 93,75 percent of the cases. CONCLUSIONS: This study showed that the majority of cutaneosus horns occured in areas of the body that are exposed to the sun, predominantly head and upper limbs. Considering the high frequency of pre-malignant lesions and also the presence of malignant lesions it is suggested surgical exeresis followed by histopathological study of the cutaneous horns for confirmation of specific diagnosis.

Seroepidemiological survey of paracoccidioidomycosis infection among urban and rural dogs from Uberaba, Minas Gerais, Brazil.

There is some evidence that dogs can be naturally infected by Paracoccidioides brasiliensis in endemic areas of paracoccidioidomycosis. In order to evaluate canine infection with this fungus, a survey with 149 urban and 126 rural dogs was carried out using ELISA and intradermal tests with the gp43 antigen of P. brasiliensis in Uberaba, Minas Gerais state of Brazil. Forty-one out of 149 urban dogs were euthanatized and had their lungs, liver and spleen removed. One slice from each viscera was processed for histopathological examination and the remaining was homogenized and then cultivated on mycobiotic agar at room temperature and Fava-Netto medium at 35 degrees C and observed for 12 weeks. Of urban dogs, 75 (50.3%) were small adult females, 56 (36%) were strays, while 93 (64%) had been donated to the municipal zoonosis control center. Nine (6.2%) had a positive intradermal test without statistical differences regarding gender, race, nutritional status or origin. No colonies with microscopic or morphology appearances resembling P. brasiliensis were isolated, nor granulomatous process or fungal structures were observed from histopathological examination. Eighty (53.6%) of the urban dogs presented seroreactivity, without statistical differences regarding gender, race, nutritional state, origin, or positive intradermal test. Of 126 rural dogs, 102 (80.5%) presented antibodies against gp43 antigen, and this was statistically significant in relation to the reactivity detected in urban dogs (P = 0.0001). Thus, dogs are commonly infected with P. brasiliensis, but they probably present natural resistance to develop paracoccidioidomycosis.

[Superficial granulomatous pyoderma: report of a case of an uncommon variant of pyoderma gangrenosum]. / Pioderma granulomatoso superficial: relato de caso de variante rara do pioderma gangrenoso.

Pyoderma gangrenosum is a rare idiopathic skin disease. It affects mainly adults, and only 4% of the cases are diagnosed on children and adolescents. There are four clinical forms of pyoderma gangrenosum: ulcerative, pustular, bullous, and vegetative (superficial granulomatous pyoderma). Superficial granulomatous pyoderma is considered the most benign and uncommon form of the disease. Patients who have undergone surgical procedures may occasionally present pyoderma gangrenosum manifestations on the surgical site. A case of a five-year-old child, victim of burn, who presented superficial granulomatous pyoderma on the skin graft donor sites is reported.

Pioderma granulomatoso superficial: relato de caso de variante rara do pioderma gangrenoso / Superficial granulomatous pyoderma: report of a case of an uncommon variant of pyoderma gangrenosum

O pioderma gangrenoso é doença cutânea inflamatória rara, idiopática. Afeta principalmente adultos; apenas cerca de 4 por cento dos casos são diagnosticados em crianças e adolescentes. Existem quatro formas clínicas de pioderma gangrenoso: ulcerativa, pustular, bolhosa e vegetante (pioderma granulomatoso superficial). O pioderma granulomatoso superficial é considerado a forma mais benigna e incomum da doença. Em pacientes submetidos a manipulação cirúrgica, uma eventual manifestação do pioderma gangrenoso ocorre nos locais de intervenção. Relata-se o caso de criança de cinco anos de idade, vítima de queimadura, que apresentou pioderma granulomatoso superficial sobre áreas doadoras de enxertos.

Pyoderma gangrenosum is a rare idiopathic skin disease. It affects mainly adults, and only 4 percent of the cases are diagnosed on children and adolescents. There are four clinical forms of pyoderma gangrenosum: ulcerative, pustular, bullous, and vegetative (superficial granulomatous pyoderma). Superficial granulomatous pyoderma is considered the most benign and uncommon form of the disease. Patients who have undergone surgical procedures may occasionally present pyoderma gangrenosum manifestations on the surgical site. A case of a five-year-old child, victim of burn, who presented superficial granulomatous pyoderma on the skin graft donor sites is reported.

Intracranial compound odontome.

An exceedingly rare case of an extragnathic odontome is described arising within the brain. A 10-year-old boy complained of progressive frontal headache for 5 years. Axial computerized tomography the head revealed a solid, calcified lesion with well-defined borders localized in the sellar and suprasellar region composed of multiple calcified structures resembling teeth. The diagnosis was compound odontome. Physical examination and blood analysis revealed hypopituitarism. The patient was submitted for radical tumour resection. He developed persistent diabetes insipidus, hypothyroidism and adrenal insufficiency for which appropriate replacement therapy has been necessary. This case demonstrates that an odontogenic lesion may arise in brain tissues due to the embryological relationship between primordial stomodeum and Rathke's pouch. Its development could be associated with endocrine disturbances.

Aspectos clínicos e histopatológicos da leishmaniose tegumentar americana em pacientes atendidos no Hospital de Clínicas da Universidade Federal de Uberlândia, MG, Brasil / Clinical and histopathological aspects of American tegumentary leishmaniasis in patients assisted at the Clinical Hospital of Federal University of Uberlandia, MG, Brazil

Nos últimos dez anos, 16.000 novos casos de leishmaniose tegumentar americana foram registrados em Minas Gerais. O presente estudo objetiva fazer uma síntese dos aspectos clínicos e histopatológicos das lesões de leishmaniose tegumentar em pacientes atendidos no Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU), Uberlândia (MG), Brasil, no período de janeiro de 1995 a dezembro de 2003. Durante esse período foram atendidos 197 pacientes, sendo 79,2por cento do sexo masculino e 32,5por cento com idade entre 30 e 39 anos. Foram observadas lesões cutâneas (60,3por cento) e únicas (63,8por cento), principalmente nos membros inferiores (55,8por cento). Apenas 80 (44,4por cento) casos tiveram suas biópsias realizadas no HC-UFU. Em 12 (15por cento) casos puderam ser observados parasitos, a maioria (66,7por cento) com densidade considerada rara. Os dados encontrados confirmam o caráter freqüente do diagnóstico de leishmaniose tegumentar americana no HC-UFU e sugerem a necessidade de acompanhamento dos casos da doença, nesta área, pela Vigilância Epidemiológica.

Infectious keratitis secondary to Histoplasma capsulatum: the first case reports in humans

The authors report an unusual case of fungal keratitis caused by Histoplasma capsulatum in a male immunocompetent patient. PCR confirmed the presence of the fungus DNA in the material studied. To our knowledge this is the first reported case in humans described all over the world.

Metallothionein immunolocalization in actinic skin nonmelanoma carcinomas.

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most frequent skin cancer. Its pathogeny is linked to genotoxic effects of actinic radiation exposure, especially to ultraviolet wavelength. Metallothionein (MT) is a low-molecular weight protein with high affinity for heavy metal. Its intracellular function has been related to heavy metals and free-radical detoxification, although many studies linked MT to protective action against actinic mutagenesis. In other way, overexpression in malignant tumors has been related to worse prognosis. We aimed to evaluate MT immunohistochemical expression in skin cancer associated to actinic radiation. Twenty-six BCC cases, 20 SCC, and 6 normal skin fragments were investigated. Immunohistochemical assay were performed by streptavidin-biotin-peroxidase technique with standard monoclonal antibody (E9). In normal skin, immunostaining was observed in basal layer of the epithelium. In the epithelium adjacent to tumors, suprabasal layer was also intensely labeled. Mean MT immunostaining indices were 18.5+21.2% for BCC and 69.1+14.4% for SCC. This difference was statistically significant. Higher MT expression in SCC as compared with BCC suggests association with tumoral aggressiveness.

Prevalência da pancreatite crônica em pacientes portadores de cirrose hepática alcoólica: estudo histopatológico / Prevalence of chronic pancreatitis in patients with alcoholic liver cirrhosis: histopathological study

INTRODUÇÃO: O abuso crônico do álcool é importante causa de cirrose hepática e de pancreatite crônica. OBJETIVO: Avaliar a frequência de pancreatite crônica (PC) em pacientes portadores de cirrose hepática alcoólica (CHA) por exame histopatológico. Casuística: Analisaram-se necropsias de 18 homens e sete mulheres portadores de CHA, com idade média e desvio padrão de 47,2 ± 13,8 anos (24 a 83 anos), que consumiam em média 239,6 ± 155,3 g de etanol/dia por um período médio de 16,7 ± 7,2 anos. MÉTODOS: O diagnóstico histopatológico de cirrose hepática baseou-se na fibrose sistematizada com formação de septos delimitando nódulos, associada à inflamação crônica inespecífica. O diagnóstico histológico de PC baseou-se na identificação de exsudato mononuclear (EM) em torno dos ductos e no tecido conjuntivo inter e intralobular, acompanhado de traves de fibrose. A PC foi classificada como leve quando havia discreto EM em região periductal, interlobular ou intralobular acompanhado por finas traves de fibrose; moderada, pelo aumento da intensidade do exsudato e da fibrose, ocasionalmente associado com pequena dilatação dos ductos; a forma grave caracterizou-se pelo EM, densa fibrose, presença de rolhas, dilatação dos ductos, atrofia glandular e, às vezes, calcificação. RESULTADOS: Observou-se PC em 20 pacientes portadores de CHA (80 por cento), que foi leve em 13 (52 por cento), moderada em dois (8 por cento) e grave em cinco (20 por cento). CONCLUSÃO: A pancreatite crônica está frequentemente associada à CHA, sendo histologicamente grave em aproximadamente 1/4 dos casos.

INTRODUCTION: The chronic alcohol abuse is an important cause of liver cirrhosis and chronic pancreatitis. OBJECTIVE: To evaluate the prevalence of chronic pancreatitis (CP) in patients with alcoholic liver cirrhosis (ALC) based on histopathological assays. Subjects: Autopsies of 25 patients with ALC, 18 men and seven women, age ranging from 24 to 83 years (mean ± standard deviation: 47.2 ± 13.8) were retrospectively analyzed. They ingested on average 239.6 ± 155.3 g ethanol/day for a mean period of 16.7 ± 7.2 years. METHODS: Liver cirrhosis histopathological diagnosis was based on the findings of systemized fibrosis with formation of septum-delimited nodules and nonspecific chronic inflammation. CP histopathological diagnosis was based on identification of mononuclear cell infiltration (MCI) around the ducts and in the inter- and intra-lobular connective tissue and presence of strands of fibrosis. CP was classified as mild (discrete MCI in the periductal, inter- or intra-lobular areas with thin strands of fibrosis), moderate (increased exudates and fibrosis, occasionally associated with small dilatation of ducts), and severe (evident MCI, dense fibrosis, presence of plugs in the ducts, irregular ductal dilatation, glandular atrophy and, sometimes, calcification). RESULTS: CP was observed in 20 patients (80 percent) with ALC, and was considered mild in 13 (52 percent), moderate in two (8 percent) and severe in five (20 percent) patients. CONCLUSION: CP is often associated with the ALC, and it can be histologically severe in approximately 1/4 of the cases.

Protective effect of lectin from Synadenium carinatum on Leishmania amazonensis infection in BALB/c mice.

The protective effect of the Synadenium carinatum latex lectin (ScLL), and the possibility of using it as an adjuvant in murine model of vaccination against American cutaneous leishmaniasis, were evaluated. BALB/c mice were immunized with the lectin ScLL (10, 50, 100 microgram/animal) separately or in association with the soluble Leishmania amazonensis antigen (SLA). After a challenge infection with 10(6) promastigotes, the injury progression was monitored weekly by measuring the footpad swelling for 10 weeks. ScLL appeared to be capable of conferring partial protection to the animals, being most evident when ScLL was used in concentrations of 50 and 100 microgram/animal. Also the parasite load in the interior of macrophages showed significant reduction (61.7%) when compared to the control group. With regard to the cellular response, ScLL 50 and 100 microgram/animal stimulated the delayed-type hypersensitivity (DTH) reaction significantly (P < 0.05) higher than SLA or SLA plus ScLL 10 weeks after the challenge infection. The detection of high levels of IgG2a and the expression of mRNA cytokines, such as IFN-gamma, IL-12, and TNF-alpha (Th1 profiles), corroborated the protective role of this lectin against cutaneous leishmaniasis. This is the first report of the ScLL effect on leishmaniasis and shows a promising role for ScLL to be explored in other experimental models for treatment of leishmaniasis.

Infectious keratitis secondary to Histoplasma capsulatum: the first case reports in humans.

The authors report an unusual case of fungal keratitis caused by Histoplasma capsulatum in a male immunocompetent patient. PCR confirmed the presence of the fungus DNA in the material studied. To our knowledge this is the first reported case in humans described all over the world.

Úlceras em megacólons chagásicos operados na urgência e eletivamente / Ulcerations in Chagas' megacolon operated at urgency and electively

RACIONAL: O megacólon é uma doença freqüente no nosso meio e abordado na urgência pelas suas complicações como fecalomas, volvos e perfurações. As úlceras de estases nos megacólons contribuem como prováveis sítios de perfurações OBJETIVO: Comparar as freqüências de úlceras de decúbito em megacólons chagásicos operados na urgência, por volvo e fecaloma, e eletivamente, objetivando melhor conduta cirúrgica na urgência MATERIAL E MÉTODOS: Analisaram-se os laudos de 356 exames anatomopatológicos de ressecções colônicas de pacientes operados por megacólon chagásico na urgência (102 casos; 29 por cento) e eletivamente (254 casos; 71 por cento), no período de 1980 a 2000. As indicações cirúrgicas de urgência foram atribuídas a volvo (71 casos; 69,6 por cento), fecaloma (25 casos; 24,5 por cento), abdome agudo perfurativo após sondagem retal ou sigmoidoscopia (6 casos; 5,9 por cento). Compararam-se as freqüências de úlceras nos dois grupos de peças cirúrgicas, com a utilização do teste do qui-quadrado RESULTADOS: Nos laudos das peças cirúrgicas obtidas nas cirurgias de urgência, constatou-se o registro de úlceras em 26 casos (25,5 por cento); nas peças de ressecções eletivas verificaram-se úlceras em 21 casos (8,25 por cento). A diferença observada foi estatisticamente significante. A comparação dos grupos de volvo, fecaloma e volvo com fecaloma, em separado com o grupo das cirurgias eletivas, evidenciou diferenças significantes em relação ao volvo e ao fecaloma CONCLUSÃO: A freqüência muito maior de úlceras nos megas operados em caráter de urgência enfatiza a necessidade da ressecção imediata do cólon sigmóide, ao invés da conduta conservadora de simples colostomia descompressiva, mesmo naquelas laparotomias exploradoras em que o exame macroscópico do sigmóide não mostre sinais de necrose. Desta forma, deve-se prevenir a ocorrência de perfuração do megacólon no pós-operatório mediato, com conseqüências usualmente graves.

BACKGROUD: The megacolon is a frequent disease in our emergencie hospital, and approached in the urgency by your complications as fecal impaction, volvulus and perforations. The ulcerations in the megacolons contribute as probable sites of perforations AIM: To compare the frequencies of stercoral ulceration in Chagas' megacolon operated at urgency, by volvulus or fecal impaction, and electively, aiming at a better surgical conduct in the urgency surgery METHODS: It was analyzed 356 anatomy-pathological exams from colon resection of operated patients due to Chagas' megacolon at urgency (102 cases; 29 percent) and electively (254 cases; 71 percent), from 1980 to 2000. The surgical urgency indications were attributed to volvulus (71 cases; 69,6 percent), fecal impaction (25 cases; 24,5 percent), perforated acute abdomen after rectal catheter or sigmoidoscopy (6 cases; 5,9 percent). The ulceration frequency was compared in both groups of resections, using chi-square RESULTS: The pathological anatomy - of surgery resection obtained at urgency surgeries, showed 26 cases of ulceration (25,5 percent) and in electively resections were verified 21 cases of ulceration (8,25 percent). The difference observed was statistically significant. The comparison among the groups of volvulus; fecal impaction and volvulus with fecal impaction, separately with electively surgery group evidenced significant differences in relation to volvulus and fecal impaction CONCLUSIONS: The higher frequency of ulcerations in the megacolon operated at urgency character emphasizes the needs of immediate resection of sigmoid colon, instead of conservative conduct of simple decompression colostomy, even in exploration laparotomy which the macroscopic examination of sigmoid does not show necrotic signs. This way, should prevent the occurrence of perforation in megacolon at mediate postoperative, with serious results.

Effect of imidocarb and levamisole on the experimental infection of BALB/c mice by Leishmania (Leishmania) amazonensis.

The adverse effects from using currently available drugs for the treatment of leishmaniasis have motivated the search for new therapeutical agents. The aim of this work was to evaluate the effect of imidocarb and levamisole on the treatment of BALB/c mice experimentally infected by Leishmania (Leishmania) amazonensis. BALB/c mice were infected with 10(6) promastigotes of L. (L.) amazonensis (IFLA/BR/67/PH8) and, starting on day 51, mice were treated subcutaneously with imidocarb (IMD, 34 mg/kg), imidocarb plus levamisole (IMD+LVS, 34 and 12 mg/kg, respectively), only levamisole (LVS, 12 mg/kg) or without treatment (control). Lesion size and swelling were weekly monitored for 10 weeks after the beginning of the treatment. On day 121 post-infection, serum levels of specific IgG from infected mice were evaluated, as well as histopathological and morphometric alterations in the footpad, lymph nodes and spleen of these animals. The data obtained in this study demonstrated that, when compared to controls, mice treated with IMD had lower levels of IgG anti-L. (L.) amazonensis (34.45%), smaller vacuolar area in macrophages (3.75%), lower number of megakaryocytes in spleen (63.19%) and lower parasite burden in the footpad (30.2%). Thus, the evaluated parameters suggest the use of imidocarb as a potential drug in the treatment of tegumentary leishmaniasis.

Carcinoma basocelular - Análise de 300 casos observados em Uberlândia - MG / Basal cell Carcinoma - Analysis of 300 cases observed in Uberlândia - MG, Brazil

FUNDAMENTO: O carcinoma basocelular é o câncer da pele mais comum, compreendendo 75 por cento dos tumores epiteliais malignos. Localiza-se na face e acomete indivíduos brancos, acima de 40 anos de idade, com história de exposição repetitiva à luz solar. OBJETIVO: Descrever o carcinoma basocelular em suas variáveis epidemiológica, clínica e histopatológica. CASUíSTICA: Realizou-se estudo transversal de 300 pacientes com carcinoma basocelular atendidos no Serviço de Dermatologia do Hospital de Clínicas, no período de 1999 a 2003. Foram preenchidos protocolos com identificação do paciente, história de exposição solar e caracterização do carcinoma basocelular. RESULTADOS: Foram identificadas 447 lesões de carcinoma basocelular nos 300 pacientes estudados, cuja maioria era do sexo feminino (59,3 por cento) e da raça branca (93 por cento), com história de exposição solar (90,3 por cento), apresentando lesão única (74 por cento), predominantemente facial (77 por cento das lesões). O tipo histopatológico mais freqüente foi o nodular (46,3 por cento das lesões), com predomínio do superficial no tronco. CONCLUSÕES: Observou-se predomínio do carcinoma basocelular no sexo feminino, demonstrando a tendência atual desse tumor. A presença de vários tumores sucessivos ou simultâneos em um mesmo paciente salienta a importância de exames periódicos nesses doentes. Não se estabeleceu correlação entre os tipos clínicos e histopatológicos. Confirmou-se que o tipo superficial é mais freqüente no tronco.

[Ulcerations in Chagas' megacolon operated at urgency and electively]. / Ulceras em megacólons chagásicos operados na urgência e eletivamente.

BACKGROUND: [corrected] The megacolon is a frequent disease in our emergencie hospital, and approached in the urgency by your complications as fecal impaction, volvulus and perforations. The ulcerations in the megacolons contribute as probable sites of perforations AIM: To compare the frequencies of stercoral ulceration in Chagas' megacolon operated at urgency, by volvulus or fecal impaction, and electively, aiming at a better surgical conduct in the urgency surgery METHODS: It was analyzed 356 anatomy-pathological exams from colon resection of operated patients due to Chagas' megacolon at urgency (102 cases; 29%) and electively (254 cases; 71%), from 1980 to 2000. The surgical urgency indications were attributed to volvulus (71 cases; 69,6%), fecal impaction (25 cases; 24,5%), perforated acute abdomen after rectal catheter or sigmoidoscopy (6 cases; 5,9%). The ulceration frequency was compared in both groups of resections, using chi-square RESULTS: The pathological anatomy - of surgery resection obtained at urgency surgeries, showed 26 cases of ulceration (25,5%) and in electively resections were verified 21 cases of ulceration (8,25%). The difference observed was statistically significant. The comparison among the groups of volvulus; fecal impaction and volvulus with fecal impaction, separately with electively surgery group evidenced significant differences in relation to volvulus and fecal impaction CONCLUSIONS: The higher frequency of ulcerations in the megacolon operated at urgency character emphasizes the needs of immediate resection of sigmoid colon, instead of conservative conduct of simple decompression colostomy, even in exploration laparotomy which the macroscopic examination of sigmoid does not show necrotic signs. This way, should prevent the occurrence of perforation in megacolon at mediate postoperative, with serious results.

Efficacy of azithromycin in the treatment of cutaneous leishmaniasis.

The present open pilot study was conducted to assess the efficacy of azithromycin for the treatment of patients with cutaneous leishmaniasis in Ara ua and Varzelândia, MG. Twenty-four patients with less of six months of disease evolution were treated after clinical examination, Montenegro test and a biopsy. The treatment schemes consisted of oral doses of 500 mg per day for 3, 5 and 10 days and of 1000 mg for two days. A clinical control was performed monthly and treatment cycles were repeated when necessary until full reepithelialization of the lesions. On the occasion of the final evaluation, 20 patients had completed the study and 17 of them (85%) were cured. The time to obtain a cure was 60 days ifor 6 (30%) patients, 90 days for 7 (35%), and 120 for 4 (20%). The three patients with treatment failure received a pentavalent antimonial for 20 days. No adverse reactions to the medication were observed and a 14 month follow-up did not show recurrence in any patient. These results suggest that azithromycin can be a good therapeutic option for the treatment of cutaneous leishmaniasis caused by Leishmania Viannia brasiliensis.