[Human accidents with stings from Africanized bees]. / Acidente humano por picadas de abelhas africanizadas.

It is report five cases of stings of africanized bees (AB). Four of them were victims of multiple stings, varying from 25 to 60, that presented severe headache, nauseas and vomits, related to the clinic effect of the toxicity of the venom, with good evolution. The other case was victim of a single sting of AB and died after probable anaphylaxis.

[Systemic talc granulomatosis in a HIV-negative intravenous drug addict]. / Correlação anátomo-clínica: granulomatose sistêmica por talco em drogadicto HIV negativo.

Anatomo-pathological correlation in a case of systemic talc granulomatosis affecting lungs, pleura, liver, spleen and mesenteric lymph nodes resulting in pulmonary arterial hypertension and cor pulmonale is described. The patient, a 26-year-old male HIV-negative intravenous drug addict had no lymphopenia or any histopathologic findings at necroscopy compatible with AIDS, despite of a chronic high-risk behavior favoring this illness.

Correlaçäo anátomo-clínica: granulomatose sistêmica por talco em drogadicto HIV negativo / Systemic talc granulomatosis in a HIV-negative intravenous drug addict

É descrita a correlação anatomopatológica de um paciente usuário de drogas injetáveis com talcose sistêmica acometendo pulmões, pleuras, fígado, baço e linfonodos e que desenvolveu hipertensão arterial pulmonar e cor pulmonale. Destaca-se o fato de que apesar do uso crônico de drogas injetáveis e outros comportamentos de alto risco para infecção pelo retrovírus, o paciente era HIV negativo, não apresentava linfocitopenia, nem alterações histopatológicas compatíveis com AIDS à necropsia.

Headache in chagasic women.

The aim of this study was to compare the frequency of headache between Chagasic and Non-chagasic women. The cross-sectional study comprised 647 female > or = 40 years old, Chagasic (n = 362) and Controls (n = 285) at a Brazilian University Hospital. Chagasic were classified as Cardiac (n = 179), Megas (n = 58) or Indeterminate (n = 125) clinical forms. Headache was ascertained according to Headache International Society diagnostic criteria. The age (57.0 +/- 11.3 versus 57.3 +/- 10.4 years), and the percentage of white women (75.8% versus 77.1%) were similar between Chagasic and Controls, respectively. Headache was more prevalent among Chagasic (32.9%) than Controls (16.1%), mainly in Cardiac form (odds ratio, 2.41; 95% confidence interval, 1.38-4.23), phenomenon possibly related to parasympathetic denervation and cerebral vessels changes.

[The weight of the spleen in chronic chagasics]. / O peso do baço em chagásicos crônicos.

During the course of systemic inflammatory reactions and chronic venous congestion, the documented phenomenon of increased spleen size is respectively called reactional hyperplasia and congestive splenomegaly. In Chagas' disease, the inflammatory process observed in the heart of chronically infected patients can result in heart failure and ultimately in congestive failure. In order to evaluate the spleen response to both inflammatory and cardiac processes, in this retrospective study we compare the weight of spleens from normal and chagasic patients, with or without congestive failure. Information about patient age, sex, race and spleen weight was collected from autopsy reports. Eighty-eight selected cases were divided into four groups: 1) chagasic patients with congestive failure, 2) chagasic patients without congestive failure, 3) non-chagasic patients with congestive failure, 4) non-chagasic patients without congestive failure. The average age was 44.9 +/- 15.4 years, 53.4% were Caucasians and 70.5% were males, and no significant difference in these parameters was observed between the four groups. The spleen weight for the groups presenting congestive failure was 183.7 +/- 85.9 g for chagasic and 206.3 +/- 101.0 g for non-chagasic patients; for the groups without congestive failure the average spleen weight was 173.7 +/- 118.9 g for the chagasic and 117.2 +/- 52.0 g for non-chagasic patients. The spleen weight was significantly higher for the chagasic patients without congestive failure when compared to the non-chagasic group without congestive failure. These results suggest that the inflammatory component in Chagas' disease plays an important role in the increase of spleen weight together with hemodynamic alterations arising from congestive heart failure.

[Frequency of diabetes mellitus and hyperglycemia in chagasic and non-chagasic women]. / Freqüência de diabetes mellitus e hiperglicemia em mulheres chagásicas e não-chagásicas.

Medical records of > or = 40 years old female seen at University Hospital from June/93 to July/95 were submitted to a cross-sectional study. According to Chagas' disease tests, patients were divided into chagasic (n = 362) and controls (n = 285). Diabetes mellitus was defined on the basis of two fasting blood glucose levels > or = 140 mg/dl and hyperglycemia as fasting blood glucose > 110 mg/dl. Chagasic patients were divided into groups with the cardiac form of the disease (n = 179), with megas (n = 58), and asymptomatic (n = 125). Groups were compared by the chi 2 test, analysis of variance, Student's "t" test, and Kruskal-Wallis and Mann-Whitney tests. A significant difference was assumed when p < 0.05. Chagasic and control groups were matched for age, white color and body mass index. Diabetes mellitus was more prevalent in patients with the cardiac form of Chagas' disease than in controls, or patients with the megas or the asymptomatic form (15.1%, 7.4%, 7.4%, and 5.6%, respectively); the same was observed for hyperglycemia (37.4%, 26.7%, 25.9%, 27.2%), in agreement with the hypothesis that the reduced parasympathetic activity caused by Trypanosoma cruzi leads to relative sympathetic hyperactivity.

[Pancreatic anatomopathologic changes in chronic chagasic women. Preliminary data]. / Alterações anatomo-patológicasdo pâncreas em chagásicas crônicas. Dados preliminares.

The aim of this study was to compare the frequency of pancreas morphologic and morphometric changes in chagasic women (n = 6) aged > or = 40 years, with non-chagasic controls (n = 4), paired concerning to age (59.8 +/- 11.5 versus 59.0 +/- 6.3 years), white color (33.3% versus 50.0%) and body mass index (22.3 +/- 7.0 versus 18.8 +/- 2.1 kg/m2). There were no pancreatic morphometric differences between necropsied chagasic and control groups. However, there was a smaller intrapancreatic neuronal population and a higher frequency of leukocyte perineural infiltrate in the pancreas of chagasic women. This possible intrapancreatic denervation could be associated with changes in carbohydrate metabolism, including hyperglycemia and diabetes mellitus, in some chronic chagasic women.

[Adrenal gland morphological alterations in the acquired immunodeficiency syndrome]. / Alterações morfológicas da glândula supra-renal na síndrome da imunodeficiência adquirida.

In the acquired immunodeficiency syndrome (AIDS), the adrenal glands are subject to opportunistic infections, neoplasm or direct cytopathic effect by HIV. It is know that the incidence and type of adrenal involvement vary according to the patient's place of origin. In this paper we evaluate adrenal involvement in fourteen patients that died from AIDS in the University Hospital of Uberaba, Brazil. The group studied was comprised of thirteen males and thirteen whites. The age was 29.9 +/- 7.8 years, and the body mass index was 19.0 +/- 4.1 kg/m2. Adrenal specimens obtained from autopsies were analyzed by light microscopy. Inflammation was found in 100% of the cases and the etiologic agent(s) was (were) identified in eight (58.1%) patients. Cytomegalovirus was identified in seven cases, Cryptococcus sp and Herpes simplex in two and Histoplasma sp in one case, these pathologic findings were similar to literature. We also found parenchymal calcification and adrenal central vein phlebitis in one case each. Injury was found in some cases without identified infections agent. This fact could be due to the direct cytopathic effect by HIV, or due to toxicity of drug therapy used during treatment of AIDS and opportunistic infections.

Alteraçoes morfológicas da glândula supra-renal na síndrome da imunodeficiência adquirida / Adrenal gland morphological alterations in the acquired immunodeficiency syndrome

Na síndrome da imunodeficiência adquirida (AIDS) pode-se verificar o acometimento da supra-renal por efeito citopático direto pelo HIV, por infecções oportunistas ou neoplasias. Estes achados poderiam variar de acordo com a procedência do paciente, devido às doenças peculiares à região. Neste trabalho avaliou-se o comprometimento da supra-renal em quatorze pacientes que morreram de AIDS no Hospital Escola, em Uberaba. Treze eram do sexo masculino e treze brancos. A idade foi de 29,9 ± 7,8 anos e o índice de massa corporal foi de 19 ± 4,1kg/m2. Os fragmentos de supra-renal obtidos nas necropsias foram analisados em microscópio de luz. Encontramos inflamação em 100% dos casos, identificando-se o agente etiológico em oito (58,1%) casos. O Citomegalovírus foi identificado em sete casos, o Cryptococcus sp e o Herpes simplex em dois e o Histoplasma sp em um caso, estes achados são semelhantes aos da literatura. Em um caso, encontramos calcificação do parênquima e em outro, flebite da veia central. Em alguns casos que apresentavam lesão não foi possível identificar o agente etiológico, talvez em decorrência do efeito citopático direto pelo HIV ou devido a toxicidade das drogas utilizadas no tratamento da AIDS e das infecções oportunistas.

In the acquired immunodeficiency syndrome (AIDS), the adrenal glands are subject to opportunistic infections, neoplasm or direct cytopathic effect by HIV. It is know that the incidence and type of adrenal involvement vary according to the patient's place of origin. In this paper we evaluate adrenal involvement in fourteen patients that died from AIDS in the University Hospital of Uberaba, Brazil. The group studied was comprised of thirteen males and thirteen whites. The age was 29.9 +/- 7.8 years, and the body mass index was 19.0 +/- 4.1 kg/m2. Adrenal specimens obtained from autopsies were analyzed by light microscopy. Inflammation was found in 100% of the cases and the etiologic agent(s) was (were) identified in eight (58.1%) patients. Cytomegalovirus was identified in seven cases, Cryptococcus sp and Herpes simplex in two and Histoplasma sp in one case, these pathologic findings were similar to literature. We also found parenchymal calcification and adrenal central vein phlebitis in one case each. Injury was found in some cases without identified infections agent. This fact could be due to the direct cytopathic effect by HIV, or due to toxicity of drug therapy used during treatment of AIDS and opportunistic infections.

[Myocardial morphometric study in protein-energy malnourished adults]. / Estudo morfométrico do miocárdio em adultos com subnutrição protéico-energética.

PURPOSE: To compare cardiac muscle cells width and cardiomyocyte lipofuscin pigment presence between malnourished and non-malnourished necropsied adults. METHODS: Out of 315 necropsy protocols of adults randomly chosen, those with edema, ascitis, systemic arterial hypertension, chronic liver disease, and heart disease were excluded. Malnutrition was defined by body mass index (BMI) < 17 kg/m2. Cardiomyocytes morphometry study and lipofuscin pigment counts were performed. RESULTS: Malnourished (n = 8) and controls (n = 4), respectively, showed statistical differences in relation to BMI (14.86 +/- 1.13 vs 22.02 +/- 0.9 kg/m2), heart weight/body weight ratio (0.68 +/- 0.09 vs 0.54 +/- 0.07%), cardiomyocytes width (10.91 +/- 0.77 vs 12.90 +/- 1.82 microns) and lipofuscin pigment presence (39.1 vs 54.4%). CONCLUSION: When compared with controls, necropsied malnourished adults showed decreased myocardial fibers diameters and lower lipofuscin pigment presence. These findings might reflect altered metabolism, and would be associated with harmful clinical effects in terminally ill patients.

Correlation between adrenal central vein parasitism and heart fibrosis in chronic chagasic myocarditis.

The correlation between Trypanosoma cruzi parasitism of the adrenal central vein (ACV) wall and fibrous connective tissue neoformation in the left ventricular myocardium (LVM) of patients with chronic Chagas' disease who were autopsied was evaluated using the following procedures: 1) a comparison of the incidence of fibrosis in the LVM among 18 chagasic patients with ACV parasitism and 18 individuals without phleboparasitism; 2) a determination of fibrosis intensity in the LVM in 12 cases with ACV parasites and in 12 cases without phleboparasitism, matched with respect to age, sex, race, and anatomoclinical form of the disease (indeterminant, cardiac, and digestive forms); and 3) in the cases with ACV parasitism, a calculation of Pearson's correlation coefficient between T. cruzi nests in the vessel and the intensity of fibrous connective tissue neoformation in the LVM. Among chagasic individuals with adrenal phleboparasitism, there was an increased incidence and intensity of fibrous connective tissue neoformation in the LVM, both highly significant, compared with patients without adrenal phleboparasitism. Furthermore, there was a positive, though nonsignificant, correlation (r = +0.19) between the density of nests in the ACV and the intensity of myocardial fibrosis. These results are consistent with previous data showing a higher intensity of the leukocyte exudate in the LVM and increased heart weight in individuals with T. cruzi nests in the ACV, suggesting a role of parasitism at that site in terms of the development of chronic chagasic cardiopathy.

[Prevalence of renal infarcts in autopsies of chronic Chagas disease patients]. / Prevalência de infartos renais em necropsias de chagásicos crônicos.

Renal infarction (RI) is usually secondary to arterial obstruction due to emboli originating from the heart. Chronic chagasic patients may present cardiac alterations originating from intracavitary thrombi, even without congestive heart failure (CHF). In this study RI incidence was comparatively evaluated in chronic chagasic individuals, in different anatomoclinic forms and in non chagasic individuals. There has been a review on necropsy reports of individuals aged 20 or over. In 259 necropsies, 78 (30.1%) were chagasics, and 19 of them (24.4%) developed RI, while 27 (15.0%) of the non chagasic individuals presented RI. The ages of chagasics with RI were similar to those of non chagasic individuals. A significant prevalence of RI and thrombosis among chronic chagasic individuals has been found. A significantly higher prevalence of RI among chronic chagasics having CHF (52.6%) was observed when they were compared to other forms of chronic Chagas disease and when compared to non chagasic individuals. It was concluded that RI was more frequent in chronic chagasic individuals, specially those who developed CHF, which probably played a role in the renal manifestations and systemic hemodynamic changes in those patients.

[Cardiac weight in patients with chronic Chagas disease with Trypanosoma cruzi nests in the central vein of the adrenal glands]. / Peso cardíaco em chagásicos crônicos com ninhos de Trypanosoma cruzi na veia central da supra-renal.

PURPOSE: Comparative analysis of cardiac weight (CW) in patients with chronic Chagas disease, with or without parasitism by Trypanosoma cruzi in the central vein of the adrenal gland (CVAG). METHODS: The CW has been studied in 96 necropsied individuals with chronic Chagas disease. Among them, 48 of them had Trypanosoma cruzi nests on the wall of the CVAG and the other 48 patients did not have nests in the CVAG. Later, this sample was paired for sex, age and anatomo-clinical form, resulting in 60 patients. Among these patients, 30 of them had Trypanosoma cruzi nests on the walls of the CVAG and the other 30 did not have. RESULTS: The CW of Chagas patients which had nests of T. cruzi in the CVAG, was 484.8 +/- 146.0g, while in the ones that did not have the nests on the walls of the CVAG, the CW weight was 415.8 +/- 125.3g. This difference was statistically significant. In the first group it had a prevail of congestive heart failure. Subsequently to the pairing for sex, age and anatomo-clinical form, the CW was respectively 464.3 +/- 146.2g and 436.0 +/- 108.9g. This difference was not statistically significant. CONCLUSION: These data suggest that the parasitism in the central vein of the adrenal gland, combined with other possible events intrinsic to the chronic Chagas disease patients' hearts, carries a supporting role in the increasing of the cardiac weight and in the congestive cardiac insufficiency.

[Acute-phase reaction and parasitism in the central adrenal vein in Chagas' disease patients]. / Reação de fase aguda e parasitismo na veia central da supra-renal de chagásicos crônicos.

The systemic reaction to severe trauma and/or infection, acute phase response (APR), are often associated with immunosuppression and reactivation of chronic latent infection. Our main purpose was to verify, in a group of 71 autopsied chronic chagasic with or without APR, the frequency of T. cruzi nests in the central vein of adrenal gland (CVAG). APR, defined by: 1) death secondary to sepsis and/or trauma plus, 2) bleeding stress gastric ulcerations or 3) spleen reactional state or 4) liver steatosis, was observed in 30 chronic chagasic (APR+). Weight, height and body mass index (BMI) were obtained. APR(+) chronic chagasic had worse nutritional status than APR(-) ones: weight = 49.0 vs 54.5 kg; BMI = 17.5 vs 20.6 kg/m2 (median p < 0.05). CVAG T. cruzi nests frequency were similar (43.3% and 43.9%, respectively) between both Groups. We conclude that APR(+) chronic chagasic had worse nutritional status than APR(-) ones, and that APR development did not change the CVAG T. cruzi nests frequency.

[Tests of inflammatory activity in endemic pemphigus foliaceus]. / Provas de atividade inflamatória no pênfigo foliáceo endêmico.

Endemic pemphigus foliaceus (EPF) has its pathogenesis frequently associated to autoimmune phenomena. In this paper, a few routine laboratory tests, usually disturbed in some autoimmune diseases, were taken in 20 patients with EPF, which were screened for antinuclear antibodies (ANA), rheumatoid factor (RF), C-reactive protein (CRP) and changes of erythrocyte sedimentation rate (ESR), serologic proteins electrophoresis and total leucocyte count. The CRP was found in 60% of cases, leukocytosis in 85%, high ESR in all of them and mild alterations in serologic proteins analysis. No ANA or RF was found. Although widely accepted as nonspecific tests, we believe that an association of the laboratory routine tests with clinical findings, can prove to be helpful in the follow up care of these patients.

Acute, subacute, and chronic x-ray effects on glomerular hemodynamics in rats.

In order to evaluate the effects of x-rays on glomerular hemodynamics, surgically exposed left kidneys of Munich-Wistar rats were irradiated with 15 Gy in a single dose. The animals were studied 45 min (acute group, n = 8), 14 days (subacute group, n = 7), and 60 days (chronic group, n = 7) after irradiation and compared with their respective controls. A decrease in total glomerular filtration (55%) and renal plasma flow (40%) rates with marked elevation of total renal vascular resistance (180%), p < 0.05, occurred within 45 min. Significant changes also occurred in the microcirculation; i.e., single-nephron glomerular filtration (SNGFR), glomerular plasma flow (QA), and glomerular capillary hydraulic pressure (PGC) declined by 35%, 40%, and 12%, respectively, due to an increase in total arteriolar resistance (90%), p < 0.05. Within 14 days, SNGFR was similar to control in spite of a moderate elevation of afferent arteriolar resistance (26%) and reduction in PGC (11%), p < 0.05, and QA (20%). Kf was significantly elevated (46%), p < 0.05. The chronic group presented a response pattern similar to that of the acute group, although less severe. Histopathological changes were not relevant and were restricted to tubules. The present results suggest that: (a) Acutely, there was a marked reduction in filtration, flow, and PGC with significant elevation of resistances. (b) Within 14 days, the maintenance of SNGFR was probably the result of an offsetting effect between QA and PGC decreases and Kf elevation. (c) After 60 days, the homeostatic mechanism was not sufficient to maintain normal renal function. (d) A functional effect is probably the most important pathogenetic mechanism, at least during the initial phase, for the development of radiation nephropathy since no morphological alterations were observed.

Possible role of an adrenal parasite reservoir in the pathogenesis of chronic Trypanosoma cruzi myocarditis.

The possible contribution of parasitism of the central vein of the adrenal gland (CVAG) to chronic Trypanosoma cruzi myocarditis was assayed by comparing the occurrence of nests of amastigotes in the left ventricular myocardium (LVM) and determining the number and extent of areas of focal leucocyte exudate (FLE) in Chagas disease patients with and without CVAG parasitism. The frequency of occurrence of T. cruzi nests in the LVM, as well as the FLE number and area, were greater among patients with CVAG parasitism. We therefore suggest that CVAG parasitism plays a role in the onset and intensity of chronic T. cruzi myocarditis.

[Comparison of parasitology of the central vein of the adrenal gland and the other tissues in chronic chagas disease]. / Comparação do parasitismo da veia central da supra-renal com o de outros tecidos em chagásicos crônicos.

By morphological and morphometric analyses of serial sections the occurrence of T. cruzi nests in the central vein and in the parenchyma of adrenal glands, in the left ventricular wall and in the inferior vena cava wall in chronic Chagasic patients was studied. Of 36 cases 50% showed parasites in the adrenal central vein wall (total 29 nests), 3.1% showed parasites in the vena caval wall (only I nest) and 16.8% we found parasites in the myocardiocytes (total 23 nests). The density of parasites measured in the nests for each 100mm2 of the tissue examined, was 0.585 for the adrenal vein, 0.001 for the vena cava and 0.01 for the myocardium. No nest was found in 269103.1mm2 of adrenal parenchyma. Although the central vein area examined was smaller, it showed the largest frequency of T. cruzi nests. Since a basic difference between these tissues is the great quantity of corticoids in the blood of the adrenal central vein, this prevalence may be because of this hormonal ambient, which with its immunosuppressor and anti-inflammatory effects could help T. cruzi survival.