No reduction with ageing of the number of myenteric neurons in benzalkonium chloride treated rats.

The number of myenteric neurons may be reduced by topical serosal application of benzalkonium chloride (BAC). We studied the effects of ageing in the population of neurons that survive after the application of BAC. Ten treated and ten control animals were killed at intervals of 2, 6, 12 and 18 months after the surgery. We performed myenteric neurons counting in serially cut histological preparations of the descending colon. The control animals revealed a continuous loss of myenteric neurons number with increasing of age. Interestingly, contrary to control animals, the BAC-treated rats presented no neuron loss with ageing at any experimental time. The reasons for their survival with ageing could be related to a neuroplasticity phenomenon.

Time necessary for neovascularization of a tracheal segment by the sternohyoid muscle.

INTRODUCTION: The reimplantation of a complete tracheal segment (CTS) as an autograft or homograft often results in total or partial necrosis of the CTS. However, previous experiments suggested that when the CTS is first vascularized by the sternohyoid muscle (SM) 21 days before the reimplantation, the CTS can be reimplanted without ischemia or stenosis. However, it is not clear if the CTS requires 21 days to attain full revascularization. GOAL: This study aims to ascertain the minimum time necessary for revascularization of the 6 rings CTS by the SM allowing reimplantation free of ischemia. METHODS: Fifteen mongrel dogs, divided into 3 groups were submitted to 2 sequential surgical procedures. In the first procedure, a SM flap was used to envelop 6 rings CTS in all dogs. After periods of 21 days (group 1, n = 5), 14 days (group 2, n = 5) and 7 days (group 3, n = 5), the compound flaps (CTS and SM) were neovascularized. Each CTS was transected and mobilized from the trachea and then replaced again in its original site, as an autoflap. RESULTS: After a period of at least 60 days, none of dogs presented any respiratory alteration. Macroscopic and microscopic analyses demonstrated adequate viability and no stenosis. CONCLUSION: Our findings suggest that it is possible to neovascularize the CTS using a SM flap within a period as short as 1 week.

Chromobacterium violaceum infection in Brazil. A case report.

We report the second case of infection with Chromobacterium violaceum that occurred in Brazil. A farm worker living in the State of São Paulo presented fever and severe abdominal pain for four days. At hospitalization the patient was in a toxemic state and had a distended and painful abdomen. Chest X-ray and abdominal ultrasound revealed bilateral pneumonia and hypoechoic areas in the liver. The patient developed failure of multiple organs and died a few hours later. Blood culture led to isolation of C. violaceum resistant to ampicillin and cephalosporins and sensitive to chloramphenicol, tetracyclin, aminoglicosydes, and ciprofloxacin. Autopsy revealed pulmonary microabscesses and multiple abscesses in the liver. The major features of this case are generally observed in infections by C. violaceum: rapid clinical course, multiple visceral abscesses, and high mortality. Because of the antimicrobial resistance profile of this Gram-negative bacillus, for appropriate empirical antibiotic therapy it is important to consider chromobacteriosis in the differential diagnosis of severe community infections in Brazil.

Paracoccidioidomycotic aortitis with embolization to the lower limbs. Report of a case and review of the literature.

The authors report a clinical case of a 60-year-old Caucasian man, with two episodes of arterial embolization in the lower limbs. A microscope investigation of the emboli revealed that they originated from fungal aortitis caused by Paracoccidioides brasiliensis. A review of aortic infections showed only one similar report of this rare clinical expression of blastomycosis. The authors suggest a routine postoperative search for emboli followed by culture and histopathology.

Retinal changes and tumorigenesis in Ramon syndrome: follow-up of a Brazilian family.

We report on the clinical evolution of the Brazilian family with Ramon syndrome described by de Pina-Neto et al. [1986, Am J Med Genet 25:441-443]. Three members (patients IV-2, IV-18, and IV-19) have developed pigmentary changes in the retina and paleness of the optic disk. Patient IV-18 also has developed giant hypertrophy of the labia minora that, when examined histopathologically, was found to be due to neoplastic fibroblast and epithelial proliferation caused by a fibromatous process similar to that reported in the gingivae of the patients with this syndrome. Audiologic function of patient IV-2 was normal, and no skin lesions were detected. The articular signs and symptoms show that the affected relatives developed rheumatoid arthritis, which is currently inactive in patient IV-18, whereas patient IV-2 did not develop these alterations.

Differential diagnosis of axillary masses.

Axillary masses are uncommon alterations when detected as an isolated finding. We evaluated 31 patients with isolated axillary masses. Patients with alterations of the breasts or the upper limbs or with Ipsilateral chest lesions were excluded from the study. Nine patients had occult breast cancer, 5 of them in the contralateral breast. Seven had metastatic lymph nodes of non-ductal origin, and 1 had carcinoma of apocrine cells with metastasis to the axilla. Four patients had benign lymphadenopathy which disappeared spontaneously, and 4 others had ruptured infundibular follicular cyst, nodular fibromatosis, inflammatory tuberculous and inflammatory rheumatoid lymphadenitis. Five had an ectopic breast (2 with a fibroadenoma and 3 with fibrocystic changes). One patient had an axillary lipoma. The mean age of patients with malignant pathology was 55.1 +/- 10.9 years, and the mean age of patients with a benign pathology was 43.1 +/- 14.7 (P < 0.01). Chest X-ray and bilateral mammography are useful when the cause of the mass cannot be determined by taking a detailed history of neoplastic or infectious antecedents, by careful physical examination of the skin of the arms, trunk and neck, or by palpation of the breasts and thyroid. Fine needle aspiration biopsy distinguishes between benign and malignant pathologies. In cases of indeterminate neoplasia, complete axillary dissection for diagnosis is indicated.

SRY-negative true hermaphrodites and an XX male in two generations of the same family.

Two 46,XX true hermaphrodites and one XX male without genital ambiguities are reported. They coexist in two generations of the same pedigree, with paternal transmission and in the absence of SRY (sex-determining region, Y chromosome). These familial cases provide evidence to support the hypothesis that these disorders are alternative manifestations of the same genetic defect, probably an autosomal dominant mutation (with incomplete penetrance) or an X-linked mutation (limited by the presence of the Y chromosome).

Tracheal neovascularization: a method involving mobilization of a complete tracheal neovascularized segment using a sternohyoid muscle flap.

Tracheal segmental free grafts always tend to undergo necrosis with consequent occlusion of the airway. Revascularized grafts are impossible to carry out, since the trachea is devoid of a major vascular pedicle that would permit microvascular reconstruction. On the other hand, neovascularized grafts carry a potential for success but have not been sufficiently studied. Neovascularization of a six-ring circumferential tracheal segment (CTS) was studied in dogs using a sternohyoid muscle (SM) flap. Three different procedures were carried out. In group 1 the six-ring CTS was inside a free graft. In group 2 the SM was freed from its proximal connection and rotated to wrap a corresponding six-ring CTS; it was then sutured and left in place for 21 days. After this period it was again approached, and the six-ring CTS was sectioned and sutured back in place, leaving the distally pedicled SM untouched. In group 3 an identical procedure was carried out, but the SM flap was left with a proximally rather than a distally based flap. All surviving animals were followed up for at least 1 year, and the results were analyzed by clinical and tracheoscopic observations and by macroscopic and microscopic studies after the animals were killed. All animals in group 1 died within 18 days; the studies showed necrosis and occlusion of the CTS. In groups 2 and 3 there was no degenerative change of the CTS, whose aspect was close to normal on macroscopic and microscopic examination. We conclude that the free CTS graft is totally inviable. In contrast, neovascularization of the CTS occurs when the segment is first wrapped around with an SM flap. This ensures CTS viability and opens new perspectives for homotransplantation.

Neonatal lupus erythematosus.

The patient is a newborn girl, born at term by cesarian section, weighing 3,550 g, and measuring 50 cm in length. According to her mother, she had been presenting erythematous spots involving the scalp, face, and trunk since birth that had increased in size with time. The mother denied any other changes and reported normal growth and development. Physical examination at 2 months of age revealed an infant in good general condition, hydrated, with no fever and no abnormalities detected on careful physical examination. The dermatologic examination revealed numerous circumscribed erythematous-brownish flat maculae with sharp borders and irregular contours, with no follicular hyperkeratosis, but with telangiectasias and areas of atrophy. They were lenticular and nummular, especially on the face (peri-orbital heliotropic lesions), and appeared as plaques on the trunk, with a tendency to confluence. The lesions also involved the scalp, neck, and extremities (Fig. 1). Histopathologic examination revealed an atrophic epidermis with focal areas of hydropic degeneration of the basal layer. A discrete perivascular and periannexal lymphohistiocytic infiltrate was observed in the superficial dermis, with melaninophages, frequent extravasation of red blood cells, angiectasia, and edema (Fig. 2). Serologic tests were reactive for antinuclear factor (ANF) (titer 1:100) of the speckled pattern, the presence of anti-Ro antibodies, and absence of anti-RNA and anti-Sm antibodies (Table 1). Blood counts and electrocardiogram were normal (Table 1). HLA typing showed positivity for DR-3 (Table 2). At 5 months of age the patient already showed a marked improvement of the skin lesions with only some areas of discrete pigmentation, a few atrophic areas, and rare telangiectasis (Fig. 3). The serologic tests (ANF, anti-Ro) had become nonreactive and the anti-RNA and anti-Sm tests continued to be negative. Examination of the mother revealed an asymptomatic 25-year-old woman reporting no manifestations suggestive of lupus. General and special physical examination revealed no abnormalities. Dermatologic examination showed no active or residual lesions of discoid or systemic lupus erythematosus. The pregnancy had been uneventful. Histopathologic examination of the girl's skin revealed the epidermis without obvious changes, minimal edema in the dermis, and a discrete perivascular inflammatory mononuclear cell infiltrate. Direct immunofluorescence of normal skin not exposed to the sun was negative. Blood counts revealed mild anemia and a tendency to leukopenia and thrombocytopenia (Table 1). Serologic tests showed reactive ANF (titers 1:400 and 1:800, speckled pattern), the presence of anti-Ro antibodies, and the absense of anti-RNA and anti-Sm antibodies (Table 1). HLA-typing revealed positivity for DR-3 (Table 2).

Entomophthoramycosis: therapeutic success by using amphotericin B and terbinafine.

A 12-year-old girl had been presenting a woody infiltration and erythema in the frontal region and on the entire left half of the face, leading to deformity of the nose and buccal fissure, and adenomegaly in a posterior cervical chain, for the last 18 months. Sinusitis was diagnosed and treated with antibiotics, and submitted to ethmoid sinusotomy, with no improvement. Several laboratory tests were made to find the correct diagnosis. An intradermal test for delayed hypersensitivity showed a positive reaction (5 mm) with necrosis for metabolic antigens for Conidiobolus. An oral mucosa biopsy showed a dense lymphohistiocytic infiltrate and focal points of necrosis. Gomori staining for fungi revealed countless wide, nonseptate hyphae. Amphotericin B was prescribed during 35 days, with no improvement. Terbinafine given orally was started in association with amphotericin B. Reduction of the lesions was observed 2 months later. No side effects were seen during 4 months of treatment.

Use of the platysma myocutaneous flap for cervical trachea reconstruction: an experimental study in dogs.

Cervical trachea reconstruction with a non-stented platysma myocutaneous door flap (NPMCF) was studied in 23 dogs. Window defects involving 5, 10, or 15 rings and the whole anterior tracheal wall were produced in 3 different groups of animals. A segmentary defect involving the resection of 3 tracheal rings but preserving the posterior membranous wall was created in another group. The results were evaluated by clinical follow-up of up to 100 days, by tracheoscopy 1 week after surgery, and by macroscopic and microscopic examination after the animals' natural death or sacrifice. The NPMCF proved to be adequate for the reconstruction of window defects limited to 5 and 10 rings, with success rates of 100% and 75%, respectively. The use of the NPMCF for tracheal reconstruction had the following main advantages: 1. relatively simple, easy, and expeditious surgery; 2. use of a single operative field; 3. availability of large amounts of donor tissue; 4. adequate thickness; 5. reliable irrigation; 6. resistance to environmental exposure as evidenced by absence of infection; and 7. 100% take rate with no granulomas or scar stenosis at the suture lines. However, luminal occlusion due to flap collapse was a 100% fatal complication when the NPMCP was used either for reconstruction of larger window tracheal defects (15 rings-group 3) or segmentary defects (group 4); this was the main limitation of the method, followed by hair growth with accumulation of secretions, which can be easily dealt with. It can be anticipated that this method has a potential for application in well-selected patients.

Síndrome do túnel carpal aguda associada a trombose da artéria mediana persistente / Acute carpal tunnel syndrome associeted to thrombosis of the persistent median artery

Os atores apresentam três casos de síndrome do túnel carpal agudamente precipitados por trombose de artéria mediana persistente. Säo discutidos aspectos referentes a anatomia e a patologia da lesäo.

Histologic changes in fibrocystic breast disease before and after treatment with bromocriptine.

Twenty-five women with fibrocystic breast disease were investigated in a double-blind study using treatment with bromocriptine (5 to 7.5 mg/day for 3 months) or placebo. Estradiol and progesterone measurements did not show any changes before, during or after treatment. Serum prolactin levels were reduced during the use of bromocriptine. Histologic evaluation demonstrated a decrease of epithelial hyperplasia and arrest of the cystic dilation picture after treatment with bromocriptine.

[Gastric paracoccidioidomycosis. A case report and considerations on the pathogenesis of this disease]. / Paracoccidioidomicose do estômago. Relato de caso e considerações sobre a patogenia desta lesão.

The authors report an unusual case of fungal gastric lesion in a patient with the chronic form of paracoccidioidomycosis. For a period of 8 months the major symptoms of the patient were abdominal pain and body weight loss. The endoscopic evaluation of the upper gastrointestinal tract showed a partial gastrectomy made previously, a great and irregular ulcer in the stomach and a granulated aspect of the duodenal mucosa. A granulomatous process and Paracoccidioides brasiliensis were observed in the histopathological examination of the gastric and duodenal biopsy tissue. New endoscopic evaluation 4 months after treatment with sulfadiazine revealed healing of the gastric ulcer. It was suggested that abdominal lymph nodes involvement, duodenal infection and anatomical and atrophic alterations of the stomach were predisposing factors for the gastric paracoccidioidomycosis.

Polycystic hydatid disease (Echinococcus vogeli). Treatment with albendazole.

Six patients with polycystic hydatid disease (PHD) were treated with 10 mg kg-1 day-1 albendazole. One patient was treated continuously for eight months and another for three months. In three other patients treatment was discontinuous, consisting of a series of at least three 30-day cycles separated by 15 days without treatment. The last patient was treated continuously with 12 mg kg-1 day-1 albendazole for 51 days and then with three 30-day cycles of treatment with 10 mg kg-1 day-1 separated by 15-day drug-free intervals. Follow-up ranged from 10-30 months. Considerable clinical improvement and cyst reduction or disappearance occurred in four patients. Clinical improvement, but no changes in the hepatic alterations detected by computerized tomography, occurred in the other two patients, although a pulmonary cyst disappeared in one of them. Adverse effects were proteinuria, alopecia, leucopenia, itching and discrete elevation in aspartate transaminase, all of them reversed after the end of treatment. These results indicate that albendazole is effective for the treatment of PHD.

Polycystic hydatid disease (Echinococcus vogeli). Clinical, laboratory and morphological findings in nine Brazilian patients.

Polycystic hydatid disease occurs in neotropical zones and is caused by Echinococcus vogeli. The paca, a wild rodent, is the intermediate host and the final host is the dog. Seven cases of polycystic hydatid disease autochthonous to the Brazilian Amazon region are described. The disease was polycystic in all cases and diagnosis was based on anatomopathological findings. E. vogeli was identified by the shape and dimensions of the rostellar hooks. The liver was the organ most often involved (6/7), followed by the lungs (2/7) and mesentery (2/7), spleen (1/7) and pancreas (1/7). The main clinical manifestations were abdominal pain, hepatomegaly, jaundice, weight loss, anemia, fever, hemoptysis, palpable abdominal masses and signs of portal hypertension. Hepatic calcifications were detected in four cases. Two cases from the hinterland of the State of São Paulo are also reported. Both had calcified round structures in the liver, highly suggestive of calcified polycystic hydatids. The aim of the present report was to report on this relatively unknown hydatid disorder of Tropical America and to disseminate its clinical, ultrasound and radiological features.

The fate of tendon grafts used to reconstruct the digital annular pulleys.

An experimental morphological study on the reconstruction of the digital annular pulleys has been carried out in dogs. The segment corresponding to zones 1 and 2 of the flexor apparatus of the 2nd and 5th digits of the left forepaw was chosen for the experiment. The whole flexor apparatus was resected and a single digital pulley (A 2) was reconstructed, using segments of the animals own deep flexor tendon. A length of silicone rubber tube was used as tendon spacer. The new pulleys showed marked degeneration of the collagen fibres and thinning which increased with time and may be the cause of decrease in strength. A layer of mesothelial cells with secretory properties developed at the interface between the tendon graft and the spacer.