Eosinophils are not a clue to the pathogenesis of granuloma annulare.

Eosinophils are variably present in biopsy specimens of granuloma annulare (GA). A retrospective study of 77 biopsy specimens from 73 patients with GA was performed to quantitate eosinophils and correlate the findings with both histologic and clinical features. Specimens were divided into absent, low (10 > x > or = 1 eosinophils per 3 sections), and high (x > or = 10 eosinophils per 3 sections) eosinophil groups and evaluated for eight histologic and 11 clinical features. Eosinophils were identified in 66% (51/77) of biopsy specimens, with 51.9% (40/77) and 14.3% (11/77) in the low and high eosinophil groups, respectively. Clinically, patients in the high eosinophil group were found to be significantly younger with a propensity towards nonannular, localized disease. These patients also did not have diabetes or use systemic medications. Histologically, the presence of eosinophils was strongly associated with palisaded architectural pattern and the presence of necrobiosis. Eosinophils were not present in areas of necrobiosis but were found predominantly perivascularly. A moderate to marked lymphocytic infiltrate at the periphery of the granulomas and reactive vessel changes were common in all three groups, but vasculitis was not identified. In summary, this study showed eosinophils to be commonly present in GA but was unable to correlate their presence with specific clinical or histologic features supportive of an allergic precipitant. A cell-mediated immune mechanism is likely involved in GA, with eosinophils recruited nonspecifically by mediators released during granuloma formation.

Subcutaneous T-cell lymphoma with associated hemophagocytic syndrome and terminal leukemic transformation.

We report a case of subcutaneous T-cell lymphoma that presented as recurrent subcutaneous nodules, pancytopenia, and fever. Histopathologic examination revealed a dense infiltrate of markedly atypical lymphoid cells localized to the panniculus. These cells were identified as T cells by immunohistochemistry. There was associated karyorrhexis and fat necrosis. Hemophagocytosis was present both in the panniculus and in the bone marrow, with no tumor evident outside the subcutaneous tissue. Despite chemotherapy in conjunction with an autologous bone marrow transplant, the patient died after metastases, including explosive leukemic transformation, developed. Review of the literature shows subcutaneous T-cell lymphoma to be a rare peripheral T-cell lymphoma, often mistaken initially as a benign panniculitis, that manifests an aggressive, fulminant presentation in approximately one half of the patients; the remainder transform into a high-grade malignancy after months to years. The hemophagocytic syndrome, though to be a reactive T-cell process mediated by cytokines, is a frequent complication of this lymphoma and is responsible for its poor prognosis. Our patient uniquely demonstrated fatal leukemic transformation.

Marginal malnutrition and reduced physical work capacity of migrant adolescent boys in Southern Brazil.

We measured the effect of marginal malnutrition on physical work capacity of adolescent children of agricultural migrant workers in Southern Brazil. Nutritional status was evaluated using 24-h dietary recall. Body size was evaluated anthropometrically. Biochemical assessments were also made. Physical work capacity (PWC170) was assessed by measuring heart rate, blood lactic acid levels, and oxygen consumption during submaximal bicycle ergometer work. The same tests were also carried out on a comparable group of local well-to-do boys of the same age in the same community who served as controls. The dietary results suggest that adolescent boys of migrant families were marginally malnourished. Their physical growth and development were retarded by at least 1 yr. They had significantly lower reserves of body fat and less muscle mass when compared with controls. Their Hb levels were normal. At the submaximal work loads measured (0, 25, 50, 75 W) the migrant children exhibited similar oxygen consumption and gross exercise efficiency as the control children, but achieved this work at a higher percentage of their maximum work capacity as shown by significantly higher heart rates for the same oxygen consumption. Higher blood lactic acid levels in the migrant children suggest that the available muscle mass was under greater stress to accomplish the same task. PWC170 was reduced one-third in the migrant children (migrant 643 +/- 162 kpm/min, control 905 +/- 345 kpm/min; p less than 0.005). These differences were largely associated with weight (migrant 20.6 +/- 5.9 kpm/min; control 18.8 +/- 4.3 kpm/kg/min; p greater than 0.1). These observations suggest that marginal as well as severe malnutrition affect physical work capacity at levels low enough to affect growth and development.

Capacidade física de trabalhadores migrantes antes e após nutrição balanceada. Análise por cicloergometria / Physical capacity of migrant workers before and after formulated diet.Analysis by cycloergometry

Quarenta e um trabalhadores migrantes (regiao de Ribeirao Preto - SP) foram submetidos a exame fisico, dosagens bioquimicas e hematimetricas. Responderam a rigoroso inquerito alimentar que evidenciou ingestao calorica subnormal. Utilizando prova cicloergometrica, determinou-se a capacidade fisica. A comparacao dos resultados com outros grupos profissionais demonstrou que os trabalhadores migrantes tem desempenho fisico muito baixo. Durante 3 meses consecutivos, foi formecida uma refeicao balanceada, quente e normocalorica (media de 1388 cal), ingerida no local do trabalho, no periodo do almoco. Ao final desta fase, novos exames antropometrico, bioquimico e cicloergometrico foram realizados em 14 trabalhadores. Estes ganharam peso e apresentaram aumento dos periometros braquial e cefalico. Os resultados ergometricos igualmente evidenciaram melhora na capacidade fisica do grupo. Cinco trabalhadores, sem suplementacao serviram para controle. Concluiu-se que estes trabalhadores migrantes sao fisicamente limitados, mas quando recebem alimentacao adequada, em condicoes nutritivas normais, aumentam seu desempenho na producao de trabalho

Anthropometric and cycloergometric assessment of the nutritional status of the children of agricultural migrant workers in Southern Brazil.

In our survey of the food habits and nutritional status of "Boia-Fria" agricultural migrant workers in Southern Brazil, a special project was undertaken to assess the influence of socioeconomic and dietary deprivation on the physical growth and development and physical performance of their children. Four hundred fifty-five children in Boia-Fria families from Vila Recreio, a periurban slum of Ribeirao Preto located in the interior of the state of Sao Paulo, were examined for body weight, standing height, mid-upper arm muscle circumference, and head circumference. For comparison, 475 children from "Vita et Pax", a private school attended primarily by children of well-to-do families from the city of Ribeirao Preto, were also examined using similar anthropometric procedures. A small group of selected Boia-Fria children and their well-to-do counterparts were subjected to ergometric-cum-electrocardiographic testing for submaximal physical work performance. The overall results of this comparative study indicate that the physical growth and development and the physical performance of the Boia-Fria children are significantly lower than their well-to-do counterparts. It is suggested that the poor anthropometric and ergometric status of the Boia-Fria children is a reflection of poor dietary habits and socioeconomic deprivation prevalent among the agricultural migrant workers and poor periurban populations of Brazil.