Piometra em uma leoa (Panthera leo): relato de caso / Pyometra in a lion (Panthera leo): case report

A piometra é uma infecção aguda ou crônica do útero que ocorre frequentemente em cadelas não castradas, podendo também ocorrer em gatas domésticas e selvagens, sendo poucos os estudos relacionados à piometra em grandes felídeos. O objetivo deste relato foi descrever um caso de piometra em uma leoa (Panthera leo) de cativeiro, as lesões de necropsia e histológicas, bem como os resultados da análise microbiológica. Uma leoa com aproximadamente 23 anos, pertencente a um criadouro conservacionista de Santa Maria-RS, foi encontrada morta pela manhã em seu recinto. Após coleta de dados, procedeu-se à necropsia e à coleta de material para análise histopatológica e bacteriológica. A análise microbiológica revelou predomínio das bactérias Streptococcus sp. e Escherichia coli no conteúdo purulento do útero, caracterizando como piometra, e a bactéria predominante em plasma, fígado e medula óssea foi E. coli. De acordo com o laudo histopatológico, as alterações observadas nessa leoa sugerem um quadro de septicemia grave, sendo a origem do foco infeccioso bacteriano, provavelmente, a piometra. Considera-se importante chamar a atenção dos médicos veterinários de animais selvagens para um diagnóstico precoce dessa doença, que é comum em cadelas, mas que pode acometer também felídeos selvagens e levá-los à morte.

Pyometra is an acute or chronic uterus infection that occurs often in not spayed dogs, but may also occur in wild and domestic cats, and there are few studies related to pyometra in big cats. The aim of this report was to describe a case of pyometra in a lion (Panthera leo) in captivity, the gross and microscopic lesions found at necropsy, and the results of the microbiological analysis. A female with approximately 23 years of age, belonging to a Conservationist Breeding Center located in Santa Maria-RS-Brazil was found dead in her enclosure in the morning. After data collection, we proceeded to the autopsy and collection of material for histopathological and bacteriological analyzes. Microbiological analysis revealed a predominance of the bacteria Streptococcus sp and Escherichia coli in the uterus content, characterized as pyometra and the predominant bacterium in the plasma, liver and bone marrow was Escherichia coli. According to histopathology, the changes observed in this lioness suggest a framework of severe septicemia, being the source of the bacterial infection, probably, pyometra. It is considered important to draw the attention of zoo and wildlife veterinarians for an early diagnosis of this common disease in dogs, which can also affect large wild cats and lead them to death.

Decreased serum T3 after an exercise session is independent of glucocorticoid peak.

Physical exercise increases serum glucocorticoids, which is believed to be involved in the fall of T3 after high intensity exercise. The objective was to evaluate whether a physical exercise session alters the thyroid economy and adrenal axis in humans, and the possible role of corticosteroids in thyroid function disturbance. Active but not athlete subjects were enrolled in an open field competition and cortisol, TSH, T3, and T4 were measured before and after the race. To give new insights into the mechanisms underlying the changes in thyroid economy after exercise, we used a rat model to evaluate the impact of blocking corticosterone synthesis during treadmill exercise by metyrapone administration. Cortisol levels increased 1.5-fold (from 28.2±3.8 to 42.2±2.2 µg/dl; p<0.05), while serum T3 decreased by 13% (from 115±5 to 99±5 µg/dl; p<0.05) 6 h after the race in humans. Also, in rats, glucocorticoid increased by 2-fold while T3 decreased 15% after exercise session (p<0.05). However, the complete blockage of corticosterone peak did not impair serum T3 decrease observed in rats submitted to exercise. Interestingly, the lack of corticosterone peak led not only to lower serum T3, but also to decreased serum T4, indicating that corticosterone might be fundamental for the maintenance of serum thyroid hormone levels after high intensity exercise. Although cortisol increases and T3 decreases after high intensity exercise in both humans and rats, it does not seem to be a cause-effect response since pharmacological blockage of corticosterone peak does not modulate T3 response.

Ultrasound biomicroscopy for biomechanical characterization of healthy and injured triceps surae of rats.

This work describes the use of ultrasound biomicroscopy (UBM) to follow up the degeneration-regeneration process after a laceration injury induced in the lateral gastrocnemius (LG) and soleus (SOL) muscles of rats. UBM (40 MHz) images were acquired and used for biomechanical characterization of muscular tissue, specifically using pennation angle (PA) and muscle thickness (MT). The animals were distributed in three groups: the variability group (VG; N=5), the gastrocnemius injured group (GG; N=6) and the soleus injured group (SG; N=5). VG rats were used to assess data variability and reliability (coefficients of variation of 9.37 and 3.97% for PA and MT, respectively). GG and SG rats were submitted to the injury protocol in the LG and SOL muscles of the right legs, respectively. UBM images of muscles of both legs were acquired at the following time points: before and after injury (immediately, 7, 14, 21 and 28 days). We observed an increase in PA for the non-injured leg 28 days after injury for both GG and SG rats (GG=10.68 to 16.53 deg and SG=9.65 to 14.06 deg; P<0.05). Additionally, MT presented a tendency to increase (GG=2.92 to 3.13 mm and SG=2.12 to 2.35 mm). Injured legs maintained pre-injury PA and MT values. It is suggested that a compensatory hypertrophic response due to the overload condition imposed to healthy leg. The results indicate that UBM allows qualitative and quantitative muscle differentiation among healthy and injured muscle at different stages after lesion.

Corporeal weight gain and metabolic syndrome in living kidney donors after nephrectomy.

UNLABELLED: The number of healthy individuals undergoing unilateral nephrectomy for kidney donation is increasing world-wide. Obesity and nephron reduction could promote a decline in the glomerular filtration rate (GFR) and an increase in urinary protein excretion in these individuals. Metabolic Syndrome (MS) is also a risk factor for these patients. This study evaluated GFR, urinary protein excretion, and the possibility of one or more components of MS in this group. METHODS: Twenty live kidney donors were evaluated at an average of 10 years after nephrectomy. We obtained measurements of systolic blood pressure, diastolic blood pressure, and waist circumference. We estimated renal function, urinary protein excretion, triglycerides, high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and fasting plasma glucose levels. The GFR was calculated through the estimated creatinine clearance using the Cokcroft-Gault equation (eGFR). RESULTS: Of the 20 participants, four developed MS. The patients with a greater number of MS components showed a greater eGFR. Only seven donors (35%) showed a normal blood pressure. Serum creatinine level changes were observed in three patients, and in five there was increased urinary protein excretion. CONCLUSION: This study showed the possibility that corporeal weight gain and MS may be additional overburdens on the GFR of the remaining kidney.

Coherence of elementary excitations in a disordered electron system.

The localization properties of the single-particle and collective electron excitations were investigated in the intentionally disordered GaAs/AlGaAs superlattices by weak-field magnetoresistance and Raman scattering. The localization length of the individual electron was found to be considerably larger than that of the collective excitations. This suggests that the disorder has a weaker effect on the electrons than on their collective motion and that the interaction which gives rise to the collective effects increases localization.

Isolation of Neospora caninum from the brain of a naturally infected dog, and production of encysted bradyzoites in gerbils.

Neospora caninum was isolated from the brain of an adult dog in Brazil. Cerebral tissue from the dog was inoculated into Mongolian gerbils. Gerbils were euthanized 3-4 months later and bradyzoite-containing tissue cysts were observed in their brains. N. caninum (designated NC-Bahia) was isolated in cell culture after inoculation with tissue cysts from the gerbils. The identity of the parasite was confirmed by immunohistochemical examination and polymerase chain reaction (PCR). Gerbils may be a useful alternative to immunosuppressed mice for isolation of N. caninum and for production of encysted bradyzoites.

A rapid assay of endotoxin in whole blood using autologous neutrophil dependent chemiluminescence.

A rapid (30 min) whole blood assay for the detection of lipopolysaccharide (LPS) is described. This chemiluminescent (CL) assay utilizes the CR1 and CR3 receptor-induced oxidant production of polymorphonuclear leucocytes as a detection platform. The differential priming of neutrophils in whole blood by LPS-antibody complexes allows the specificity of the assay to be achieved. Oxidant released in response to complement opsonized zymosan results in luminol oxidation and subsequent light emission. This is dependent on heat labile putative complement proteins in the plasma. The assay consists of a control which measures baseline whole blood neutrophil oxidant production. The test assay contains murine monoclonal IgM antibody against the Lipid A epitope of LPS and measures the enhanced chemiluminescent response of the neutrophils in the presence of LPS-antibody complexes. Maximal sensitivity of the CL assay is dependent upon optimal antigen-antibody equivalence and duration of pre-incubation with the whole blood sample. The quantification of LPS is possible by inclusion of a positive control containing a maximally reactive LPS dose (800 pg/ml Escherichia coli 055:B5 LPS at an antibody concentration of 0.8 microg/assay). The CL assay is insensitive to variations in patient neutrophil concentration over a minimum range of 0.5 to 20 x 10(9) cells/l. The CL assay is widely reactive with the LPS of many strains of gram negative bacteria but not with the cell wall products of gram positive bacteria or Candida and Aspergillus. In comparison to acid extraction chromogenic LAL, the CL assay demonstrates superior recovery precision and accuracy in in vitro studies. This was reproducible over a wide range of LPS concentrations (0.017-1.6 EU/ml or 20-2000 pg/ml). This assay may be a clinically useful tool for the diagnosis of infection or endotoxin in patients.

Colorectal adenocarcinoma in Crohn's disease.

OBJECTIVE: The authors' aim was to review the clinical features and estimate the long-term survival of patients with colorectal carcinoma complicating Crohn's disease. SUMMARY BACKGROUND DATA: Recent studies have demonstrated a significantly increased risk of colorectal carcinoma in patients with Crohns disease. METHODS: The authors reviewed retrospectively the medical records of 30 patients with Crohn's disease admitted to The Mount Sinai Hospital between 1960 and 1989 in whom colorectal adenocarcinoma developed. All patients were operated on and follow-up was complete for all patients to 10 years after operation, to the time of death, or to the closing date of the study in December 1989. RESULTS: The 30 patients in the series had 33 colorectal adenocarcinomas; three patients (10%) presented with two synchronous cancers. The patients were relatively young (mean age, 53 years) and had long-standing Crohn's disease (duration >20 years in 87%). The 5-year actuarial survival was 44% for the overall series: 100% for stage A, 86% for stage B, 60% for stage C. All five patients with excluded bowel tumor died of large bowel cancer within 2.4 years; by contrast, the actuarial 5-year survival for patients with in-continuity tumors was 56%. CONCLUSIONS: The incidence, characteristics, and prognosis of colorectal carcinoma complicating Crohn's disease are similar to the features of cancer in ulcerative colitis, including young age, multiple neoplasms, long duration of disease, and greater than a 50% 5-year survival rate (without excluded loops). These observations suggest the advisability of surveillance programs for Crohn's disease of the colon similar to those for ulcerative colitis of comparable duration and extent.

Mast cell modulation of macrophage procoagulant activity and TNF production.

The expression of surface procoagulants by macrophages represents an important mechanism underlying local fibrin deposition at sites of extravascular inflammation. Mast cells by virtue of their perivascular location are in a potent position to influence the inflammatory process. The present studies investigated the role of the mast cell in the generation of macrophage procoagulant activity (PCA) and tumor necrosis factor (TNF) production. Mast cell lysates caused a marked induction of macrophage PCA (dose and time dependent) and TNF release while whole mast cells had little effect. This effect was prevented by the tyrosine kinase inhibitor herbimycin. At the molecular level, Northern blot analysis revealed marked induction of the murine macrophage tissue factor transcript in response to incubation with mast cell lysate compared to control. These studies thus suggest that mast cell-macrophage interactions promote macrophage-mediated fibrin deposition and TNF release and that this effect is in part mediated via induction of tyrosine phosphorylation. These observations suggest novel mechanisms of involvement of the mast cell in the inflammatory microenvironment and macrophage activation.

Survival with colorectal cancer in ulcerative colitis. A study of 102 cases.

OBJECTIVE: This study was undertaken to correlate postoperative survival of patients with ulcerative colitis-associated colorectal cancer with the stage, configuration, size, and mucin content of the tumor. SUMMARY BACKGROUND DATA: The factors influencing prognosis in colorectal cancer in the general population are well accepted, but less is known about their influence in cases of colorectal cancer associated with ulcerative colitis. METHODS: The authors reviewed the records of 102 patients with ulcerative colitis-associated colorectal cancer admitted to The Mount Sinai Hospital between 1959 and 1988. Tumors were classified on independent pathologic review according to histologic stage, configuration, size, and mucin content. Comparisons among survival curves were tested by the generalized Wilcoxon test. Cox regression models were used to examine the joint effects of selected clinicopathologic features on postoperative survival rates. RESULTS: Complete follow-up was obtained for 93 patients (92%). Overall 5-year actuarial survival was 52%. When factors were analyzed one at a time, survival was significantly poorer among patients with advanced cancer stage, larger tumor size, infiltrating and ulcerating configuration, and high mucin concentration. On multivariate analysis by the Cox regression model, however, only cancer stage emerged as a factor independently predicting survival. CONCLUSIONS: For colitis-associated colorectal cancers, as for noncolitic cancers, histologic stage is the most important variable determining postoperative survival. The distribution of stages in our series and the survival rates within each stage did not differ appreciably from the distributions and survival rates reported for noncolitic colorectal cancers.

Portal endotoxemia stimulates the release of an immunosuppressive factor from alveolar and splenic macrophages.

Impairment of cell-mediated immunity is both a common manifestation of critical illness and a potential cause of increased infectious morbidity and mortality. The mechanisms responsible for alterations in systemic immune regulation are incompletely understood; however, monocytes and fixed tissue macrophages appear to play a central role. We have previously shown that infusion of gram-negative organisms into the portal vein, but not into the systemic circulation, induces suppression of delayed hypersensitivity responsiveness in vivo and of mitogen-stimulated lymphocyte proliferation in vitro. The present studies were undertaken to probe the mechanisms of this suppression. Rats received 3 x 10(8) killed Pseudomonas aeruginosa via the inferior vena cava or the portal vein; they were sacrificed 24 hr later and the mitogen-driven proliferative responses of isolated splenocytes were assayed. Portal infusion resulted in significant suppression of Con A-induced proliferative responses (15.5 +/- 2.7 cpm x 10(-3) compared to 68.6 +/- 9.8 cpm x 10(-3) for infrahepatic vena cava-infused animals and 48.0 +/- 5.4 cpm x 10(-3) for nonoperated controls). Suppression was shown to be a consequence of the release of a soluble suppressive factor from splenic adherent cells. Suppression of the proliferative responses of control lymphocytes could also be induced by a soluble factor present in culture supernatants of alveolar macrophages harvested from portally infused animals (4.7 +/- 0.4 cpm x 10(-3) vs 88.6 +/- 27 cpm x 10(-3) for systemically infused animals and 60.1 +/- 8.4 cpm x 10(-3) for nonoperated controls). The stimulus for the release of this factor was not endotoxin, but a second factor released from the liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral contraceptive use and blood pressure levels among women workers in São Paulo, Brazil.

Oral contraceptive use has been increasing in Brazil since the late 1970s, and oral contraceptives have been associated with higher incidence of cardiovascular diseases, including hypertension, since their release in the United States and Europe. We examined the association between oral contraceptive use and blood pressure levels in 1457 workers from 10 sectors of the economy, between the ages of 15 and 49 years, in São Paulo, Brazil. Oral contraceptive use was associated with higher age, lower parity, higher income, white ethnic group, and administrative occupations. Using multiple linear regression and logistic regression techniques, we evaluated blood pressure and hypertension differences between users and nonusers. Oral contraceptive users had a mean systolic blood pressure 2.6 mm Hg higher than nonusers after adjustment for multiple potential confounders, including age, income, parity, ethnicity, body mass index, and occupation. There was a statistically significant positive trend between length of time on oral contraceptives and mean systolic blood pressure levels. After adjustment for demographic and social variables, there were no differences between whites and blacks. Oral contraceptive users have an adjusted odds ratio for hypertension of 2.66 (95% CI: 1.51-4.70). The finding of an increasingly positive association between oral contraceptive use and mean systolic blood pressure level suggests cause and effect. This observation has substantial importance because systolic blood pressure is considered the primary predictor of blood pressure-associated morbidity and mortality. This may pose a particular problem in Brazil, since most women on oral contraceptives are not under medical supervision.

Adenocarcinoma of the small intestine in Crohn's disease.

Nineteen patients admitted to The Mount Sinai Hospital with Crohn's disease between 1960 and 1989 had 20 adenocarcinomas of the small intestine. Sixteen patients had regional enteritis and three, ileocolitis. There were 15 males and four females. Carcinomas occurred in association with fistulas (four patients), fistulous tracts (three patients), excluded bowel (five patients/six cancers) and multiple strictures (three patients). None of the patients in our study had cancer develop in the first decade of Crohn's disease, and 11 had carcinoma in the third decade. As cancers occurred in three patients with multiple strictures admitted for strictureplasty, we recommend that all strictures be widely opened and carefully examined prior to strictureplasty, with frozen section biopsies of all suspicious areas. The possibility of small intestinal Crohn's carcinoma should be suspected in patients with long-standing disease, with or without excluded bowel, who present with sudden change in symptoms, especially after a lengthy quiescent period. Cancer should also be considered in patients in whom complete obstruction fails to resolve with adequate decompression and in those with multiple strictures.

Malignant colorectal strictures in Crohn's disease.

One hundred thirty-two of 980 patients (13.5%) with Crohn's disease (CD) involving the colon, admitted to The Mount Sinai Hospital between 1959 and 1985, developed 175 colonic strictures. Thirty-three patients developed more than one stricture. The frequency was twice as great in colitis (19%) as in ileocolitis (11%). Ten malignant strictures were identified in nine patients (three ileocolitis, six colitis). One of these patients had three strictures (two malignant, and one benign), and two had two strictures (one malignant and one benign). The frequency of cancer in patients with stricture (6.8%) was higher than in those without stricture (0.7%, six of 848, p less than 0.001). There were no differences in clinical symptoms between patients with benign and malignant stricture. Seventeen of 165 benign strictures (10.3%) were long, extending over more than one anatomical segment of colon, but all 10 malignant strictures were short (p less than 0.0001). The age at the diagnosis of stricture was higher in the nine patients with malignant stricture than in the 123 patients with benign stricture (mean age 57.2 vs. 41.4 yr, respectively, p less than 0.01). The proportion of strictures that were malignant increased with duration of disease from 3.3% with less than 20 yr of CD, to 11% with CD of 20 yr or more. All nine patients with malignant stricture were treated surgically, and four of the nine died of colon cancer during a mean follow-up of 4.3 yr. Prognosis was worse in six other nonstricture cancers in this series, with five colon cancer deaths during mean follow-up of 1.6 yr. In view of the high rate of malignancy, 6.8% in this series, colonoscopy with biopsy is essential in Crohn's disease patients with colonic strictures, and surgery must be considered when a stricture cannot be fully assessed during colonoscopy.

Colorectal cancer in ulcerative colitis. Influence of anatomical extent and age at onset on colitis-cancer interval.

We have examined the age at onset of both ulcerative colitis and colitis-associated colorectal cancer in 100 patients seen at Mount Sinai Hospital between 1959 and 1988. There were 85 patients with extensive colitis and 15 with left sided colitis. There was a strong direct correlation between the age at onset of ulcerative colitis and age at diagnosis of cancer (p less than 0.0001); this correlation was found both in patients with extensive colitis (p less than 0.0001) and in those with left sided colitis (p less than 0.005). Patients with left sided colitis developed both their colitis and their cancers about a decade later than did those with extensive disease, but the mean duration of colitis before diagnosis of cancer was virtually the same (about 21 years) in both groups, irrespective of the age at onset of disease.

Intra-abdominal abscess in regional enteritis.

Intra-abdominal abscess (IAA) developed in 129 of 610 patients (21.2%) with Crohn's disease confined to the small bowel. The location of the abscess was intraperitoneal (IPA) in 109 (17.9%) and retroperitoneal (RPA) in 20 (3.3%). There was a marked preponderance of male patients in the retroperitoneal group (ratio, 18:2) (p less than 0.0001). All 129 patients were operated on. Thirteen of one hundred nine patients (12%) with IPA were reoperated on for recurrent abscess, and nine (8.2%) for other reasons. External fistula developed in 24 patients (22%) after simple incision and drainage. Four (3.7%) died; one from hepatitis, and three from sepsis 5, 14, and 90 days after surgery. Of the 20 patients with RPA, two (10%) were reoperated on for recurrent abscess and four (20%) for other reasons. External fistula developed in two patients (10%). There were no deaths in this group. A small number of patients with IAA complicating regional enteritis had persistent sepsis causing postoperative death, which is, however, six times lower than in our comparable series of Crohn's (ileo)colitis.

[Experience with peroral biopsy of the small intestine at the University Hospital--Federal University of Rio de Janeiro]. / Experiência com biopsia peroral do intestino delgado no Hospital Universitário--UFRJ.

The experience with 103 jejunal biopsies in the Rio de Janeiro University Hospital--UFRJ, from January 1983 to June 1985 is presented. It is reported the effectiveness of the method and the low number of complications. The importance as a valuable complementary method of diagnosis and the usefulness in the small intestine disease's scientific investigation is emphasized.

Epidemiological and demographic considerations. Hypertension in underdeveloped countries.

Data obtained from subjects in the city of São Paulo show that hypertension will be an increasing major public health problem as the adult population grows older. Information from over 5000 subjects indicated that males had a prevalence of hypertension almost 3 times that of females, with this difference being significant up to 44 years of age. Although mild and moderate forms of hypertension increased with age among both males and females, black males were noted to have diastolic blood pressures greater than or equal to 90 mm Hg in almost twice the frequency of their white counterparts. In addition, the demographic tendencies in São Paulo of increasing older age groups over the last 2 decades compare similarly with data from other developed Western countries. Thus, the importance of hypertension in underdeveloped countries must not be underestimated.

Hypertension among female workers in São Paulo, Brazil. Predictors and joint effects.

Previous analysis based on data derived from a prevalence study of hypertension among workers in different economic activities in the Greater Metropolitan Area of São Paulo, Brazil, have shown separate effects of biologic and social attributes on diastolic blood pressure levels (DBP). The present paper explores joint effects of sociodemographic, anthropometric, and behavioral characteristics on blood pressure levels. For that purpose, the Morgan-Sonquist procedure on interaction effects in the prediction of DBP levels was used. Six independent variables emerged as predictors: age, Quetelet index, occupation, schooling years, subsector of the economy, and smoking. Very young and lean women who were also smokers had the lowest mean DBP levels (66.1 mm Hg). Young, overweight women without college education showed intermediate levels (71.5 mm Hg). Highest levels were found among older women in production-linked occupations engaged in transportation and metallurgy activities (89.5 mm Hg). The study suggests that the potential role of work-related characteristics on blood pressure levels is greatest among older women.