Light microscopy study of cisplatin-induced ototoxicity in rats.

BACKGROUND: Although most studies on animal ototoxicity employ scanning electron microscopy, all cochlear structures may be identified with light microscopy. This paper describes a simple method of histological assessment of cisplatin-induced ototoxicity in rats, and relates morphological changes to functional changes in hearing detected by distortion product evoked otoacoustic emissions. MATERIALS AND METHODS: Male Wistar rats were injected with 8 mg/kg/day cisplatin, or with an equivalent volume of saline solution, for three consecutive days. They underwent distortion product evoked otoacoustic emission testing at baseline and at 24 or 48 hours after the last administration. At the end of the experiment, the animals were sacrificed and their cochleae were retrieved and prepared for haematoxylin and eosin staining. RESULTS: A four-point scoring system was used to grade injury to the external ciliated cells, as indicated by the number of cells absent from the basal turn of the cochlear duct. A four-point scoring system was also used to grade stria vascularis injury, as indicated by the degree of shrinkage of the intermediate cells. Scores were significantly higher in groups treated with cisplatin compared with controls. Morphological changes were confirmed by decreased distortion product evoked otoacoustic emission amplitudes in animals treated with cisplatin. CONCLUSION: This method is simple to perform with routine histology equipment and is appropriate for the study of acute, cisplatin-induced ototoxicity in rats.

Dengue infection: neurological manifestations and cerebrospinal fluid (CSF) analysis.

Neurological manifestation is considered a rare complication of dengue infection. Neurological and cerebrospinal fluid (CSF) findings of 13 patients with dengue infection were studied. Seven patients had encephalitis, two had myelitis and four showed Guillain-Barré syndrome (GBS). No alteration in CSF was found from 57% of those with encephalitis. Patients with GBS and myelitis showed a CSF-blood barrier dysfunction. The differences in the CSF may be related to the location of the lesion and multiple mechanisms of the disease in the nervous system.

Three-dimensional evaluation of skeletal and dental asymmetries in Class II subdivision malocclusions.

The objective of this study was to determine if any significant differences existed with regard to dental and skeletal asymmetries between subjects with Angle Class II subdivision malocclusions and subjects with normal occlusions. The sample consisted of 30 subjects in each of the 2 groups. Each possessed a full complement of permanent teeth, including first molars. The average age of subjects was 15.76 years in the Class II subdivision group and 22.42 years in the normal occlusion group. Measurements were obtained with the use of submentovertex, posteroanterior, and corrected oblique cephalometric radiographs. In the submentovertex radiographs, symmetry was assessed by measuring the relative differences in the spatial positions of dental and skeletal landmarks between the right and the left sides in both anteroposterior and transverse dimensions. Coordinate systems were used to represent the mandible, cranial floor, and the maxilla. In the posteroanterior radiographs, symmetry was assessed similarly by measuring the relative differences in the spatial positions of dental and skeletal landmarks between the right and the left sides. In the corrected oblique radiographs, symmetry was assessed by measuring the differences in size of dental and skeletal structures between the right and the left sides. Variables were analyzed with multivariate logistic regression analysis. The results demonstrated that the primary contributor to the differences between the 2 groups was the distal positioning of the mandibular first molars on the Class II side in patients whose mandibles showed no unusual skeletal or positional asymmetries. A secondary contributor was the mesial positioning of the maxillary first molars on the Class II side. Furthermore, the posteroanterior radiographic analysis showed that the more frequent distal positioning of the mandibular molars on the Class II side, compared with the mesial positioning of the maxillary molars on that side resulted in mandibular dental midline deviation to the Class II side more frequently than the maxillary dental midline to the opposite side.

[Sexual problems experienced by women in HIV-1 crisis]. / Dificuldade sexual vivenciada por mulheres em crise de HIV-1.

This descriptive study was based on the assumptions of qualitative investigation methods and on the Crisis Theory formulated by CAPLAN (1966). The objective of the study was to identify the sexual problems experienced by women undergoing an HIV-1 crisis. Data were collected through a semi-structured interview recorded by the method of FREITAS et al. (1992) and analyzed by the method of MEIHY (1996). Authors concluded that these women maintained themselves unbalanced using negative coping mechanisms. Thus, authors believe that it would be possible to help them using adequate nursing actions such as educational and guidance actions, but mainly by actions directed to the needs of patients undergoing an HIV-1 crisis.

Benign monomelic amyotrophy: a study of twenty-one cases.

A consecutive series of 21 patients with single limb atrophy (monomelic amyotrophy) is reported. Sixteen had lower limb atrophy and five had upper limb involvement. The median age of the onset was 20 years. Characteristic features were sporadic occurrence, wasting confined to one limb, insidious onset with slow progression, stabilizing in 1 to 4 years, and absence of pyramidal signs. All the patients with upper limb involvement were male, however in our cases with lower limb amyotrophy there were no male preponderance. We observed wasting of the entire length of the lower limbs in six patients. There were nine cases with amyotrophy restricted to the leg and one with amyotrophy only in the thigh. In the upper limb in four cases the involvement was distal and in one patient the atrophy was proximal. The electromyographic features were suggestive of anterior horn disease not only in the affected limb but also, in some cases, in clinically uninvolved limb. Cervical or lumbar MRI was normal. MRI of the lower limb disclosed increased signal intensity in the gastrocnemius and soleus muscles in one patient suggesting denervation.

A radiographic comparison of apical root resorption after orthodontic treatment with 3 different fixed appliance techniques.

Apical root resorption is an undesirable, but frequent side effect of orthodontic treatment, and therefore improvements in orthodontic techniques and materials are in constant development to decrease it. One of the most recently developed orthodontic techniques is the Bioefficient Therapy that uses contemporary orthodontic materials. Therefore, the primary objective of this study was to compare the amount of root resorption after orthodontic treatment between the simplified standard edgewise technique (group 1), the edgewise straight wire system (group 2), and the Bioefficient Therapy (group 3). It was also the purpose of this investigation to evaluate the amount of root resorption in the whole sample studied and the prevalence of root resorption in the upper and lower incisors. Thus, periapical radiographs were obtained with the long cone paralleling technique for the upper and lower incisors from 30 patients for each group. Root resorption was ranked by scores by 2 examiners who had an excellent intra and interexaminer calibration by Kendall concordance coefficient. Results of the Kruskal-Wallis test demonstrated that group 3 (Bioefficient Therapy) presented less root resorption than the others. It was speculated that the factors responsible for the lesser resorption in this technique were the use of heat-activated and superelastic wires with the bracket design in this technique as well as the use of a smaller rectangular stainless steel wire (0.018 x 0.025 inch) in a 0.022 x 0.028 inch slot during incisor retraction and the finishing stages, as compared to the other techniques. Considering the whole sample, there was no root resorption in 2.25% of the analyzed teeth. There was only a slight resorption in 42.56%, a moderate resorption in 53.37%, an accentuated resorption in 1.40% and an extreme root resorption in only 0.42% of the teeth. The prevalence of resorption for each incisor indicated, in decreasing order, a greater resorption for the upper centrals, followed by the upper laterals, lower centrals, and lastly the lower lateral incisors.

[Contribution to the understanding of the sexuality of partners of people with permanent colostomy]. / Subsídios para a compreensão da sexualidade do parceiro do sujeito portador de colostomia definitiva.

The general purpose of the present investigation was to describe the sexual interactions involving colostomized individuals, aiming at understanding this experience. The authors aimed also at identifying the mode regarding sexual procedures used by colostomized individuals and the possible effects of colostomy on these procedures. Therefore, a semi-structured interview, recorded or not, was applied to partners of colostomized subjects. The interviews were transcribed and analyzed according to the content analysis technique. Authors divided the results in 39 subcategories with 4.361 speech units that were gathered in three main categories. The category I "Precedence of the crisis" included 4 subcategories with 113 (36.67%) speech units. The category II "Crisis" comprised 17 subcategories with 1599 (36.67%) speech units and Category III "Crisis' Results" comprehended 18 subcategories with 2649 (60.74%) speech units. Data were validated by an expert on content analysis and the conclusion was that the main concern of health professionals is to keep subjects with a definitive colostomy alive, providing orientations focussing on the stoma, its care and gastrointestinal function. The speech of partners showed a clear presence of post-crisis results, representing a great danger to their general and sexual integrity and to their general and sexual adaptation on a short, medium and long-term basis.

[Understanding the sexuality of HVI-1 carriers]. / Compreendendo a sexualidade de indivíduos portadores de HIV-1.

The objective of the present investigation was to identify the sexual difficulties experienced by persons in an HIV-1 crisis. This is a study of a descriptive nature based on the Theory of Crisis. The sample consisted of 5 patients with HIV-1 followed up clinically in a town in the hinterland of the state of São Paulo. Semistructured interviews were tape recorded and transcribed. Data were analyzed according to MEIHY (1996) and BARDIN (1994). We conclude that the subjects presented a negative adaptation with respect to sexual, social and emotional difficulties. The results indicate the need for effective nursing interventions with persons in an HIV-1 crisis.

[Critical illness polyneuropathy: case report]. / Polineuropatia do paciente crítico. Registro de caso.

The critical illness polyneuropathy has an acute onset and an axonal predominantly motor nature. It occurs in sepsis or in multiple organ failure usually requiring mechanical ventilation in critical care units. Electroneuromyography corroborates the diagnosis. Usually it courses satisfactorily. We report on a 35-year-old female patient who, after a permanence in a critical care unit due to sepsis and removal of a dead phetus, developed tetraparesis. She had an important improvement in four months. Electromyography showed reduction of amplitude of motor and sensory action potentials, positive waves and fibrillations. The sural nerve biopsy showed axonmyelinic neuropathy. These findings are consistent with those in literature and we believe they support the diagnosis of critical illness neuropathy.

[Ulnar nerve palsy in leprosy without skin changes: biopsy of the superficial branch of the ulnar nerve in the hand]. / Paralisia do nervo ulnar na lepra sem alterações cutâneas. Biópsia do ramo superficial do nervo ulnar na mão.

Leprosy is one of the most common diseases of peripheral nerves in the world. In Brazil it is particularly frequent, being a major health problem. In tuberculoid leprosy the ulnar nerve is the most common affected nerve. Sometimes there are no skin changes. In these cases in spite of nerve thickening only the nerve biopsy is capable to make a specific diagnosis. We performed a biopsy in the dorsal sensory branch of the ulnar nerve in the hand in 17 patients with ulnar palsy with thickening of the nerve in the elbow, without skin changes. The pathological findings consisted mainly of: loss of fibers (14 cases), inflammatory infiltration (13), fibrosis (12), demyelination and remyelination (9), presence of granuloma (6) and presence of bacilli (5 cases). We conclude that in case of ulnar nerve palsy in leprosy without skin changes, the biopsy of the dorsal sensory branch of this nerve in the hand is a good procedure for the diagnosis of leprosy.

Nickel hypersensitivity reaction before, during, and after orthodontic therapy.

Nickel is a strong biological sensitizer and consequently may induce a delayed hypersensitivity reaction (type IV immune response). Because nickel is a component of the majority of the orthodontic alloys, the objectives of this cross-sectional study were to determine the prevalence of nickel hypersensitivity reaction before, during, and after orthodontic therapy with conventional stainless steel brackets and wires; to evidence the induction of this reaction by the orthodontic appliances; and to characterize the nickel hypersensitive persons. Nickel patch tests and a questionnaire were used to evaluate the hypersensitivity to this metal. The total sample consisted of 170 patients, 105 females and 65 males, from the orthodontic department at Bauru Dental School, University of São Paulo. They were divided into three groups as follows: A (n = 60), patients before the beginning of orthodontic therapy; B (n = 66), patients currently undergoing orthodontic treatment, and C (n = 44), patients who had undergone orthodontic treatment previously. The chi-square test (chi2) showed an allergic reaction in 28.3% of the total sample with 23% female and 5.3% male. This indicated a gender difference (chi2 = 10.75, p < 0.001). There was a positive association between nickel hypersensitivity and previous personal allergic history to metals (chi2 = 34.88, p < 0.0001) as well as with the daily use of metal objects (chi2 = 11.95, p < 0.0005). There was no statistically significant difference in the prevalence of contact dermatitis among the three groups (chi2 = 0.39, p = 0.848). This suggests that orthodontic therapy with conventional stainless steel appliances does not initiate or aggravate a nickel hypersensitivity reaction.

Guillain-Barré syndrome and head trauma. Case report.

The authors report the case of a 29 years old male patient presenting classical Guillain-Barré syndrome following head trauma. Only one other similar case is described in the literature. Head trauma as a precipitating event of the disease is discussed.

[Sural nerve biopsy in myotonic muscular dystrophy]. / Biópsia do nervo sural na distrofia muscular miotônica.

Twelve patients with myotonic dystrophy were studied to look for the involvement of the peripheral nervous system in this disease. All of them showed the main signs and symptoms of the disease. They did not have another causes to justify a polineuropathy. They were submitted to sural nerve biopsy with counting of myelinated fibers and histogram. Patients showed a reduction in the number of myelinated fibers and in two patients the histogram was unimodal. We concluded that polineuropathy may be another multisystemic manifestation of myotonic dystrophy.

Modification of Ca2+ metabolism in the rabbit aorta as a mechanism of spasmolytic action of warifteine, a bisbenzylisoquinoline alkaloid isolated from the leaves of Cissampelos sympodialis Eichl. (Menispermaceae).

The regulation of intracellular Ca2+ as a mechanism of spasmolytic activity of a bisbenzylisoquinoline alkaloid, warifteine, isolated from the leaves of Cissampelos sympodialis, Eichl (Menispermaceae) was studied in the rabbit aorta. Warifteine (pD2' 4.12 +/- 0.09) similar to verapamil (pD2' 6.89 +/- 0.05) antagonized, in a noncompetitive and reversible manner, KCl-induced contractions, mediated by Ca2+ entry through voltage-operated channels. Noradrenaline-induced sustained contractions mediated by Ca2+ entry through receptor-operated channels were also inhibited by warifteine (IC50 6.03 x 10(-5) M) and the standard agent sodium nitroprusside (IC50 1.9 x 10(-8) M). In Ca(2+)-free medium, the alkaloid reduced the intracellular Ca(2+)-dependent transient contraction to noradrenaline by inhibiting the release of Ca2+ (IC50 2.6 x 10(-5) M) from the stores and the refilling (IC50 1.9 x 10(-5) M) of the intracellular stores. The standard agent, procaine, also inhibited the release of Ca2+ (IC50 3.2 x 10(-5) M) but had no significant effect on Ca2+ uptake into the stores. Warifteine failed to affect intracellular Ca2+ stores sensitive to caffeine, while procaine inhibited (IC50 7.9 x 10(-4) M) the release of Ca2+ from these stores. The results indicate that warifteine may cause muscle relaxation by inhibiting Ca2+ channels and by modifying the intracellular Ca2+ stores sensitive to noradrenaline.

[Charcot-Marie-Tooth disease. Clinical study in 45 patients]. / Doença de Charcot-Marie-Tooth. Estudo clínico em 45 pacientes.

Charcot-Marie-Tooth (CMT) disease is the commonest inherited peripheral neuropathy. The clinical study of 45 patients with CMT is presented. They were derived from Antonio Pedro Hospital of Universidade Federal Fluminense in Niteroi, RJ, Brazil. Such patients could be divided by the motor conduction velocity in two types: a demyelinating form or type I (11 cases) and an axonal form or type II (34 cases). The disease was inherited as an autosomal dominant trait in 23 patients and as an autosomal recessive trait in 7 cases. In 15 patients the disorder was sporadic. The age of onset was in most of our cases before the 20 years. All of them had distal weakness in lower limbs. 38.2% had also distal weakness in upper limbs. 80% had distal wasting of the lower limbs and 50% had distal wasting of upper limbs. The tendon reflexes were absent in 64% in lower limbs and in 28% in upper limbs. The sensitive impairment in the distal regions of the extremities was mild in most patients. We found enlargement of peripheral nerves in 7 patients of type I. Pes cavus was present in 21 cases and scoliosis in 7. We found postural tremor of hands in 6 patients. In 9 cases there were rare features as mental retardation, trigeminal nevralgia, optic atrophy, deafness and calf enlargement. In most of our cases the clinical course was very slow progressive. A greater severity was seen in our sporadic cases.

Clinical and morphological study of calf enlargement following S-1 radiculopathy.

Calf enlargement following sciatica is a rare condition. It is reported the case of a 28-year-old woman who complained of repeated episodes of lower back pain radiating into the left buttock and foot. One year after the beginning of her symptoms, she noticed enlargement of her left calf. X-ray studies disclosed L5-S1 disk degeneration. EMG showed muscle denervation with normal motor conduction velocity. Open biopsies of the gastrocnemius muscles were performed. The left gastrocnemius muscle showed hypertrophic type 2 fibers in comparison with the right gastrocnemius. Electron microscopy showed mildly increased number of mitochondria in these fibers. A satisfactory explanation for denervation hypertrophy has yet to be provided.

[Polyneuropathy caused by ethylene oxide. Report of a case with clinical, electrophysiological and histopathological studies]. / Polineuropatia devida ao óxido de etileno. Registro de caso com estudo clinico, eletrofisiológico e histopatológico.

A man who worked as an operator in a factory of sterilization of heat-sensitive materials has been exposed to ethylene oxide for seven years. He developed a mild sensori-motor polyneuropathy. The electromyography and nerve condition studies showed an axonal degenerative type of neuropathy. The sural nerve biopsy revealed mild loss of myelinated fibers, some fibers with axonal degeneration, some clusters of regeneration and few rows of myelin ovoids in the teased nerve fiber preparation. This is the first report of ethylene-oxide polyneuropathy in Brazil.

Tapia's syndrome caused by Paracoccidioidis brasiliensis.

Tapia's syndrome is due to extracranial involvement of the XIIth nerve and the recurrent laryngeal branch of the Xth nerve. There is ipsilateral paralysis of vocal cords, soft palate and tongue. The main causes are parotid and other tumors or injuries to the high neck. We describe here a Brazilian female patient who presented with a lesion in the nasal mucosa, and soon after had dysphagia and dysphonia. Examination revealed paralysis of the soft palate, vocal cords and tongue ipsilaterally. Microscopic examination of the lesion in the nasal mucosa revealed the presence of the fungus. The patient was treated with sulfonamide and ketoconasol.