Acute Chagas' disease (Trypanosomiasis americana) in acquired immunodeficiency syndrome: report of two cases.

Two heterosexual men, aged 31 and 40 years, with the acquired immunodeficiency syndrome and presenting with the acute form of Chagas' disease are reported. The first patient, a carrier of hemophilia A, was treated for 20 years with Chilean and Brazilian cryoprecipitates. This patient acquired both diseases through this medium. The second patient, an inhabitant of northern Chile (fourth region), was allegedly bitten by Triatoma infestans and was an intravenous drug addict. The hemophilic patient presented with a neurologic syndrome; a brain biopsy showed a necrotizing encephalitis with an obliterative angiitis and abundant macrophages. The second patient developed intractable congestive heart failure; necropsy showed a dilated myocarditis with rupture of myofibers and an inflammatory infiltrate rich in plasma cells, lymphocytes, and macrophages. Using light and electron microscopy, abundant amastigotes of Trypanosoma cruzi were seen in brain tissue, especially in the cytoplasm of macrophages, as well as in some myocardial fibers. In both cases, determination of anti-T cruzi antibodies (indirect hemagglutination technique) and xenodiagnosis were positive.

Motor cortex excitability in patients with cerebellar degeneration.

OBJECTIVES: To study motor cortex (M1) excitability and the effect of subthreshold transcranial magnetic stimulation (TMS) in patients with cerebellar degeneration and normals performing a reaction time (RT) task. METHODS: Time to wrist flexion after a visual go-signal was measured. TMS was always delivered at 90% of resting motor evoked potential (MEP) threshold. In one experiment, test TMS was delivered at various intervals after the go-signal. In half the trials priming TMS was also given with the go-signal. A second experiment examined the effect on RT of M1 and occipital priming stimulation alone. RESULTS: M1 excitability, measured as the likelihood of producing MEPs in the wrist flexor muscles, increased immediately after the go-signal in the patients and stayed high until movement. In controls, excitability rose gradually. This difference was largely eliminated by priming TMS. RT was longer in the patient group, but improved with priming TMS. Occipital priming produced less effect on RT than M1 stimulation in both controls (P=0.008) and patients (P=0.0004). CONCLUSIONS: M1 excitability prior to movement in an RT task increases abnormally early in cerebellar patients. This may reflect compensation for deficient thalamocortical drive. Subthreshold TMS can partially normalize the prolonged RT and abnormal excitability rise in cerebellar patients.

Actinomycosis and nocardiosis. A morphologic study of 17 cases.

Actinomycosis and nocardiosis are bacterial infectious diseases with distinct morphologic features, that can be diagnosed in tissue sections. The clinico-pathologic features of 17 cases are reported with emphasis on their histopathologic diagnosis by using a simple combination of common tissue stains. Actinomycosis was frequently observed as a secondary and localized infection often with lung involvement, especially in residual cavities or bronchiectasis; in these cases numerous actinomycotic granules and only occasionally individual bacterial filaments within the suppurative foci and/or granulomas with suppurative centers were identified. Nocardiosis was observed as an opportunistic infection in the three cases studied; in these, isolated filaments of acid-fast and Gram-positive bacteria were observed. The morphologic features and the differential diagnosis in tissue sections of both infections are discussed with emphasis on their identification by the general pathologist in the routine material.

Histoplasmosis duboisii (African histoplasmosis). An African case reported from Chile with ultrastructural study.

A case of histoplasmosis duboisii in a 30 year-old engineer is presented. The diagnosis was made with the help of light microscopy, electron microscopy and cultures. Although diagnosed in Chile, the patient probably acquired the disease in the endemic African area, more precisely in the Ivory Coast. Differential diagnosis between Histoplasma capsulatum var. capsulatum and Histoplasma capsulatum var. duboisii is based primarily on the larger in-vivo yeast form size of the latter. Electron microscopy study, the first done on the duboisii variety of Histoplasma capsulatum in human material to our knowledge, was not essential for this purpose. Differential diagnosis between Histoplasma capsulatum var. duboisii and Blastomyces dermatitidis is based on morphological tissue changes and mycologic characteristics. Once more, a case of an "exotic" or geographically restricted disease is detected far from its endemic area, thanks to easier means of transportation. Earth is a shrinking planet.

Intestinal microsporidiosis in a Chilean patient with acquired immunodeficiency syndrome (AIDS).

A 24-year-old male patient with AIDS diagnosed in 1989, and with several episodes of pneumocystosis, was admitted because of a chronic diarrheic syndrome and severe epigastric pain. Endoscopy showed a granular duodenal mucosa. Light microscopy showed a moderate villous atrophy with round-cell inflammatory infiltration of the chorion. Giemsa, Ziehl-Neelsen, and Gram stains showed microsporidial spores measuring between 1.5 and 2 microns in the supranuclear cytoplasm of some enterocytes. Electron microscopy showed sporoblasts and spores consistent with Enterocytozoon bieneusi, with an apparently non-tubular, rather electron-dense polar filament showing up to 7 coils and also a microtubular internal structure with annular disposition, a finding which has not been adequately emphasized in the pertinent literature, probably representing a contractile property of the polar filament, rather than a mere duct for the parasitic sporoplasm to be inoculated.

Intestinal leiomyosarcoma in childhood: report of two cases.

Two girls, 5 and 8 years old, with a leiomyosarcoma of the rectosigmoid and ileum, respectively, were treated at Hospital Luis Calvo Mackenna. In each case, a segmental resection with primary anastomosis was done. After the initial surgery, neither girl has received further treatment for the tumor. To date the two patients remain clinically well and apparently tumor free.

Helical tomotherapy versus conventional radiation to deliver abdominopelvic radiation.

While whole abdominopelvic radiation (APRT) provided satisfactory radiation dosimetry for the treatment of cancers with peritoneal dissemination, APRT was abandoned due to unsatisfactory tumor control from necessary radiation shielding of vital organs. Our goal was to develop a helical tomotherapy (TOMO) abdominopelvic radiation technique improving target tissue coverage while dose-limiting vital organs, especially hematopoietic bone marrow. This study reports our clinical development of a TOMO abdominopelvic radiation technique for treatment of patients with advanced stage ovarian cancer. Novel chemoradiosensitizing agent clinical trials incorporating our TOMO abdominopelvic radiation technique for treatment of patients with recurrent ovarian cancer are under development.

Recurrent ovarian dysgerminoma after laparoscopy.

To our knowledge, recurrent dysgerminoma at the site of tumor removal by laparoscopy in a patient with stage IA disease has not been previously reported. A woman with ovarian dysgerminoma treated by laparoscopy and tumor removed through the cul-de-sac recurred the 17 months later at the site of tumor removal. She was successfully treated with etoposide, bleomycin, and cisplatin chemotherapy with complete response. This case illustrates the potential for surgical site implant of an ovarian dysgerminoma; surgeons should follow strict guidelines when performing laparoscopic procedures for ovarian malignancies in order to prevent this type of incident.

[Pneumocystis carinii: an optic and electron microscopy study in samplings of 16 cases]. / Pneumocystis carinii: estudio con microscopía óptica y electrónica en muestras de 16 casos.

Sixteen patients with P. carinii infection were studied between 1977 and 1989; 12 were male and the age ranged from 4 months to 53 years old. 19 samples, 5 from autopsy, 7 from biopsy and 7 cytological aspirates were stained with hematoxylin-eosin, Gomori-Grocott, Giemsa and 0 toluidine. Autopsy material was studied by transmission electron microscopy. The diagnosis was made premortem in 11 patients. AIDS was the underlying disease in 6 patients, the rest having other immunodepressant conditions. P. carinii infection was limited to the lung in all patients. The Gomori Grocott stain gave positive results in all cases; cytological studies were generally noncontributory. Opportunistic agents were found in 4 patients (aspergillus, cytomegalovirus and C. neoformans).

[Abdominal actinomycosis: review apropos of 3 cases]. / Actinomicosis abdominal. Revisión a propósito de tres casos.

Actinomycosis is a chronic bacterial infectious disease, characterized by multiple abscesses, draining sinuses and abundant dense fibrous tissue. The intra-abdominal variety is rarely found and difficult to diagnose. We report three cases of intra-abdominal actinomycosis successfully treated by surgery and by longterm antibiotic therapy. One patient had a liver actinomycosis and two had ileo-caecal disease. Pertinent literature is reviewed.

[Probable pulmonary damage caused by bleomycin. Communication of 4 cases]. / Probable daño pulmonar por bleomicina. Comunication de 4 casos.

Four patients with advanced germinal cell testicular tumors were treated with cisplatinum, vinblastine and bleomycin. Histopathologic studies revealed pulmonary damage and various degrees of respiratory insufficiency developed in all patients, one of whom died. There was no instance of opportunistic infections in any patient. The pathophysiology relating pulmonary damage to the action of bleomycin is discussed.

[Leiomyosarcoma of the saphenous vein]. / Leiomiosarcoma de vena safena.

A 48 years old male presenting with a painless tumor of the right thigh is reported. An initial surgical excision showed that the tumor was joint to the saphenous vein. The histopathological study showed that it was a venous vascular leiomyosarcoma of intermediate degree of malignancy. The patients was re-operated performing a resection of the abductor muscle and two weeks later was subjected to radiotherapy (50 Gray). The only postoperative sequel was a moderate lymphedema of the right limb. This is the first reported case in the Chilean literature.

[Intestinal Microspora infections in a patient with acquired immunodeficiency syndrome]. / Microsporidiosis intestinal en un paciente con síndrome de inmunodeficiencia adquirida.

A 24 year old man with AIDS diagnosed in 1989 and a history of several episodes of pulmonary pneumocystosis developed chronic diarrhea and severe epigastric pain. Endoscopy revealed a granular intestinal mucosa. There was atrophy of villi and Giemsa, Ziehl-Nielsen and Gram staining identified 1.5 to 2 u spores in the cytoplasm of intestinal cells. Transmission electron microscopy of the spores revealed a thick wall, a sporoplasm with a nucleus, ribosomes, a posterior vacuole and a polar filament with multiple coils; no mitochondria were seen. Thus, the patient had intestinal microsporidiosis caused by Enterocytozoon bieneusi. This is a rare pathogen recently identified in man.

[Progressive multifocal leukoencephalopathy in a patient with acquired immunodeficiency syndrome]. / Leucoencefalopatía multifocal progresiva en un paciente con síndrome de inmunodeficiencia adquirida.

We report a 28 year old heterosexual male with AIDS that presented with progressive motor disturbances and malaise. Light and transmission electron microscopy of a stereotaxic brain biopsy demonstrated a progressive multifocal leukoencephalopathy. This is a demyelinating infectious cerebral disease attributed to JC virus and must be considered in the differential diagnosis of central nervous system disturbances in AIDS patients.

[Unusual sarcomas of the breast. Report of 3 cases]. / Sarcomas inhabituales de la mama. Comunicacion de tres casos.

Non phylloides sarcomas of the breast are infrequent malignant tumors that can be identified only at histologic examination since clinical presentation may not differ from the more frequent phylloides type. In addition to fibrosarcoma, leiomyosarcoma, rhabdomyosarcoma, angiosarcoma and liposarcoma, the stromal sarcoma of the breast has been recently identified. We report 3 such cases with heterologous components of osteosarcoma, chondrosarcoma and liposarcoma. A third case with an anti-sarcoma appearing post radiotherapy for breast carcinoma is also reported.

[Cyto-histologic evaluation of parametrial involvement in cervico-uterine cancer using aspiration puncture guided by transvaginal echography]. / Evaluación cito-histologica del compromiso parametrial en cáncer cérvico-uterino mediante punción aspirativa guiada por ecografía transvaginal.

Vaginal tact is not sufficient for staging the extension of cervical Ca in its adnexal compromise. The use of transvaginal echography with a cytological hystological parametrial biopsy allow the diagnosis to be certified. In 23 cases studied, 21 epidermoid carcinoma and one adenocarcinoma related with of original cervical tumor were revealed. The clinical staging had a 8.3% error margin.

[Leiomyosarcoma of the inferior vena cava. Presentation of 1 case of autopsy and review of the literature]. / Leiomiosarcoma de la vena cava inferior. Presentación de un caso de autopsia y revisión de la literatura.

This is a clinico-pathological report of a 30 years old male patient that presented with acute epigastric pain. Ultrasound examination showed a retroperitoneal tumor, thrombosis of the inferior vena cava and ascites. CAT scan disclosed thrombosis of hepatic vein and inferior vena cava with right atrium involvement. Necropsy showed a leiomyosarcoma of the inferior vena cava. There are seldom reports of this tumor in the last 5 years and an early diagnosis allows therapeutic interventions associating surgery, radiotherapy and chemotherapy.

[Acalculous acute cholecystitis caused by Cryptosporidium in a patient with AIDS]. / Colecistitis aguda alitiásica por Cryptosporidium en un paciente con SIDA.

We report a patient with the acquired immunodeficiency syndrome who developed acute cholecystitis. Removal of the gallbladder revealed infection by Cryptosporidium spp. The clinical course after cholecystectomy was favourable. The pathogenesis and therapy of this complication in patients with AIDS is discussed.

[Chagas disease with the acquired immunodeficiency syndrome. Clinical cases]. / Enfermeedad de Chagas en el sindrome de inmunodeficiencia adquirida. Casos clinicos.

We report 2 patients with AIDS who developed Chagas infection, one with encephalitis, the other with acute myocarditis. The implications of immune depression for the manifestations and course of Chagas disease are discussed. Chagas disease should be considered in patients with AIDS who live in endemic zones and who develop cerebral or cardiac manifestations.

[A patient with AIDS: infection associated with pneumocystis carinii and cryptococcus neoformans]. / Paciente con SIDA: infeccion asociada por pneumocystis Carinii y cryptococcus Neoformans.

A patient with AIDS developed pulmonary infiltrates typical of infection by P. carinii. However, therapy for this agent was unsuccessful. Further studies including blood cultures revealed the presence of C neoformans. Specific therapy for this agent led to recovery. Concomitant opportunistic infections may cause diagnostic and therapeutic problems in patients with AIDS.