RESUMO
BACKGROUND AND OBJECTIVES: Dermatitis herpetiformis is a chronic bullous disease that is currently considered a cutaneous expression of gluten hypersensitivity. The aim of this study was to analyze and describe the clinical, histological, and immunopathological characteristics of patients with dermatitis herpetiformis assessed at Hospital Clinic de Barcelona, Spain between 1995 and 2010. MATERIAL AND METHODS: Demographic, clinical, serologic, and histopathological data were reviewed for 33 patients with dermatitis herpetiformis. RESULTS: The median age of the patients at the time of disease onset was 30 years and the majority were men. Associated autoimmune disease was present in 49% of patients. In 6 patients, celiac disease was diagnosed before dermatitis herpetiformis. Although excoriations were the most predominant lesions, 9 patients had blisters. Histological findings in skin lesions were compatible with dermatitis herpetiformis in 46% of cases. The most frequently observed staining pattern by indirect immunofluorescence was the presence of granular immunoglobulin A deposits in the basement membrane (62%). More than 80% of intestinal biopsies were compatible with celiac disease. Antibodies linked to gluten sensitivity were observed in 79% of patients. Only 1 malignant tumor was detected. CONCLUSIONS: Notable findings were the frequent presence of bullous lesions, the high prevalence of celiac disease, and the positive findings on intestinal biopsy, all of which are suggestive of late diagnosis. Our findings confirm the lack of specificity of conventional histology in dermatitis herpetiformis and the association of the disease with other immunological disorders.
Assuntos
Dermatite Herpetiforme/diagnóstico , Dermatite Herpetiforme/imunologia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Fatores de Tempo , Adulto JovemRESUMO
To study the influence of reflux esophagitis on the carcinogenic response of 2,6-dimethylnitrosomorpholine (2,6-DMNM), an experiment was designed, composed of 6 groups of 8-week-old Sprague-Dawley rats, each consisting of 20 males and 20 females. Group 1 served as untreated controls. All animals of groups 2, 4, and 6 underwent an esophagojejunostomy with gastric preservation to produce a chronic reflux esophagitis. 2,6-DMNM was injected s.c. once weekly for life at doses of 1/100 and 1/10 of the 50% lethal dose to groups 3 and 4 and groups 5 and 6, respectively. Carcinogen exposure began in groups 4 and 6 15 days after the esophagojejunostomy. Squamous cell carcinomas were observed in the esophagus of 36 animals, mainly in those receiving the higher dose. Exophytic squamous cell carcinomas, a variety rarely seen in humans, were mostly seen in the groups receiving 2,6-DMNM alone, whereas endophytic squamous cell carcinomas, the variety most frequently seen in humans, mainly developed in the groups receiving the combined treatment. In addition adenocarcinomas with abundant mucin production were found in the distal esophagus of 23 animals. They were found exclusively in animals of groups 4 and 6 which underwent esophagojejunostomy plus 2,6-DMNM exposure. No adenocarcinomas were encountered in groups without experimental reflux esophagitis. These findings may contribute to further understanding of the association between reflux esophagitis and the various histological types of esophageal carcinoma in humans.
Assuntos
Adenocarcinoma/induzido quimicamente , Adenocarcinoma/etiologia , Neoplasias Esofágicas/etiologia , Esofagite/complicações , Adenocarcinoma/patologia , Animais , Peso Corporal , Neoplasias Esofágicas/patologia , Esofagite/patologia , Feminino , Jejunostomia , Masculino , Nitrosaminas/farmacologia , Ratos , Ratos EndogâmicosRESUMO
Weekly SC administration of 2,2-dioxopropylnitrosamine to 88 Sprague-Dawley rats resulted in the induction of 76 separate neoplasms in the respiratory region of the nasal cavities. No tumors of the olfactory region were found. Histologically there were 37 squamous papillomas, 17 transitional papillomas, and 22 squamous cell carcinomas. These tumors were compared with a selected group of 53 related human tumors of the nasal and paranasal cavities, consisting of 11 squamous cell papillomas, 13 transitional papillomas, and 29 squamous cell carcinomas. While the experimental squamous cell papillomas showed a striking histological resemblance with the squamous papillomas observed in man, none of the experimental transitional papillomas had evidence of the characteristics inverted pattern seen in humans; nevertheless, the experimental tumors showed signs of incomplete squamous metaplasia and preservation of intraepithelial secretory glands, features commonly seen in transitional papillomas of man. The squamous cell carcinomas of this experiment were very similar to the corresponding human tumors in morphology and sex incidence. In both species a significant number of squamous cell carcinomas were keratinizing and of a high grade of histological malignancy. In addition, 69% of the human squamous cell carcinomas occurred in the male sex, and 72% of the experimental carcinomas developed in males. This comparative study suggests that further studies investigating the significance of nitrosamines as suspected etiologic factors of nasal carcinogenesis in man may be useful.
Assuntos
Carcinógenos , Nitrosaminas/toxicidade , Neoplasias Nasais/patologia , Adolescente , Adulto , Idoso , Animais , Carcinoma de Células Escamosas/induzido quimicamente , Carcinoma de Células Escamosas/patologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/induzido quimicamente , Papiloma/patologia , Ratos , Ratos EndogâmicosRESUMO
The authors reviewed 78 colonic biopsies from 63 patients undergoing bone marrow transplantation (BMT), 56 allogeneic and 7 autologous, to assess different morphologic changes related with intestinal acute graft-versus-host disease (A-GVHD). Only five biopsies were done before the 20th day after BMT. The authors studied the presence of ulcers and atrophy in the mucosa, the nuclear atypia, and inflammatory infiltrate in the surface epithelium, and the architectural abnormalities, as well as dilation of the glands, and the presence of crypt abscesses. The authors explored the glandular epithelium for apoptosis and intraepithelial lymphocytes. They examined the lamina propria for inflammatory infiltrate, especially for so-called "focal periglandular infiltrate (FPGI)," edema fibrosis, increase of capillary vessels and presence of muciphages and clusters of enterochromaffin cells. Cases were grouped according to clinical symptoms and histologic diagnosis of A-GVHD in skin or liver. Group A had 15 asymptomatic cases (control). Group B had 20 cases from asymptomatic patients with a histologically proven A-GVHD. Group C had 43 cases with gastrointestinal symptoms and histologically proven A-GVHD. Then, the relative frequency of every histologic feature previously described were compared in the different groups by means of an univariate analysis. Apoptosis of the glandular epithelium was found in 48 cases, two of them in patients carrying an auto-BMT. Focal periglandular infiltrate was found in 11 cases that was associated with apoptosis (P < .03, Fisher's exact test). In this series, the presence of FPGI was linked with finding apoptosis in a given specimen with a probability of 91%. Glandular architectural changes and dilation were also more frequent in group C than in groups A and B when compared in the univariate analysis.
Assuntos
Colo/patologia , Doença Enxerto-Hospedeiro/patologia , Doença Aguda , Adolescente , Adulto , Apoptose , Biópsia , Transplante de Medula Óssea , Criança , Feminino , Humanos , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Generalized follicular hamartoma is a rare condition that has been described in association with alopecia, myasthenia gravis, and circulating autoantibodies. To date, all reported cases have appeared in female individuals. We report a kindred in which three siblings were affected by this condition in association with alopecia and cystic fibrosis. OBSERVATIONS: Three children of two consanguineous patients were affected by cystic fibrosis. They also had the same phenotype characterized by senilized facies, partial alopecia, and hypohidrosis, severe retardation of physical growth, and hyperelasticity of the skin. In all three children, skin biopsy specimens revealed the presence of basaloid proliferations at the level of the hair follicles that could not be demonstrated in their healthy parents. Myasthenia gravis did not appear during the clinical course of our patients, and circulating autoantibodies were not detected. All three patients died during childhood due to complications of cystic fibrosis. CONCLUSIONS: Generalized follicular hamartoma is a rare condition previously reported in association with alopecia, myasthenia gravis, and/or circulating autoantibodies (antinuclear and antiacetylcholine receptor antibodies). These are the first congenital cases of generalized follicular hamartoma described, and it is also the first time that an association with cystic fibrosis is reported. The striking association of generalized follicular hamartoma with cystic fibrosis in these three siblings suggests that there may be a genetic linkage between the two conditions.
Assuntos
Alopecia/genética , Fibrose Cística/genética , Hamartoma/genética , Alopecia/complicações , Alopecia/patologia , Pré-Escolar , Fibrose Cística/complicações , Fibrose Cística/patologia , Feminino , Hamartoma/complicações , Hamartoma/patologia , Humanos , Lactente , Masculino , LinhagemRESUMO
Localization of monoamine oxidases (MAO) A and B and beta-adrenoceptors, was studied in aged human peripheral tissues (age 68-80 years) by quantitative autoradiography. The tissues analyzed were heart, lung, liver, kidney, spleen and duodenum. [3H]Ro41-1049 and [3H]lazabemide, two recently characterized selective radioligands were used to map MAO-A and MAO-B respectively. The regional pattern of distribution of MAO-A and MAO-B did not differ markedly, except in kidney and especially in duodenum. Highest levels of MAOs were measured in liver, and lowest in spleen. MAO-A was more abundant than MAO-B in lung and duodenal mucosa, and the reverse was true in myocardium. These results show marked differences in the abundance and patterns of distribution of MAOs, particularly MAO-B, in human and rodent peripheral tissues.
Assuntos
Isoenzimas/metabolismo , Monoaminoxidase/metabolismo , Idoso , Idoso de 80 Anos ou mais , Autorradiografia , Duodeno/enzimologia , Humanos , Rim/enzimologia , Fígado/enzimologia , Pulmão/enzimologia , Inibidores da Monoaminoxidase/metabolismo , Miocárdio/enzimologia , Ácidos Picolínicos/metabolismo , Receptores Adrenérgicos beta/metabolismo , Baço/enzimologia , Tiazóis/metabolismoRESUMO
Electron microscopic aspects in ten cases of normolipidemic cutaneous xanthomatosis have been investigated. Two additional types IV and V hyperlipoproteinaemic xanthomatosis have also been included. Ultrastructural findings in all cases were similar. Abundant histiocytic cells with numerous intracytoplasmic lipid vacuoles, lysosomes, and myelin-figures, were the striking features. Moreover, in older lesions microfilaments and lipid vacuoles were found in some fibroblastic cells, as well as long space collagen around them. In some specimens we observed: giant multinucleated histiocytic cells, crystalline cleft-like spaces in histiocytes and some mastocytes with lipidic crystals in the extracellular space, as well as lipid vacuoles in Schwann cells, endothelial cells and pericytes. Rod-shaped tubulated bodies were found in some endothelial cells, with multiple basal vascular laminae. In xantelasma palpebrarum and in disseminate plane xanthoma the histiocytary foamy cells adopted a perivascular arrangement, as in hyperlipoproteinemic xanthomatosis. We concluded that ultrastructural aspects of different xanthomatosis are fairly similar as a consequence of the large amount of intracytoplasmic lipids accumulated in xanthomatosus cells. In xanthelasma palpebrarum and in disseminated plane xanthoma this cell phase is reached by similar pathways to those for hyperlipoproteinemic xanthomatosis, whilst in xanthoma disseminatum and juvenile xanthogranuloma the pathways seem to be different. A classification of normolipidemic xanthomatosis is also provided.
Assuntos
Dermatopatias/patologia , Pele/ultraestrutura , Xantomatose/patologia , Histiócitos/ultraestrutura , Humanos , Hiperlipoproteinemia Tipo IV/complicações , Hiperlipoproteinemia Tipo IV/patologia , Hiperlipoproteinemia Tipo V/complicações , Hiperlipoproteinemia Tipo V/patologia , Lipídeos , Xantogranuloma Juvenil/patologia , Xantomatose/classificação , Xantomatose/complicaçõesRESUMO
Cytomegalovirus (CMV) is an ubiquitous agent and is recognized as a pathogen in all age groups. Although symptomatic infection by CMV (CMV disease) in normal adults is generally mild, the virus is known to produce severe symptoms, mostly in immunocompromised patients. In this group of patients, the primary involvement of the colon by CMV is reported to be rare. However, chronic renal failure patients are prone to CMV infection. Nevertheless, despite the high incidence of infection in these patients and the recognition of a defective immune response in some of them, clinical manifestations are an exception. Two chronic renal failure patients who developed acute colitis due to CMV infection are presented. Of interest are the rarity of the association, the favorable clinical course and the differential diagnosis with other gastrointestinal disorders which are more common in these patients.
Assuntos
Colite/microbiologia , Infecções por Citomegalovirus/complicações , Falência Renal Crônica/complicações , Idoso , Colite/diagnóstico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise RenalRESUMO
A case of adenosquamous carcinoma of the esophagus is presented. This carcinoma is a typical neoplasm of the upper aerodigestive tract almost exclusively originating in squamous epithelium in continuity with minor salivary glands. It is a very rare tumor in the esophagus, and is often diagnosed as mucoepidermoid carcinoma. The differential diagnosis between them is important due to the better prognosis of the last entity. The histology and electron microscopy is described and the literature is reviewed.
Assuntos
Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Adenocarcinoma/ultraestrutura , Carcinoma de Células Escamosas/ultraestrutura , Neoplasias Esofágicas/ultraestrutura , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The autopsy findings in 24 cases (representing 17 males and seven females) that underwent bone marrow transplantation during the course of disease are reported. The mean age of the patients was 20.0 years, with individual ages ranging from 7 to 40 years. In 23 cases, serious infectious disease occurred. A patient frequently exhibited more than one type of infection. In total, there were seven mycotic, eight cytomegalovirus, and 15 bacterial infections. Twenty-three cases showed striking lung pathology, the most prevalent lesions being infectious diseases and those of diffuse alveolar damage, which was found in ten cases. Gastrointestinal tract pathology of differing types was observed in 13 cases. Necrotizing enterocolitis was observed in three of these cases. Three cases also displayed cholangiolar cholestasis, probably related to their terminal infectious disease. In only two cases could graft-vs-host disease be proved histologically.
Assuntos
Anemia Aplástica/patologia , Transplante de Medula Óssea , Leucemia/patologia , Doença Aguda , Adolescente , Adulto , Anemia Aplástica/complicações , Anemia Aplástica/terapia , Criança , Feminino , Doença Enxerto-Hospedeiro/patologia , Humanos , Leucemia/complicações , Leucemia/terapia , MasculinoRESUMO
For evaluating the therapeutic approaches in the follow-up and complications of patients treated with bone marrow transplantation (BMT), the histopathology is important on many occasions. The authors describe the different morphological changes that have an important role for treatment of these patients, classified according to their target organs of localization: skin, digestive tract, liver, and bone marrow. Graft-versus-host disease (GVHD) mainly affects the skin, gastrointestinal tract, and liver, and is sometimes difficult to differentiate from radiochemotherapy or infectious diseases. In the liver, the most frequent complications are GVHD, veno-occlusive disease, and infections. In the bone marrow, it is most important to evaluate the elimination of hemopathy and the reconstitution of normal hematopoiesis.
Assuntos
Transplante de Medula Óssea/patologia , Transplante de Medula Óssea/efeitos adversos , Gastroenteropatias/etiologia , Gastroenteropatias/patologia , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/patologia , Humanos , Hepatopatias/etiologia , Hepatopatias/patologia , Dermatopatias/etiologia , Dermatopatias/patologiaRESUMO
Myoepitheliomas of the salivary glands remain a controversial entity. To contribute to the knowledge of this entity, 16 myoepithelial tumors of the salivary glands were studied: 12 benign myoepitheliomas (BME) and 4 malignant myoepitheliomas (MME). The clinical and the histologic findings of each case were studied Immunohistochemistry and flow-cytometry analysis were performed from the paraffin-embedded material in 15 cases. An electron-microscopy study was performed in 8 cases. The myoepithelial tumors affected patients of both sexes equally. The mean age of the patients with BME was 54 years, and the mean age of patients with MME was 62 years. Eight cases of BME originated in the parotid gland and 4 cases originated in the minor salivary glands. All the MME developed from a benign preexistent tumor: two developed from a pleomorphic adenoma in the parotid gland, and the other two MME developed in the minor salivary gland from a BME. The myoepithelial tumors were composed of epithelioid, plasmacytoid, spindle, or clear cell types, and they showed a solid or a myxoid pattern of growth. Immunohistochemical studies revealed marked and diffuse positivity to cytokeratins, vimentin, and S-100 protein in all cases. Glial fibrillary acidic protein was positive in 8 cases (53%), and muscle-specific actin and smooth-muscle actin were positive in only 3 cases (20%); they were all cases of BME. Desmin was negative in all tumors. Ultrastructural studies showed the presence of basal membrane, tight junctions, intermediate filaments, and microvilli as well as actin-like filaments lacking focal densities in all cases. But actin-like filaments with focal densities were not identified. Flow cytometry determined that all BME were diploid with a mean proliferative index of 7.73%. Two of the MME were diploid and the other two MME were aneuploid. The mean proliferative index of MME was 11.93%. In conclusion, BME and MME originated in major and minor salivary glands can display different histologic patterns and cellular features. Some immunohistochemical and ultrastructural characteristics have been found in all these neoplasms, which supports the idea that myoepitheliomas are composed by neoplastic modified myoepithelial cells, not fully differentiated. These techniques can be useful for the diagnosis of these tumors.
Assuntos
Carcinoma/patologia , Mioepitelioma/patologia , Neoplasias das Glândulas Salivares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/química , Carcinoma/ultraestrutura , DNA de Neoplasias/análise , DNA de Neoplasias/genética , Desmina/análise , Feminino , Citometria de Fluxo , Proteína Glial Fibrilar Ácida/análise , Humanos , Imuno-Histoquímica , Queratinas/análise , Masculino , Neoplasias Maxilares/química , Neoplasias Maxilares/patologia , Neoplasias Maxilares/ultraestrutura , Microscopia Eletrônica , Pessoa de Meia-Idade , Mioepitelioma/química , Mioepitelioma/ultraestrutura , Neoplasias Parotídeas/química , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/ultraestrutura , Ploidias , Proteínas S100/análise , Neoplasias das Glândulas Salivares/química , Neoplasias das Glândulas Salivares/ultraestrutura , Glândulas Salivares/química , Glândulas Salivares/patologia , Glândulas Salivares/ultraestrutura , Glândulas Salivares Menores/química , Glândulas Salivares Menores/patologia , Glândulas Salivares Menores/ultraestrutura , Vimentina/análiseRESUMO
In 38 patients suffering from rickettsiosis caused by Rickettsia conorii (Mediterranean Exanthematous Fever), hepatic involvement was studied via laboratory tests and in 26 cases by means of liver biopsy. SGOT, SGPT and alkaline phosphatase were found to be elevated in more than half of the patients (SGOT 74.4 +/- 93 U.K., SGPT 82.2 +/- 93 U.K., a.p. 58 +/- 21 mU/ml). In 14 patients, liver biopsy showed the existence of inclusion corpuscles in Kupffer's cells. Electron microscopic study demonstrated the existence of phagosomes inside the epithelioid cells, which, however, were difficult to categorize. The frequent existence of granulomatous hepatitis in this rickettsiosis was confirmed, while the presence of the infecting agent in the liver could not be established.
Assuntos
Febre Familiar do Mediterrâneo/complicações , Hepatite/etiologia , Fígado/enzimologia , Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Biópsia por Agulha , Humanos , Fígado/ultraestruturaRESUMO
To investigate the influence of reflux esophagitis (RE) on the glandular differentiation of carcinomas of the esophagus induced by 2,6-dimethylnitrosomorpholine (2,6-DMNM), a study was carried out using 4 experimental groups and 2 control groups of 8-week-old Sprague-Dawley rats, each consisting of 20 males and 20 females. An esophagojejunostomy (EJ) with gastric preservation was performed in two groups of animals. Fifteen days thereafter the potent esophagotropic carcinogen 2,6-DMNM was subcutaneously injected, once a week for life, at doses of 1/100 and 1/10 of the 50% lethal dose in each group respectively. The result was a spectrum of carcinomatous tumors mainly developing in the lower half of the esophagus, which were thoroughly investigated by serial sectioning, staining for mucins, and in selected cases by electron microscopy. They were classified as follows: 16 pure squamous cell carcinomas (SCC), 5 SCC with focal mucous or glandular differentiation (FGD), 11 pure adenocarcinomas (ADC), and 12 ADC with areas of squamous cell differentiation (SCD). By contrast, in 2 similar experimental groups in which the previous EJ was not performed, 15 animals showed SCC of the pure type, without evidence of mucous or glandular differentiation. No tumors were observed in the two control groups without carcinogen treatment. Of these, the group that underwent EJ showed reflux esophagitis. In conclusion, the tumors of the esophagus induced by 2,6 DMNM under the influence of EJ are not only pure ADC and pure SCC, as we have previously reported, but also intermediate tumors showing either SCC with focal mucous or glandular differentiation (SCC + FGD) or ADC with areas of squamous cell differentiation (ADC + SCD).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Carcinoma/patologia , Neoplasias Esofágicas/patologia , Esofagostomia , Jejunostomia , Nitrosaminas , Adenocarcinoma/induzido quimicamente , Adenocarcinoma/patologia , Animais , Carcinoma/induzido quimicamente , Carcinoma Adenoescamoso/induzido quimicamente , Carcinoma Adenoescamoso/patologia , Carcinoma de Células Escamosas/induzido quimicamente , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/induzido quimicamente , Feminino , Masculino , Microscopia Eletrônica , Ratos , Ratos Sprague-DawleyRESUMO
Clinicopathologic correlation was analyzed in the primary diagnoses for a series of 500 clinical post mortem studies of 440 adults, 9 children aged 1-14 and 51 infants of perinatal age. The diagnoses were incorrect in 43% of all cases, of which 17% were important errors, 14% of relative importance and 12% of slight importance. There is an inverted relationship between the proportion of errors and duration of the hospital stay of the patients. This underlines the importance of clinical post mortem studies for control, improvement and better teaching methods in a hospital.
Assuntos
Autopsia , Erros de Diagnóstico , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Criança , Pré-Escolar , Estudos de Avaliação como Assunto , Feminino , Humanos , Lactente , Recém-Nascido , Infecções/diagnóstico , Cirrose Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Tuberculose/diagnósticoRESUMO
Anatomopathologic diagnosis were studied in a series of 500 clinical autopsies (440 adults and 9 children between 1 and 14 years old). Cancer was the most frequent cause of death (27.7%) followed by infectious processes (26.9%) divided between respiratory infections (14.3%), non-respiratory (8.8%) and tuberculosis (3.8%). Vascular disorders accounted for 25.2% and cirrhosis for 10.2%. The diagnosis of cancer were incorrect in 28.8%, of those, 16% were over-assessed and 12.8% under-assessed. Cancer was multiple in 2.7% of all cases, hepatic cancer was found in 17.6% of cirrhosis cases and in 11% of all cases, thromboembolism of different degree was seen.
Assuntos
Autopsia , Diagnóstico , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Criança , Pré-Escolar , Erros de Diagnóstico , Feminino , Humanos , Lactente , Recém-Nascido , Infecções/diagnóstico , Cirrose Hepática/diagnóstico , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Tuberculose/diagnósticoRESUMO
Enterocytozoon bieneusi is a protozoa belonging to the Microsporidia family which prevalence has increased in AIDS patients. Although diagnosis is performed by the demonstration of the parasite in the epithelium of the small intestine by light and electron microscopy, techniques allowing diagnosis from stools or duodenal or biliary aspirates have recently been described. Three cases of intestinal microsporidiosis diagnosed by the mentioned method are reported. The patients were 3 males with chronic diarrhea of several months of evolution with an important ponderal loss. All were in advanced stages of HIV infection with CD4-lymphocyte counts lower than 0.1 x 10(9)/l. In all the patients in whom intestinal absorption tests were performed these were found to be altered. One of the patients presented concommitant cholestasis with parasitation by E. bieneusi being demonstrated as by the biliary route in this patient. Confirmation of infection by E. bieneusi was performed in the 3 cases by electron microscopy study of stools. A review of intestinal microsporidiosis in AIDS patients is carried out and the therapeutic possibilities available for this infection are discussed.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Microsporidiose/complicações , Adulto , Humanos , Masculino , Microsporidiose/parasitologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Severe mucosal dysplasia (SMD) in endoscopic gastric biopsies is a controversial lesion because some authors consider it as an histologic lesion associated to superficial gastric cancer (SCG). This study is aimed to asses the prevalence of SCG in Barcelona; if the presence of SMD is associated to SCG and, the clinical and endoscopic manifestations which induced the diagnosis. METHODS: We studied a total of 4,800 patients who had been submitted to gastroscopy during 1.5 years. A total of 79 patients suffered gastric cancer, 56 of them were submitted to resection. Ten of these 56 patients (17%) had SCG. The most frequent first clinical manifestation of SCG was gastrointestinal haemorrhage. RESULTS: Endoscopic aspect suggested malignancy in five cases. Biopsies during endoscopy allow diagnosis of gastric cancer in five. In four histologic studies showed SMD. In the tenth patient, the first endoscopy with biopsies showed a gastric peptic ulcer. A later endoscopic control showed the persistence of the macroscopically benign lesion but one among seven biopsies showed adenocarcinoma. The four patients with SMD had gastric cancer in further endoscopic procedures, except in one which was operated after two endoscopies demonstrating SMD. CONCLUSIONS: This study suggests: 1) prevalence of SGC in Barcelona is similar than the other European countries. 2) haemorrhage is a frequent first manifestation of SCG, and 3) the finding of SMD in endoscopic biopsy strongly suggests the presence of SCG in the stomach.
Assuntos
Neoplasias Gástricas/epidemiologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Idoso , Biópsia , Estudos Transversais , Diagnóstico Diferencial , Feminino , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Estômago/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND: Data about the etiology of chronic enteropathy in AIDS patients are scarce and are very dependent upon the geographical area. The aim of this study was to detect microorganisms potentially associated with chronic enteropathy in AIDS patients with diarrhoea for more than one month, and initial negative routine stool bacterial cultures and examinations for ova and parasites. The degrees of associated intestinal malabsorption and immunodeficiency were also analysed. PATIENTS AND METHODS: Forty consecutive patients were recruited from January 1993 to December 1994. The following studies were performed: Intestinal absorption tests (d-xylose and 14C-triolein), CD4/CD8 cell counts, microbiological studies (standard stool cultures for detection of bacteria and examinations for ova and parasites including the detection of Enterocitozoon bieneusi spores by the Weber's stain), upper gastrointestinal endoscopy or colonoscopy with intestinal biopsies and blood cultures for CMV and mycobacteria. RESULTS: The median duration of diarrhoea was 4 months and the mean weight loss was 8.4 kg. Ninety percent of patients had less than 0.1 x 10(9) CD4+ cells/l, with a mean CD4+ cell count of 0.035 x 10(9)/l. Malabsorption was found in 84% of patients. An etiological diagnosis of chronic enteropathy was reached in 60% of the patients. The yield of pathological examination was 37% and the microbiological test using samples of faeces and blood were positive in 45% and 20% of cases respectively. The most frequently identified microorganisms were CMV (10 cases), E. bieneusi (9), enterobacteria (8), Cryptosporidium parvum (5), Leishmania donovani (2). Patients with enteropathy caused by E. bieneusi had lower count of CD4 cells (p = 0.005) and with higher serum levels of alkaline phosphatase (p = 0.02) than patients with CMV enteropathy. CONCLUSIONS: Stool Weber's stain and CMV and mycobacterial blood cultures should be added to the standard work-up diagnosis in patients with chronic diarrhoea and a CD4+cells count below 0.1 x 10(9) l. Upper and/or lower gastrointestinal endoscopies with intestinal biopsies should be performed only in patients with persistent diarrhea without microbiological diagnosis or a lack of response to treatment.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Enteropatias/complicações , Síndrome da Imunodeficiência Adquirida/sangue , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Antivirais/uso terapêutico , Contagem de Linfócito CD4 , Relação CD4-CD8 , Doença Celíaca/complicações , Doença Crônica , Colonoscopia , Citomegalovirus/isolamento & purificação , Enterobacteriaceae/isolamento & purificação , Feminino , Gastroscopia , Humanos , Enteropatias/sangue , Enteropatias/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVE: To describe the characteristics of patients included in the pancreatic tumor registry of the Hospital Clínic of Barcelona. PATIENTS AND METHOD: All patients with pancreatic tumors attended between July 1990 and March 2003 were registered. Data collection included: age, gender, date of diagnosis, diagnosis, histology, size, location and tumor stage, and treatment. The correlation between tumor stage and age, date of diagnosis, and tumor location was also evaluated. RESULTS: Six hundred thirty patients with pancreatic tumors were included, representing an incidence of 60 patients/year. The mean age was 66 years and the male-to-female ratio was 1,18:1. The most frequent lesion was malignant tumor of the pancreas (92%), and the most frequent histological type was pancreatic ductal adenocarcinoma (73%). The most frequent location was the head of the pancreas (64%). In 28% of the patients, pancreatic cancer was diagnosed in stage I and II. Resection was performed in 31% of patients, whereas 48% of the patients received no treatment. The ratio between local (stage I)/disseminated (stage IV) disease was 0,34. The ratio between stage I/IV increased with age, diagnosis prior to 1994, and tumor location in the head of the pancreas. CONCLUSION: Hospital tumor registries can be used to define the profile of the attended population, which can help to delineate the best diagnostic-therapeutic strategy and can be useful in clinical research.