Effect on hemostasis of an absorbable hemostatic gelatin sponge after transrectal prostate needle biopsy

Objectives To examine the usefulness of an absorbable hemostatic gelatin sponge for hemostasis after transrectal prostate needle biopsy. Subjects and Methods The subjects comprised 278 participants who underwent transrectal prostate needle biopsy. They were randomly allocated to the gelatin sponge insertion group (group A: 148 participants) and to the non-insertion group (group B: 130 participants). In group A, the gelatin sponge was inserted into the rectum immediately after biopsy. A biopsy-induced hemorrhage was defined as a case in which a subject complained of bleeding from the rectum, and excretion of blood clots was confirmed. A blood test was performed before and after biopsy, and a questionnaire survey was given after the biopsy. Results Significantly fewer participants in group A required hemostasis after biopsy compared to group B (3 (2.0%) vs. 11 (8.5%), P=0.029). The results of the blood tests and the responses from the questionnaire did not differ significantly between the two groups. In multivariate analysis, only “insertion of a gelatin sponge into the rectum” emerged as a significant predictor of hemostasis. Conclusion Insertion of a gelatin sponge into the rectum after transrectal prostate needle biopsy significantly increases hemostasis without increasing patient symptoms, such as pain and a sense of discomfort. .

Comparison of oxidative stress & leukocyte activation in patients with severe sepsis & burn injury.

Background & objectives: We evaluated pro- and anti-oxidant disturbances in sepsis and non-sepsis burn patients with systemic inflammatory response syndrome (SIRS). Adhesion molecules and inflammation markers on leukocytes were also analyzed. We hypothesized that oxidative stress and leukocyte activation markers can lead to the severity of sepsis. Methods: In 28 severe sepsis and 27 acute burn injury patients blood samples were collected at admission and 4 days consecutively. Oxidative stress markers: production of reactive oxygen species (ROS), myeloperoxidase, malondialdehyde and endogenous antioxidants: plasma protein sulphydryl groups, reduced glutathione, superoxide dismutase and catalase were measured. Flow cytometry was used to determine CD11a, CD14, CD18, CD49d and CD97 adhesion molecules on leukocytes. Procalcitonin, C-reactive protein, fibrinogen, platelet count and lactate were also analyzed. Results: Pro-oxidant parameters were significantly elevated in sepsis patients at admission, ROS intensity increased in burn patients until the 5th day. Endogenous antioxidant levels except catalase showed increased levels after burn trauma compared to sepsis. Elevated granulocyte activation and suppressed lymphocyte function were found at admission and early activation of granulocytes caused by increasing activation/migration markers in sepsis. Leukocyte adhesion molecule expression confirmed the suppressed lymphocyte and monocyte function in sepsis. Interpretation & conclusions: Severe sepsis is accompanied by oxidative stress and pathological leukocyte endothelial cell interactions. The laboratory parameters used for the evaluation of sepsis and several markers of pro- and antioxidant status were different between sepsis and non-sepsis burn patients. The tendency of changes in these parameters may refer to major oxidative stress in sepsis and developing SIRS in burns.

Leukocyte infiltration and anti-myeloperoxidase immunoreactivity in granulocytes of the mucosa and submucosa of the large intestine of horses submitted to dietetic starch overload / Infiltração de leucócitos e imunorreatividade antimieloperoxidase em granulócitos da mucosa e submucosa do intestino grosso de equinos submetidos à sobrecarga dietética com amido

This study was carried out to evaluate leukocyte infiltration and anti-myeloperoxidase immunoreactivity in granulocytesof the mucosa and submucosa of the large intestine of horses submitted to dietetic starch overload. Eight adult horseswere allocated randomly in three treatments: Treatment I (Control) (n = 2), animals euthanized without starch overload;and Treatments II (n = 3) and III (n = 3), animals undergoing starch overload, with gastric infusion of 17.6 g starch perkg of body weight, euthanized after 24 and 36 hours, respectively. Only afflux of neutrophils in the intestinal mucosa andsubmucosa blood vessels (leukocyte stasis) was observed. Eosinophils were the predominant cells in the mucosa andsubmucosa in all horses, independent of dietetic overload, with infiltration grade from mild to moderate. Lymphocyteinfiltration was also observed in all horses, but with lower intensity when compared to eosinophils. Congestion, edemaand dilatation of lymphatic vessels were the main circulatory alterations observed, with more intensity in the submucosa.Higher immunoreactivity to the anti-myeloperoxidase antibodies was observed in the mucosa and submucosa of horses36 hours after overload. Horses submitted to dietetic starch overload showed intestinal inflammatory response withprevalence of eosinophils, leukocyte stasis and circulatory alterations, varying from discreet to moderate

Este estudo teve como objetivo avaliar a infiltração de leucócitos e a imunorreatividade antimieloperoxidase emgranulócitos da mucosa e submucosa do intestino grosso de equinos submetidos à sobrecarga dietética com amido.Oito equinos adultos foram distribuídos aleatoriamente em três tratamentos: Tratamento I (Controle) (n = 2), equinoseutanasiados sem sobrecarga com amido; Tratamento II (n = 3) e III (n = 3), equinos submetidos à sobrecarga comamido, com infusão gástrica de 17,6 g de amido/kg de peso vivo e eutanasiados após 24 e 36 horas, respectivamente.Observou-se apenas afluxo de neutrófilos (leucocitoestase) nos vasos sanguíneos da mucosa e submucosa intestinal.Eosinófilos foram as células predominantes na mucosa e submucosa em todos os equinos, independente da sobrecargadietética, com grau de infiltração de leve a moderada. Infiltração por linfócitos também foi observado em todos osequinos, porém com menor intensidade quando comparado aos eosinófilos. Congestão, edema e dilatação de vasoslinfáticos foram as principais alterações circulatórias observadas, com maior intensidade na submucosa. Maiorimunorreatividade para anticorpos antimieloperoxidase foi observado na mucosa e submucosa dos equinos 36 horasapós a sobrecarga. Equinos submetidos à sobrecarga dietética com amido apresentam resposta inflamatória intestinalcom predominância de eosinófilos, leucocitoestase e alterações circulatórias variando de discreta a moderada

Estudo da anomalia de Pelger-Huët em núcleo familiar: [carta ao editor] / Pelger-Huët anomaly study in a family: [letter to the editor]

The Pelger-Huët anomaly is a dominant autosomal disease, characterized by the incomplete segmentation of the granulocytes nucleus without lost of the cellular function. The heterozygotes form of this anomaly is assintomatic and it did not possess physic meant, while the homozygote form is rare and can be lethal, being therefore, important differentiates of other infectious alterations. The pseudo-anomaly can occasionally be observed in cases of granulocitic leukemia, mieloproliferatives Diseases, some infections and after exposition the determined drugs. We evaluate eleven members of a familiar nucleus and, after the blood cells analysis, six of then had presented neutrophils and eosinophils with nuclei characteristic of the heterozygotes form of the Pelger-Huët anomaly. The recognition of this leukocyte anomaly, mainly in patients without infection and presenting great number of not segmented neutrophils, can prevent wrong interpretations of the blood cells count and unnecessary clinical and therapeutically behaviors.

Policitemia vera: relato de caso / Polycythemia vera: case report

A policitemia vera (PV) é um transtorno mieloproliferativo das células hematopoiéticas, caracterizada poruma produção anormal e acentuada de eritrócitos, leucócitos e plaquetas. É uma doença rara, com uma incidênciade 2,3/100.000 pessoas por ano. Apresentamos um relato de caso de uma paciente de 45 anos com sintomas,sinais e achados sugestivos de policitemia vera.

The polycythemia vera is a myeloproliferative disturb from haematopoietic cells characterized by abnormal and overstated production of erythrocytes, leukocytes and platelets. It is a rare disease with an incidenceof 2.3/100.000 people per year. We present a case report of a 45 years old patient with symptoms, signs andsuggestive results of polycythemia vera.

Histological analysis of the association between formocresol and endotoxin in the subcutaneous tissue of mice

This study performed a histological analysis of the effect of formocresol associated to endotoxin (LPS) in the subcutaneous connective tissue of mice. Ninety mice were randomly assigned to 3 groups (n=30). Each animal received one plastic tube implant containing endotoxin solution (10 mg/mL), formocresol (original formula) or a mixture of endotoxin and formocresol. The endotoxin and formocresol groups served as controls. The periods of analysis were 7, 15 and 30 days. At each experimental period, tissue samples were collected and submitted to routine processing for histological analysis. Endotoxin and formocresol produced necrosis and chronic inflammation at 7 and 15 days. At 30 days, the endotoxin group showed no necrosis, while in the formocresol group necrosis persisted. The formocresol-endotoxin association produced necrosis and chronic inflammation in the same way as observed with formocresol at all experimental periods. In conclusion, formocresol seems not to be able to inactive the toxic effects of endotoxin in connective tissues.

O objetivo deste estudo foi avaliar histologicamente o efeito da associação do formocresol com endotoxina (LPS) em tecido conjuntivo de camundongos. Noventa camundongos foram divididos em três grupos de 30 camundongos cada. Cada camundongo recebeu um implante subcutâneo de tubo plástico contendo solução de endotoxina (10 mg/ml), formocresol (fórmula original), ou uma mistura de formocresol com endotoxina. Os grupos da endotoxina e formocresol foram considerados grupos controle. Os períodos de análise foram 7, 15 e 30 dias. Após os períodos experimentais, os tecidos foram removidos e submetidos a processamento histológico. Os resultados obtidos indicam que a endotoxina e o formocresol produzem necrose e inflamação tecidual crônica aos 7 e 15 dias e aos 30 dias o grupo da endotoxina não mostrava necrose e no grupo do formocresol a necrose persistiu. A combinação formocresol e endotoxina mostrou necrose e inflamação crônica com resultados semelhantes ao do grupo formocresol para todos os períodos experimentais. Pode-se concluir que o formocresol parece não ser capaz de inativar os efeitos tóxicos da endotoxina.

Proteína antiinflamatória anexina 1: mecanismos celulares e relevância clínica / Anti-inflammatory protein annexin 1: cellular mechanisms and clinical relevance

Um dos eventos de importância no processo inflamatório é o recrutamento dos leucócitos da circulação sanguínea para os sítios da inflamação por meio de interações com as células endoteliais das vênulas pós-capilares. O mecanismo de recrutamento é desencadeado por uma série de mediadores pró-inflamatórios quesão produzidos por células como mastócitos, macrófagos, células endoteliais ativadas, bem como leucócitos transmigrados para o tecido inflamado. Por outro lado, a resposta inflamatória é controlada pela ação de mediadores antiinflamatórios que atuam para manter a homeostasia da resposta imunológica e prevenir alesão tecidual. Entre esses mediadores destaca-se a anexina 1, primeiro membro descrito de uma família de proteínas ligantes de fosfolipídios dependentes de cálcio, com seqüências de aminoácidos altamente conservadas nos vertebrados. Esta proteína atua como um potente modulador endógeno da inflamação,inibindo a atividade de enzimas que atuam na produção de mediadores pró-inflamatórios e interferindo no processo de transmigração dos leucócitos. Nesta revisão, a estrutura, a expressão, os mecanismos de açãoe os efeitos farmacológicos da anexina 1 em diferentes modelos experimentais são abordados. O objetivo final das investigações é avaliar a adequação do uso da anexina 1 como um agente terapêutico eficaz no tratamento de patologias causadas pela inflamação, como a artrite reumatóide, lesão do miocárdio por isquemia-reperfusão, neoplasias e asma, por exemplo.

Utility of white blood cell suspect flags and histogram pattern in the detection of acute leukemia by Advia-60 automated hematology analyzer.

Blood samples from patients with acute leukemia, when analyzed with automated hematology counters, tend to introduce inaccuracies in the automated differential count and can cause diagnostic confusion without providing definite clues to the presence of abnormal cells. We designed this study to assess the utility of white blood cell (WBC) flags and histogram pattern generated by Advia-60 automated hematology analyzer in the recognition and categorization of acute leukemia. Data printouts of 31 newly diagnosed cases of acute leukemia, 22 with acute myeloid leukemia (AML) and 9 with acute lymphoblastic leukemia (ALL) were reviewed. All cases of AML and ALL generated the WBC suspect blastflag M2 associated with two of the non blast suspectflags G1 and G2. Among the cases of AML, 95.5% of the WBC histogram patterns were definitive of the presence of abnormal cells and were indicative of the myeloid nature of cells. Only 44.4% of the histograms in the cases of ALL could be definitive of the presence of abnormal cells and 33.3% were indicative of their lymphoid nature. Significantly, 55.5% of the histograms in ALL were normal. The false positives for both AML and ALL were 10.5% when only WBC flagging was considered and were reduced to 0.05% when the flags were combined with histogram patterns for interpretation. Combined flagging and histogram recognition can be of aid in identifying cases of acute leukemia and the morphologist can then assess these samples further. This ensures that cases of acute leukemia, especially in high output laboratories, are not inadvertently missed.

Increased levels of multiple forms of dihydrofolate reductase in peripheral blood leucocytes of cancer patients receiving haematopoietic colony-stimulating factors: interim analysis

The precise mechanism whereby granulocytes proliferate when haematopoietic colony stimulating factors (CSFs) are used in neutropenic cancer patients is poorly understood. The purpose of this study was to investigate whether these cytokines bring about leucocyte proliferation by increasing the levels of multiple forms of dihydrofolate reductase (DHFR). Blood samples were collected from 36 cancer patients (25 males and 11 females) with chemotherapy-induced neutropenia. One sample of blood from each patient was obtained before therapy either with CSF, such as granulocyte colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) or with placebo, and another one at the time of resolution of neutropenia. Peripheral blood leucocytes in these blood samples were counted, separated and lysed. From lysates, cytoplasmic samples were prepared and analyzed for active DHFR by a methotrexate-binding assay and for total immunoreactive DHFR by an enzyme linked immunosorbent assay. The increase in total leucocyte count (TLC) was most prominent (P < 0.005) in the CSF group and less so (P < 0.05) in the placebo group. The mean +/- SD concentration values of active DHFR before and after stimulation with GM-CSF found were to be 0.34 +/- 0.4 ng/mg protein and 0.99 +/- 0.82 ng/mg protein, respectively, and in the group treated with G-CSF, 0.24 +/- 0.32 ng/mg protein and 1.18 +/- 2.4 ng/mg protein, respectively. This increase in active DHFR after stimulation with CSF was statistically significant (P <0.05). Similarly, concentration values of immunoreactive but nonfunctional form of DHFR (IRE) were 110 +/- 97 ng/mg protein and 605 +/- 475 ng/mg protein before and after stimulation with GM-CSF, and 115 +/- 165 ng/mg protein and 1,054 +/- 1,095 ng/ mg protein before and after stimulation with G-CSF. This increase in concentration of IRE after stimulation with GM-CSF or G-CSF was statistically significant (P < 0.005). In the control group, there was an increase in the concentration of both active DHFR and IRE after treatment with placebo. However, this was not statistically significant. Resolution of neutropenia was quicker in the groups treated with CSF compared to the control group. Results of this study indicate that colony stimulating factors (G-CSF and GM-CSF) induce white cell proliferation by increasing the levels of multiple forms of DHFR.

Jordans' anomaly.

A case of Jordans' Anomaly of leucocytes is reported in a young boy with congenital ichthyosis and hepatosplenomegaly. Cytoplasmic vacuoles were seen in granulocytes, monocytes and lymphocytes of the patient and his father. Serum triglyceride was found elevated in the child but not in the father. Ultrasonogram of the patient's liver showed features suggestive of fatty change, thus pointing to a possible abnormality of systemic triglyceride storage.

Chediak-Higashi syndrome--a case report with ultrastructural and cytogenetic study.

We report the ultrastructural abnormalities of the leukocyte granules and the cytogenetic findings in a patient of Chediak-Higashi syndrome (CHS), who presented with cutaneous melanosis as the only clinical feature. The diagnosis of CHS was established by peripheral smear and bone marrow examination. Chediak-Higashi syndrome, a rare autosomal recessive disorder is characterized by enlarged abnormal organelles in leukocytes and other cells. An interesting aspect of our patient was the absence of recurrent infections or any other clinical stigmata. Ultrastructurally, the leukocytes and their precursors in the bone marrow showed characteristic homogenous and heterogenous giant inclusions of variable sizes and shapes. These represent the primary granules which enlarge to attain the giant abnormal size by fusion with other primary or secondary granules. Cytogenic study of the bone marrow cells showed monosomy of chromosomes 8 and 17 in 20 percent of the metaphases. Neither the gene nor the chromosomal abnormalities specific for CHS have been identified as yet and thus the significance of our cytogenetic finding is presently not clear.

Anomalia de Pelger-Huet ou hipossegmentacao de leucocitos: relato de quatro casos / Pelger-Huet anomaly: report of four cases

Os autores apresentam quatro individuos com a anomalia de Pelger-Huet, em duas familias. Dois dos pacientes foram encaminhados para diagnostico de infeccao devido a interpretacao erronea de hemograma. Os outros dois eram parentes de um dos casos-indices. Os autores enfatizam a importancia do diagnostico da anomalia para nao se incorrer em condutas diagnosticas e terapeuticas desnecessarias

Host tissue reaction to Gnathostoma malaysiae (Nematoda: Gnathostomidae) in Rattus surifer Miller.

The occurrence of adult Gnathostoma malaysiae in Rattus surifer and R. tiomanicus in Malaysia has been reported but there are no known reports on the host tissue reactions. This paper reports on the gross pathology caused by G. malaysiae in a red spiny forest rat, R. surifer and the tissue reactions caused. A tumor-like growth was located on the mid-stomach wall in a female rat captured in Gunung Bachock, Kelantan, Malaysia. This growth consisted of four tunnel-like structures containing sanguinopurulent fluid and leukocytes and this structure led into a central canal. The tissue surrounding the tumor was greatly inflamed and there was localized gastritis. The tunnel-like structure was surrounded by dense fibrotic tissue. The stomach wall was devoid of superficial epithelium and smooth muscle but mucinous glands were present. The midregion of the fibrotic scar contained eggs of G. malaysiae which had evoked a strong tissue reaction and were surrounded by pus. Blood vessels were empty, dilated and had undergone vasculitis and thrombosis.

Aspectos morfológicos e morfométricos da reaçäo tecidual a película celulósica introduzida no plano muscular da parede abdominal de ratos / Morphological and morphometric aspects of the tissular reaction to a cellulosical pellicle inserted in the muscular plan of the abdominal wall rats

O objetivo deste trabalho experimental foi analisar os aspectos morfológicos e os resultados da histometria de leucócitos, fibroblastos e fibras colágenas no tecido inflamatório provocado pela inclusäo de película celulósica no plano muscular da parede abdominal de ratos machos da linhagem Wistar. Foram utilizados 15 animais e reoperados em grupos iguais no 7§, l4§ e 28§ dias de pós-operatório, com retirada de parte da parede abdominal contendo a película e os tecidos adjacentes para realizaçäo de estudo histológico. Os resultados obtidos mostraram reaçäo inflamatória exsudativa intensa que vai diminuindo com o evoluir do processo, e aparecimento de células gigantes de corpo estranho. Houve diminuiçäo significante da proporçäo de leucócitos e aumento significante da proporçäo de fibroblastos e fibras colágenas. Concluímos que a inclusäo de película celulósica provoca reaçäo inflamatória, que diminui no evoluir do processo de reparaçäo, com formaçäo de grnauloma de corpo estranho, envolto por fibrose