Atypical gastric presentation of strongyloidiasis in HIV-infected patient--case report.

Strongyloides stercoralis is an intestinal helminth of systemic distribution, which, once in its host, has the ability to perpetuate itself through an autoinfection cycle, leading to chronic infection. In healthy hosts, the parasite usually does not cause any symptoms, or only mild symptoms that are limited mainly to the small intestine. However, in immunocompromised hosts, uncontrolled multiplication with massive infection may occur, causing hyperinfection syndrome or disseminated strongyloidiasis, which are both associated with high morbidity and mortality. There are few reports of gastric involvement, particularly presenting as ulcer in the stomach. We report a case of gastric ulcer caused by S. stercoralis in HIV-infected patient.

Distinct patterns of Trypanosoma cruzi infection in Leontopithecus rosalia in distinct Atlantic coastal rainforest fragments in Rio de Janeiro--Brazil.

Previous studies on infection of Trypanosoma cruzi in the Poço das Antas Biological Reserve population of wild free-ranging Leontopithecus rosalia have shown the presence of genotype T. cruzi II, associated in Brazil with human disease. Herein, this study has been extended, the infection being evaluated in L. rosalia of 3 different tamarin populations, inhabiting distinct forest areas located in the same Atlantic Coastal Rainforest. Edentata, Marsupialia, Rodentia and Chiroptera were examined exclusively in the Poço das Antas Biological Reserve. Excluding Chiroptera, T. cruzi infection was found in all orders. Biochemical and molecular characterization demonstrated that golden lion tamarins maintained stable infections by T. cruzi II. The isolates from the other mammals corresponded to T. cruzi I, suggesting independent transmission cycles occurring among the sylvatic mammals inside Poço das Antas Biological Reserve. Significant differences in the infection patterns presented by the 3 populations of wild and captive-born golden lion tamarins were noticed. In Poço das Antas a considerably higher number of positive haemocultures from tamarins with positive serological titres was observed in comparison to those obtained from other areas. The implications for conservation and public health of an active sylvatic cycle in the Atlantic Coastal Rainforest of Rio de Janeiro are discussed.

Intestinal metaplasia in the distal esophagus and correlation with symptoms of gastroesophageal reflux disease.

Barrett's esophagus is a metaplastic condition that occurs in patients with gastroesophageal reflux disease (GERD) and its importance lies in its potential to develop adenocarcinoma of the esophagus. The diagnosis of Barrett's esophagus is based on finding of intestinal metaplasia of at least 3 cm of the distal esophagus. The diagnosis of intestinal metaplasia of less than 3 cm of the distal esophagus is controversial, regarding implications with GERD, adenocarcinoma, and Helicobacter pylori. The aims of the study were to determine the prevalence of intestinal metaplasia in the distal esophagus in patients with short segments of esophageal columnar-appearing mucosa (less than 3 cm), diagnosed endoscopically, in two groups of patients, with and without symptoms of GERD. In total, 97 patients were examined, with endoscopic finding of esophageal columnar-appearing mucosa less than 3 cm. From the total, 52 patients had symptoms of GERD and 45 patients were without these symptoms. These patients were subjected to distal esophageal biopsies obtained immediately below the epithelial transition. The biopsies were stained with hematoxylin-eosin and alcian blue at pH 2.5. Urease test for H. pylori detection in two fragments of gastric antrum was carried out. The presence of intestinal metaplasia in the distal esophagus was diagnosed in 16 (30.8%) patients in the GERD group and 12 (26.7%) patients without GERD symptoms. No statistical differences were observed (P = 0.82; 95% CI: 0.61-2.17). The variables sex, mean age and positivity for H. pylori did not show statistical differences. This study diagnosed high prevalence of intestinal metaplasia in the distal esophagus with columnar-appearing mucosa, less than 3 cm, with no statistical differences in the two groups studied with and without GERD symptoms.

[Micronuclei research the esophageal mucosa and its relationship with risk factors with cancer of the esophagus]. / Pesquisa de micronúcleos na mucosa esofágica e sua relação com fatores de risco ao câncer de esôfago.

PURPOSE: To demonstrate the frequency of micronucleus in esophageal mucous cells of smokers, consumers of alcoholic beverages and "maté" drinkers. METHODS: Material collected from the midlle esophagus in 250 consecutive patients submitted to upper digestive endoscopy was stained with acridine orange and the cytologist determined the number of micronuclei vizualized per each 500 cells examined. RESULTS: The frequency of micronucleated cells did not vary significantly (p > 0.05) when the following variables were considered: sex, place of residence (rural or urban), type of care (outpatient or inpatient), ingestion of alcohol. For two variables, smoking and "maté" consumption, there were significant differences in the frequency of micronuclei in the categories exposed and formerly exposed in relation to never exposed. CONCLUSION: A higher frequency of micronucleus in the esophageal mucous in smoking and "maté" drinkers was evidenced by this study.

Pesquisa de micronúcleos na mucosa esofágica e sua relaçäo com fatores de risco ao câncer de esôfago / Research of micronuclei in the esophageal mucosa and its relationship with risk factors to esophagus cancer

Micronúcleos sao fragmentos de DNA nao incorporados ao núcleo na divisao celular e que apresentam relaçao com agentes genotóxicos (mutagênicos ou clastogênicos). Os micronúcleos podem ser detectados nas células esfoliadas dos tecidos. OBJETIVO: Determinar a freqüência de micronúcleos na mucosa esofágica, relacionando com determinados hábitos. PACIENTES E MÉTODOS: Em pacientes submetidos à endoscopia digestiva alta e sem evidências de anormalidades esofágicas, foram colhidos materiais através de escovado do esôfago médio, para pesquisa de micronúcleos. Após à endoscopia, os pacientes foram questionados sobre seus hábitos. RESULTADOS: A freqüência de micronúcleos nao mostrou diferenças significativas (p > 0,05) em relaçao ao sexo, local de residência (rural ou urbana), tipo de atendimento (ambulatorial ou hospitalizado), ingestao de álcool. Nas variáveis fumo e mate houve diferenças significativas entre as categorias expostos e ex-expostos em relaçao à categoria nunca expostos. CONCLUSAO: A freqüência de micronúcleos na mucosa esofágica foi maior nos pacientes fumantes e bebedores de mate

[High temperature "matè" infusion drinking in a population at risk for squamous cell carcinoma of the esophagus]. / Mate (chimarrão) é consumido em alta temperatura por população sob risco para o carcinoma epidermóide de esôfago.

UNLABELLED: "Matè", a popular hot infusion of a herb (Ilex paraguayensis) drunk in large volumes, is a known risk factor for squamous cell carcinoma of the esophagus and there is a suspicion that high temperature of boiled water used for the infusion may contribute for carcinogenesis. METHODS: We measured the temperature of "matè" infusion drunk by a sample of the population at risk for this carcinoma in Taquara, southern Brazil. We interviewed inhabitants for drinking habits and the temperature of the infusion was measured with high precision thermometers. Temperature of the infusion was asked to consumers and their estimate compared to our measurements. We considered 60 degrees C or higher as "hot". RESULTS: In 36 residencies, 107 individuals were drinking "matè". Most individuals drank it daily (97.2%), and the medium daily volume was 1,265 ml (SD +/- 1,132 mL) ranging from 250 to 6,000 mL. The measured temperature was 60 degrees C or higher in 72% of residencies with medium of 63.4 degrees C (51-78 degrees C) and median 64.4 degrees C. CONCLUSION: In this study, "matè" was consumed in large volumes at high temperature and individuals did not estimate correctly the temperature of infusion. High temperatures of "matè" may contribute to carcinogenesis in this population.

Trypanosoma cruzi infection in Leontopithecus rosalia at the Reserva Biológica de Poco das Antas, Rio de Janeiro, Brazil.

Wild golden lion tamarins (Leontopithecus rosalia) - endangered primates that are native to the Brazilian Atlantic coastal forest - were surveyed for the presence of Trypanosoma cruzi with the use of Giemsa-stained blood smears, hemocultures and an indirect immunofluorescence assay (IFAT). Positive IFAT with titers ranging from 1:20 to 1:1280 were observed in 52% of the 118 wild tamarins examined and the parasite was isolated from 38 tamarins. No patent parasitemia was observed among the tamarins from which T. cruzi was isolated. Serum conversion and positive hemoculture was observed for three animals that had yielded negative results some months earlier, which indicates that T. cruzi is actively transmitted among tamarins. In contrast to observations with other sylvatic isolates, those from the tamarins were significantly more virulent and most of them produced mortality in experimentally infected Swiss mice. Some variation in the kDNA restriction profiles among the isolates was observed. Electrophoresis with GPI, G6PDH, IDH, MDH and ME enzymes showed a Z2 profile.

[Prevalence of adenocarcinoma of the esophagus and esophagogastric junction in a 10 year period at a cancer referral center in southern Brazil]. / Prevalência de adenocarcinoma do esôfago e da junção esofagogástrica durante 10 anos num centro de referência para câncer no sul do Brasil.

UNLABELLED: There is increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction in the USA and Europe, however, data in Brazil are scanty. OBJECTIVE AND METHODS: We reviewed all histology confirmed esophageal and esophagogastric junction cancer reports during a 10-year period (1987-1996) obtained by upper digestive endoscopy biopsies at a cancer referral center in Southern Brazil. Cancer cases were classified in three categories: adenocarcinoma, squamous cell carcinoma, and others. RESULTS: Among 349 cases, adenocarcinoma was found in 53 (15.2%), squamous cell carcinoma in 283 (81.1%) and others in 13 (3.7%). CONCLUSIONS: In this study, the prevalence of adenocarcinoma was 15%.

Food transfers in wild and reintroduced golden lion tamarins, Leontopithecus rosalia.

We collected data from wild and reintroduced golden lion tamarins (Leontopithecus rosalia) to describe the behavior of donor and recipient during food transfers, evaluate the effect of supplemental feeding on food transfer behavior, and examine various hypotheses concerning the function of food transfers in primates. Behavioral observations were conducted on 12 groups of tamarins with young (N = 30) between the ages of 1 week and 1 year old. Results show that food transfers involve various behaviors, from steals by recipients to offers by donors; transfers mostly derive from adults and are directed at immature weaned young (between 3 and 9 months old); and that most items transferred were prey or fruits that require skill to process. Eleven percent of food transfers were preceded by an adult vocalization specific to that context, whereas 86% were preceded by conspicuous infant vocalizations and begging behavior. The most common vocalizations were loud and atonal (rasps) and broad banded frequency modulated (trills). Infants born to reintroduced parents vocalized less, whereas reintroduced adults vocalized more before transferring food than their wild counterparts. Reintroduced adults and young received more food transfers (4.4 per hr) than did wild-born adults and young (2.2 per hr). Our findings suggest that food transfer in golden lion tamarins is best understood as provisioning of young that have not fully developed foraging skills to ensure they get the necessary resources for growth and survival.

Esophageal dysplasias are detected by endoscopy with Lugol in patients at risk for squamous cell carcinoma in southern Brazil.

Diagnosis of squamous cell carcinoma of the esophagus is usually late. Staining of the mucosa with Lugol's solution during endoscopy has been suggested to identify early cancer/dysplasia and may improve prognosis. Lugol was tested during endoscopy in 96 asymptomatic subjects at risk for this tumor, who were found to have atypias after exfoliative cytology in southern Brazil. Biopsies were obtained in Lugol's 'stained' and 'unstained' areas in the esophageal mucosa and the histologic results were compared. 'Unstained' areas were present in 64 (66.7%) instances: 44 'unstained' areas over mucosa with normal appearance revealed seven dysplasias (four high and three low grade), whereas 20 'unstained' areas with visible lesions contained only one dysplasia (low grade). 'Stained' areas in 96 (100%) subjects showed two additional dysplasias (one high and one low grade). In this study, Lugol 'unstained' areas were of great value for detection of dysplasias (sensitivity = 80%; specificity = 63%; p = 0.01, Fisher's exact test; CI = 95%; odds ratio = 6.7).

[Risk factors related to esophageal cancer in Rio Grande do Sul, Brazil]. / Fatores de risco relacionados ao câncer de esôfago no Rio Grande do Sul.

BACKGROUND: Rio Grande do Sul, a State in southern Brazil, shows high mortality rates for esophageal cancer. Important geographical variations suggest external factors in the etiology. OBJECTIVE: The relationship between smoking, alcohol and "mate" to esophageal cancer. METHOD: 55 patients with esophageal cancer were interviewed, soon after the endoscopy, about risk factors; 110 patients who did not showed esophageal tumor in the endoscopy were the controls. RESULTS: Among the patients with esophageal cancer there were more farmer-workers (OD 3.3; 95% CI 0.9-11.2), father with antecedent cancer (OD 6.9; 95% CI 1.9-25.6), smoking and ex-smoking (OD 2.5; 95% CI 1.1-5.9), drinkers and ex- of alcohol (OD 5.3; 95% CI 2.6-11.0), drinkers and ex- of "mate" (OD 3.6; 95% CI 1.3-9.8). Others variables more frequent in the cases were: smoking for > 20 years; kind of alcohol (spirits), drinking alcohol every day, drinking "mate" every day and adding salt to food. CONCLUSIONS: Smoking, alcohol, "mate", farmer-workers and antecedent of father with cancer were significantly more frequent in the cases of esophageal cancer than in the controls.

Fatores de risco relacionados ao câncer de esôfago no Rio Grande do Sul / Risk factors fo esophageal cancer in Rio Grande do Sul, Brazil

Objetivo. O Rio Grande do Sul apresenta significativos coeficientes de mortalidade ao câncer de esôfago, com diferenças importantes nas microregioes, sugerindo a açao de fatores de riscos externos. Este estudo tem como objetivo mostrar a relaçao do câncer de esôfago com o hábito de fumar, ingerir álcool e mate. Casuística e Metologia. Foram entrevistados 55 pacientes com câncer de esôfago e 110 pacientes controles, sem evidências de tumor à endoscopia. Resultados. Nao foram observadas diferenças em relaçao ao sexo e idade entre casos e controles (p>0,05). Entre os casos foram verificados mais freqüentemente a presença de indivíduos cuja profissao estava ligada à atividade agrícola (RC 3,3; 95 por cento IC 0,9-11,2), pai com antecedente de câncer (RC 6,9; 95 por cento IC 1,9-25,6), fumantes e ex-fumantes (RC 2,5; 95 por cento IC 1,1-5,9), tomadores e ex-tomadores de bebidas alcoólicas (RC 5,3; 95 por cento IC 2,6-11,0), tomadores e ex-tomadores de mate (RC 3,6; 95 por cento IC 1,3-9,8). Outras variáveis mais freqüentes entre os casos de câncer de esôfago: fumantes > 20 anos, entre os tipos de álcool o uso de cachaça, ingestao de álcool diariamente, ingestao de mate diariamente e o hábito de adicionar sal nos alimentos. Conclusoes. Fumo, álcool, mate, agricultores e antecedentes de pai com câncer foram significativamente mais freqüentes entre os casos de câncer de esôfago em relaçao aos controles. Mate foi significativo, independente da quantidade ingerida/dia.

Diferenças geográficas na mortalidade por câncer de esôfago no Rio Grande do Sul / Geographical differences in esophageal neoplasms mortality in Rio Grande do Sul

Os coeficientes de mortalidade por 100.000 habitantes, com relaçäo ao câncer de esôfago, foram estudados nas 34 microrregiöes que compöem o Estado do Rio Grande do Sul, período de 1979 a 89. Estes coeficientes foram calculados a partir de dados de mortalidade divulgados pela Secretaria de Saúde e Meio Ambiente do Rio Grande Sul. As populaçöes referentes aos censos foram obtidas no Instituto Brasileiro de Geografia e Estatística (IBGE) e as populaçöes dos anos intermediários foram estimadas pela Fundaçäo de Economia e Estatística. A partir destes dados foram calculados os coeficientes por 100.000 habitantes, as médias dos coeficientes, desvios padröes e as tendências do Estado do Rio Grande do Sul e das 24 microrregiöes. Notou-se grande variabilidade nas médias dos coeficientes quando comparados às microrregiöes, com valores entre 16,49 e 4,74, sexo masculino. As microrregiöes do sul do Estado, onde predominam os latifúndios, apresentaram os coeficientes mais elevados na mortalidade por esta neoplasia. A tendência mostrou-se ascendente em 54// das microrregiöes, no sexo masculino

[Geographical differences in esophageal neoplasm mortality in Rio Grande do Sul]. / Diferenças geográficas na mortalidade por câncer de esôfago no Rio Grande do Sul.

Mortality data from cancer of esophagus were studied in the 24 microregions of the State of Rio Grande do Sul (RS), Brazil, from 1970 to 1989, in males and females. The mortality data were calculated through information from the Health Department of RS and the population was obtained in IBGE and FEE. The average, the standard deviation and, by linear regression, the angular parameter of the temporal series for the State and each microregion, were calculated. We noticed great differences between the average of death rates in the 24 microregions, with values between 16.49 to 4.74, in males. The microregions of the south of the State, where there are many farms, revealed higher death rates of mortality by esophageal cancer. The tendency showed to be ascending in 54% of the microregions, in the males.

Mortalidade por câncer de colo uterino no Rio Grande do Sul / Mortality from uterine cervix neoplasm in Rio Grande do Sul

O objetivo deste estudo refere-se a mortalidade por câncer do colo uterino (Cid 180), através da verificaçäo dos coeficientes de mortalidade no Rio Grande os Sul e nas 24 microrregiöes que compöem o referido Estado, com estudo das tendências (regressäo linear simples), período de 1970 a 1989. Como objetivos secundários foram abordados a feqüência relativa desta neoplasia em relaçäo ao total de óbitos por neoplasias malignas, estudo comparativo com outras localidades e correlaçäo com fatores de risco. Os dados que permitiram este estudo foram obtidos na Secretaria de Saúde e Meio Ambiente do Rio Grande do Sul, Instituto Brasileiro de Geografia e Estatística IBGE), Ministério de Saúde e Organizaçäo Mundial de Saúde. A média dos coeficientes de mortalidade/100.000 mulheres no Rio Grande do Sul (1970-1989) foi de 3,8, com tendência ascendente. Observaram-se diferenças importantes na distribuiçäo dos coeficientes de mortalidade nas 24 microrregiöes do Estado, com médias oscilando entre 2,5 e 6,7. O câncer de colo uterino ocupou o 4§ lugar na mortalidade por neoplasias entre as mulheres do Rio Grande do Sul, em 1989. Vírus de papiloma humano e tabagismo säo importantes fatores de risco nesta neoplasia

[Mortality from uterine cervix cancer in Rio Grande do Sul]. / Mortalidade por câncer de colo uterino no Rio Grande do Sul.

The mortality from cervical cancer was studied by checking the death rates in Rio Grande do Sul (RS) and in its 24 microregions. Each tendency (linear regression), in the period from 1970 to 1989, was also investigated. We have also studied the relative rates of this kind of cancer, the comparison with the rate in other places and the risk factors. The data were obtained at the Office of Health in Rio Grande do Sul as well as in the Statistics and Geography Brazilian Institute and World Health Organization. The average mortality rates/100,000 women in RS (1970-1989) was 3.8, with ascending tendency. Important differences in the death rates in the 24 microregions in RS were observed and they ranged from 2.5 to 6.7. The cervical cancer was the fourth cause of death in women from RS (mortality by cancer), in 1989. Papillomaviruses and smoking were important factors in the development of cervical cancer.

Ectoparasitic acari found on golden lion tamarins (Leontopithecus rosalia rosalia) from Brazil.

Anesthetized golden lion tamarins (Leontopithecus rosalia rosalia), a highly endangered species, were examined for ectoparasites by brushing the fur and swabbing the ears. Ectoparasites recovered from the fur included four species of immature ticks (Amblyomma spp.), three species of chiggers (Euschoengastia sp., Microtrombicula brennani and Speleocola tamarina), and one species of follicular mite (Rhyncoptes anastosi). Ectoparasites do not seem to be of particular significance to the health of the golden lion tamarin; this may in part result from grooming.