Texture-based classification of lung disease patterns in chronic hypersensitivity pneumonitis and comparison to clinical outcomes.

Computer-aided detection algorithms applied to CT lung imaging have the potential to objectively quantify pulmonary pathology. We aim to develop an automatic classification method based on textural features able to classify healthy and pathological patterns on CT lung images and to quantify the extent of each disease pattern in a group of patients with chronic hypersensitivity pneumonitis (cHP), in comparison to pulmonary function tests (PFTs).27 cHP patients were scanned via high resolution CT (HRCT) at full-inspiration. Regions of interest (ROIs) were extracted and labeled as normal (NOR), ground glass opacity (GGO), reticulation (RET), consolidation (C), honeycombing (HB) and air trapping (AT). For each ROI, statistical, morphological and fractal parameters were computed. For automatic classification, we compared two classification methods (Bayesian and Support Vector Machine) and three ROI sizes. The classifier was therefore applied to the overall CT images and the extent of each class was calculated and compared to PFTs. Better classification accuracy was found for the Bayesian classifier and the 16x16 ROI size: 92.1±2.7%. The extent of GGO, HB and NOR significantly correlated with forced vital capacity (FVC) and the extent of NOR with carbon monoxide diffusing capacity (DLCO).Clinical Relevance- Texture analysis can differentiate and objectively quantify pathological classes in the lung parenchyma and may represent a quantitative diagnostic tool in cHP.

Imiquimod cream and C02 laser vaporization in vulvar intraepithelial neoplasia (VIN) 2/3 treatment.

OBJECTIVES: To compare the use of topical 5% imiquimodt (IMQ) cream or CO2 laser vaponization as the treatment of vulvar inmraepithelial lesions (VIN) 2/3 and to evaluate the degrees of residual or recurrent lesions. MATERIALS AND METHODS: Twenty-nine women with VIN 2/3 were separated into two groups, according to the proposed treatments. All were submitted to collection of vulvar swabs for DNA genotyping of human papillomavirus (HPV), vulvoscopy, and biopsy of the found lesions. After treatment they were followed up in quarterly consultations to (until) possible appearance of new lesions or along one year. RESULTS: The findings were similar in effectiveness and presence of residual or recurrent lesions on the performed treatments. However, patients treated with topical 5% IMQ cream had less severe lesions in histological recurrence when compared to those submitted to the CO2 laser vaporization. CONCLUSIONS: The effectiveness of topical 5% IMQ cream was similar to that of CO2 laser vaporization. There was no difference between the treatments for the presence of residual or recurrent lesions. However, patients who received IMQ had less aggressive lesions than those submitted to the treatment with CO2 laser vaporization.

Experimental evidence of twin fast metastable H(2(2)S) atoms from dissociation of cold H2 induced by electrons.

We report the direct detection of two metastable H(2^{2}S) atoms coming from the dissociation of a single cold H(2) molecule, in coincidence measurements. The molecular dissociation was induced by electron impact in order to avoid limitations by the selection rules governing radiative transitions. Two detectors, placed close to the collision center, measure the neutral metastable H(2(2)S) through a localized quenching process, which mixes the H(2^{2}S) state with the H(2^{2}P), leading to a Lyman-α detection. Our data show the accomplishment of a coincidence measurement which proves for the first time the existence of the H(2(2)S)-H(2(2)S) dissociation channel.

Sífilis exuberante em paciente co-infectado pelo HIV / Severe syphilis in patient infected with HIV

A sífilis é uma doença infecto-contagiosa produzida pelo Treponema pallidum e apresenta alta associação com o vírus da imunodeficiência adquirida,pela possibilidade de transmissão comum via sexual. Apresentamos paciente do sexo feminino, 48 anos, com lesões papulo-nodulares exuberantes ehistória epidemiológica positiva para Imunodeficiência Adquirida, confirmando neurossífilis, sífilis cutânea e positividade para HIV pela investigaçãoclínico-laboratorial. Houve excelente resposta terapêutica após a introdução da Penicilina Cris (AU)

Syphilis is an infectious disease caused by Treponema pallidum presenting high association with human virus immunodeficiency, because of the samesexually transmitted way of transmission. A 48 years old woman, with severe nodular lesions and medical background of immunodeficiency, is reportedneurosyphilis, cutaneous syphilis and HIV-infection was presented. There was an excellent response to standart therapy with Penicillin (AU)

Polymorphisms of p53, GSTM1 and GSTT1, and HPV in uterine cervix adenocarcinoma.

OBJECTIVE: To analyze the participation of glutathione-S-transferase (GST) M1 and T1 polymorphisms associated or not with protein p53 polymorphism at codon 72 and in the presence of HPV in the carcinogenesis of uterine cervix adenocarcinoma. METHODS: Forty-three samples of uterine cervix adenocarcinoma were studied and 86 samples of endocervical cells of women without tumors formed the control group. The presence of HPV was determined in order to genotype the isoforms of p53 at codon 72, GSTM1, GSTM1*0, GSTT1 and GSTT1*0 which were evaluated by the PCR method. RESULTS: HPV was present in 97.67% of the adenocarcinoma cases and in 31.40% of the control group. Statistical analysis showed differences (p = 0.001) and an OR of 113.3 (CI 95%: 13.67-947.14). GSTT1 and GSTT1*0 analysis showed a significant difference between the groups (p = 0.001) with an OR of 4.58 (CI 95%: 2.041-10.28) (p < 0.001) for the presence of GSTT1*0. When it was associated with HPV OR was 6.6 (CI 95%: 0.04-0.50). Analyses of p53 and GSTM1 and GSTM1*0 either alone or associated with HPV were not significant. CONCLUSION: The presence of GSTT1*0 increased the risk for uterine cervix adenocarcinoma development while the allele GSTT1 had a protective action. The other isoforms did not appear to participate in the carcinogenesis of uterine cervix adenocarcinoma.

Collagen and elastic system in the remodelling process of major types of idiopathic interstitial pneumonias (IIP).

AIMS: Structural remodelling in acute and chronic idiopathic interstitial pneumonia (IIP) has been extensively investigated, but little attention has been directed to the elastic tissue in these situations. The aim of this study was to determine whether elastic deposition accompanies collagen deposition in the four major histological patterns of IIP: diffuse alveolar damage (DAD), organizing pneumonia (OP), non-specific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP). METHODS AND RESULTS: We measured, by image analysis, the content of fibres of the collagenous and elastic systems of the alveolar septum in histological slides of open lung biopsies, using the picrosirius-polarization method and Weigert's resorcin-fuchsin stain, respectively. Five groups were studied: 10 cases of DAD; nine cases of OP; nine cases of NSIP; and 10 cases of UIP. Four normal lungs were used for comparison. The content of collagen fibres was significantly higher in UIP when compared to DAD, NSIP, OP and normal lung. The content of elastic fibres was increased in comparison with normal lungs but this was not significantly different among the histological patterns. CONCLUSION: Acute and chronic IIP cause a similar increase in the collagen and elastic contents of the lungs, representing a process of 'fibroelastosis' rather than an exclusive process of fibrosis. A profibrogenic mechanism is responsible for the unparallelled collagen augmentation observed in UIP subjects, the nature of which is yet to be determined.

A software tool to straighten curved chromosome images.

A software tool for straightening curved chromosomes has been developed and integrated into the freely available image analysis application Image SXM (available via the Internet at http://reg.ssci.liv.ac.uk). This new tool straightens curvilinear objects in one simple step after minimal input from the user. The ends of a curvilinear chromosome are identified by the user using the mouse and a window is opened displaying the object as it would appear if it was straightened out. This image processing produces linear images of chromosomes with no loss of resolution or spatial calibration, making subsequent analysis significantly more straightforward.

Different low constant flows can equally determine the lower inflection point in acute respiratory distress syndrome patients.

Among the possible techniques to obtain the pressure-volume (P x V) curve at the bedside the low constant flow (CF) is the easiest and quickest one. However, the best value for CF to perform a good semi-static P x V curve is still to be determined. The purpose of this study was to evaluate the influence of 4 different CFs (1, 2, 5, and 10 L/min) on determination of lower inflection point of the P x V curve (L-Pflex) and upper inflection point of the P x V curve (U-Pflex) on the maximum slope and on the inspiratory work of breathing (up to volume of 1.35 L; inspiratory work L/cm H2O), comparing the volume estimated from the CF with the measured volume obtained by the respiratory inductive plethysmograph. The design was a prospective study, and the setting was an adult medical intensive care unit of a university hospital. There were 7 acute respiratory distress syndrome (ARDS) patients, less than 5 days of installation, after the standardization of lung volume history received sequentially from 4 different low inspiratory CFs in 2 trials. The P x V curve lasted from 73 +/- 1.6 s (1 L/min) to 8.8 +/- 0.69 s (10 L/min). The L-Pflex differed in the 2 performed trials (p = 0.04). There was no difference of L-Pflex among the 4 CFs comparing the 3 methods (p = 0.072) used for its calculation as well as comparing the estimated and the measured volume (p = 0.456). The maximum slope decreased significantly while increasing the flow from 1 to 10 L/min just in the estimated volume (p = 0.03). The inspiratory work did not increase with the increment of the flow either in the estimated volume (p = 0.217) or in the measured volume (p = 0.149). The U-Pflex differed among the trials (p = 0.003) and the methods used for its calculation (p < 0.01). Constant flows from 1 to 10 L/min can equally determine L-Pflex in ARDS patients and is an easy and quick way to obtain the L-Pflex in order to optimize positive end expiratory pressure (PEEP) in ARDS patients.

Solid-phase microextraction method for the quantitative analysis of styrene in water.

A headspace solid-phase microextraction (HS-SPME) method is developed for the determination of styrene in drinking water. Gas chromatography (GC)-mass spectrometry is utilized for qualitative analysis. A manual SPME holder with 85-microm polyacrylate coating is used to extract the styrene from water, which is determined to have good linearity (correlation coefficient r = 0.9999 for 1.00-100.00 microg/L range), a relative standard deviation of 1.9%, and a detection limit of 0.30 microg/L. This method is compared with a classical headspace GC method.

Chromomeric pattern of maize pachytene chromosomes after trypsin treatment.

The bivalent chromomeres of maize were analyzed by means of enzymatic treatment with trypsin. The aim was to verify if the effect of swelling observed in human meiotic chromosomes also occurs in these bivalents, and if this morphological change allows a greater visual resolution of the chromomeric pattern. Bivalents treated with trypsin showed a structure with sequential and linear distribution of small rings. Comparisons between bivalent morphology, treated and non-treated, indicated a collinearity among the sequences of rings and the chromomeres. The results obtained were considered useful to analyze and to make a chromomere map. This treatment can also provide cytological evidence that may help to understand the pairing process. It was concluded that the ring-shape was caused by trypsin-induced "disjoining" just in the chromomeric but not in the interchromomeric regions.

Primary malignant fibrous histiocytoma of the lung. Report of a case with bronchial brushing cytologic features.

BACKGROUND: Malignant fibrous histiocytoma (MFH) arising primarily in the lungs is rare, and a preoperative diagnosis, as well as a surgical planning, is very important because of the tumor's propensity for vascular invasion and its low incidence of lymph node metastasis. The correct preoperative diagnosis of thoracic MFH is not easy to establish because the small fragments from needle and transbronchial biopsies are often inadequate for a conclusive histologic analysis. A preoperative bronchial brushing cytology suggestion of the diagnosis of primary MFH of the lungs may be helpful in such cases. CASE: A 37-year-old male presented with a large, irregular mass in the inferior and middle lobes on chest roentgenography as well as on computed tomography. Two bronchoscopies were performed, with the diagnosis of undifferentiated large cell carcinoma. After surgical resection a more sophisticated pathologic analysis, including immunohistochemical and ultrastructural studies, revealed a primary MFH of the lungs. Revision of the bronchial brushing cytology disclosed many spindle-shaped cells with a "comet" configuration, strongly suggestive of MFH. CONCLUSION: The bronchial brushing cytology features of spindle-shaped and bizarre, multinucleated giant cells with a comet appearance may be the key to the cytomorphologic diagnosis of MFH.

Quantitation in inflammatory pleural disease to distinguish tuberculous and paramalignant from chronic non-specific pleuritis.

AIM: To determine by morphometry if pleural biopsies with the histopathological diagnosis of "non-specific pleuritis", malignant, and tuberculous disease could be distinguished morphologically from those with truly non-specific disease. METHODS: Each pleural biopsy was reviewed taking into account three compartments of reference: the visceral/parietal mesothelial compartment, the submesothelial screen compartment, and the submesothelial adipose tissue compartment. Normal connective tissue, granulation tissue, fibrocellular proliferation, fibrin, polymorphonuclear cells, mononuclear cells, and mesothelial cells were measured using conventional point counting procedures in terms of the fractional area occupied by each parameter within each compartment of reference. Ranking was carried out on 164 patients, based on their diagnosis: chronic non-specific disease (n = 57), tuberculosis (n = 27), malignant disease (n = 58), and conditions associated with transudative effusions (n = 22). RESULTS: Stepwise discriminant analysis of the resulting data showed that biopsies from patients with tuberculosis, malignant disease, and chronic non-specific disease could be distinguished between themselves and normal cases. Statistical differences among the four groups were observed for eight morphometric parameters related to components of inflammation and extension throughout the three pleural anatomical compartments. A robust discriminant function permitted an adequate classification of the three groups of disease in 88.41% of the cases. Pleural biopsies with fibrin incorporated within granulation tissue on the submesothelial screen compartment showed 100% specificity for patients with tuberculosis, while mononuclear cells in a band-like infiltrate on the submesothelial adipose tissue compartment showed 93.1% specificity for patients with malignant disease. The truly non-specific pleuritis was characterised by deposits of fibrin in the subpleural compartment and discrete signs of chronic inflammation and reparatory fibrosis on the submesothelial screen. CONCLUSIONS: Morphometric analysis of pleural biopsies may be a useful supplementary histological procedure to support the diagnosis of pleural tuberculosis and malignant disease.

Interstitial lung disease in primary Sjögren's syndrome. Clinical-pathological evaluation and response to treatment.

Interstitial disease is a recognized form of lung involvement in primary Sjögren's syndrome in which frequency and severity have not yet been established. We studied 20 patients 61.2 +/- 36.4 mo after the first symptoms of the syndrome that fulfilled criteria for both xerostomia and xerophtalmia. Eighteen patients exhibited pulmonary symptoms; nine presented a restrictive functional pattern. The chest roentgenogram disclosed interstitial involvement in nine patients. Gallium-67 lung scan presented hypercaptation in 15 of 19 patients studied. Thirteen patients who submitted to bronchoalveolar lavage presented higher cell counts with increases of lymphocytes and/or polymorphonuclear cells. All patients had abnormal results in at least one of the above. Lung biopsy, undertaken in 12 patients, showed a whole spectrum of interstitial disease, from a follicular bronchiolitis to a lymphoid interstitial pneumonia and finally fibrosis with honeycombing. One patient presented with associated sarcoid granulomas. We treated 11 patients with an azathioprine-based regimen and found a significant improvement in the forced vital capacity (p < 0.05) after at least 6 mo when compared with nontreated patients. We conclude that the frequency of interstitial lung disease is high in Sjögren's syndrome and that an azathioprine-based treatment can favorably change the outcome in this population.

[Predictive factors of abandoning treatment in tuberculosis patients]. / Fatores preditivos de abandono de tratamento por pacientes com tuberculose.

In spite of the efforts to control the spread of tuberculosis worldwide this disease remains one of the biggest problems in public health. Multiresistance has a dramatic effect in this scenario. Non compliance with treatment is directly related to disease spread and the appearance of multiresistance bacilli. Aiming to verify if it is possible to identify patients prone to non compliance from data obtained in the first visit we have studied a population enrolled in a prospective study. Among 257 consecutive patients evaluated between january 1991 and january 1994, we compared 87 patients that abandoned treatment before six months (group A) with 97 that completed six months of treatment (group C). The abandon rate in this group as 33.85% which is larger than 12.9% rate reported by the Health Ministry. Comparing A to C, only the prevalence of alcoholism (A 33.3% x C 22.5%, p = 0.015) and risk behavior for HIV infection (A 27.6% x C 10.2%, p = 0.046), as well as the frequency of non pulmonary disease (A 38.0% x C 24.5%, p = 0.034) were significantly different between both groups. Regarding the moment of abandon (0, 1st or 3rd month) there was no difference in the A group. We conclude that patients at high risk of abandoning tuberculosis treatment can be identified with data obtained at the first visit, allowing to establish a different policy such as supervised treatment for this population.

An air drying technique for maize chromosomes without enzymatic maceration.

The air drying technique, widely used in animal cytogenetics, was adapted for use with Zea mays L. chromosomes. Using a simple protocol without enzymatic maceration and avoiding the inconvenience of the squashing technique, good staining and C-banding were obtained from maize chromosome preparations.

Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure.

This study reports the preliminary clinical evaluation of a new mode of ventilation--volume-assured pressure support ventilation (VAPSV)--which incorporates inspiratory pressure support (PSV) with conventional volume-assisted cycles (VAV). This combination optimizes the inspiratory flow during assisted/controlled cycles, reducing the patient's respiratory burden commonly observed during VAV. Different from conventional PSV, VAPSV assures precise control of tidal volume (VT) in unstable patients. Eight patients with acute respiratory failure (ARF) were submitted to assisted ventilation under VAV and VAPSV. Patient's ventilatory workload (evaluated through the pressure-time product, mechanical work per liter of ventilation, and work per minute) and patient's ventilatory drive (occlusion pressure--P0.1) were significantly reduced during VAPSV. This "relief" was more evident among the most distressed patients (p < 0.001), allowing a reduction of more than 60 percent in muscle load, without the need of increasing peak tracheal pressure. Mean inspiratory flow (VT/TI), VT, and effective dynamic compliance were significantly increased during VAPSV, whereas the effective inspiratory impedance decreased. These mechanical advantages of VAPSV allowed a reduction of intrinsic PEEP, whenever it was present. Blood gas values were similar in both periods. We concluded that VAPSV is a promising form of ventilatory support. At the same time that it was able to safely assure a minimum preset VT, VAPSV reduced patient workload and improved synchrony between the patient and the ventilator during ARF.

[Kidney failure as a complication of the treatment of pulmonary paracoccidioidomycosis]. / Insuficiência renal como complicação do tratamento da paracoccidioidomicose pulmonar.

Sulfadiazine is one of the drugs of choice in the treatment of paracoccidioidomycosis. Side effects are uncommon. Cutaneous and gastrointestinal reactions and rarely leucopenia and jaundice may occur. A patient on sulfadiazine 6 g daily exhibiting a good response is reported. On the 12th day, he presented an intense abdominal pain and reduced urinary output. An ultrasonography revealed diffuse calculosis in urinary tract. Peritoneal dialysis, urinary alkalinization and rehydration were instituted with complete restoration of renal function. This case illustrates the importance of an adequate hydratation of patients receiving sulfadiazine, a simple measure in the prevention of this uncommon complication which carries a high morbidity.