Treating low back pain with combined cerebral and peripheral electrical stimulation: A randomized, double-blind, factorial clinical trial.

BACKGROUND: Recent evidence suggests that chronic low back pain is associated with plastic changes in the brain that can be modified by neuromodulation strategies. This study investigated the efficacy of transcranial direct current stimulation (tDCS) combined simultaneously with peripheral electrical stimulation (PES) for pain relief, disability and global perception in patients with chronic low back pain (CLBP). METHODS: Ninety-two patients with CLBP were randomized to receive 12 sessions on nonconsecutive days of anodal tDCS (primary motor cortex, M1), 100 Hz sensory PES (lumbar spine), tDCS + PES or sham tDCS + PES. Pain intensity (11-point numerical rating scale), disability and global perception were applied before treatment and four weeks, three months and six months post randomization. RESULTS: A two points reduction was achieved only by the tDCS + PES (mean reduction [MR] = -2.6, CI95% = -4.4 to -0.9) and PES alone (MR = -2.2, CI95% = -3.9 to -0.4) compared with the sham group, but not of tDCS alone (MR = -1.7, CI95% = -3.4 to -0.0). In addition to maintaining the analgesic effect for up to three months, tDCS + PES had a higher proportion of respondents in different cutoff points. Global perception was improved at four weeks and maintained three months after treatment only with tDCS + PES. None of the treatments improved disability and the affective aspect of pain consistently with pain reduction. CONCLUSION: The results suggest that tDCS + PES and PES alone are effective in relieving CLBP in the short term. However, only tDCS + PES induced a long-lasting analgesic effect. tDCS alone showed no clinical meaningful pain relief. SIGNIFICANCE: Transcranial direct current stimulation combined simultaneously with PES leads to a significant and clinical pain relief that can last up to three months in chronic low back pain patients. For this article, a commentary is available at the Wiley Online Library.

Respiratory syncytial virus induces phosphorylation of mTOR at ser2448 in CD8 T cells from nasal washes of infected infants.

Respiratory syncytial virus (RSV)-specific CD8(+) T cell responses do not protect against reinfection. Activation of mammalian target of rapamycin (mTOR) impairs memory CD8(+) T cell differentiation. Our hypothesis was that RSV inhibits the formation of CD8(+) T cells memory responses through mTOR activation. To explore this, human and mouse T cells were used. RSV induced mTOR phosphorylation at Ser2448 in CD8 T cells. mTOR activation by RSV was completely inhibited using rapamycin. RSV-infected children presented higher mTOR gene expression on nasal washes comparing to children infected with metapneumovirus and rhinovirus. In addition, RSV-infected infants presented a higher frequency of CD8(+) pmTORser2448(+) T cells in nasal washes compared to RSV-negative infants. Rapamycin treatment increased the frequency of mouse CD8 RSV-M282-90 pentamer-positive T cells and the frequency of RSV-specific memory T cells precursors. These data demonstrate that RSV is activating mTOR directly in CD8 T cells, indicating a role for mTOR during the course of RSV infection.

Serum activity of creatine kinase and aminotransferase aspartate enzymes of horses submitted to muscle biopsy and incremental jump test

The objective was to evaluate serum activity of the enzymes creatine kinase (CK) and aspartate aminotransferase (AST), which are leakage enzymes responsive to muscle injury, of athletic horses that underwent muscle biopsy and incremental jump test (IJT) involving incremental jumps. The animals were grouped as follows: the first group, horses with history of superior performance (SP); the second, with a history of inferior performance (IP); and lastly, a control group (CG). All groups underwent biopsy of the gluteus medius muscle, while groups SP and IP were also submitted to the incremental jump test (IJT) 24 hours after biopsy. The IJT consisted of three stages with 40 jumps each, where jump height increased progressively, from 40 to 60 and last, 80cm. Blood samples were drawn before biopsy, and 6 and 24 hours after the exercise as well. The levels of CK serum activity increased 6 hours after exercise and decreased 24 hours later in all groups, including CG. AST activity did not increase after biopsy and exercise. There was no increase of both enzyme activities that could be attributed to the exercise, possibly due to exercise short duration and/or low intensity. We conclude that the muscle biopsy was able to show that there was enough stimulus to cause CK enzyme leakage into the plasma, and consequent detection of increased serum activity, while the incremental jump test did not.

Objetivou-se avaliar a atividade sérica das enzimas creatina quinase (CK) e aspartato aminotransferase (AST), enzimas de extravazamento responsivas à lesão muscular, de equinos de salto submetidos à biópsia muscular e a um teste de exercício padronizado, envolvendo saltos incrementais. Foram utilizados três grupos de animais, um com histórico de desempenho superior (SP), um com histórico inferior (IP) e um grupo controle (CG). Todos os grupos foram submetidos à biópsia muscular no gluteus medius e somente os grupos SP e IP ao teste de saltos incrementais (IJT), 24h após a biópsia. O IJT foi constituído de três estágios de alturas progressivas, com 40 saltos cada, nas alturas de 40, 60 e 80cm. Amostras de sangue foram coletadas antes da biópsia, 6h e 24h após o exercício. Os níveis de atividade sérica da CK elevaram-se 6h e diminuíram 24h após o exercício em todos os grupos, inclusive no CG. A atividade da AST não demonstrou aumento após a realização da biópsia e do exercício. Não foi visto aumento da atividade de ambas enzimas mensuradas que pudesse ser atribuído ao exercício, possivelmente pela baixa duração e/ou intensidade do mesmo. Conclui-se que a biópsia muscular caracterizou estímulo suficiente para haver extravasamento somente da enzima muscular CK para o plasma, e consequente detecção de aumento de sua atividade sérica, enquanto o teste de exercício padronizado realizado não.

Serine-like proteolytic enzymes correlated with differential pathogenicity in patients with acute Acanthamoeba keratitis.

Acute ocular infection due to free-living amoebae of the genus Acanthamoeba is characterized by severe pain, loss of corneal transparency and, eventually, blindness. Proteolytic enzymes secreted by trophozoites of virulent Acanthamoeba strains have an essential role in the mechanisms of pathogenesis, including adhesion, invasion and destruction of the corneal stroma. In this study, we analysed the relationship between the extracellular proteases secreted by clinical isolates of Acanthamoeba and the clinical manifestations and severity of disease that they caused. Clinical isolates were obtained from patients who showed typical symptoms of Acanthamoeba keratitis. Trophozoites were cultivated axenically, and extracellular proteins were collected from cell culture supernatants. Secreted enzymes were partially characterized by gelatin and collagen zymography. Acanthamoeba trophozoites secreted proteases with different molecular masses, proteolysis rates and substrate specificities, mostly serine-like proteases. Different enzymatic patterns of collagenases were observed, varying between single and multiple collagenolytic activities. Low molecular weight serine proteases were secreted by trophozoites associated with worse clinical manifestations. Consequently, proteolytic enzymes of some Acanthamoeba trophozoites could be related to the degree of their virulence and clinical manifestations of disease in the human cornea.

Regulation of oxidative stress in response to acute aerobic and resistance exercise in HIV-infected subjects: a case-control study.

Human immunodeficiency virus (HIV)-infected subjects have increased levels of oxidative stress which could impair immunological function and therefore contribute to the progression of AIDS. These characteristics are usually evaluated at rest and responses to exercise have yet to be evaluated. The aim of the present study was to assess the effect of a bout of aerobic exercise followed by resistance exercises on antioxidant system in HIV-infected and non-HIV subjects. There were included 14 cases (HIV-positive) and 14 controls (HIV-negative). The exercise protocol consisted of a single session of 20 minutes on a cycloergometer followed by a set of six resistance exercises. The activity of glutathione S-transferase (GST) and catalase were measured in plasma samples, total glutathione (TGSH) and thiobarbituric acid reactive substances (TBARS) were measured in erythrocytes. T CD4+ cells, T CD8+, viral load, complete blood count, and white blood count were also assessed. All measurements were performed at three times: baseline, after aerobic exercise, and after resistance exercises. At baseline, the HIV group had lower GST activity than controls, but after the exercise session GST values were similar in both groups. Compared to the control group TGSH was significantly lower in the HIV group at baseline, after aerobic and resistance exercises. The control group presented higher TBARS values after aerobic exercise compared to the HIV group. The neutrophil count was lower in the HIV group after aerobic and resistance exercises. These data indicate that HIV-infected subjects had lower antioxidant activity at rest. Physical exercise stimulated the enzymatic activity similarly in both groups.

Seasonal and organ variations in antioxidant capacity, detoxifying competence and oxidative damage in freshwater and estuarine fishes from Southern Brazil.

This study analyzed biochemical biomarkers of freshwater and estuarine fish species from Southern Brazil. It analyzed three organs (muscle, liver and gills), in four fish species (Micropogonias furnieri, Pimelodus pintado, Loricariichthys anus and Parapimelodus nigribarbis) in order to perform an environmental diagnosis. Obtained results showed that liver of L. anus and gills of M. furnieri presented higher total antioxidant capacity against peroxyl radicals during fall, whereas a clear seasonality was found for gill reduced glutathione (GSH) levels of all studied species, with higher concentration during spring. In terms of oxidative damage (TBARS), liver of M. furnieri and gills of P. nigribarbis showed higher TBARS levels during fall, whereas P. pintado showed the lowest TBARS value. Finally, a conspicuous seasonal effect was observed for purified and non-purified glutathione-S-transferase (GST), where minimum values were registered during fall, pointing to this season as one where fish species are less competent to perform detoxifying reactions.

Differential effects of alpha-helical and beta-hairpin antimicrobial peptides against Acanthamoeba castellanii.

In this work we evaluated the ability of different types of antimicrobial peptides to promote permeabilization and growth inhibition of Acanthamoeba castellanii trophozoites, which cause eye keratitis. We used cationic alpha-helical peptides P5 and P6, corresponding to the N-terminus of the pore-forming protein from Triatoma infestans, a blood-sucking insect, and a beta-hairpin amphipathic molecule (gomesin), of the spider Acanthoscurria gomesiana haemocytes. A. castellanii permeabilization was obtained after 1 h incubation with micromolar concentrations of both types of peptides. While permeabilization induced by gomesin increased with longer incubations, P5 permeabilization did not increase with time and occurred at doses that are more toxic for SIRC cells. P5, however, at doses below the critical dose used to kill rabbit corneal cells was quite effective in promoting growth inhibition. Similarly, P5 was more effective when serine protease inhibitor was added simultaneously to the permeabilization assay. High performance chromatography followed by mass spectrometry analysis confirmed that, in contrast to gomesin, P5 is hydrolysed by A. castellanii culture supernatants. We conclude that the use of antimicrobial peptides to treat A. castellanii infections requires the search of more specific peptides that are resistant to proteolysis.

Evaluation of temporomandibular joint in stress-free patients.

OBJECTIVES: The aetiology of temporomandibular disorders (TMD) is presently considered to be multifactorial, and stress has been regarded as an important factor in their onset. Many studies have evaluated the importance of stress in TMD; however, only patients with TMD and stress have been assessed. This study aimed at evaluating signs and symptoms of TMD in stress-free patients. METHODS: The temporomandibular joints (TMJs) of 40 stress-free patients were evaluated during clinical examination and in MRI. RESULTS: The individuals lived in an area without electric power supply or telephone services. They worked in agriculture and fishery. 77.5% of the patients presented normal mandibular function; 70% presented normal mandibular trajectory; 61.25% did not present sounds in TMJ and 93.75% did not present joint pain during palpation. Image screening showed that 70% of TMJ presented normal disc position. Only one patient (1.25%) presented TMD. CONCLUSIONS: The absence of stress is a strong factor for the non-development of TMD.

Exercise intensity, but not electrolyte reposition, alters plasmatic cortisol and glucose levels of horses submitted to 30 and 60km distance endurance rides

This study was aimed at comparing cortisol and glucose plasmatic levels in a group of trained horses submitted to 30 and 60km endurance exercises, at the average speed of 10 and 15km h-1, respectively. The horses were randomly divided in two groups, one treated, orally, with a hypertonic electrolyte paste before, during and after the tasks and the other used as control. Cortisol data revealed significant increase in the first moment when the intensity of the exercise was higher (15km/h) or with the prolongation of it (30km long), in the second moment to all groups. Glucose data remained constant during 30km ride; however after 20km distance, in 60km ride, it revealed a significant increase in control group, returning to basal levels in the subsequent moment. Electrolyte replenishment has its importance in the maintenance of the hidroelectrolyte and acid-base status and, in this study, may have contributed to the homeostasis of glucose levels.

O presente estudo teve como objetivo comparar os níveis plasmáticos de glicose e cortisol de um grupo de eqüinos atletas submetidos ao esforço de longa duração (enduro eqüestre) em distâncias de 30 e 60km, com velocidades médias de 10 e 15km h-1, respectivamente. Os animais foram aleatoriamente separados em dois grupos, sendo que a um deles foi administrada, por via oral, uma pasta eletrolítica hipertônica antes, durante e após as referidas provas. O outro grupo foi usado como controle. Os resultados das concentrações de cortisol revelaram um aumento significativo, no primeiro momento, em que a intensidade do esforço era maior (15km/h), ou com a continuação deste (30km de distância), no segundo momento, para todos os grupos. Os resultados referentes à concentração de glicose permaneceram constantes durante a prova de 30km; entretanto, nos primeiros 20km da prova de 60km, tais resultados revelaram um aumento significativo no grupo controle, retornando a valores basais no momento subseqüente. A reposição eletrolítica tem a sua importância na manutenção do equilíbrio hidroeletrolítico e ácido básico e, no presente estudo, pode ter contribuído para a manutenção da concentração média de glicose plasmática.

Hematological values and total protein of Brasileiro de Hipismo and Breton mares during pregnancy

Erythrocyte and leukocyte parameters and total protein (TP) of Brasileiro de Hipismo (BH) and Breton mares were studied during pregnancy. A total of 175 healthy mares, varying from 3 to 13 years old were used. Among the animals, 89 were BH mares (14 non pregnant and 75 pregnant) and 86 Breton mares (11 non pregnant and 75 pregnant). The mares were divided into four groups for each breed: control group (non pregnant mares). group 1 (first period of pregnancy, 25-110 days, n=25), group 2 (second period of pregnancy, 111-210 days, n=25) and group 3 (third period of pregnancy, 211-340 days, n=25). The values for erythrocyte, leukocyte were compared with the obtained total protein. Red blood cells count (RBC), packed cell volume (PCV) and haemoglobin concentration (Hb) increased in the second period of pregnancy and decreased in the last period in both the BH and Breton breed, furthermore these same variables were found to significantly higher in the BH breed for non pregnant and pregnant mares during all three gestational periods. The numbers of total leucocytes and segmented neutrophils increased after the second period in both breeds studied.

Estudaram-se as variáveis eritrométricas, leucométricas e a concentração de proteína total (PT) de éguas gestantes das raças Brasileiro de Hipismo (BH) e Bretão. Utilizaram-se 175 éguas sadias, com 3 a 13 anos de idade. Dentre as éguas utilizadas, 89 foram da raça BH, divididas em 14 não-prenhes e 75 prenhes, e 86 éguas da raça Bretão divididas em 11 não-prenhes e 75 prenhes. As éguas foram subdivididas em quatro grupos por raça: grupo controle (éguas não-prenhes, n=14 para BH e n=11 para Bretão); grupo I (primeiro período de gestação, 25-110 dias, n=25 para BH e Bretão), grupo II (segundo período de gestação, 111-210 dias, n=25 para BH e Bretão); e grupo III (terceiro período de gestação, 211-340 dias, n=25 para BH e Bretão). Os valores médios de cada variável eritrométrica, leucométrica e de proteína total foram obtidos para cada raça e, posteriormente, realizou-se comparação entre as mesmas. O número de hemácias (He), volume globular (VG) e teor de hemoglobina (Hb) aumentaram no segundo período de gestação e diminuíram no último período tanto para a raça BH, como para a raça Bretão. Além disso, essas mesmas variáveis apresentaram diferença estatística significativa tanto nas éguas não-prenhas como nas prenhes durante os três períodos gestacionais. Os valores médios obtidos de leucócitos e neutrófilos segmentados aumentaram a partir do segundo período de gestação para as duas raças estudadas.

Hematological values and total protein of Brasileiro de Hipismo and Breton mares during pregnancy

Erythrocyte and leukocyte parameters and total protein (TP) of Brasileiro de Hipismo (BH) and Breton mares were studied during pregnancy. A total of 175 healthy mares, varying from 3 to 13 years old were used. Among the animals, 89 were BH mares (14 non pregnant and 75 pregnant) and 86 Breton mares (11 non pregnant and 75 pregnant). The mares were divided into four groups for each breed: control group (non pregnant mares). group 1 (first period of pregnancy, 25-110 days, n=25), group 2 (second period of pregnancy, 111-210 days, n=25) and group 3 (third period of pregnancy, 211-340 days, n=25). The values for erythrocyte, leukocyte were compared with the obtained total protein. Red blood cells count (RBC), packed cell volume (PCV) and haemoglobin concentration (Hb) increased in the second period of pregnancy and decreased in the last period in both the BH and Breton breed, furthermore these same variables were found to significantly higher in the BH breed for non pregnant and pregnant mares during all three gestational periods. The numbers of total leucocytes and segmented neutrophils increased after the second period in both breeds studied.

Estudaram-se as variáveis eritrométricas, leucométricas e a concentração de proteína total (PT) de éguas gestantes das raças Brasileiro de Hipismo (BH) e Bretão. Utilizaram-se 175 éguas sadias, com 3 a 13 anos de idade. Dentre as éguas utilizadas, 89 foram da raça BH, divididas em 14 não-prenhes e 75 prenhes, e 86 éguas da raça Bretão divididas em 11 não-prenhes e 75 prenhes. As éguas foram subdivididas em quatro grupos por raça: grupo controle (éguas não-prenhes, n=14 para BH e n=11 para Bretão); grupo I (primeiro período de gestação, 25-110 dias, n=25 para BH e Bretão), grupo II (segundo período de gestação, 111-210 dias, n=25 para BH e Bretão); e grupo III (terceiro período de gestação, 211-340 dias, n=25 para BH e Bretão). Os valores médios de cada variável eritrométrica, leucométrica e de proteína total foram obtidos para cada raça e, posteriormente, realizou-se comparação entre as mesmas. O número de hemácias (He), volume globular (VG) e teor de hemoglobina (Hb) aumentaram no segundo período de gestação e diminuíram no último período tanto para a raça BH, como para a raça Bretão. Além disso, essas mesmas variáveis apresentaram diferença estatística significativa tanto nas éguas não-prenhas como nas prenhes durante os três períodos gestacionais. Os valores médios obtidos de leucócitos e neutrófilos segmentados aumentaram a partir do segundo período de gestação para as duas raças estudadas.

Exercise intensity, but not electrolyte reposition, alters plasmatic cortisol and glucose levels of horses submitted to 30 and 60km distance endurance rides

This study was aimed at comparing cortisol and glucose plasmatic levels in a group of trained horses submitted to 30 and 60km endurance exercises, at the average speed of 10 and 15km h-1, respectively. The horses were randomly divided in two groups, one treated, orally, with a hypertonic electrolyte paste before, during and after the tasks and the other used as control. Cortisol data revealed significant increase in the first moment when the intensity of the exercise was higher (15km/h) or with the prolongation of it (30km long), in the second moment to all groups. Glucose data remained constant during 30km ride; however after 20km distance, in 60km ride, it revealed a significant increase in control group, returning to basal levels in the subsequent moment. Electrolyte replenishment has its importance in the maintenance of the hidroelectrolyte and acid-base status and, in this study, may have contributed to the homeostasis of glucose levels.

O presente estudo teve como objetivo comparar os níveis plasmáticos de glicose e cortisol de um grupo de eqüinos atletas submetidos ao esforço de longa duração (enduro eqüestre) em distâncias de 30 e 60km, com velocidades médias de 10 e 15km h-1, respectivamente. Os animais foram aleatoriamente separados em dois grupos, sendo que a um deles foi administrada, por via oral, uma pasta eletrolítica hipertônica antes, durante e após as referidas provas. O outro grupo foi usado como controle. Os resultados das concentrações de cortisol revelaram um aumento significativo, no primeiro momento, em que a intensidade do esforço era maior (15km/h), ou com a continuação deste (30km de distância), no segundo momento, para todos os grupos. Os resultados referentes à concentração de glicose permaneceram constantes durante a prova de 30km; entretanto, nos primeiros 20km da prova de 60km, tais resultados revelaram um aumento significativo no grupo controle, retornando a valores basais no momento subseqüente. A reposição eletrolítica tem a sua importância na manutenção do equilíbrio hidroeletrolítico e ácido básico e, no presente estudo, pode ter contribuído para a manutenção da concentração média de glicose plasmática.

Long-term creatine supplementation improves the aerobic capacity of horses

The aim of the present study was to investigate the effect of long-term oral supplementation of creatine on the physiological responses to aerobic training. Twelve purebred Arabian horses were submitted to aerobic training for 90 days, with and without creatine supplementation which consisted of the daily administration of 75g of creatine monohydrate mixed into the ration for 90 days of training. Physical conditioning was conducted on a high performance treadmill and training intensity was stipulated by calculating the V4 (velocity at which blood lactate reaches 4mmol L-1) determined monthly for each animal. The individual intensity of physical force at 80% of aerobic threshold was established. An incremental exercise test was used to set the individual V4. After a warm up period of 4 min at 4m s-1, the speed was increased at 2min intervals to 6, 8 and 10m s-1. The blood samples were collected 15s before the end of each step to determine the concentration of lactate, packed cell volume, hemoglobin and red cell values. The results demonstrated a significant increase (P 0.05) in V4 in the groups that received creatine supplementation for 60 days or more when compared to the animals without creatine supplememntation. The other hematological variables were similar to all groups. The results showed that the prolonged creatine supplementation may have a beneficial al effect on the equine athletic performance.

O objetivo do presente estudo foi investigar os efeitos da suplementação oral com creatina sobre respostas fisiológicas ao treinamento aeróbico. Doze cavalos da raça Puro Sangue Árabe foram submetidos a treinamento aeróbico por 90 dias, com ou sem suplementação com creatina, que consistia da administração diária de 75g de monoidrato de creatina misturada à ração durante os 90 dias de treinamento. O treinamento físico foi conduzido exclusivamente em esteira rolante de alto desempenho sendo a intensidade do treinamento estabelecida em 80% da velocidade obtida através da V4 (velocidade na qual a concentração sangüínea de lactato atinge 4mmol L-1) determinada mensalmente para cada animal. Para o estabelecimento da V4 individual foi empregado um teste físico de esforço crescente em que, após um período de aquecimento de 4min a 4m s-1, a velocidade era aumentada à cada intervalo de dois minutos, para 6, 8 e 10m s-1. As amostras sangüíneas foram coletadas 15s antes do témino de cada intervalo para a determinação do lactato, hematócrito, hemoglobina e eritrócitos. Os resultados demonstraram um aumento significativo (P 0,05) da V4 dos animais que receberam creatina por 60 e 90 dias quando comparados, no mesmo período, com os animais que não receberam a suplementação. As outras variáveis hematológicas não apresentaram alterações. É possível sugerir que a suplementação prolongada com creatina pode promover efeitos benéficos no desempenho atlético de eqüinos.

Osteopetrosis--a review and report of two cases.

We present a brief review of the rare condition of osteopetrosis together with two case reports of this disease in the same family affecting the jaws. The first in a 41-year-old woman, and the second in her 39-year-old brother. Plain films and computed tomography showed marked sclerosis of the affected bones with obliteration of the medullary cavities and thickening of the cortices as well as multiple absent and unerupted teeth. In addition radiographs showed discrete mixed radiopaque/radiolucent areas consistent with the appearance of fibro-cemento-osseous dysplasia, but which may also represent part of the overall spectrum of bone changes in osteopetrosis.

Cloning and partial characterization of a Boophilus microplus (Acari: Ixodidae) glutathione S-transferase.

A cDNA of glutathione S-transferase (GST) was isolated from a cDNA library of salivary glands of Boophilus microplus. The recombinant protein was purified by glutathione affinity chromatography and assayed upon the chromogenic substrate CDNB. The 864 bp cloned fragment was sequenced and showed an open reading frame coding for a protein of 220 amino acids. Expression of the GST gene was tested by RT-PCR in tick tissues and larvae mRNA. Comparison of the deduced amino acid sequence with GSTs from other species revealed that the enzyme is closely related to the mammalian class mu GSTs.

Anterior stromal puncture in the treatment of bullous keratopathy: six-month follow-up.

PURPOSE: This study was designed to evaluate the effect of anterior stromal puncture to treat patients with symptomatic bullous keratopathy. METHODS: Fourteen patients with bullous keratopathy who had decreased vision and were or were not awaiting penetrating keratoplasty were evaluated before and 1, 4, 12, and 24 weeks after anterior stromal punctures with a 25-gauge needle. The patients were questioned about pain intensity, foreign-body sensation, and photophobia. Biomicroscopy, esthesiometry, and pachymetry results were evaluated. The results before and after the punctures were compared using the McNemar test, Friedman test, and multiple comparison tests. RESULTS: The comparisons among before and 1, 4, and 12 weeks after the anterior stromal puncture of pain (p = 0.00000556), photophobia (p = 0.0252), foreign-body sensation (p = 0.0000743), and esthesiometry (p = 0.0243) showed significant statistical differences in terms of decreasing symptoms and corneal sensitivity. The average pachymetry did not show statistical difference among before and 1, 4, 12, and 24 weeks after the procedure (p = 0.956). We did not find important differences in terms of corneal neovascularization. CONCLUSION: Anterior stromal puncture is an effective, simple, and low-cost alternative for treating patients with symptomatic bullous keratopathy.

Autoimmune keratolysis in a patient with leukocytoclastic vasculitis: unusual erythema elevatum diutinum with granulomatous pattern.

PURPOSE: Leukocytoclastic vasculitis (LCCV) is an immune complex-mediated, small vessel disease that is clinically characterized by the presence of palpable purpuric lesions, most often in association with rheumatic diseases. Ocular manifestations of LCCV are rare. METHODS: We describe a patient with an unusual granulomatous pattern of erythema elevatum diutinum (EED) associated with autoimmune keratolysis. RESULTS: We studied a 64-year-old man with decreased visual acuity and nodular lesions in both hands. Ocular examination revealed bilateral superior corneal melting with perforation in the left eye and conjunctival thickening in both eyes, in association with a severe inflammatory reaction. Histopathologic examination of the conjunctiva revealed granulomatous vasculitis with neutrophilic infiltrate, giant cells, and fibroblastic proliferation. A punch biopsy taken from his skin showed similar characteristics that suggested EED; however, there were no giant cells. CONCLUSION: To our knowledge, autoimmune keratolysis secondary to cutaneous LCCV (EED) has not been described previously, and there has been no description of granulomatous reaction (in the conjunctiva) in EED.

Findings in the anterior segment on ultrasound biomicroscopy in Maroteaux-Lamy syndrome.

PURPOSE: Maroteaux-Lamy syndrome is one of the mucopolysaccharidoses caused by enzyme deficiency (arylsulfatase B) that leads to incomplete degradation and storage of dermatan sulfate. We report a case of mucopolysaccharidosis type VI (MPS VI; Maroteaux-Lamy syndrome) with corneal involvement and introduce ultrasound biomicroscopy (UBM) as an examination with which to follow disease progression in relation to deposition in cornea, angle, and iris. METHODS: We describe a 11-year-old boy with a clinical and laboratorial diagnosis of MPS VI who developed increasing bilateral corneal opacification and decreased visual acuity. He underwent two seriate UBM (50-MHz transducer) evaluations. RESULTS: UBM examination showed diffuse and homogeneous stromal hyper-reflective deposit in both eyes and an increase in peripheral corneal thickness throughout time. CONCLUSION: High-frequency ultrasound documentation of corneal deposit and anterior segment involvement in a patient with Maroteaux-Lamy syndrome is unique, and follow-up revealed thickening of the corneal periphery, which may be related to the progression of the disease (continuous mucopolysaccharide deposits in corneal stroma). UBM was used to locate and document the deposit, as well as to accompany the deposit's evolution, characterizing corneal changes and angle structure involvement.

Transitional cell carcinoma of the ureter and struvite calculi.

CONTEXT: The association of primary carcinoma of the ureter and lithiasis is extremely rare. We report a rare case of a primary carcinoma of the ureter with corariform calculus. CASE REPORT: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years and had received treatment for urinary infections a number of times. The first clinical presentation was related to lithiasis and the tumor had not been shown up by excretory urography, cystoscopy or ultrasonography. Two months after the calculus had been eliminated, the patient began to have serious symptoms and a grade III transitional cell carcinoma of the ureter was discovered. Total nephroureterectomy and M.V.A.C. (Methotrexate + Vinblastina + Doxo Rubicina + Cisplatina) chemotherapy were tried unsuccessfully. In this report we emphasize the diagnostic difficulty caused by the concomitant presence of the two pathologies. In our opinion, the rapid evolution in this case is directly related to the high grade of the tumor.

Penis wound by scorpion sting.

CONTEXT: The majority of scorpion stings are oligosymptomatic, occurring mainly on the hands and feet. Fatality is rare. CASE REPORT: A 33-year old man suffered a severe sting on his penis from a scorpion of the species Tytius trivittatus. Alcohol and salt were used without success in an effort to relieve pain. Medical assistance was sought 4 hours after the event, at which time diffuse erythema, edema and punctiform injury on the glans penis were observed, with no systemic manifestation. Intravenous meperidine was administered with immediate relief of the pain. The local signs disappeared within 48 hours, with the patient remaining asymptomatic.