Radiographic follow-up of a phalangeal brown tumor.

We report the 6-year radiographic follow-up of a phalangeal brown tumor in a patient with severe hyperparathyroidism secondary to chronic renal failure treated with hemodialysis. The phalangeal lesion increased in size during the first 3 years, until the patient finally accepted to undergo parathyroidectomy. The initial radiographic change was a small intracortical lytic area. Two years later, an expansile cystic lesion was visible in the phalanx, and computed tomography showed a cortical defect. Ossification of the lesion occurred over the 2.5 years following parathyroidectomy. The epidemiology, radiographic changes and post-treatment evolution of brown tumor in dialysed patients is reviewed. Surgical parathyroidectomy is the standard treatment for brown tumor complicating secondary hyperparathyroidism. The usefulness and limitations of treatment with vitamin D analogs, recently reported in a few case reports, are discussed.

Evaluation of insecticide resistance and biochemical mechanisms in a population of Culex quinquefasciatus (Diptera: Culicidae) from São Paulo, Brazil.

To establish an insecticidal resistance surveillance program, Culex quinquefasciatus mosquitoes from São Paulo, Brazil, were colonized (PIN95 strain) and analyzed for levels of resistance. The PIN95 strain showed low levels of resistance to organophosphates [malathion (3.3-fold), fenitrothion (11.2-fold)] and a carbamate [propoxur (3.0-fold)]. We also observed an increase of 7.4 and 9.9 in alpha and beta esterase activities, respectively, when compared with the reference IAL strain. An alteration in the sensitivity of acetylcholinesterase to insecticide inhibition was also found in the PIN95 mosquitoes. The resistant allele (Ace.1R), however, was found at low frequencies (0.12) and does not play an important role in the described insecticide resistance. One year later, Cx. quinquefasciatus mosquitoes were collected (PIN96 strain) at the same site and compared to the PIN95 strain. The esterase activity patterns observed for the PIN96 strain were similar to those of the PIN95 mosquitoes. However the occurrence of the Ace.1R allele was statistically higher in the PIN96 strain. The results show that esterase-based insecticide resistance was established in the PIN95 Cx. quinquefasciatus population and that an acethylcholinesterase based resistant mechanism has been selected for. A continuous monitoring of this phenomenon is fundamental for rational mosquito control and insecticide application programs.

Lost stones during laparoscopic cholecystectomy.

BACKGROUND: Gallbladder perforation, with loss of calculi in the abdomen is frequent during laparoscopic cholecystectomy. Recent publications report complications in port sites or in the abdominal cavity. A study of 3686 laparsocopic cholecystectomies performed by 6 surgeons was undertaken. In 627 patients, perforation of the gallbladder occurred and in 254 stones were spilled into the abdominal cavity. In 214 they were retrieved and in 40 left in the abdomen. Twelve patients developed complications. Percutaneous drainage was successful in 2 with serous collections. Two patients with abdominal abscesses were reoperated, stones retrieved and the abdomen drained. One patient developed an intestinal obstruction due to a stone in the ileum. One patient who had a cholecystectomy in another hospital developed a paraumbilical tumor. At reoperation a stone was retrieved. In another six patients, stones were found in port sites. Stones lost into the abdomen should be removed because of their potential morbidity, especially if they are large or if infection is present in the gallbladder at the time of initial surgery. There is no indication for routine conversion to open surgery when stone spillage occurs, although patients should be informed to avoid legal consequence, and to hasten early diagnosis of later complications.

[Resistance to organophosphorous and carbamates insecticides in a population of Culex quinquefasciatus]. / Resistência a inseticidas organofosforados e carbamatos em população de Culex quinquefasciatus.

The population of Culex quinquefasciatus breeding in the Pinheiros River (S. Paulo, Brazil) has been controlled with organophosphates since 1980. However, the biting has constituted a continual nuisance to the human population who live in the vicinity of the river. The occurrence of insecticide resistance to at least two organophosphates and one carbamate (malathion, fenitrothion and propoxur, respectively) to this insect population is reported. The results show the need to develop an insecticide management program. The susceptibility to permethrin (pyretroid) suggests the possibility of using this class of insecticide should the need for replacement of the insecticide in use arise.

Detection of embolic signals using Doppler ultrasound: a new approach to cardiac embolism.

Cerebral embolism from cardiac, aortic or carotid cause can be detected by Doppler examination of carotid arteries or transcranial Doppler with long-duration recordings. The signals detected called HITS (high intensity transient signals), which have been described in vitro and in vivo, have specific physical characteristics. This novel technique is considered promising in establishing the relationship between the discovery of embolic heart disease and its clinical neurological manifestations. In the evaluation of a stroke, the detection of HITS could provide evidence in support of an embolic cause. The areas of application of this new technique are many: screening for asymptomatic embolism in patients with an embolic cardiac disorder, and effects of antiplatelet and anticoagulant medications or surgical treatments.

Tumoral calcinosis in hemodialysis patients. A review of three cases.

Soft tissue calcification are common in chronic hemodialysis patients and often affect the periarticular tissues, where they occasionally form tumoral masses. In a retrospective study of 254 hemodialysis patients we identified three such cases. Affected sites were the wrist, shoulder, and chest wall. None of the patients had secondary hyperparathyroidism. A discussion is provided of the roentgenographic and clinical features of tumoral calcinosis, of current pathogenic hypotheses, and of available treatments.

Cutaneous panniculitis and relapsing polychondritis: two cases.

We report 2 uncommon cases of skin panniculitis (Pa) occurring during the course of relapsing polychondritis (RP). Skin histological findings were characterized by septal and lobular involvement associated with vasculitis. Chondritis and Pa lesions both regressed with steroid therapy and showed parallel clinical courses. To our knowledge, this type of cutaneous involvement has never been reported in RP.

[Single larva sampling for Aedes aegypti surveillance]. / Amostragem por larva-única na vigilância de Aedes aegypti.

Buildings in Araraquara city, Southeastern Brazil, were searched during a year for the presence of Aedes larvae using single larva sampling in order to check the single-larva methodology. In those breeding places in which Aedes larvae were found, one of them was collected. As a control, after the single larva had been collected, all the larvae from the breeding place were collected for later identification. This process was repeated in the laboratory. Of the 447 domiciles searched, 12 were considered positive and 20 breeding places were found. Of the breeding places, 13 contained Aedes larvae, 5 both Aedes and Culex larvae and 2 Culex larvae only. The results show that all the breeding places in the field were properly recognized showing the method may be used for Aedes surveillance in cities infested with one species only or without any domiciliary infestation.

Aspergillus arthritis of the shoulder in a renal transplant recipient. Failure of itraconazole therapy.

We report a case of Aspergillus arthritis of the shoulder in a renal transplant recipient. Cultures of three joint fluid specimens grew Aspergillus fumigatus. Itraconazole as sole treatment resulted in initial clinical and roentgenographic improvements but failed to prevent deterioration in joint function. A relapse with fatal neurologic involvement occurred. Immune deficiency-inducing risk factors for aspergillosis include neutropenia and corticosteroid therapy. Previously published cases of Aspergillus arthritis of limb joints are reviewed. The advantages and limitations of itraconazole as single drug therapy are outlined.

[Useful investigations for the prevention of recurring lithiasis (in the absence of anomalies of the urinary tract)]. / Les investigations utiles pour la prévention des récidives des lithiases (en l'absence d'anomalies des voies urinaires).

The prevalence of renal lithiasis and the rate of recurrences in affected patients raises the problem of the minimum number of investigations really needed to arrive at an accurate diagnosis and establish a potentially effective treatment. Stone recuperation is very important as it allows to carry out an accurate analysis of its constituent(s) (frequently heterogenous). Such analysis already brings forth accurate indications as to the etiology. Other biological investigations should be limited after a first episode of kidney stone disease, but recurring lithiasis will necessitate a much more thorough work-up. Recurrences in certain lithiases, such as those caused by urate calculi, are readily prevented by conventional therapy (uricosuric agents, alkalinization of urine). Withdrawal of certain medicines is paramount in iatrogenic lithiasis. Regarding calcium stones associated with hypercalciuria, results from dynamic tests and their pertinence for differentiating between hypercalciuria due to abnormally high digestive absorption and that due to excessive elimination are currently strongly contested. The role of alimentary factors seems extremely important and prescription of adapted diets appears to be quite effective in view of the present lack of crystal formation inhibitors.

[The insertion of permanent pacemaker leads via the retro-pectoral veins (author's transl)]. / Mise en place des sondes de stimulation cardiaque permanente par les veines rétro-pectorales.

When it is not possible to use the cephalic vein for the insertion of a permanent pacemaker wire, the veins situated below the clavicular head of the pectoralis major, close to the lateral border of its upper part, can be used. This is possible in 87.6% of cases. The use of this approach is associated with a lower reoperation rate than the cephalic vein way.