A myzozoan-specific protein is an essential membrane-anchoring component of the succinate dehydrogenase complex in Toxoplasma parasites.

Succinate dehydrogenase (SDH) is a protein complex that functions in the tricarboxylic acid cycle and the electron transport chain of mitochondria. In most eukaryotes, SDH is highly conserved and comprises the following four subunits: SdhA and SdhB form the catalytic core of the complex, while SdhC and SdhD anchor the complex in the membrane. Toxoplasma gondii is an apicomplexan parasite that infects one-third of humans worldwide. The genome of T. gondii encodes homologues of the catalytic subunits SdhA and SdhB, although the physiological role of the SDH complex in the parasite and the identity of the membrane-anchoring subunits are poorly understood. Here, we show that the SDH complex contributes to optimal proliferation and O2 consumption in the disease-causing tachyzoite stage of the T. gondii life cycle. We characterize a small membrane-bound subunit of the SDH complex called mitochondrial protein ookinete developmental defect (MPODD), which is conserved among myzozoans, a phylogenetic grouping that incorporates apicomplexan parasites and their closest free-living relatives. We demonstrate that TgMPODD is essential for SDH activity and plays a key role in attaching the TgSdhA and TgSdhB proteins to the membrane anchor of the complex. Our findings highlight a unique and important feature of mitochondrial energy metabolism in apicomplexan parasites and their relatives.

Asbestos burden in lungs of mesothelioma patients with pleural plaques, lung fibrosis and/or ferruginous bodies at histology: a postmortem SEM-EDS study.

The causal attribution of asbestos-related diseases to past asbestos exposures is of crucial importance in clinical and legal contexts. Often this evaluation is made based on the history of exposure, but this method presents important limitations. To assess past asbestos exposure, pleural plaques (PP), lung fibrosis and histological evidence of ferruginous bodies (FB) can be used in combination with anamnestic data. However, such markers have never been associated with a threshold value of inhaled asbestos. With this study we attempted to shed light on the dose-response relationship of PP, lung fibrosis and FBs, investigating if their prevalence in exposed individuals who died from malignant mesothelioma (MM) is related to the concentration of asbestos in lungs assessed using scanning electron microscopy equipped with energy dispersive spectroscopy. Moreover, we estimated the values of asbestos concentration in lungs associated with PP, lung fibrosis and FB. Lung fibrosis showed a significant positive relationship with asbestos lung content, whereas PP and FB did not. We identified, for the first time, critical lung concentrations of asbestos related to the presence of PP, lung fibrosis and FB at histology (respectively, 19 800, 26 400 and 27 400 fibers per gram of dry weight), that were all well-below the background levels of asbestos identified in our laboratory. Such data suggest that PP, lung fibrosis and FB at histology should be used with caution in the causal attribution of MM to past asbestos exposures, while evaluation of amphibole lung content using analytical electron microscopy should be preferred.

A postmortem case control study of asbestos burden in lungs of malignant mesothelioma cases.

BACKGROUND: Asbestos lung content is regarded as the most reliable tool for causal attribution of malignant mesothelioma (MM) to previous asbestos exposures. However, there is a lack of studies on asbestos burden in lungs of MM patients in comparison with healthy individuals. This study aims to provide such a comparison, investigating, as well, differences in asbestos lung burden with sex and time trends. METHODS: Asbestos lung content has been assessed on formalin-fixed lung fragments using scanning electron microscopy coupled with energy dispersion spectroscopy (SEM-EDS) on individuals deceased from MM (cases) and healthy subjects without any lung disease who died from violent causes (controls) between 2005 and 2023. RESULTS: Asbestos and asbestos bodies (ABs) were found, respectively, in 73.7% and 43.2% of cases and in 28 and 22% of controls; in MM cases the most represented asbestos types were crocidolite and amosite, whereas in controls it was tremolite-actinolite asbestos. The concentration of both asbestos fibers and ABs was statistically significantly higher in MM cases compared to controls. The mean asbestos fibers width was also significantly higher in cases than controls. Males and females with MM showed similar asbestos and ABs concentrations, but females had higher concentrations of chrysotile, and significantly lower fibers width compared to males. Time trends show that MM lung asbestos concentrations decreased starting in 2011. DISCUSSION: The results suggest a correlation between asbestos burden in lungs and MM risk. The different concentration of chrysotile, as well as the different width of asbestos fibers in MM males and females might reflect a sex difference in response of the lung microenvironment to inhaled asbestos. Finally, this study provides the first pathological evidence of the effect of the ban of asbestos use, demonstrating a significant decrease of asbestos lung content after 2011.

CPD in the remote environment: a role for practice-based small group learning?

BACKGROUND: Continuous professional development (CPD) is recognised as essential and mandated by the Royal College of General Practitioners and other medical professional colleges. However, it can be difficult to maintain when deployed and remote from normal training and support structures. There is no literature directly discussing how military doctors in the deployed and remote environment maintain CPD and if practice-based small group learning (PBSGL) could be an appropriate tool to facilitate this in future. AIM: To describe the CPD experience of medical officers (MOs) working for the Defence Medical Services (DMS) and assess if offering PBSGL would be welcomed and likely beneficial. DESIGN AND SETTING: This is a quantitative survey of doctors working in primary care within the DMS. METHOD: A questionnaire was designed to elicit opinions, current practice and previous experience of CPD within the deployed and firm base environments. It also aimed to elicit prior experience of and appetite for PBSGL as a solution. This was then distributed via email to MOs working for the DMS. RESULTS: 130 responses (25%) were received. 122 (96%) had heard of PBSGL, 56% had participated in PBSGL in the firm base. 60% agreed or strongly agreed PBSGL was an effective way to maintain CPD. 73% reported eLearning as a mode of maintaining CPD while deployed or working in a remote environment. CONCLUSION: This study demonstrated that many general practitioners deployed to remote locations feel that CPD provision could be improved and that PBSGL is a potential solution.

Reconstructing historical exposure to asbestos: the validation of 'educated guesses'.

BACKGROUND: In both the epidemiological and legal context, the causal attribution of asbestos-related lung diseases requires retrospective exposure assessment (REA). AIMS: To assess the correlation between the retrospective assessment of occupational and anthropogenic environmental exposure to asbestos and its content in the lung tissue. METHODS: Based on the available exposure information, a team of occupational physicians retrospectively assessed cumulative exposure to asbestos in 24 subjects who died of asbestos-related diseases. The asbestos lung content was analysed using analytical scanning electron microscope (SEM-EDS). The Log10 asbestos fibre count in the autoptic samples was predicted as a function of the Log10 estimated cumulative exposure using univariate regression analysis. RESULTS: The median count of asbestos fibres by grams of dry weight (ff/gdw) in the lung tissue was 81 339 (range 0-2 135 849.06); it was 287 144 (range 0-2 135 849.06) among the occupationally exposed, and 29 671 (range 0-116 891) among the subjects who only had anthropogenic environmental and/or household exposure. Amphiboles, and particularly amosite (52%) and crocidolite (43%), were detected in all the study subjects. Chrysotile was not detected in any of the samples. Overall, the retrospective estimate of lifetime cumulative exposure to asbestos showed a moderate correlation with the total asbestos fibre count in the autoptic lung, with the regression model explaining 38-55% of the total variance. CONCLUSIONS: Detailed information on occupational, environmental and household exposure circumstances would be indispensable for experienced industrial hygienists and/or occupational physicians to reliably assess past exposure to amphiboles or mixed types of asbestos.

Wild rats as urban detectives for latent sources of asbestos contamination.

Based on a large body of evidence asbestos minerals have been classified as carcinogens. Despite the Italian ban on asbestos in 1992 and the subsequent remediation activities, latent sources of contamination may still represent a hazard where asbestos were particularly used. Using wild rats as sentinel animals, this study aimed at uncovering sites with the greatest potential for non-occupational exposure to asbestos in the city of Casale Monferrato (Piedmont Region, Italy), where the largest Italian manufacturing plant of asbestos-cement had been active. During the study period (2013-2015) a total of 40 wild rats were captured from 16 sampling capture points. The lungs of wild rats have been investigated by using scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS). The SEM-EDS detected the presence of asbestos fibers (tremolite/actinolite, amosite, and chrysotile) in rats' lungs from 11 sampling points. The hypothetical rats' home-range and the observed site-specific concentration of asbestos fibers per gram of dry lung tissue were used to identify areas to be targeted by additional search of latent sources of asbestos. In conclusion, our results showed that the use of wild rats as sentinel animals may effectively integrate the strategies currently in use to reduce the exposure to asbestos.

Bilateral penile cavernosal abscess secondary to Escherichia coli: a case report of a rare diagnosis.

Cavernosal abscess is a rare diagnosis. Disparity exists in the literature but the most common colonising agents appear to be Neisseira gonorrhoea and Staphylococcus aureus. We describe a 75-year-old man who presented with sepsis and was found to have Escherichia coli positive blood and urinary cultures. Following initial treatment for sepsis of unknown origin, computed tomography demonstrated a bilateral cavernosal abscess. The patient was successfully treated with incision and drainage, multiple re-looks and a delayed closure, alongside a course of appropriate antibiotics. A defect in the bulbar urethra was identified and repaired with bladder drainage via both suprapubic and urethral catheters. Following discharge, a urethrogram showed no urethral leak or stricture and the patient is now catheter free.

Avaliação diagnóstica na síndrome disfunção cognitiva canina / Diagnostic Evaluation of Canine Cognitive Dysfunction Syndrome

O objetivo do presente estudo foi avaliar o questionário observacional e os testes de reatividade como forma de triagem e diagnóstico da disfunção cognitiva em cães idosos. Foram estudados 10 cães acima de sete anos, que apresentavam queixas comportamentais. Foi utilizado questionário que abordava questões comportamentais, como desorientação, atividade, interação socioambiental, alterações no padrão do sono e casa-sujidade. As respostas foram convertidas em pontuações, cujo somatório classificou o cão com disfunção cognitiva canina (DCC), ou borderline (BL), ou sem alterações comportamentais (SAC). Logo depois, foram realizados, em todos os cães, os seguintes testes cognitivos: open field, curiosidade, interação com humano e com espelho. Pela avaliação do questionário, foi determinado que dois cães tinham DCC, três eram BL, cinco eram SAC. Os cães classificados com DCC tinham idade superior aos demais e apresentaram alterações em todos os testes de reatividade, enquanto os cães BL apresentaram alterações em dois testes de reatividade e os SAC não apresentaram alterações. Conclui-se que, com o aumento da expectativa de vida canina, o questionário observacional foi um instrumento de triagem para a identificação dos cães classificados com DCC, BL e SAC, e os testes de reatividade como um método inovador para identificar o verdadeiro estado cognitivo dos pacientes idosos.(AU)

The objective was to evaluate the observational questionnaire and the reactivity tests as a way of screening and diagnosis of cognitive dysfunction in elderly dogs. Ten dogs over seven years of age, with behavioral complaints, were studied. A questionnaire was used that addressed behavioral issues such as disorientation, activity, socioenvironmental interaction, changes in sleep pattern, and house-dirtiness. Responses were converted into scores, which summed the dog with canine cognitive dysfunction (DCC), or Borderline (BL) or without behavioral changes (SAC). Soon after, the following cognitive tests were performed on all dogs: open field, curiosity, interaction with human and with mirror. Through questionnaire evaluation, two dogs had CHD, three were BL, and five were SAC. The dogs classified with DCC were older than the others and presented alterations in all reactivity tests, while the BL dogs presented changes in two reactivity tests and CAD showed no alterations. With the increase in canine life expectancy, the observational questionnaire was a screening instrument for the identification of dogs classified with DCC, BL and SAC and the reactivity tests as an innovative method to identify the true cognitive status of the dogs elderly patients.(AU)

Criterios Médicos de elegibilidad para el uso de anticonceptivos de la OMS / Medical eligibility criteria for the use of WHO contraceptives

Introducción: Los "Criterios Médicos de Elegibilidad para el Uso de Anticonceptivos" de la Organización Mundial de la Salud (OMS) son una guía para la correcta elección y uso de los métodos anticonceptivos en variadas condiciones de salud. En este documento revisaremos las principales modificaciones en su quinta y última edición publicada en inglés el año 2015. Desarrollo: Las modificaciones de la quinta edición son fundamentalmente la adición de nuevos métodos y la modificación de la categoría de recomendación para algunas condiciones de salud. Se agregan el acetato de medroxiprogesterona de depósito vía subcutánea, el anillo vaginal de progesterona, el implante anticonceptivo subcutáneo sinoimplant(II)® y el método anticonceptivo de emergencia acetato de ulipristal. Se modifican las recomendaciones para las mujeres en lactancia, permitiendo el uso de algunos métodos de progestágeno solo desde el posparto inmediato, salvo el acetato de medroxiprogesterona de depósito por entregar una dosis elevada del esteroide y el dispositivo intrauterino (DIU) con levonorgestrel, el cual sigue las normas de los DIU con cobre. También hay modificación en las recomendaciones en cuanto al uso de anticonceptivos combinados en el puerperio, con más restricciones para mujeres sin lactancia. Por último, sobre el uso de terapia antiretroviral, cambian algunas categorías y se amplía el listado de fármacos detallados. Conclusión: Es necesario que los profesionales de salud conozcan estas modificaciones para poder entregar una atención de calidad a las usuarias de anticoncepción.

Introduction: The "Medical Eligibility Criteria for Contraceptive Use" published by the World Health Organization (WHO) is a guide for the correct choice and use of the contraceptive methods in many different health conditions. In this document we will review the main changes made in the fifth and last edition of this guide published in English in 2015. Development: The modifications of this last edition are the addition of new contraceptive methods and the modification of the category of the recommendation for some health conditions. It adds the medroxiprogesterone acetate subcutaneous injection, the progesterone vaginal ring, the subcutaneous contraceptive implant sinoimplant(II)® and ulipristal acetate as emergency contraception. There are modifications of the recommendations for breastfeeding women, allowing the use of some progestin only methods since the immediate postpartum, with the exception of medroxiprogesterone acetate because it delivers a high dose of the steroid and the levonorgestrel intrauterine device that follows the same recommendations as the copper intrauterine device. There are also modifications in the recommendations for the use of combined contraceptives in the first 42 days postpartum, with more restrictions for non-breastfeeding women. Finally, on the use of antiretroviral therapy drugs, there were changes of some categories and a detailed categorization for each drug. Conclusion: It is necessary for health care providers to know these changes in order to deliver a quality care to contraception users.

Potencial cicatricial da Bixa orellana L. em feridas cutâneas: estudo em modelo experimental / Therapeutic potential of Bixa orellana L. in skin wounds: a study in the rat model of open wound healing

O uso de fitoterápicos é uma alternativa de baixo custo e de fácil acesso para o tratamento de feridas cutâneas. Objetivou-se avaliar a ação do extrato oleoso de urucum na cicatrização de feridas cutâneas abertas. Inicialmente, identificaram-se os principais ácidos graxos do óleo de urucum. Foi realizado ensaio citotóxico para determinar as concentrações a serem utilizadas no ensaio in vivo. No experimento, feridas cutâneas em ratos Wistar foram diariamente tratadas com: extrato de urucum 0,1% (U 0,1%), extrato de urucum 0,01% (U 0,01%), vaselina (V) e solução fisiológica (SF), por até 21 dias. Aos quatro, sete, 14 e 21 dias, foi avaliada clinicamente a presença de exsudato, crosta e epitelização. Determinaram-se as áreas da lesão, e amostras de pele, fígado e rins foram coletadas para avalição histológica. Aos 21dias, amostras de pele foram coletadas para análise tensiométrica. Clinicamente, todos os grupos de tratamento apresentaram evolução cicatricial fisiológica. Os grupos U 0,1% e U 0,01% apresentaram maior presença de epitelização aos sete dias e maior retração cicatricial aos quatro dias. Na histologia, U 0,1% e U 0,01% apresentaram aos quatro e sete dias maior quantidade de fibrina e inflamação que V e SF, e, nos demais momentos, não houve diferenças entre os grupos. Quanto à fase cicatricial, aos quatro dias todos os grupos encontravam-se na fase inflamatória, aos sete dias U 0,1% e U 0,01% permaneciam na fase inflamatória, diferindo de SF e V, que se caracterizavam na fase proliferativa. Aos 14 dias, os grupos apresentavam-se em transição de fase proliferativa para maturação e, aos 21dias, estavam todos na fase de maturação. Os grupos tratados com urucum expressaram menor resistência à tensão que V e SF. Concluiu-se com este estudo que o extrato oleoso de urucum acelera o processo cicatricial nos primeiros dias, mas proporciona uma cicatriz de baixa qualidade.

Phytotherapies are a low cost, easily accessible alternative to traditional medicines in wound healing management. The purpose of this study was to assess the oil extract of Bixa orellana L. as a healing agent in the rat model of open wound healing. Initially, the oil was obtained and characterized through gas chromatography. Furthermore, the cytotoxic potential of the oil was verified in cell cultures to determine the doses used in animal experiments. Wounds were surgically produced in Wistar rats, these were treated with the oil extract at 0.1% (U 0.1%), 0.01% (U 0.01%), petrol jelly (V) and saline (SF) for up to 21 days. At four, seven and 14 days of treatment the wounds were assessed clinically regarding the presence of exudate, crust and epithelialization. The wound area was also determined and skin, kidney and liver tissues were harvested for histopathology. At 21 days of treatment the skins were also harvested for tension resistance assessment. Clinically, all groups evolved similarly, however, those treated with U 0.1% and U 0.01% had a greater amount of epithelialized wounds by day seven, and grater shrinkage by day four. Histopathologicaly, the skin samples of oil treated wounds had more lesions in the inflammatory phase at seven days, when compared to the controls, which were majorly in the proliferation phase. By 14 days no difference was observed among groups, which were all in the transition from the proliferation to the maturation phase. By day 21, all wounds were in the maturation phase. Oil treated wounds also had more fibrin in the first two assessment dates, when compared to the controls. Tension resistance of the oil treated wounds was, however, inferior to that of the controls. This study shows that B. orellana L. oil will hasten the onset of the healing process and its initial phases, but will ultimately produce a scar of poorer quality.

Cardiopatías congénitas: diagnóstico prenatal y seguimiento / Congenital heart disease: prenatal diagnosis and follow-up

Objetivo: Valorar la capacidad diagnóstica y el seguimiento de las cardiopatías congénitas con diagnóstico prenatal realizadas en el Centro de Referencia Perinatal Oriente (CERPO). Método: Se analizan todas las cardiopatías congénitas con diagnóstico prenatal que ingresaron al CERPO entre abril 2003 y diciembre de 2011. Se realiza seguimiento postnatal, se evalúa la concordancia entre el diagnóstico pre y postnatal, y se compara el pronóstico con la experiencia previamente reportada en la literatura. Resultados: Se detectaron 568 cardiopatías congénitas, el 53 por ciento correspondían a pacientes referidas desde otras regiones del país. En relación a la edad materna y paterna el 28 por ciento y el 35 por ciento tenían 35 años o más, respectivamente. De las 568 cardiopatías congénitas controladas, el 75 por ciento fueron pesquisadas con la ecocardiografía por visión de 4 cámaras y el 25 por ciento por visión de tractos de salida. La concordancia entre la ecocardiografía prenatal y postnatal fue de 87 por ciento Los diagnósticos más frecuentes correspondieron a comunicación interventricular, síndrome de hipoplasia ventricular izquierdo, arritmias y canal aurículoventricular. Se detectaron 60 cromosomopatías, 8 síndromes genéticos y 145 malformaciones extracardiacas asociadas. Se pudo realizar seguimiento de sobrevida al año en 390 pacientes, la sobrevida global en este grupo (excluidas las aneuploidías incompatibles con la vida) alcanzó un 44 por ciento. Conclusión: Existe una alta tasa de diagnóstico prenatal de cardiopatías congénitas a nivel terciario, con un 87 por ciento de concordancia entre ecocardiografía pre y postnatal. La sobrevida global de pacientes con cardiopatías congénitas fue de 44 por ciento al año de seguimiento. Por las características territoriales de nuestro país debiera contarse con más centros de referencia perinatal, al menos en las zonas norte y sur del país.

Objective: To evaluate the diagnostic and follow-up congenital heart disease with prenatal diagnosis performed in the Centro de Referencia Perinatal Oriente (CERPO). Method: We analyzed all the congenital heart disease with prenatal diagnosis admitted to CERPO between April 2003 and December 2011. Postnatal follow-up is performed, evaluating the correlation between pre and postnatal diagnosis and prognosis compared with the experience previously reported in the literature. Results: We detected 568 congenital heart diseases of which 53 percent were patients referred from other regions of the country. In relation to maternal and paternal age, 28 percent and 35 percent were 35 years or older, respectively. From 568 controlled congenital heart diseases, 75 percent could be researched to ultrasound echocardiography 4-chamber view and 25 percent per-view outflow tracts. The correlation between prenatal and postnatal echocardiography in this series was 87 percent. The most frequent diagnosis was interventricular communication, hypoplastic left heart syndrome, arrhythmias and atrioventricular canal. In this series we detected 60 chromosomal, 8 genetic syndromes and 145 extracardiac malformations. Follow-up could be performed one year survival in 390 patients, overall survival in this group (excluding aneuploidies with life incompatibility) reached 44 percent. Conclusion: There is a high rate of prenatal diagnosis of congenital heart disease at the tertiary level, with 87 percent concordance between pre-and postnatal echocardiography. Overall survival of patients with congenital heart disease is 44 percent at one year. For the territorial characteristics of our country should be counted more perinatal referral centers, at least in the north and south.

Frecuencia y factores asociados a daño hepático inducido por medicamentos en tratamiento antituberculosis / Frequency and factors associated with DILI in antituberculosis treatment

Introduction: Potentially hepatotoxic drugs are used in tuberculosis treatment. The incidence range of drug-induced liver injury (DILI) varies from 0.6 to 33 percent. Adverse reactions can be asymptomatic; therefore periodical liver tests are required. Multiple risk factors are described, such as age and HIV infection, among others. Objective: To determine risk factors associated to DILI and secondary lethality in patients receiving anti-tuberculosis drugs. Materials and Methods: The database from the Servicio de Salud Metropolitano Central de Chile was used. 1,249 patients were analyzed from 2003 to 2008 to determine DILI’s frequency and time of appearance. Multivariate binominal regression was used to study possible risks associated to hepatotoxicity. Results: 2,8 percent of our patients presented DILI (n = 35), three of them died from this cause (8.5 percent). Association between DILI and HIV infection and extrapulmonary tuberculosis was observed (p < 0.01). DILI was present in 50 percent of our patients before the 23rd day. Conclusions: We propose a more exhaustive control of the liver function in patients with DILI risk factors, including HIV carriers and extrapulmonary tuberculosis.

Introducción: El tratamiento antituberculosis incluye drogas hepatotóxicas, estimándose una incidencia de daño hepático inducido por medicamentos (DHIM) entre 0,6 y 33 por ciento. Puede ser asintomático, debiendo evaluarse periódicamente con perfil hepático. Se han descrito múltiples factores de riesgo, como mayor edad e infección por VIH, entre otros. Objetivo: Determinar factores asociados al desarrollo de DHIM y letalidad secundaria a tratamiento antituberculosis. Materiales y Métodos: Base de datos del Programa de Tratamiento antituberculosis del Servicio de Salud Metropolitano Central de Chile. Se analizaron 1.249 pacientes entre 2003 y 2008. Se determinó frecuencia y tiempo de aparición de DHIM. Se estudiaron posibles factores asociados a hepatotoxicidad mediante regresión binomial. Resultados: se diagnosticó DHIM en 2,8 por ciento de los pacientes (n = 35), falleciendo 3 de ellos por esta causa (8,5 por ciento). Se observó asociación entre DHIM con ser portador de VIH (+) y tuberculosis extrapulmonar (p < 0,01). Aparición de DHIM antes del día 23 en 50 por ciento de los casos. Conclusión: Sugerimos un control más exhaustivo del perfil hepático en pacientes con factores de riesgo, entre los cuales deben considerarse los portadores de VIH y tuberculosis extrapulmonar.

Malignant pleural mesothelioma in a female lion (Panthera leo).

An 18-year-old female lion (Panthera leo) was referred to the Department of Animal Pathology of the University of Turin (Italy). At necropsy, multiple nodular, 4-20-mm, confluent white firm nodules were scattered throughout the pleural surfaces of the thoracic wall and of the lungs. Histological lesions were represented by proliferations of papillary structures lined by cuboidal basophilic mesothelial cells with large, oval nuclei and abundant granular eosinophilic cytoplasm. Immunohistochemistry revealed immunoreactivity for pancytokeratin and vimentin. None of the cells expressed calretinin antigen. Asbestos fibers and asbestos bodies were not detected respectively by light microscopy and by Scanning Electron Microscope-Energy Dispersive Spectrometer investigations. On the contrary, chrysotile asbestos were identified in samples from shelter material. Histological and immunohistochemical findings were consistent with the diagnosis of an epithelial malignant mesothelioma. To our best knowledge, this is the first report of a pleural mesothelioma in a lion.

In vitro study of biofunctional indicators after exposure to asbestos-like fluoro-edenite fibres.

The in vitro biological response to fluoro-edenite (FE) fibres, an asbestos-like amphibole, was evaluated in lung alveolar epithelial A549, mesothelial MeT-5A and monocyte-macrophage J774 cell lines. The mineral has been found in the vicinity of the town of Biancavilla (Catania, Sicily), where an abnormal incidence of mesothelioma has been documented. Cell motility, distribution of polymerized actin, and synthesis of vascular endothelial growth factor (VEGF) and of beta-catenin, critical parameters for tumour development, progression and survival, were investigated in A549 and MeT-5A cells exposed to 50 microg/ml FE fibres for 24 hr and 48 hr. The levels of cyclooxygenase (COX-2) and prostaglandin (PGE2), two molecules involved in cancer pathogenesis by affecting mitogenesis, cell adhesion, immune surveillance and apoptosis, were measured in J774 cells treated with FE fibres under the same experimental conditions. Finally, FE fibres were studied by SEM and EDS analysis to investigate their chemical composition. Exposure of A549 and MeT-5A cells to FE fibres affected differentially phalloidin-stained cytoplasmic F-actin networks, cell motility and VEGF and beta-catenin expression according to the different sensitivity of the two cell lines. In J774 cells it induced a significant increase in COX-2 expression, as assessed by Western blot analysis, and in the concentration of PGE2, measured in culture media by ELISA. SEM-EDS investigations demonstrated two types of FE fibres, edenite and fluoro-edenite, differing in chemical composition and both recognizable as calcic amphiboles. Fibre width ranged from less than 1 microm (prevalently 0.5 microm) to 2-3 microm (edenite) up to several microm (fluoro-edenite); length ranged from about 6 to 80 microm (edenite) up to some hundred microm (fluoro-edenite). Results provide convincing evidence that FE fibres are capable of inducing in vitro functional modifications in a number of parameters with crucial roles in cancer development and progression. Inhaled FE fibres have the potential to induce mesothelioma, even though their ability to penetrate lung alveoli depends on their aerodynamic diameter.

[Mineral fibers and bladder cancer. Morphological and minerological investigations in a subject without professional exposure]. / Fibre minerali e carcinoma vescicale. Indagine morfologica e mineralogica in un soggetto non professionalmente esposto.

It is confirmed that occupational and paraoccupational exposure to mineral fibres, particularly asbestos fibres, plays a fundamental role in the induction of lung cancer and pleural mesothelioma. The possible association with other human cancers (e.g. larynx cancer, gastro-intestinal cancer, uro-genital cancer and emolinfopoietic cancer) is not yet demonstrated, even if some mineral fibres are identified in tissues different from the lung ones, such as kidney, bladder, and some biological fluids (e.g. urine of subjects with occupational exposure to asbestos). The possibility of damage caused to tissues in consequence of exposure to low concentration of mineral fibres (e.g. environmental exposure) has still to be defined. In this work we report the results of a mineralogical study by means of scanning electron microscopy with microprobe of a case of bladder cancer in a subject without professional exposure to mineral fibres where asbestos bodies are identified by optical microscopy.

Osteomyelitis caused by Paracoccidioides brasiliensis in a child from the metropolitan area of Rio de Janeiro.

The authors describe a case of paracoccidioidomycosis in a 7-year-old girl from the city of Rio de Janeiro who initially presented to her physician with a lesion in her calcaneous which was misdiagnosed and treated as bacterial osteomyelitis. Later, cutaneous manifestations, lymph node enlargement, and hepatosplenomegaly developed and biopsy of the skin and cervical lymph nodes showed the fungus which was also present in the sputum. It is emphasized that Paracoccidioides brasiliensis can be the cause of bone lesions in endemic areas of Latin America and that response to treatment with amphotercin B is good.

Uterine thermal balloon therapy under local anaesthesia for the treatment of menorrhagia: a pilot study.

This study evaluates the use of local anaesthesia in a subset of patients undergoing uterine thermal balloon endometrial ablation for the treatment of menorrhagia. Out of 51 patients with dysfunctional uterine bleeding, 18 were included for uterine balloon therapy under local anaesthesia. Inclusion criteria were dysfunctional bleeding with absence of organic lesions in the uterine cavity, adequate relaxation and pain control during physical examination and diagnostic hysteroscopy, and patient desire to avoid a general anaesthetic. Paracervical block was performed with 20 ml of dilute 1% lignocaine HCl with epinephrine 1:200,000. Success of the procedure was defined as amenorrhoea, hypomenorrhoea, or eumenorrhoea. The median follow-up period was 13.9 +/- 5 months and 11 patients (61%) had follow-up of >1 year. Treatment led to a significant decrease in menstrual flow, duration, and pad count in all patients (P < 0.0001). No intra-operative complications occurred. A pain scale (level 1-10) was used to evaluate the patients' tolerance of the procedure (mean 3.8 +/- 1.3). In light of these successful and well tolerated procedures, thermal balloon endometrial ablation, utilizing local anaesthesia, appears practical as an office-based therapy.