Heterotopia pancreática em vesícula biliar: um relato de caso / Heterotopic pancreas in the gallbladder: a case report

A heterotopia pancreática é definida como a presença de tecido pancreático em localização topográfica anômala. Essa patologia pode acometer variadas estruturas da cavidade abdominal, mas raramente manifesta-se na vesícula biliar. Até o momento, menos de 40 casos de heterotopia pancreática em vesícula biliar foram relatados na literatura médica. Apresentamos um caso de uma mulher de 25 anos, que realizou uma colecistectomia videolaparoscópica por colelitíase, com exame anatomopatológico que identificou uma heterotopia pancreática. Apesar de rara, a doença deve ser considerada em pacientes com sintomatologia de doenças da via biliar e de doenças pancreáticas e sem diagnóstico após uma investigação de rotina, tendo em vista que o tecido pancreático ectópico está sujeito às mesmas alterações patológicas, manifestações clínicas e complicações encontradas no próprio pâncreas. (AU)

Heterotopic pancreas is defined as the presence of pancreatic tissue at an anomalous location. This condition may affect multiple structures in the abdominal cavity but rarely appears in the gallbladder. To date, fewer than 40 cases of heterotopic pancreas in the gallbladder have been reported in the medical literature. We present a case of a 25 year-old woman who underwent a laparoscopic cholecystectomy for cholelithiasis, with a pathology test that detected heterotopic pancreas. Despite its rarity, this disease must be considered in cases of corresponding symptoms without a diagnosis after a routine evaluation, considering that ectopic pancreatic tissue is exposed to the same pathological alterations, clinical manifestations, and complications found in the pancreas. (AU)

Oral manifestation associated with multiple pituitary hormone deficiency and ectopic neurohypophysis.

Multiple pituitary hormone deficiency (MPHD) is the diminished secretion of all the hormones produced in the anterior lobe of the pituitary gland. The oral manifestation of this condition includes delayed eruption and prolonged retention of primary teeth, delayed formation and eruption of permanent teeth, delay in development and growth of the jaws, tendency towards development of deep bite and enamel disturbances. This paper reports the case of an adolescent patient with MPHD. Clinical examination revealed partial ankylosis and prolonged retention ofprimary second molars, primary maxillary canines and deep bite. Dental treatment included extraction of all molars with prolonged retention preceded by the necessary medical care with clinical and radiographic follow-up afterwards. The patient was also referred to an orthodontist for orthodontic treatment. Patients' medical condition should always be investigated by clinicians when faced with cases of delayed tooth eruption and bone development.

The function of proprioceptors in bone organization: a possible explanation for neurogenic heterotopic ossification in patients with neurological damage.

Neurogenic heterotopic ossification is characterized by the formation of extra osseous bone in soft tissue surrounding peripheral joints in neurological patients. It occurs in 25% of spinal cord injury patients, and in 20% of these the pathologic process is severe enough to cause limitations in joint motion. Vascular and metabolic changes resulting from autonomic nervous system impairment may play a role in the etiology of heterotopic ossification. Repetitive vigorous passive manipulation of the joint to preserve range of motion, in the presence of reduced defense mechanisms, may also traumatize soft tissue, thereby initiating the pathological process. Nerve terminals within ligaments and capsules that allow for proprioception have a determinant role in triggering on and off muscle contraction, permitting acceleration and deceleration during gait. The Sarah Network of Rehabilitation Hospitals has treated over 20,000 patients with spinal cord and brain injury in the past 20 years. Based on the observation of heterotopic ossification development in some of these patients, and its tendency to relapse, this present article speculates whether, after an interruption in the neural pathways: (1) altered proprioception can forge a different relationship between tissues; and (2) chaotic new bone formation can occur. We postulate that heterotopic ossification in patients with injury to the central nervous system (CNS) may be related to a dysfunction of proprioception. With interruption of the neural tract of a given limb, ligaments lose control and coordination of their proprioceptive function and begin to react to direct stimulus in an independent, isolated and haphazard way. Free of CNS control and directly stimulated by such independent signals, mesenchymal osteoprogenitor cells located in soft tissues begin to occasion tissue maturation and differentiation into bone: heterotopic bone.

Tecido cerebral ectópico na órbita: relato de dois casos / Ectopic brain tissue in the orbit: two case report

Tecido cerebral na órbita, tendo continuidade com o conteúdo intracraniano, é relativamente incomum. Tecido cerebral isolado na órbita, entretanto, é muito mais raro. No presente trabalho säo apresentados dois casos de tecido cerebral ectópico na órbita, com cisto ependimal. Säo analisadas as similaridades e diferenças com outros casos da literatura, bem como as dificuldades no diagnóstico desta malformaçäo. Näo conhecemos nenhum caso descrito na literatura nacional.

Expresión de los oncogenes (c-myc-neu) y el receptor de prolactina (PRLr) en tejidos de mujeres con endometriosis / Expression of oncogens (cmyc-neu) and the prolactin receptor (PRLr) in tissues of women with endometriosis

La endometriosis es una enfermedad cuya etiología no se conoce y sobre la cual existen diferentes teorías que a la fecha no han sido totalmente demostradas. Está claramente demostrado que las mujeres que presentan dicha enfermedad cursan con infertilidad y que la recurrencia de aparición de los focos endometriósicos es alta, y al parecer no dependientes del estímulo estrogénico. Este fenómeno se ha atribuido a otros factores de crecimiento y algunos oncogenes los cuales son expresados para contrarrestar la falta del estímulo estrogénico. Sin embargo, pocos estudios existen en relación a los oncogenes u otros receptores hormonales, por lo que el presente trabajo tuvo por objetivo el evaluar su expresión tanto en tejido eutópico como en ectópico de mujeres con diagnóstico previo de endometriosis. El análisis de la expresión tanto de c-myc, neu y el receptor de prolactina (PRLr) se realizó por la técnica de RT-PCR. Nuestros resultados demuestran que tanto myc como el PRLr se expresan de manera distinta entre los diferentes tejidos, en tanto que neu se expresa de la misma manera entre los dos tejidos. Con estos datos concluimos que las células que conforman el foco endometriósico presentan un estado diferencial en relación a la expresión de algunos de sus genes, lo cual favorece el desarrollo y mantenimiento de los mismos en un ambiente hormonal diferente al de la cavidad uterina.

Embarazo heterotópico: presentación de un caso

Se presenta el caso de una paciente con gestación heterotópica. Se revisan aspectos relacionados con la etiología, diagnóstico y manejo de esta entidad. Se hace énfasis en el aumento de la incidencia de esta patología, especialmente en pacientes sometidas a técnicas de reproducción asistida. Las estadísticas previas donde se refería a esta entidad como infrecuente deben ser revaluadas

Complexo óculo-aurículo-vertebral (síndrome de Goldenhar): achados oculares em oito pacientes / Oculo auriculovertebral complex (Goldenhar's syndrome) ocular findings in 8 patients

Entre 1989 e 1994, foram estudados 8 pacientes com COAV (síndrome de Goldenhar) no setor de Plástico Ocular da Universidade Federal de Säo Paulo - Escola Paulista de Medicina. Cinco pacientes eram do sexo masculino e três do feminino. A idade variou de seis meses a 23 anos e sete pacientes eram da raça caucasiana e um da oriental. Todos os pacientes foram casos isolados na família. As duas alteraçöes mais frequentes foram dermóide epibulbar temporal inferior e coloboma da pálpebra superior, seguidos por simbléfaro, anomalias da musculatura extrínceca ocular e entrópio, que coincidem com os achados da literatura.

[Morphofunctional correlation in congenital anomalies of the coronary arteries. II. The ectopic origin of the coronary arteries]. / Correlación morfofuncional en las anomalías congénitas de las arterias coronarias. II. Origen ectópico de las arterias coronarias.

The authors describe the morphogenesis and functional alterations of the coronary arterial net in the ectopic coronary arteries: a) with origin in the aorta or its branches and b) with origin in the pulmonary artery. The coronary arteries are developed from: 1) endothelial sprouts localized in the great arteries walls at the level of the sigmoidal values, 2) right and left subepicardial vascular network and 3) the intramyocardial sinusoids. Most of the ectopic coronary arteries result from alterations in the connection between these three embryonic elements. The deviation of one of the subepicardial vascular network in a wrong way (in direction of pulmonary artery or the opposite Valsalva sinus) will stimulate the development of endothelial sprouts which will connect such network originating abnormal connections and anomalous origin of the coronary arteries. The origin of both coronary arteries from the pulmonary artery is in compatible with life. Myocardial ischemia is absent in patients with type I (infant) or type II (adult) anomalous origin of one coronary artery from the pulmonary artery, only in the transitional phase between both types (I and II) there is myocardial ischemia previous to the formation of the collateral coronary circulation. The ectopic origin of the coronary artery from the aortic Valsalva sinus have very little hemodynamic repercussion in the patient. Although there are cases with postexercise sudden dead. These anomalies associated to atherosclerotic coronary stenosis have an impact on the evolution and prognosis of ischemic heart disease.