Melanoma oral amelanótico metastático com acometimento neurológico e gonadal em um cão fêmea - relato de caso / [Metastatic oral amelanotic melanoma with neurologic and gonadal involvement in a female dog - case report]

Relata-se um caso de melanoma oral disseminado em uma cadela de dois anos, com protrusão de bulbo ocular unilateral e quadro convulsivo progressivo. Os exames de imagem revelaram aumento de volume nas regiões submandibular, maxilar e cerebral, padrão nodular pulmonar e aumento das dimensões ovarianas. A citologia da massa submandibular indicou proliferação epitelial maligna, enquanto a biópsia excisional foi sugestiva de melanoma amelanótico. Na necropsia, havia uma massa gengival localmente infiltrativa e nodulações brancas nos linfonodos, nos rins, no pulmão, no cérebro e nos ovários, indicativas de metástase. O diagnóstico histopatológico consistiu de neoplasia maligna metastática indiferenciada, indicativo de melanoma amelanótico. Células caracterizadas por núcleo com cromatina espessa, múltiplos nucléolos bem evidentes, mitoses atípicas e multinucleações consistiram nos principais critérios de malignidade. No espaço peritrabecular ósseo facial, havia rara diferenciação pigmentar melanocítica, confirmada histoquimicamente pela técnica de Fontana-Massom e Giemsa. Algumas células foram positivas pela imuno-histoquímica para PNL-2 e Melan-A, e o diagnóstico de melanoma amelanótico disseminado foi firmado. A indiferenciação neoplásica marcante, com disseminação metastática multissistêmica e acometimento mútuo de sítios anatômicos pouco comuns, conjuntamente com a ampla variação dos padrões celulares, foi responsável pelo desafio diagnóstico do presente caso, ressaltando o papel decisivo da imuno-histoquímica para confirmação diagnóstica. A importância clínica deste trabalho consiste ainda em alertar a comunidade clínica e científica acerca da dificuldade diagnóstica, devendo-se considerar o melanoma amelanótico como diferencial mesmo em casos de lesões orais menos perceptíveis e/ou desprovidas de pigmentação.(AU)

A case of disseminated oral melanoma in a two year old female dog with unilateral protuberance of the eye bulb and progressive seizure is described. Imaging exams revealed increase of the submandibular, maxillary and cerebral regions, nodular pattern in lungs and increased ovarian dimensions. The cytology of the submandibular mass indicated a malignant epithelial proliferation, whereas the excisional biopsy indicated an amelanotic melanoma. At necropsy, a locally infiltrating gingival mass and white nodules in the lymph nodes, kidneys, lung, brain and ovaries were observed, indicative of metastases. Histopathological diagnosis consisted of an undifferentiated malignant metastatic neoplasm. Nucleus with coarse chromatin, prominent nucleoli, bizarre mitotic figures and multinucleated cells were the major malignant features. There was a poor melanocytic pigment differentiation in the peritrabecular space of facial bones, confirmed by Fontana-Masson and Giemsa histochemical techniques. Only a few cells were immunohistochemically positive for PNL-2 and Melan-A and the diagnosis of a disseminated amelanotic melanoma was performed. The diagnostic challenge was based on marked neoplastic undifferentiation, with multisystemic metastasis and mutual involvement of uncommon anatomic sites, associated with a large variability of cellular patterns, highlighting the decisive role of immunohistochemistry for diagnostic confirmation. Therefore, the clinical importance of this study is to warn the clinical and scientific community about the diagnostic challenge, considering the amelanotic melanoma as a differential even in cases of poorly apparent and/or nonpigmented oral lesions.(AU)

Barriers to investigating and reporting nosocomial outbreaks to health authorities in São Paulo, Brazil: a mixed methods approach.

BACKGROUND: Not all nosocomial outbreaks (NOs) are reported to health authorities (HAs). AIM: To identify barriers to investigating and reporting NOs to HAs. METHODS: A mixed methods approach was performed with a convergent parallel design. The quantitative and qualitative branches of the study were a statewide (electronic) survey and focus groups (FGs), respectively. Infection control practitioners (ICPs) working in the State of São Paulo, Brazil were recruited. FINDINGS: Eighty-five ICPs were enrolled in the survey and 22 ICPs were enrolled in the FGs. Barriers to investigating and reporting NOs included: (i) difficulty in translating outbreak investigation knowledge into practice; (ii) weak planning in outbreak investigation process; (iii) organizational culture and context; (iv) lack of awareness about reporting; and (v) lack of autonomy of ICPs to report outbreaks to HAs. CONCLUSION: HAs could overcome these barriers by revising their strategies to work with healthcare services, as well as delivering translational educational programmes to support improvement in knowledge and skills for NO investigation.

LH and FSH concentration and follicular development in Nellore heifers submitted to fixed-time artificial insemination protocols with different progesterone concentrations.

Nine heifers were pre-synchronized (PGF2α, 12 days) and assigned into three groups with 6 repetitions each: (1) CL (∼8 days old, n=13); (2) DIB+CL (n=18); (3) DIB+EB (150 µg of PGF2α and 2mg estradiol benzoate, n=18). After progesterone (P4) device removal (8 days) and/or final PGF2α, heifers were injected with either GnRH or EB in a 3×2 factorial totalling 49 observations (5 were excluded). The blood sampling schedule: every 12 h during P4 period; for LH pulse frequency on Days 3-5, every 15 min for 6 h during P4 period; after P4 removal and EB treatment, samples were collected every 3 h for 24 h or after GnRH every 1 h for 10 h. Ovarian follicle number and diameter were evaluated by ultrasonography every 12 h until the last blood sample and then 24 h and 48 h later. After device insertion (12 h), the DIB+CL group had a lesser LH concentration than the DIB+EB group. After 36 h, all DIB+CL-treated heifers had less LH than CL-heifers, and after 60 h, the DIB+EB group had less LH than the CL-group. Considering all P4 groups combined, LH peak amplitude was greater after GnRH compared to EB treatment but total area of LH peak amplitude and time to first peak was less. The CL-group had fewer follicles and a greater largest follicle diameter than DIB+CL and DIB+EB groups. When treated with EB, the DIB+CL group had a lesser ovulation rate at 24 h than the CL- and DIB+EB-groups. Fixed time artificial insemination (FTAI) protocols promoted a pre-ovulatory LH peak, independent of previous exposure to the DIB coupled with a CL or not. The progesterone excess interfered with FSH and LH secretion, follicular development and ovulation within 24 h.

Effect of resorbable calcium aluminate ceramics on regulation of calcium and phosphorus in rats.

Ions released from resorbable ceramics could be toxic to the animal. Experiments were designed to study the effect of implanting three different weights of porous resorbable calcium aluminate ceramics (0.172, 0.332, and 0.504 g) in rats for a total duration of 300 days. Gross and microscopic examination of heart, liver, kidneys, trachea with thyroid, and muscle adjacent to the implant did not show any pathological changes. Calcium and inorganic phosphate content of bone, serum and urine were not affected by the implants. Urine hydroxyproline excretion did not change in the animals implanted with ceramics. Animals implanted with 0.332 g of ceramics had a significantly higher serum alkaline phosphatase activity than the control animals. Resorption of calcium and depositon of inorganic phosphates in the implanted ceramics suggested that ions were being exchanged with the body fluids. Implantation of 0.172 to 0.332 g porous resorbable calcium aluminate ceramic was not toxic to the animal.