Pancreatic involvement in co-infection visceral leishmaniasis and HIV: histological and ultrastructural aspects.

The involvement of the gastrointestinal tract in the co-infection of HIV and Leishmania is rarely reported. We report the case of an HIV-infected adult man co-infected with a disseminated form of leishmaniasis involving the liver, lymph nodes, spleen and, as a feature reported for the first time in the English literature, the pancreas. Light microscopy showed amastigote forms of Leishmania in pancreatic macrophages and immunohistochemical staining revealed antigens for Leishmania and also for HIV p24. Microscopic and ultrastructural analysis revealed severe acinar atrophy, decreased zymogen granules in the acinar cytoplasm and also nuclear abnormalities such as pyknosis, hyperchromatism and thickened chromatin. These findings might correspond to the histologic pattern of protein-energy malnutrition in the pancreas as shown in our previous study in pancreas with AIDS and no Leishmania. In this particular case, the protein-energy malnutrition may be due to cirrhosis, or, Leishmania or HIV infection or all mixed. We believe that this case represents the morphologic substratum of the protein energy malnutrition in pancreas induced by the HIV infection. Further studies are needed to elucidate these issues.

Involvement of the pancreas in AIDS: a prospective study of 109 post-mortems.

BACKGROUND: Pancreatic involvement in AIDS is rarely mentioned in medical literature. AIMS: To identify the main morphological patterns of the pancreas using optical and electron microscopy in AIDS patients. DESIGN: An open, prospective, and sequential study in a tertiary institutional hospital. METHODS: Consecutive post-mortems of 109 AIDS patients and 38 controls (1995). Baseline characteristics of AIDS patients and controls were evaluated. Morphological analysis consisted of: (i) semi-quantitative score of acinar and parenchymal elements; (ii) qualitative analysis of ducts, vascular components, nerves, and Langerhans' islets; (iii) specific stains and immunohistochemistry for opportunistic agents; (iv) ultrastructural data. RESULTS: The mean age of AIDS patients was 37 years; 80% were male; 60% were white; 21% were alcoholic. All patients with AIDS had normal blood amylase, blood glucose, and pancreatic ultrasound. Histological findings were: acinar atrophy (60%), few zymogen granula in acinar cytoplasm (52%), abnormalities in acinar nucleus (65%), pancreatic steatosis (66%), and focal necrosis (17%). Immunohistochemistry revealed: mycobacteriosis (22%), toxoplasmosis (13%), cytomegalovirus (9%), Pneumocystis carinii (9%), and HIV p24 antigen in macrophage cytoplasm (22%). Ultrastructural examination showed: decreased zymogen granula, enlargement and proliferation of the endoplasmic reticulum and mitochondria, nuclear abnormalities, and increased lipid droplets in acinar cytoplasm. CONCLUSION: Pancreatic involvement in AIDS is very frequent (90%) and is usually asymptomatic. Morphological changes showed three patterns of pancreatic alterations: 'nutritional-like', inflammatory and both of these together. The 'nutritional-like' pattern (atrophy, few zymogen granula and steatosis) may be due to many factors such as nutritional characteristics (Kwashiorkor-like) induced by the HIV infection or related to the HIV virus itself.

[Tumors of the brain stem: anatomo-pathologic study of 35 necropsy cases]. / Tumores do tronco cerebral: estudo anatomopatológico em 35 casos de necrópsia.

Brain stem tumors are rare and are usually treated without histological diagnosis. Its incidence varies in literature between 1.09% and 17.5% of all cerebral tumors. The objective of our study is to present a casuistic of these tumors in 28500 necropsies performed from 1952 till 1985 at the Department of Pathology, Santa Casa Hospital, São Paulo. We emphasize neuropathologic aspects, and compare our cases with those of other series. Also, we point out those tumors which are most frequent in this region, with the aim of possibly contributing to a better therapeutic approach. We used some clinical data and pathological diagnosis, and localized the tumor in the brain stem. Its microscopic diagnosis was determined according to the World Health Organization criterion. Among 428 intracranial tumors observed, 35 were localized in the brain stem. Intrinsic tumors and metastasis were included, and excluded those tumors which infiltrated the brain stem. Greatest incidence occurred in the first decade and cerebral edema was the predominant cause of death. Preferential topography was in the pons and the most frequent tumor was glioblastoma multiformis (19 cases). Metastasis ranked second (9 cases), being mostly from lungs. Some authors oppose tumor biopsy in this region because of high surgical risk. We do not agree with this opinion. We believe that the diagnosis of glioma is important to rule out the characteristics of malignancy. We can not leave without considering the diagnosis of other pathologies which can cause expansion in the brain stem. Therapeutical approach can be more adequate with the histological diagnosis of glioma or of other possibilities as shown here.

Nonfatal demyelinating encephalomyelitis induced by coronavirus (JHM strain) infection in mice.

C3H mice infected intravenously with the JHM strain of coronavirus showed high incidence of demyelination (44.8%) and low incidence of encephalitis-induced mortality (6.9%). High titers of virus were detectable in the brain and liver of mice only during the first 3 to 12 days of infection (10(3) and 10(4) PFU/g, respectively). Most of the animals recovered from the first phase of disease and some (11.1%) came down with paralysis 6 to 7 weeks after the infection, with no histological changes or virus detectable in their tissues.

Nonfatal demyelinating encephalomyelitis induced by coronavirus (JHM strain) infection in mice

C3H mice infected intravenously with the JHM strain of coronavirus showed high incidence of demyelination (44.8%) and low incidence of encephalitis-induced mortality (6.9%). High titers of virus were detectable in the brain and liver of mice only during the first 3 to 12 days of infection (10 and 10 PFU/g, respectively). Most of the animals recovered from the first phase of disease and some (1.1%) came down with paralysis 6 to 7 weeks after the infection, with no histological changes or virus detectable in their tissues

Resultados do tratamento da incontinencia urinaria de esforco pela operacao de Burch. / Results of treatment of effort urinary incontinence by Burch's operation

Sao analisados 51 casos de incontinencia urinaria de esforco, tratados pela tecnica de Burch, no periodo compreendido entre 1975 e 1979 no Departamento de Tocoginecologia do Hospital de Clinicas da Universidade Federal do Parana. A idade das pacientes variou entre 30 e 49 anos e a maioria era de multiparas. O sintoma mais constante foi a perda de urina aos esforcos, existindo tambem disuria e polaciuria. O teste de Bonney e a uretrocistografia miccional foram poucas vezes excutados (27% o primeiro e 14% o segundo). Concomitantemente, foram realizados 28 perineoplastias, 7 laqueaduras e 3 histerectomias. Por ocasiao da alta, todas as pacientes estavam assintomaticas. Durante o seguimento houve recidiva da incontinencia urinaria em 6 casos (12%) e a cura efetuou-se em 45 pacientes (88%). As complicacoes foram em numero reduzido: alem da recidiva em 6 casos, ocorreram 13 casos de infeccao urinaria e 2 casos com infeccao de sutura da pele