Fecal calprotectin as a biomarker of microscopic bowel inflammation in patients with spondyloarthritis.

AIM: Microscopic bowel inflammation is present in up to 60% of all patients with spondyloarthritis (SpA) and appears to be associated with more severe joint disease and a higher risk of developing inflammatory bowel disease (IBD). This study aimed to determine the utility of fecal calprotectin (fCAL) in evaluating endoscopic and histological bowel inflammation in SpA patients. METHODS: Ileocolonoscopies with biopsies and fCAL measurements were performed in 65 patients with SpA. RESULTS: In 47 (72.3%) patients, the fCAL levels were higher than 50 µg/g, whereas in 20 (30.7%), these levels were greater than 250 µg/g. A total of 38 (58.5%) patients presented with microscopic bowel inflammation, and 13 (20%) presented with signs of endoscopic inflammation. fCAL levels were significantly higher in patients with microscopic bowel inflammation than in those without inflammatory findings (P < .001); additionally, these levels were slightly higher in patients with endoscopic signs of bowel inflammation (P = .053). A fCAL cutoff value of 96 µg/g predicted histological bowel inflammation with 73% sensitivity and 67% specificity. No statistically significant difference was observed in the fCAL levels between patients who had been treated or not treated with nonsteroidal anti-inflammatory drugs (NSAIDs). CONCLUSION: Our findings confirm a high prevalence of microscopic bowel inflammation in SpA patients, regardless of the use of NSAIDs. The evaluation of fCAL levels proved to be useful in the identification of microscopic inflammation and could help in the more judicious indication of ileocolonoscopy. These results support the use of fCAL for the evaluation of microscopic bowel inflammation in SpA patients.

Effect of Oral Nutrition Supplements and TGF-ß2 on Nutrition and Inflammatory Patterns in Patients With Active Crohn's Disease.

BACKGROUND: Crohn's disease (CD) is often associated with nutrition disorders. Many nutrition therapeutic alternatives have been studied. Nevertheless, the actual role of nutrition therapy is still controversial. The objective of this study was to assess the effects of nutrition supplementation with and without transforming growth factor-beta 2 (TGF-ß2) on inflammatory, endoscopic, histopathologic, and nutrition parameters in active CD. MATERIALS AND METHODS: Thirty-eight patients were allocated into 3 groups: group 1 (patients who received only nutrition orientation), group 2 (nutrition orientation and a normoproteic, normocaloric nutrition supplement), and group 3 (nutrition orientation and the nutritional supplement with TGF-ß2). Clinical and nutrition evaluation, C-reactive protein (CRP) levels, and assessment of endoscopic and histologic parameters in the intestinal mucosa were performed before and after nutrition intervention. RESULTS: The mean follow-up period was 3 months. In the beginning of the study, groups were homogeneous regarding age, gender, CD behavior and localization, and medication in use. In the end of the study, the Clinical Disease Activity Index score was reduced in groups 2 and 3; in group 3, a reduction in CRP levels and an improvement in histologic findings were observed. Among patients who received nutritional supplement, some anthropometric patterns were improved. CONCLUSION: The results of the study indicate that nutritional supplementation improved nutrition and inflammatory patterns in patients with active CD. However, only patients receiving TGF-ß2-enriched formula showed improvement in histologic parameters and significant reduction in CRP levels.

Effects of different periods of gastric ischemia on liver as a remote organ1.

PURPOSE: To evaluate the hepatic changes associated with gastric ischemia. METHODS: Thirty male rabbits were studied, distributed in 3 groups (n=10). Group 1: ligature and section of the gastric vasculature and removal of the liver after three hours; Group 2: ligature and section of the gastric vasculature and removal of the liver after 6 hours; Group 3: ligature and section of the gastric vasculature and removal of the liver after 12 hours. Blood samples were collected immediately before surgery and after the determined time of ischemia in each group to evaluate the hepatic function. After the death of the rabbits, the liver was removed for macro and microscopic study. RESULTS: An increase in aminotransferases and bilirubin occurred in groups 2 and 3. Total protein and albumin diminished in all of the animals. All of the rabbits from groups 2 and 3 presented hepatocellular necrosis. CONCLUSION: The devascularization of the stomach for a period of above three hours is associated with hepatic morphological and functional disorders.

Effects of different periods of gastric ischemia on liver as a remote organ

Abstract Purpose: To evaluate the hepatic changes associated with gastric ischemia. Methods: Thirty male rabbits were studied, distributed in 3 groups (n=10). Group 1: ligature and section of the gastric vasculature and removal of the liver after three hours; Group 2: ligature and section of the gastric vasculature and removal of the liver after 6 hours; Group 3: ligature and section of the gastric vasculature and removal of the liver after 12 hours. Blood samples were collected immediately before surgery and after the determined time of ischemia in each group to evaluate the hepatic function. After the death of the rabbits, the liver was removed for macro and microscopic study. Results: An increase in aminotransferases and bilirubin occurred in groups 2 and 3. Total protein and albumin diminished in all of the animals. All of the rabbits from groups 2 and 3 presented hepatocellular necrosis. Conclusion: The devascularization of the stomach for a period of above three hours is associated with hepatic morphological and functional disorders.

Morphologic and Functional Study of Heterotopic Splenic Tissue Allografts in Rabbits.

OBJECTIVES: To assess the viability and induction of immunotolerance of nonvascularized splenic alloimplants. The phagocytic functions of splenic implants also were studied. MATERIALS AND METHODS: Thirty-six adult female New Zealand and California rabbits were used, and these animals were divided into the following 5 groups: (n = 6 / groups 1-4) group 1 (sham operations); group 2 (total splenectomy); group 3 (implantation of autologous sliced splenic tissue in the greater omentum following splenectomy); group 4 (implantation of allogenic sliced splenic tissue in the greater omentum after splenectomy); and group 5 (n = 12) (implanting allogenic sliced splenic tissue in the greater omentum after splenectomy and receiving oral cyclosporine at a dosage of 40 mg/kg/d). All animals were followed for 120 days after the operations, then received venous injections of China ink (groups 1, 2, 3, 4, 5A) or a colloidal radiopharmaceutical (group 5B), and subsequently underwent reoperations. Hematimetric examinations were performed, and the histologic aspects and phagocytic functions of the implants were assessed. RESULTS: Spontaneous immunotolerance was not induced by sliced splenic allografts implanted in the greater omentum. The use of cyclosporine did not preserve the viabilities of the implants. All animals in group 3, which were subjected to autologous implants, exhibited viable implants that exhibited phagocytic function, although this phagocytic function was reduced compared with that of the normal spleen. CONCLUSIONS: No viable spleen alloimplants were observed regardless of the presence of cyclosporine. Spontaneous immunotolerance was not induced by sliced splenic alloimplants.

Preliminary study of coconut water for graft tissues preservation in transplantation.

OBJECTIVE: to verify the effectiveness of coconut water in preserving tissues for transplant. METHODS: Fifty male Wistar rats were randomly distributed in five groups, according to the following preservation solutions for tissue grafts: Group 1: Lactated Ringer; Group 2: Belzer solution; Group 3: mature coconut water; Group 4: green coconut water; Group 5: modified coconut water. In Group 5, the green coconut water has been modified like the Belzer solution. From each animal we harvested the spleen, ovaries and skin of the back segment. These tissues were preserved for six hours in one of the solutions. Then, the grafts were reimplanted. The recovery of the function of the implanted tissues was assessed 90 days after surgery, by splenic scintigraphy and blood exam. The implanted tissues were collected for histopathological examination. RESULTS: The serum levels did not differ among groups, except for the animals in Group 5, which showed higher levels of IgG than Group 1, and differences in relation to FSH between groups 1 and 2 (p <0.001), 4 and 2 (p = 0.03) and 5 and 2 (p = 0.01). The splenic scintigraphy was not different between groups. The ovarian tissue was better preserved in mature coconut water (p <0.007). CONCLUSION: the coconut water-based solutions preserves spleen, ovary, and rat skin for six hours, maintaining their normal function.

Closure of large wounds using rubber bands in rabbits.

OBJECTIVE: to verify the effectiveness of the rubber elastic band in the treatment of large wounds of the body wall of rabbits by means of traction of its edges. METHODS: we studied 30 New Zealand rabbits, divided into three groups (n=10): Group 1- healing by secondary intention; Group 2- removal and eutopic repositioning of skin as full thickness skin graft; Group 3- Approximation of wound edges with elastic rubber band. In all animals, we removed a segment of the back skin and subcutaneous tissue down to the fascia, in accordance with an acrylic mold of 8 cm long by 12 cm wide. All animals were observed for 21 days. RESULTS: two animals of groups 1 and 2 had wound abscess. In Group 2, there was partial or total graft loss in 90% of animals. The complete closure of the wounds was observed in four animals of Group 1, six of Group 2 and eight of Group 3. There was no difference between the scar resistance values of groups 2 and 3, which were higher than those in Group 1. The scars of the three groups were characterized by the presence of mature connective tissue mixed with blood vessels and inflammatory infiltration, predominantly polymorphonuclear. CONCLUSION: the tensile strength of the wound edges with rubber elastic band is as efficient as the skin graft to treat rabbits' large body wounds.

Preliminary study of coconut water for graft tissues preservation in transplantation / Estudo preliminar da água de coco para preservação de enxertos teciduais em transplante

OBJECTIVE: To verify the effectiveness of coconut water in preserving tissues for transplant. METHODS: Fifty male Wistar rats were randomly distributed in five groups, according to the following preservation solutions for tissue grafts: Group 1: Lactated Ringer; Group 2: Belzer solution; Group 3: mature coconut water; Group 4: green coconut water; Group 5: modified coconut water. In Group 5, the green coconut water has been modified like the Belzer solution. From each animal we harvasted the spleen, ovaries and skin of the back segment. These tissues were preserved for six hours in one of the solutions. Then, the grafts were reimplanted. The recovery of the function of the implanted tissues was assessed 90 days after surgery, by splenic scintigraphy and blood exame. The implanted tissues were collected for histopathological examination. RESULTS: The serum levels did not differ among groups, except for the animals in Group 5, which showed higher levels of IgG than Group 1, and differences in relation to FSH between groups 1 and 2 (p <0.001), 4 and 2 (p = 0.03) and 5 and 2 (p = 0.01). The splenic scintigraphy was not different between groups. The ovarian tissue was better preserved in mature coconut water (p <0.007). CONCLUSION: the coconut water-based solutions preserves spleen, ovary, and rat skin for six hours, maintaining their normal function.

OBJETIVO: Verificar a eficácia da água de coco na preservação de tecidos para transplante. MÉTODOS: cinquenta ratas Wistar foram distribuídas aleatoriamente em cinco grupos, de acordo com as seguintes soluções de preservação para enxertos teciduais: Grupo 1- Ringer lactato, Grupo 2- Solução de Belzer, Grupo 3- Água de coco maduro, Grupo 4- Água de coco verde, Grupo 5- Água de coco modificada. No Grupo 5, a água de coco verde foi modificada à semelhança da solução de Belzer. De cada animal, retirou-se o baço, os ovários e um segmento de pele do dorso. Esses tecidos foram preservados durante seis horas em uma das soluções. Em seguida, os enxertos foram reimplantados. A recuperação da função dos tecidos implantados foi avaliada 90 dias após a cirurgia, por meio de cintilografia esplênica, exames de sangue. Os tecidos implantados foram coletados para estudo anatomopatológico. RESULTADOS: as dosagens séricas não apresentaram diferença entre os cinco grupos, exceto pelos animais do Grupo 5, que apresentaram valores mais elevados de IgG do que o Grupo 1,e pelas diferenças em relação ao FSH entre os grupos 1 e 2 (p<0,001), 4 e 2 (p=0,03), 5 e 2 (p=0,01). A cintilografia esplênica não foi diferente entre os grupos. O tecido ovariano foi melhor preservado em água de coco maduro (p<0,007). CONCLUSÃO: as soluções à base de água de coco preservam baço, ovário e pele de rato durante seis horas, mantendo sua função normal.

Closure of large wounds using rubber bands in rabbits / Fechamento de grandes feridas com fita elástica de borracha em coelhos

OBJECTIVE: To verify the effectiveness of the rubber elastic band in the treatment of large wounds of the body wall of rabbits by means of traction of its edges. METHODS: we studied 30 New Zealand rabbits, divided into three groups (n=10): Group 1- healing by secondary intention; Group 2- removal and eutopic repositioning of skin as full thickness skin graft; Group 3- Approximation of wound edges with elastic rubber band. In all animals, we removed a segment of the back skin and subcutaneous tissue down to the fascia, in accordance with an acrylic mold of 8cm long by 12cm wide. All animals were observed for 21 days. RESULTS: two animals of groups 1 and 2 had wound abscess. In Group 2, there was partial or total graft loss in 90% of animals. The complete closure of the wounds was observed in four animals of Group 1, six of Group 2 and eight of Group 3. There was no difference between the scar resistance values of groups 2 and 3, which were higher than those in Group 1. The scars of the three groups were characterized by the presence of mature connective tissue mixed with blood vessels and inflammatory infiltration, predominantly polymorphonuclear. CONCLUSION: the tensile strength of the wound edges with rubber elastic band is as efficient as the skin graft to treat rabbits' large body wounds.

OBJETIVOS: Verificar a eficácia da fita elástica de borracha no tratamento de grandes feridas de parede corpórea de coelhos por meio da tração de suas bordas. MÉTODOS: foram estudados 30 coelhos da raça Nova Zelândia, distribuídos em três grupos (n=10): Grupo 1. Cicatrização por segunda intenção. Grupo 2. Retirada e reposicionamento eutópico da pele como enxerto de pele total. Grupo 3. Aproximação das bordas da ferida com fita elástica de borracha. Em todos os animais, foi retirado segmento de pele e tecido subcutâneo até a fáscia musculoaponeurótica do dorso, de acordo com um molde de acrílico, com 12cm de comprimento por 8cm de largura. Todos os animais foram acompanhados durante 21 dias. RESULTADOS: dois animais dos grupos 1 e 2 apresentaram abscesso na ferida. No Grupo 2, houve perda parcial ou total do enxerto em 90% dos animais. O fechamento completo das feridas foi observado em quatro animais do Grupo 1, seis do Grupo 2 e oito do Grupo 3. Não houve diferença entre os valores de resistência cicatricial dos grupos 2 e 3, que foram maiores do que os do Grupo 1. As cicatrizes dos três grupos caracterizaram-se pela presença de tecido conjuntivo maduro entremeado por vasos sanguíneos e infiltrado inflamatório, predominantemente polimorfonuclear. CONCLUSÃO: a tração das bordas da ferida com fita elástica de borracha constitui método tão eficaz quanto o enxerto de pele para tratar grandes feridas de parede corpórea de coelhos.

Use of alloplastic meshes in abdominal wounds of rats with induced peritonitis.

BACKGROUND: The use of alloplastic meshes has been historically contra-indicated in patients with infection. AIM: To evaluate the use of polypropylene meshes in the treatment of abdominal wall defects in rats with peritonitis. METHODS: Twenty Wistar female rats were divided into two groups: induction of peritonitis (test group) and without peritonitis (control group). An abdominal wall defect was created in all animals, and polypropylene mesh was applied. The evaluation of the tensile strength of the mesh was carried out using tensiometer and microscopic analysis of the healing area was done. RESULTS: More adhesion of the mesh to the rat abdominal wall was observed in test group. The histopathological analyses showed prevalence of moderate to accentuated granulation tissue in both groups, without significant differences. CONCLUSION: The use of the mesh coverage on abdominal wall defects of rats with induced peritonitis did not show worse results than its use in healthy animals, nor was its integration to the resident tissue any worse.

Use of alloplastic meshes in abdominal wounds of rats with induced peritonitis / Uso de telas inorganicas em feridas abdominais de ratos com peritonite induzida

Background : The use of alloplastic meshes has been historically contra-indicated in patients with infection. Aim : To evaluate the use of polypropylene meshes in the treatment of abdominal wall defects in rats with peritonitis. Methods : Twenty Wistar female rats were divided into two groups: induction of peritonitis (test group) and without peritonitis (control group). An abdominal wall defect was created in all animals, and polypropylene mesh was applied. The evaluation of the tensile strength of the mesh was carried out using tensiometer and microscopic analysis of the healing area was done. Results : More adhesion of the mesh to the rat abdominal wall was observed in test group. The histopathological analyses showed prevalence of moderate to accentuated granulation tissue in both groups, without significant differences. Conclusion : The use of the mesh coverage on abdominal wall defects of rats with induced peritonitis did not show worse results than its use in healthy animals, nor was its integration to the resident tissue any worse. .

Racional: O uso de telas inorgânicas historicamente é contra-indicado em paciente com infecções. Objetivo : Avaliar o comportamento e cicatrização de paredes abdominais com uso de telas de polipropileno após infecções intra-cavitárias. Método : Foram estudadas 20 ratas Wistar aleatoriamente divididas nos grupos Estudo (com peritonite) e Controle (sem peritonite). Um defeito na parede abdominal foi criado em todos os animais, onde foi aplicada tela de polipropileno. Foi feita avaliação da força de tensão com uso de tensiômetro, além de análise histológica da área cicatricial. Resultados : Observou-se maior adesividade da tela às paredes dos animais do grupo Estudo quando comparado ao grupo Controle. A análise histopatológica mostrou prevalência de tecido de granulação de acentuado à moderado em ambos os grupos, sem diferença significativa. Conclusão : O uso de telas inorgânicas nos defeitos da parede abdominal em ratos com peritonite induzida não mostrou resultado pior do que aquele obtido de animais sem infecção, tanto em relação à sua integração quanto ao tecido cicatricial no defeito da parede abdominal. .

Quantification of endocrine cells and ultrastructural study of insulin granules in the large intestine of opossum Didelphis aurita (Wied-Neuwied, 1826).

This study aimed to investigate the distribution of argyrophil, argentaffin, and insulin-immunoreactive endocrine cells in the large intestine of opossums (Didelphis aurita) and to describe the ultrastructure of the secretory granules of insulin-immunoreactive endocrine cells. Fragments of the large intestine of 10 male specimens of D. aurita were collected, processed, and subjected to staining, immunohistochemistry, and transmission electron microscopy. The argyrophil, the argentaffin, and the insulin-immunoreactive endocrine cells were sparsely distributed in the intestinal glands of the mucous layer, among other cell types of the epithelium in all regions studied. Proportionally, the argyrophil, the argentaffin, and the insulin-immunoreactive endocrine cells represented 62.75%, 36.26%, and 0.99% of the total determined endocrine cells of the large intestine, respectively. Quantitatively, there was no difference between the argyrophil and the argentaffin endocrine cells, whereas insulin-immunoreactive endocrine cells were less numerous. The insulin-immunoreactive endocrine cells were elongated or pyramidal, with rounded nuclei of irregularly contoured, and large amounts of secretory granules distributed throughout the cytoplasm. The granules have different sizes and electron densities and are classified as immature and mature, with the mature granules in predominant form in the overall granular population. In general, the granule is shown with an external electron-lucent halo and electron-dense core. The ultrastructure pattern in the granules of the insulin-immunoreactive endocrine cells was similar to that of the B cells of pancreatic islets in rats.

Cystic fibrosis, gastroduodenal inflammation, duodenal ulcer, and H. pylori infection: the "cystic fibrosis paradox" revisited.

BACKGROUND: In cystic fibrosis (CF) patients a duodenal impaired bicarbonate secretion and unbuffered gastric acid are always described and the development of duodenal ulceration is uncommon (CF paradox). Helicobacter pylori (HP) infection is the main cause for duodenal ulceration and its prevalence in CF patients is controversial. AIM: The objective of this study is to evaluate HP prevalence, gastric histology, and duodenal ulceration in adult FC patients. METHODS: 32 adult CF patients were submitted to (13)C-urea breath test and serum immunoblotting test for HP diagnosis. Among them, 20 patients were submitted to endoscopy. RESULTS: 19/32 (68%) patients showed positive serology. Endoscopy showed erosive duodenitis (15%), and duodenal ulcer scar in 10%. On duodenal histology, 94.5%, showed active inflammation and 66.7% gastric metaplasia. CONCLUSION: HP infection prevalence in adult CF patients was similar to that of general Brazilian population. CF patients have all the duodenal spectrum of alterations, including duodenal ulcer. CF paradox may not exist.

Serum levels of vitamin B12 are not related to low bone mineral density in postmenopausal Brazilian women.

INTRODUCTION: Osteoporosis and vitamin B12 deficiency are conditions with an increasing prevalence over time. It has been described an association between low serum vitamin B12, osteoporosis and increased risk of bone fractures, but the studies are heterogeneous and the results are controversial. OBJECTIVE: To investigate the association between plasma levels of vitamin B12 and bone mineral density in a group of asymptomatic women after menopause. METHODS: Asymptomatic postmenopausal women were consecutively invited to participate in this cross-sectional study. Bone mineral density (lumbar spine and femur) was measured by DXA Lunar Prodigy Vision, and blood levels of vitamin B12, calcium, phosphorus, bone alkaline phosphatase (BAF), and parathyroid hormone were determined. For the diagnostic of osteoporosis the World Health Organization criteria were considered. RESULTS: Seventy women were included, mean age 62.5 ± 7 years. Eighteen (25.7%) women had normal bone mineral density, 33 (47.1%) had osteopenia and 19 (27.1%) had osteoporosis. Six (8.6%) patients had wrist fracture; two (2.8%) reported a diagnosis of vertebral fracture and only one (1.4%) patient had suffered a hip fracture. The levels of vitamin B12 (mean ± SD, pg/mL) of women with normal bone mineral density, osteopenia and osteoporosis were 590.2 ± 364.3, 536.6 ± 452.3, and 590.2 ± 497.9, respectively (P = 0.881). Multiple regression analysis showed that body mass index and BAF were the main predictors of lumbar spine bone mineral density. CONCLUSION: The results indicate that vitamin B12 serum levels are not related to bone mineral density in this group of Brazilian postmenopausal women.

Níveis séricos de vitamina B12 não se relacionam com baixa densidade mineral óssea em mulheres brasileiras na pós-menopausa / Serum levels of vitamin B12 are not related to low bone mineral density in postmenopausal Brazilian women

INTRODUÇÃO: Osteoporose e deficiência de vitamina B12 são condições de prevalência crescente com o envelhecimento. A associação entre níveis séricos de vitamina B12, baixa massa óssea e risco aumentado de fraturas ósseas tem sido descrita, mas os estudos não são homogêneos e os resultados são controversos. OBJETIVO: Investigar a associação entre níveis plasmáticos de vitamina B12 e densidade mineral óssea em mulheres assintomáticas na pós-menopausa. MÉTODOS: Mulheres assintomáticas no período pós-menopausa foram consecutivamente incluídas neste estudo transversal. A densidade mineral óssea (coluna lombar e fêmur) foi avaliada pelo método DXA Lunar Prodigy Vision, e foram determinados níveis sanguíneos de vitamina B12, cálcio, fósforo, fosfatase alcalina óssea e hormônio paratireoidiano. Os critérios da Organização Mundial de Saúde foram considerados para o diagnóstico de osteoporose. RESULTADOS: Foram incluídas neste estudo 70 mulheres, com média de idade de 62,5 ± 7 anos. Do total, 18 (25,7%) apresentaram densidade mineral óssea normal, 33 (47,1%) tinham osteopenia e 19 (27,1%) tinham osteoporose. Seis (8,6%) pacientes haviam apresentado fratura de punho, duas (2,8%) reportaram diagnóstico de fratura vertebral e apenas uma (1,4%) paciente havia sofrido fratura de quadril. Os níveis de vitamina B12 (média ± DP; pg/mL) das mulheres com densidade mineral óssea normal, osteopenia e osteoporose foram 590,2 ± 364,3, 536,6 ± 452,3 e 590,2 ± 497,9, respectivamente (P = 0,881). A análise de regressão múltipla mostrou que o índice de massa corporal e a fosfatase alcalina óssea foram preditores da densidade mineral óssea na coluna lombar. CONCLUSÃO: Os resultados indicam que níveis de vitamina B12 não se relacionam à densidade mineral óssea neste grupo de mulheres brasileiras na pós-menopausa.

INTRODUCTION: Osteoporosis and vitamin B12 deficiency are conditions with an increasing prevalence over time. It has been described an association between low serum vitamin B12, osteoporosis and increased risk of bone fractures, but the studies are heterogeneous and the results are controversial. OBJECTIVE: To investigate the association between plasma levels of vitamin B12 and bone mineral density in a group of asymptomatic women after menopause. METHODS: Asymptomatic postmenopausal women were consecutively invited to participate in this cross-sectional study. Bone mineral density (lumbar spine and femur) was measured by DXA Lunar Prodigy Vision, and blood levels of vitamin B12, calcium, phosphorus, bone alkaline phosphatase (BAF), and parathyroid hormone were determined. For the diagnostic of osteoporosis the World Health Organization criteria were considered. RESULTS: Seventy women were included, mean age 62.5 ± 7 years. Eighteen (25.7%) women had normal bone mineral density, 33 (47.1%) had osteopenia and 19 (27.1%) had osteoporosis. Six (8.6%) patients had wrist fracture; two (2.8%) reported a diagnosis of vertebral fracture and only one (1.4%) patient had suffered a hip fracture. The levels of vitamin B12 (mean ± SD, pg/mL) of women with normal bone mineral density, osteopenia and osteoporosis were 590.2 ± 364.3, 536.6 ± 452.3, and 590.2 ± 497.9, respectively (P = 0.881). Multiple regression analysis showed that body mass index and BAF were the main predictors of lumbar spine bone mineral density. CONCLUSION: The results indicate that vitamin B12 serum levels are not related to bone mineral density in this group of Brazilian postmenopausal women.

Ghrelin and pre-proghrelin immunoreactive cells in gastric neuroendocrine tumors associated with atrophic body gastritis / Grelina e pré-progrelina em tumores neuroendócrinos do estômago associados à gastrite atrófica do corpo

INTRODUCTION: Ghrelin is a 28 amino acid peptide secreted mainly by endocrine cells present in the gastric mucosa and acknowledged as an endogenous releaser of growth hormone. The immunohistochemical expression of ghrelin has been described in neuroendocrine tumors, and it is believed that may exert modulating action related to the growth of these tumors. OBJECTIVE: To study the presence of ghrelin and preproghrelin immunoreactive cells in gastric neuroendocrine tumors associated with atrophic body gastritis. METHODS: Endoscopic biopsies from 15 patients with neuroendocrine tumor of the gastric mucosa associated with atrophic body gastritis were performed for immunohistochemistry, and specific chromogranin, ghrelin and preproghrelin antibodies were applied. The immunohistochemical expression was assessed in tumor cells and endocrine micronodular hyperplasia present in mucosa adjacent to the tumor, and it was classified in relation to the number of stained cells. RESULTS: Chromogranin was positive in 14 out of 15 tumors. Ghrelin and preproghrelin immunoreactive cells were detected in 11 (73 percent) and 13 (87 percent) tumors, respectively. There was a significant correlation between the immunohistochemical results of both antigen expressions (kappa = 81 percent). Ghrelin and preproghrelin expression was detected in hyperplastic nodules present in the mucosa adjacent to the tumor in seven and eight cases, respectively. There was no correlation between these results and those observed in neoplastic cells. CONCLUSION: Ghrelin and preproghrelin immunoreactive cells may be found in variable number in Type I neuroendocrine gastric tumors and in hyperplastic nodules associated with these tumors. However, it remains unclear what role these peptides play on the development of these tumors.

INTRODUÇÃO: Grelina é um peptídeo de 28 aminoácidos, reconhecido como liberador endógeno do hormônio do crescimento, sendo secretado principalmente por células endócrinas da mucosa gástrica. A expressão imuno-histoquímica da grelina tem sido descrita em tumores neuroendócrinos, acreditando-se que possa ter ação moduladora relacionada com o crescimento desses tumores. OBJETIVO: Estudar a presença de células imunorreativas a grelina e pré-progrelina em tumores neuroendócrinos gástricos associados à gastrite crônica atrófica do corpo. MÉTODOS: Biópsias endoscópicas de 15 pacientes portadores de tumor neuroendócrino da mucosa gástrica, associados à gastrite crônica atrófica do corpo, foram obtidas para as colorações imuno-histoquímicas, utilizando-se anticorpos contra cromogranina, grelina e pré-progrelina. A expressão imuno-histoquímica foi avaliada nas células tumorais e na hiperplasia endócrina micronodular presente na mucosa adjacente ao tumor e classificada em relação ao número de células coradas. RESULTADOS: A cromogranina foi positiva em 14 dos 15 tumores. Células imunorreativas à grelina foram detectadas em 11 (73 por cento) tumores e à pré-progrelina em 13 (87 por cento), ocorrendo excelente concordância (kappa = 81 por cento) entre os resultados imuno-histoquímicos dos dois antígenos. A expressão de grelina e pré-progrelina foi detectada em nódulos hiperplásicos presentes na mucosa adjacente ao tumor em sete e oito casos, respectivamente, não ocorrendo concordância entre esses resultados e aqueles observados nas células neoplásicas. CONCLUSÃO: Células imunorreativas a pré-progrelina e grelina podem ser encontradas em número variável nos tumores neuroendócrinos tipo I do estômago e nas lesões hiperplásicas associadas a esses tumores. Entretanto, permanece obscuro o papel desses peptídeos em relação ao desenvolvimento desses tumores.