Etiological treatment of Chagas disease patients with benznidazole lead to a sustained pro-inflammatory profile counterbalanced by modulatory events.

In the present study, we characterized the phagocytic capacity, cytokine profile along with the FCγ-R and TLR expression in leukocytes from Chagas disease patients (indeterminate-IND and cardiac-CARD) before and one-year after Bz-treatment (INDT and CARDT). A down-regulation of IL-17, IFN-γ and IL-10 synthesis by neutrophils was observed in CARDT. The Bz-treatment did not impact on the expression of phagocytosis-related surface molecules or monocyte-derived cytokine profile in INDT. Although CARDT showed unaltered monocyte-phagocytic capacity, up-regulated expression of Fcγ-RI/III and TLR-4 may be related to their ability to produce IL-10 and TGF-ß. Down-regulation of lymphocyte-derived cytokine was observed in INDT whereas up-regulated cytokine profile was observed for lymphocytes in CARDT. Analysis of cytokine network revealed that IND displayed a multifaceted cytokine response characterized by strong connecting axes involving pro-inflammatory/regulatory phagocytes and lymphocytes. On the other hand, CARD presented a modest cytokine network. The Bz-treatment leads to distinct cytokine network: decreasing the links in INDT, with a pivotal role of IL-10(+) monocytes and expanding the connections in CARDT. Our findings highlighted that the Bz-treatment contributes to an overall immunomodulation in INDT and induces a broad change of immunological response in CARDT, eliciting an intricate phenotypic/functional network compatible with beneficial and protective immunological events.

Impaired phagocytic capacity driven by downregulation of major phagocytosis-related cell surface molecules elicits an overall modulatory cytokine profile in neutrophils and monocytes from the indeterminate clinical form of Chagas disease.

The distinct ability of phagocytes to present antigens, produce cytokines and provide co-stimulatory signals may contribute to the severity of the outcome of Chagas disease. In this paper, we evaluate the phenotypic features of phagocytes along with the cytokine signature of circulating T-cells from Chagas disease patients with indeterminate (IND) and cardiac (CARD) clinical forms of the disease. Our data demonstrated that neutrophils from IND patients displayed an impaired ability to produce cytokines. A lower Trypanosoma cruzi phagocytic index and higher nitric oxide levels were characteristics of monocytes from IND. The impaired phagocytic capacity did not reflect on the levels of anti-T. cruzi IgG, but was detectable in the downregulation of Fc-γR, TLR and CR1 molecules. The monocyte-derived cytokine signature demonstrated that a down-regulated synthesis of IL-12 and a modulatory state were evidenced by a positive correlation between IL-12 and IL-10 with a lower synthesis of TNF-α. The down-regulation of MHC-II and CD86 in monocytes supports the occurrence of particularities in the APC-activation-arm in IND, and may be involved in the T-cell pro-inflammatory pattern counterbalanced by a potent IL-10 response. Our findings support the hypothesis that differential phenotypic features of monocytes from IND may be committed to the induction of a distinct immune response related to low morbidity in chronic Chagas disease.

Lipoma of the right atrium.

The patient is a 54-year-old asymptomatic male with a tumor in the right atrium that was diagnosed on transesophageal echocardiography and confirmed as a lipoma of the right atrium on computerized tomography. The patient underwent surgical repair with extracorporeal circulation. The tumor was resected, and its base of implantation in the atrium was repaired with a flap of bovine pericardium. The diagnosis of lipoma was confirmed on histopathological examination. Locating of the tumor with the aid of transesophageal echocardiography was very useful in the strategy of cannulation of the venae cava for installation of the circuit of extracorporeal circulation. The patient had a good postoperative evolution.

[Multiple gliomas. Illustrative cases of 4 different presentations]. / Gliomas múltiplos: casos ilustrativos de quatro formas de apresentação.

Multiple gliomas are uncommon and may be classified according to: a) the time of presentation in early (at diagnosis) or late (during treatment); b) the characteristics of computed tomography or magnetic resonance imaging (CT/MRI) in multifocal (with evidence of spread) and multicentric (without evidence of spread). From 212 patients with histopathologic diagnosis of glioma evaluated from March/90 to September/99, 15 (7%) had multiple lesions. We describe 4 patients: early multicentric, late multicentric, early multifocal and late multifocal, with emphasis on characteristics of CT/MRI and possible differential diagnosis. The differential diagnosis of multiple lesions in the central nervous system includes mainly infectious/inflammatory diseases and metastasis, however multiple gliomas should always be considered, even in patients with known systemic cancer, as described by others. Considering that CT/MRI features are not definite, the diagnosis should always be confirmed by histopathologic examination.

[Modified Fontan's operation]. / Operação de Fontan Modificada.

Nine-year-old female patient presented with cianosis since she was born, fatique and dyspnea when sucking. The diagnosis was univentricular heart with left ventricular morphology, transposition of the great arteries, moderate pulmonary valve stenosis and atrial septal defect. Submitted to surgical correction with superior vena cava-right pulmonary artery anastomosis, inferior vena cava anastomosis using lateral tunnel, with cardiopulmonary bypass. After surgical correction, the clinical and laboratorial (echocardiogram and cardiac catheterization) evaluation showed Fontan operation with good surgical results. Total cavopulmonary connection was proposed as a modification of the Fontan procedure that might have greater benefits than previous proposed techniques. The results demonstrate that this modification provides excellent early definitive treatment, increasing hemodynamic profile, with low morbidity and mortality, for a variety of complex congenital heart lesions.

[Lead poisoning caused by a bullet in the hip. Report of 2 cases]. / Saturnismo causado por projétil de arma de fogo no quadril. Relato de dois casos.

Two cases of lead poisoning from retained bullets in the hip region are reported. General considerations about lead intoxication are made and the intoxication caused by bullets retained in the body are specifically focused.

An analysis of the proopiomelanocortin systems in the pituitary of the squamate reptile Lacerta galloti.

Acid extracts of the pars intermedia of the squamate reptile Lacerta galloti were screened for immunoreactive forms of proopiomelanocortin (POMC)-related end products following Sephadex G-50 column chromatography. alpha-MSH-sized end products were detected with a Val-NH2, C-terminal-specific RIA, and beta-endorphin-sized end products were detected with a separate C-terminal-directed RIA. Five peaks of alpha-MSH-related immunoreactivity were isolated following fractionation by reversed-phase HPLC. Based on a comparison of the reversed-phase HPLC properties and the net positive charges (pH 2.75) of the Lacerta forms of alpha-MSH to those of the mammalian forms of alpha-MSH and Anolis carolinensis ACTH(1-13)NH2, it appears that the N-acetylation of alpha-MSH is a major post-translational processing event in the pars intermedia of L. galloti. Although multiple forms of beta-endorphin were detected in the pars intermedia of L. galloti following cation-exchange chromatography, the low levels of N-acetylated beta-endorphin detected with an N-acetyl-specific beta-endorphin RIA indicate that the N-acetylation of beta-endorphin in this species is a minor post-translational processing event. This pattern of POMC processing in the pars intermedia of L. galloti is similar to the processing events observed for the turtle Pseudemys scripta, but distinct from the processing events observed in the squamate reptile A. carolinensis.

Presence of substance P and angiotensin II in corticotropic cells of the lizard Gallotia galloti: immunochemical study in the adult and during ontogenesis.

The hypophysis of the lizard Gallotia galloti showed substance-P-like immunoreactivity in both the adenohypophysis (pars distalis, PD; pars intermedia, PI) and the neurohypophysis (median eminence and pars nervosa), whereas angiotensin-II-like immunoreactivity appeared only in PD and PI. The elution-restaining procedure has allowed us to demonstrate the colocalization of both peptides with adrenocorticotropic hormone (ACTH) in PD and PI cells. Electron microscopic study revealed the presence of substance P immunoreactivity on ACTH secretory granules. The ontogeny of both peptides in corticotropic cells has been studied, revealing that the presence of substance P in ACTH-containing cells of the PI occurs from the embryonic stage 33 (S 33), whereas in the PD it occurs from S 34, coinciding with the appearance of ACTH within the same cells. In both median eminence and pars nervosa of the neurohypophysis, substance P appeared later in development, at S 38. Angiotensin II immunoreactivity in PI cells first appeared at S 38, while in PD it appeared from S 40.

Ontogeny and immunohistochemical differentiation of the Pars Tuberalis in the lizard Gallotia gallotti.

The development of the pituitary Pars Tuberalis (PT) was studied in the lizard Gallotia galloti using classical, histological and immunohistochemical techniques. As early as stage 32 of development, the Rathke's pouch exhibits 2 lateral extensions that will give rise to the PT. In these extensions, cellular proliferation results in the formation of two cell masses which develop rostro-laterally and contact the basal diencephalon at stage 35. At stage 37, these two cell groups lose their connection with the pars distalis (PD). Until the end of embryonic development, connective tissue separates the nervous tissue from the glandular one. At hatching, the disappearance of this connective tissue results in the incorporation of the two cell groups into the nervous tissue without visible separation. During development, immunoreactivity for anti-betaLH and anti-TSH appears in the cells of the PT respectively at stage 39 and 37. In adults, almost all cells of the PT can be demonstrated using antisera against gonadotrophins.

Early neuronal development in the spinal cord of a reptile assessed by neurofilament protein immunoreactivity.

The neural tube in the Gallotia galloti Stage 22 (S.22) embryo is already closed at the level of the cervical flexure, while caudal closure does not end until S.23. Cell proliferation begins shortly after the final neural tube closure, being rapid and giving rise, by S.26, to a thick ventricular zone. Cell migration does not start until S.28, initially in the basal plate, and forming putative motoneurons. Migration in the alar plate does not start until S.33. The appearance of the first neurofilament protein-positive perikarya coincides with the structural and ultrastructural identification of the neuron, although neurofilament-immunoreactive cells can already be identified inside the ventricular zone. Finally, from S.35 onwards, after major cell migration has already occurred, neuronal maturation continues in situ.

Neuropeptide tyrosine (NPY) and its C-terminal flanking peptide (C-PON) in the developing and adult spinal cord of a reptile.

The developmental pattern and the adult distribution of neuropeptide tyrosine (NPY) and its C-terminal flanking peptide (C-PON) were investigated in the spinal cord of the lizard Gallotia galloti. Embryonic, postnatal and adult animals were studied by means of the immunohistochemical technique. Neurons containing both peptide immunoreactivities first appeared at the embryonic Stages 37/38. Immunoreactive perikarya were more numerous in the embryonic than in either the postnatal or the adult spinal cord. Fibres immunoreactive for both antisera appeared around the time of hatching, being numerous and widespread in the adult spinal cord. NPY- and C-PON-like-containing neurons and fibres in the adult spinal cord of Gallotia galloti were related to sensory, autonomic and motor areas.

Development of the ventral striatum in the lizard Gallotia galloti.

The ventral striatum nucleus (VS) begins development at Stage 31 (E. 31) from the neuroblasts which proceed from the cellular proliferation of both the ventral and terminal sulci. The ultrastructural features of the neuroblasts of VS between E. 31 and E. 34 have the aspect of immature cells, but as from E. 38 neuronal maturity is gradual until hatching. At E. 34 cellular death occurs. The first degenerated cells belong to Type I (nuclear degeneration) of the pycnotic cells; as from E. 40 cytoplasmic degeneration appears. Vascularisation starts at E. 35 and from E. 38 the first synaptic contacts are observed, especially those of the axodendritic type.

Immunohistochemical study on the development of the adenohypophysial cells in the lizard Gallotia galloti.

Immunohistochemical methods have been used to study the embryonic and postnatal development of the hormone-producing cells in the adenohypophysis of the lizard Gallotia galloti. In this species, Rathke's pouch is formed between stages 30 to 32 of the embryonic development, although the first sign of immunoreactivity to antisera against adenohypophysial hormones occurs in stage 33 in the pars distalis anlage. These cells derive from the dorsal face of Rathke's pouch and are immunoreactive to anti-ACTH serum. The cytodifferentiation of ACTH and MSH cells occurs in the pars intermedia in stage 34. The TSH cells appear at stage 35 and the gonadotrope cells at stage 37. These cells derive from both the dorsal and ventral face of the Rathke's pouch. The LTH cells are revealed at stage 39 and are only originated from the dorsal face. The STH cells, which come from the dorsal as well as ventral face, are the last secretory cells differentiated just before hatching. During postnatal development an increase and also a redistribution of the immunoreactive cells occur until acquiring the adult distribution.

Anterior dorsal ventricular ridge in the lizard: Embryonic development.

In lacertids the telencephalic vesicle starts its development at stage E = 30, at which time it is lined by a homogeneous nucleated zone in which particular ventricular zone territories or sulci cannot be distinguished. At stage E = 32 coinciding with the initial development of the anterior dorsal ventricular ridge (ADVR), one may distinguish the ventricular zone b in the dorsolateral wall of the ventricle adjacent to the sulcus lateralis. The ADVR continues growing by incorporation of cells produced in two proliferative zones (zone b and wall of the sulcus lateralis) and appears fully developed in postnatal lizards. Ultrastructural characteristics of young ADVR neurons between stages E-32 and E-33 are typical of those in immature cells. Beginning at stage E-34, some of these neurons appear to be degenerating (pycnotic). Thereafter, neurons of the ADVR develop abundant cytoplasmic organelles and the neuropile grows quickly. Myelination starts in the ADVR between stages E-38 and E-40, but is not observed in other striatal masses in the same period. Vascularization begins and is well developed at E-40. The first synaptic contacts were observed in embryos of stage E=38; they are chiefly axo-dendritic, although some are axo-somatic. Degenerating neurons were found in the ADVR up to hatching. From stage E-40 onward, the ADVR shows a greater and more rapid differentiation than all other striatal nuclei, including the ventral and amygdaloid complex.

Annulate lamellae and whorl bodies in the diffuse supraoptic nucleus of the hamster.

The ultrastructure of neurons of the diffuse supraoptic nucleus of the hamster has been studied. These neurons show two specializations of the endoplasmic reticulum: annulate lamellae and whorl bodies. From one to three whorl bodies are found in the same neuron. The annulate lamellae and the whorl body cisterns are continuous with the cisterns of the rough endoplasmic reticulum. These neurons present an extraordinarily developed rough endoplasmic reticulum, small mitochondria, neurosecretory vesicles and a Golgi complex filled with electron-dense material. Astrocytic processes of different thickness surround the neurosecretory cells.

Ciliated neurons in the paraventricular nuclei in old hamsters.

The ciliated neurons of the paraventricular nuclei in old hamsters have been studied by electron microscope. These neurons exhibit cilia of 9 + 0 pattern. The single cilia, emerging from typical basal bodies, project into the intercellular space in parallel to the plasmalemma. The basal bodies are connected to ciliary rootlets and close to the Golgi complex. Double or single centrioles in different locations, frequently related to rootlets, can be observed. From a morphological point of view we suggest that these cilia, in the aging process, may represent a sensory structure which could perceive stimuli from the intercellular space.