Liver morphology with emphasis on bile ducts changes and survival analysis in mice submitted to multiple Schistosoma mansoni infections and chemotherapy.

In an attempt to be as close as possible to the infected and treated patients of the endemic areas of schistosomiasis (S. mansoni) and in order to achieve a long period of follow-up, mice were repeatedly infected with a low number of cercariae. Survival data and histological variables such as schistosomal granuloma, portal changes, hepatocellular necrosis, hepatocellular regeneration, schistosomotic pigment, periductal fibrosis and chiefly bile ducts changes were analysed in the infected treated and non treated mice. Oxamniquine chemotherapy in repeatedly infected mice prolonged survival significantly when compared to non-treated animals (chi-square 9.24, p = 0.0024), thus confirming previous results with a similar experimental model but with a shorter term follow-up. Furthermore, mortality decreased rapidly after treatment suggesting an abrupt reduction in the severity of hepatic lesions. A morphological and immunohistochemical study of the liver was carried out. Portal fibrosis, with a pattern resembling human Symmers fibrosis was present at a late phase in the infected animals. Bile duct lesions were quite close to those described in human Mansonian schistosomiasis. Schistosomal antigen was observed in one isolated altered bile duct cell. The pathogenesis of the bile duct changes and its relation to the parasite infection and/or their antigens are discussed.

[Infective endocarditis: analysis of 300 episodes]. / Endocardite infecciosa: análise de 300 episódios.

PURPOSE: Study of clinical features and etiologic agents, treatment and mortality of patients with infective endocarditis (IE). PATIENTS AND METHODS: 300 episodes of IE occurring in 288 patients, ages ranged between 0.2 and 78 (mean 30.76) years; 185 (62%) episodes occurred in males. RESULTS: a) etiologic agents: viridans group streptococci in 93 (31%) episodes, enterococci en 21 (7%), group D-non enterococci in 19 (6%) (13 S. bovis), other streptococci in 14 (5%), Staphylococcus aureus in 59 (20%), Staphylococcus epidermidis in 14 (5%), gram-negative bacteria in 16 (5%), gram-positive bacteria other than streptococci and staphylococci and staphylococci in 8 (3%), fungi in 4 (1%). The etiologic agents were not identified in 52 (17%) episodes; b) underlying cardiac diseases: valvular heart disease in 119 (40%) episodes, congenital heart disease in 37 (12%), prosthetic heart valves in 69 (23%), other heart diseases in 6 (2%). There was no evidence of previous heart disease in 69 (23%); c) treatment: surgical treatment was undertaken in 102 (34%) episodes. The frequency of surgical treatment in relation to the etiologic agents ranged between 1% (non-group D streptococcus) and 62% (negative blood cultures). The frequency of operation in relation to underlying heart disease ranged between 17% (other heart diseases), 19% (congenital heart disease) and 54% (prosthetic heart valve); d) mortality: 78 (26%) patients died, 56 (28%) of the 198 submitted to medical treatment and 22 (21%) of the 102 submitted also to surgical treatment. The mortality in the different groups of etiologic agents ranged between 5% (non group D streptococcus) and 62% (gram-positive bacteria other than streptococci ans staphylococci); in relation to the underlying with other heart disease, 19% in valvular heart disease patients, 21% in patients with congenital heart disease, 23% in patients without known heart disease and 43% in patients with prosthetic heart valves. CONCLUSION: The mortality associated with IE remains still high in spite of modern treatment; the mortality is different in relation to the cardiac status before the IE.

[Incidence of dyslipidemia and its relation to coronary artery disease in Brazilian populations]. / Incidência de dislipidemia e sua relação com doença arterial coronária em populações brasileiras.

PURPOSE: To describe the incidence of dyslipidemia and its relation to coronary artery disease (CAD) in two brazilian populations. PATIENTS AND METHODS: 1.261 subjects were analyzed; 674, whose mean age was 53 years, came from a cardiology private office (population A) and 587, whose mean age was 37 years, were employees of an engineering company (population B). Cholesterol was determined by the enzymatic method Chod-pap and LDL calculated by the Friedwald's formula. RESULTS: CAD was present in 35.1% of population A and in 1.4% of population B. In population A total cholesterol and LDL were above the expected, in all age groups. About 70% of these patients had cholesterol greater than 200 mg% and LDL greater than 130 mg%, which are considered desirable levels; 28% of women and 44% of men had HDL less than 35 mg%. Conversely, in population B total cholesterol and LDL were slightly above normal only in patients greater than 45 years old. In addition, about 65% of population had cholesterol less than 200 mg% and LDL less than 130 mg%; even so, 28% of women and 48% of men had HDL less than 35 mg%. In population A, there were no significant differences between the percentages of patients with and without CAD, over a wide range of cholesterol values. Similarly, levels of LDL, HDL and triglycerides as well as the incidence of hypertension, smoking and diabetes did not differ between patients with and without CAD. CONCLUSION: There is a high incidence of dyslipidemia in these brazilian populations, especially among patients from private office. Further, the isolated measurement of lipid fractions does not discriminate between patients with and without DAC, suggesting that other factors are involved in the genesis of the disease.

[Infective endocarditis: analysis of 300 episodes]. / Endocardite infecciosa: análise de 300 episódios.

PURPOSE: Study of clinical features and etiologic agents, treatment and mortality of patients with infective endocarditis (IE). PATIENTS AND METHODS: 300 episodes of IE occurring in 288 patients, ages ranged between 0.2 and 78 (mean 30.76) years; 185 (62%) episodes occurred in males. RESULTS: a) etiologic agents: viridans group streptococci in 93 (31%) episodes, enterococci en 21 (7%), group D-non enterococci in 19 (6%) (13 S. bovis), other streptococci in 14 (5%), Staphylococcus aureus in 59 (20%), Staphylococcus epidermidis in 14 (5%), gram-negative bacteria in 16 (5%), gram-positive bacteria other than streptococci and staphylococci in 8 (3%), fungi in 4 (1%). The etiologic agents were not identified in 52 (17%) episodes; b) underlying cardiac diseases: valvular heart disease in 119 (40%) episodes, congenital heart disease in 37 (12%), prosthetic heart valves in 69 (23%), other heart diseases in 6 (2%). There was no evidence of previous heart disease in 69 (23%); c) treatment: surgical treatment was undertaken in 102 (34%) episodes. The frequency of surgical treatment in relation to the etiologic agents ranged between 1% (non-group D streptococci) and 62% (negative blood cultures). The frequency of operation in relation to underlying heart disease ranged between 17% (other heart diseases), 19% (congenital heart disease) and 54% (prosthetic heart valve); d) mortality: 78 (26%) patients died, 56 (28%) of the 198 submitted to medical treatment and 22 (21%) of the 102 submitted also to surgical treatment. The mortality in the different groups of etiologic agents ranged between 5% (non-group D streptococci) and 62% (gram-positive bacteria other than streptococci and staphylococci); in relation to the underlying heart disease, the mortality was 16% in patients with other heart disease, 19% in valvular heart disease patients, 21% in patients with congenital heart disease, 23% in patients without known heart disease and 43% in patients with prosthetic heart valves. CONCLUSION: The mortality associated with IE remains still high in spite of modern treatment; the mortality is different in relation to the different etiologic agents and in relation to the cardiac status before the IE.

[Differences between men and women in fatal cases of myocardial infarction: study of 200 necropsies]. / Diferenças entre homens e mulheres em casos fatais de infarto do miocárdio. Estudo de 200 necrópsias.

PURPOSE: To compare morphological characteristics from myocardial infarction (IM) in men and women in 200 consecutive necropsies. MATERIAL AND METHODS: Necropsy heart findings from 62 female cases compared with those from 138 male cases, from patients who died from transmural myocardial infarction. Age ranged from 21 to 82 (mean 60) years. RESULTS: Concerning the coronary arteries, the number of 3 major (right, left anterior descending and left circumflex) epicardial coronary arteries narrowed at some point greater than 70% in cross-sectional area by atherosclerotic plaque was not significantly different; on the other hand, there were more severe lesions in the left main coronary artery in men (10.33%) than in women (1.64%) (p = 0.050). 33.33% of men and 43.55% of women had only recent myocardial infarction (1 month or less); 33.33% of men and 14.52% of women had only old myocardial infarction (more than 1 month); 33.33% of men and 41.94% of women had both recent and old myocardial infarction. 12.90% of women and 2.17% of men showed rupture of the left ventricle (p = 0.0220). 15.22% of men and 6.45% of women had left ventricular aneurysms (p = 0.830). CONCLUSION: There are more deaths during the acute phase of MI, in the first infarction and from rupture of the left ventricle in female patients; in men, there are more deaths occurring in chronic phases of the disease and with previous myocardial infarction; and more severe narrowing from the left main coronary artery.

Liver biopsy in neonatal cholestasis: a review on statistical grounds.

The aim of this study was to improve the accuracy of the histopathologic diagnosis in the differential diagnosis between obstructive and nonobstructive forms of neonatal cholestasis, using this clinical situation as a model for a mathematical approach. The study was blind, and we performed it in two steps. In the first step, 49 histologic parameters were visually estimated and were scored on a scale of 0 to 4+ in 100 liver biopsy specimens obtained between 1980 and 1985 from 78 patients with neonatal cholestasis. Forty-eight of these 100 specimens were from patients with final diagnosis of obstructive cholestasis (Group I), and 52 were from patients with nonobstructive cholestasis (Group II). The age range was 3 to 24 weeks (median, 12.5 wk). Twelve histologic variables were selected by chi 2 and Fisher's exact test (P < .05). Next, a series of combinations among these variables were submitted to statistical analysis by logistic regression method, defining a six-variable model that had the most powerful predictive value to classify the type of cholestasis. The variables were portal ductal proliferation, bile plugs in portal bile ductules, portoportal bridges, neutrophils, hepatocyte swelling, and multinucleated giant hepatocytes. The score obtained by this model correspond to the probability of a case belonging to Group I. The accuracy, sensitivity, and specificity rates were 94.0%. In the second step, the model was applied to a new sample of 74 needle-liver biopsy specimens obtained between 1990 and 1995, 45 from patients in Group I and 29 from patients in Group II. The age range was 3 to 15 weeks (median, 8 wk). The accuracy, sensitivity, and specificity rates were 90.5%, 100%, and 75.9%, respectively. In our diagnostic routine, this score has been systematically reported and has been helpful in orienting the therapeutic decision in this group of patients.

Liver morphology with enphasis on bile ducts changes and survival analysis in mice submitted to multiple Schistosoma mansoni infections and chemotherapy

Numa tentativa de estar o mais próximo possível a pacientes infectados e tratados nas áreas endêmicas de esquistosomose (S. mansoni) e também para obter um período mais longo de seguimento, camundongos foram repetidamente infectado com um número baixo de cercarias. Dados de sobrevivência e variáveis histológicas tais como granuloma esquistosomótico, alteraçöes portais, necrose hepatocelular, regeneraçäo hepática, pigmento esquistosomótico, fibrose periductal e principalmente, alteraçöes dos ductos biliares foram analisados nos animais infectados tratados e näo tratados. Aa terapêutica por oxamniquina ns animais repetidamente infectados prolonga a sobrevivência de maneira singificante (Chi-quadrado 9,24, p = 0,0024), portanto confirmando resultados anteriores com um modelo semelhante mas com um período mais curto de seguimento. Ainda, a mortalidadade decresce rapidamente depois do tratamento, sugerindo uma abrupta reduçäo na gravidade das lesöes hepáticas. O fígado foi anida estudados sob o ponto de vista morfológico imunohistoquímico. Fibrose portal, com um quadro que lembra a fibrose humana do tipo Symmers está presente na fase tardia da infecçäo. As alteraçöes de ductos biliares säo muito próximas daquelas descritas na esquistosomose manônica humana. Antígeno esquistomótico foi observado e, uma célula isolada do revestimento alterado de ductos biliares. A patogênese das alteraçöes ductais e sua possível relaçäo com a infecçäo parasitária e/ou seus antígenos foi discutida