[Occurrence of cysticercosis in autopsies performed in Uberlandia, Minas Gerais, Brazil]

3937 autopsies were performed between 1971 and 1993 in the Serviço de Anatomia Patológica of the Hospital de Clínicas of the Fundação de Assistência, Estudo e Pesquisa de Uberlândia, Universidade Federal de Uberlândia, in Minas Gerais, Brazil. At this Service of Pathology are realized all the autopsies of the municipal district of Uberlândia. The analysis of 2862 concluded autopsy reports, of death above the age of one year, disclosed 39 cases (1.4%) of cysticercosis. The age range was 16 to 83 years and 66.6% were males; 82.1% of the patients were from Minas Gerais State, 15.4% were from Goiás State, and in one case (2.5%) the origin was not registered. From these 39 cases, 35 (89.7%) showed central nervous system involvement, isolated or in association to other clinical forms of the disease; in 9 occurred the isolated or associated cardiac form; in 4 the muscular form, isolated or associated, was found; 4 presented the isolated or associated visceral form. In only 7 (17.9%) cases, the cysticercosis was assumed to be the direct cause of the death.

Comparative efficacy of three different diethylcarbamazine regimens in lymphatic filariasis

To assess the efficacy of diethylcarbamazine (DEC) in clearing Wuchereria bancrofti microfilariae (mf) from the circulation, we conducted a single blind hospital-based therapeutic trial of 3 DEC regimens. All patients were assessed by filtration of 1 mL of venous blood taken before and 1, 3, 6 and 12 months after DEC administration. The efficacy of a 12 d course of 6 mg/kg DEC once daily was identical to that of a similar course with 2 mg/kg given 3 times daily, indicating that split-dose treatment does not improve mf clearance over single daily drug administration. Microfilarial densities in patients treated only once with 6 mg/kg DEC remained significantly higher at 1, 3, and 6 months after treatment. However, all 3 treatment regimens proved equally effective in controlling microfilaraemia after 12 months, when 41, 42 and 40% of patients in the 3 treatment groups were amicrofilaraemic. These results suggest that a single DEC dose of 6 mg/kg administered annually or biannually may be a suitable regimen to control bancroftian filariasis in Recife, Brazil.

Effect of ruminally undegradable protein from fish meal on growth and reproduction of peripuberal Brahman bulls

Thirty-nine Brahman bulls (301.7 +/- 4.1 d; 202.7 +/- 4.7 kg) were allotted to one of two treatments and fed soybean meal (SBM)- or fish meal (FIS)-based supplements and hay to examine the effects of source of protein on growth and reproductive development. The fish meal supplement had 72% ruminally undegradable protein (RUP) and the soybean meal supplement had 47% RUP. Bulls assigned to the FIS treatment had higher (P < .01) total weight gain (81.2 +/- 1.4 vs 71.2 +/- 2.2 kg), higher (P < .01) ADG (.97 +/- .02 vs .85 +/- .03 kg), and better (P < .05) feed:gain ratio (7.6 +/- .1 vs 8.6 +/- .1 feed/BW gain for FIS vs SBM, respectively). Age at first motile spermatozoa was not affected (P > .05) by source of protein (429.9 +/- 9.6 vs 427.2 +/- 9.5 d, for bulls receiving FIS or SBM supplements, respectively). Likewise, age at puberty (473.3 +/- 21.7 d vs 465.9 +/- 12.9 d for bulls receiving FIS and SBM supplements, respectively) was similar for both treatment groups. There were no differences between treatments in scrotal circumference at those stages. At puberty semen quality was similar for bulls receiving FIS or SBM treatments, and no differences existed in LH and testosterone concentrations between treatments. We conclude that fish meal supplement increased growth but did not alter reproductive parameters in Brahman bulls.

Frequency of cholelithiasis in alcoholics

In order to determine the frequency of biliary lithiasis in alcoholic patients without signs of hepatic cirrhosis, we submitted 106 male alcoholics (mean age, 42.2 +/- 11.2 years) to ultrasound examination of the biliary system. Cholelithiasis was present in 6 (5.6%). We did not observe any association between the quantity of ethanol consumed and/or the time of consumption and the presence of cholelithiasis. There was no significant difference between the frequency of cholelithiasis in these patients and that found in autopsies carried out on 716 male patients (6%) at the Hospital de Clínicas, Universidade Federal de Uberlândia, during the period 1982 to 1993. Thus, we conclude that in the cases we examined, alcoholism did not represent a risk factor for biliary lithogenesis.

Treatment of bancroftian filariasis in Recife, Brazil: a two-year comparative study of the efficacy of single treatments with ivermectin or diethylcarbamazine

The effectiveness of single oral doses of ivermectin (200 or 400 micrograms/kg) and diethylcarbamazine (DEC, 6 mg/kg), preceded 4 d earlier by either placebo or very small doses of these drugs, was compared, over a 2-year period, in a double-blind trial in 67 microfilaraemic Brazilian men with bancroftian filariasis. Regimens containing ivermectin alone decreased the number of microfilariae significantly faster and more effectively for the first month after treatment than regimens containing DEC alone, but the latter were significantly more effective throughout the second year after treatment (1.7-8.2% of pretreatment levels with DEC vs. 12.6-30.8% with ivermectin during that period); the higher ivermectin dose showed a tendency towards more effectiveness than the lower dose. Most effective was the combination of ivermectin (20 micrograms/kg) followed 4 d later by DEC (6 mg/kg), with reduction of microfilaraemia to 2.4% of pretreatment levels at 2 years. Adverse reactions were well tolerated with all regimens, the reactions being significantly more generalized (i.e., fever) following ivermectin and localized (i.e., scrotal inflammatory nodules around dying adult worms) following DEC. Further trials of single-dose combination therapy vs. single high doses of ivermectin or DEC should determine the ideal regimen for treatment and control of bancroftian filariasis.

Follicular dynamics, embryo production, and hormonal responses in Brahman heifers following sympathetic stimulation

The purpose of this experiment was to characterize adrenal and ovarian responses to N-methyl-beta-phenethylamine (NMP) or ACTH. Thirty-three heifers with functional midcycle corpora lutea were placed on a 4-d superovulation regimen. They were injected twice daily with FSH-P and either saline (Control), ACTH (80 IU), or NMP (1 mg/kg BW). An initial blood collection preceded jugular delivery of saline, NMP, or ACTH, i.m. delivery of FSH and PGF2 alpha (d 3), and ultrasound (d 1 to 4). A second blood collection was made 6 min after treatment. Sampling continued daily until d 13. Embryos (age 6 to 7 d) were collected and evaluated. Concentrations of cortisol (posttreatment minus pretreatment) were greatest (P < .05) in NMP- and ACTH-treated heifers. Treatment did not affect mean numbers of small (< 4 mm), large (> 8 mm), or total follicles on d 2 to 4. Heifers receiving NMP had fewer medium follicles (4 to 8 mm) on d 2 and 3, and ACTH-treated heifers had fewer medium follicles on d 4 (P < .07). Mean estradiol concentrations on d 2 to 4 were unaffected by treatment (P > .32). Following PGF2 alpha, time to onset of standing estrus was less (P < .05) in Control than in ACTH- and NMP-treated heifers (41.4 vs 47.9 and 58.9 h, respectively). A greater frequency (P < .05) of reproductive anomalies (no estrus; no ovulation [i.e., progesterone < 1 ng/mL]; luteal failure [i.e., progesterone < 1 ng/mL but embryos recovered]) occurred in NMP (5/11) than in Control (0/10) or ACTH (2/10) heifers.(ABSTRACT TRUNCATED AT 250 WORDS)

[The histopathology of the trabecular section of the right branch of the bundle of His in chronic chagasic patients with a right bundle-branch block]

PURPOSE

To evaluate possible morphological changes in chronic chagasic of the right bundle trabecular branch (RB) with right branch block (RBB) and to draw clinicopathological correlations.

METHODS

Eight RBB chronic chagasic septo-marginal trabeculae (SMT) (group A), six left branch block (LBB) chagasic SMT (group B) and six SMT from non-chagasics with no heart disease (group C) were analyzed. Every SMT was completely embedded in paraffin, sub-serially sectioned to the end of the paraffin-block and the sections were processed for pathological study.

RESULTS

Right bundle branch trabecular segment mononuclear infiltrate and/or fibrosis were found for 87.5 (7/8) of group A, 50% (3/6) of group B and 16.6% (1/6) of group C. Moderate mononuclear infiltrate and fibrosis were noted respectively for 3 and 1 cases, from group A. For the remaining group A cases and for all the group B and C cases the mononuclear infiltrate and fibrosis were slight.

CONCLUSION

The frequency and degree of RB lesions might explain some of RBB. On the other hand, the absence of lesions in one case RBB and the slight degree of RB lesions in chagasics with LBB and in one non-chagasic case indicate that sometimes it is not possible to establish electrocardiographic-pathological correlations after TSM histological examination.

[Prevalence of biliary lithiasis in cirrhotics: necropsy evaluation]

In order to investigate a possible association between hepatic cirrhosis and biliary lithiasis, an analysis on 3,332 necropsy report diagnosis was carried out. Gallstones were present in 19.5% of 123 cirrhotics and in 4.9% of 3,209 non-cirrhotics patients. We concluded that lithiasis is significantly more frequent in cirrhotics than in non-cirrhotics. Chronic hemolysis, slow emptying of the gallbladder, and defective bile acidification by the gallbladder would explain such association. The male-to-female ratio of lithiasis occurrence was 2.08:1 in the cirrhotic group and 2.4:1 among the non-cirrhotics. This difference was not significant. Pigmentary gallstones were commoner among cirrhotics and significantly more frequent in cirrhotics than in non-cirrhotics. This would be explained by chronic hemolysis and by bilirubin conjugation defects. Lithiasis was more frequent in secondary biliary cirrhosis, followed by postnecrotic cirrhosis of viral etiology.

Ivermectin treatment of bancroftian filariasis in Recife, Brazil

To determine the effectiveness of single oral dosages of ivermectin ranging between 20 and 200 micrograms/kg and to make detailed observations of both the kinetics of parasite killing and the adverse reactions induced by treatment, the present double-blind study on ivermectin treatment of lymphatic filariasis caused by Wuchereria bancrofti was undertaken with 43 microfilaremic patients in Recife, Brazil. Follow-up at one year indicated equivalent efficacy for the 20-, 100-, and 200-micrograms/kg drug dosages in reducing microfilaremia to geometric means of 13-25% of pretreatment levels. Adverse clinical reactions (predominantly fever, headache, weakness, and myalgia) occurred to some degree in almost all patients but generally lasted only 24-48 hr and were easily managed symptomatically. Adverse reactions were significantly milder in those receiving the lowest (20 micrograms/kg) ivermectin dose, and they were significantly correlated with individuals' pretreatment microfilaremia levels in all groups. Posttreatment eosinophilia was a regular feature of the response to treatment, with the magnitude and kinetics also proportional to pretreatment microfilarial levels. Transient pulmonary function abnormalities (16 of 42, 38%), liver enzyme elevations (10 of 43, 23%), and hematuria (9 of 42, 22%) developed posttreatment, but all cleared without significant complications. The results indicate that W. bancrofti from Brazil is similar to strains of the parasites studied elsewhere in susceptibility to ivermectin, that the drug's systemic adverse reactions are essentially those resulting from parasite clearance, and that the intensity of these reactions can be significantly reduced by using the low (20 micrograms/kg) dose of ivermectin. This detailed dose-finding study provides information necessary for developing optimal regimens to treat bancroftian filariasis with ivermectin either alone or in combination with other medications.

Pathology of patients with Chagas' disease and acquired immunodeficiency syndrome

The main pathologic findings in 23 patients with acquired immunodeficiency syndrome (AIDS) and Chagas' disease are reviewed; five are from our own experience and 18 from the literature. The presence of Trypanosoma cruzi parasites and/or T. cruzi antibodies in blood and cerebrospinal fluid was recorded and computerized tomograms of the brain were evaluated. Twenty (87%) of the 23 subjects developed severe, multifocal or diffuse meningoencephalitis with necrosis and hemorrhage associated with numerous tissue parasites. The second most severely affected site was the heart. Seven (30.4%) of the 23 cases had myocarditis on pathologic examination. It was acute in four patients, chronic in two, and simultaneously acute and chronic in one. Acute myocarditis and meningoencephalitis are interpreted as being caused by relapses of chronic T. cruzi infections. An AIDS permissive role is suggested for these conditions since immunologic defense against T. cruzi is mediated mainly by T lymphocytes, whose CD4 subpopulation is depleted in patients with this disease. Consequently, AIDS is a factor that may favor the reactivation of T. cruzi infections. The lesions reported in the association of Chagas' disease with AIDS were compared with those reported from patients without AIDS having fatal, acute, vector-transmitted infections, contaminated blood transfusions, or accidental exposures in the laboratory. For the latter three, meningoencephalitis is uncommon. Only immunosuppressed cases of Chagas' disease have been described as having a pseudotumoral presentation that shows expanding lesions with a mass effect in the cranial cavity that causes intracranial hypertension and simulates neoplasms (tumors such as gliomas, lymphomas, metastases, etc.).

[Comparative studies on endemic areas of bancroftian filariasis in Greater Recife, Brazil]

Two districts in Recife (Santo Amaro and Campo Grande) and two districts in Olinda (Sapucaia and Salgadinho), were selected for a comparative study of bancroftian filariasis in Greater Recife. Selection parameters included similar socio-economic, demographic, and endemic levels of lymphatic filariasis. In the districts studied, streets were chosen randomly. These clusters consisted of 110 people each. A population sample was stratified by sex and age: 0-4, 5-9, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59 and 60 years old and over. The parasitological data were obtained by measuring thick blood smears (60 micro l), collected from 8:00 to 12:00 PM and processed and stained with hematoxylin. The data were described in tables, and logarithimic expression graphics were used to analyze parasitic densities. In general, Recife showed a prevalence of 13.5%, and Olinda 12.3%. Mean parasitic densities were 41 and 70 microfilariae/60 micro l (mf/60 micro l), respectively. Higher microfilaremic rates were observed in Recife for the 20-29-year age bracket and in Olinda in the 30-39-year bracket. The authors concluded that the disease has returned to former endemic levels, and the data described call for a reevaluation of control campaigns carried out by the Brazilian National Health Foundation, since the endemic has already reached serious proportions.

Relationships between seminal vesicle size and copulatory activity in bulls

Two experiments were designed to investigate the hypothesis that dimensions of the seminal vesicle are positively correlated with copulatory behavior in bulls. In Experiment 1, thirty Santa Gertrudis bulls (16.5 mo old) were used to study the relationship between copulatory activity and seminal vesicle length and width (palpation per rectum), seminal vesicle thickness (ultrasonography), and volume. The bulls showed a low level of copulatory activity (6.0+/-1.5, 0.8+/-0.3 and 0.3+/-0.1 for mean number of mounts, intromissions and ejaculations, respectively) in 2 tests. The mean number of mounts but not the mean number of intromissions or ejaculations differed (P<0.01) among bulls. No significant correlations were found between seminal vesicle size and any of the variables of sexual behavior. In Experiment 2, 16 beef bulls (18 mo old) were used to study the relationship between copulatory activity and seminal vesicle length (palpation) or dorso-ventral thickness (ultrasonography). Differences were detected (P<0.01) among bulls in mean number of mounts, intromissions and ejaculations achieved in 2 serving capacity tests. No significant correlations were found between copulatory activity and seminal vesicle length or thickness. These data do not support the hypothesis of a positive relationship between seminal vesicle length or thickness with copulatory activity, even for bulls with marked diffences in intensity of sexual behavior.

Correlation of in vivo testicle and seminal vesicle size with post mortem dimensions in bulls

This study was conducted to quantify the relationships between in vivo measurements of testicular and seminal vesicle size and post mortem size of these organs in 30 Santa Gertrudis bulls. The in vivo measurements of testicles were obtained by transrectal ultrasonography and palpation per rectum, while scrotal circumference was measured by scrotal tape. Linear post mortem dimensions were obtained by direct measurements of the excised organs. Volume was assessed by water displacement while the testicles were weighed. Seminal vesicle length, determined by palpation, had the highest correlation with post mortem measurements (r = 0.70; P = 0.0001). Accurate estimation of the thickness of the vesicles (1.47 vs 1.55 cm for in vivo and post mortem, respectively) was performed by ultrasonograph. Of all seminal vesicle linear measurements, width had the highest correlations with volume measured by water displacement (r = 0.67; P = 0.0001 and r = 0.38; P = 0.04 for post mortem and in vivo, respectively). Testicular diameter was accurately measured by ultrasonography (5.54 vs 4.58 cm in vivo and post mortem, respectively) and was highly correlated (range r = 0.84 to 0.89; P = 0.0001) with post mortem measurements of testicular volume, weight and circumference. The correlation between scrotal circumference and diameter of the testicle was 0.75 (P = 0.0001). The correlations of testicular diameter measured by ultrasound with the post mortem measurements of testicular weight and circumference were similar to the correlations between scrotal circumference and those 2 post mortem measurements. We conclude that palpation of vesicle length is highly correlated with volume of the seminal vesicle in situ. Individual linear measurements do not seem to be an accurate predictor of the relativ size of the seminal vesicle. Furthermore, ultrasonography does not seem to be a more accurate measure of testicular size than scrotal circumference for evaluation of breeding soundness.

[Chronic Chagas' cardiopathy causing congestive heart failure in childhood: a clinical and histopathological study of a case with emphasis on the lesions of the intracardiac conduction and autonomic nervous systems]

A case of decompensated chagasic cardiopathy in a nine-year-old boy from the south of the State of Goiás, is described. He developed congestive heart failure four months before death. The serological reaction for Chagas' disease and the xenodiagnosis were positive. Electrocardiograms showed sinusal tachycardia, ventricular and supraventricular extrasystoles, left anterior hemiblock, complete right bundle branch block and signs of chambers overload. The echocardiogram demonstrated chamber dilatation with diffuse hypocontractility. He presented a downhill course complicated with several pneumonic episodes, the last one just before death. At necropsy, the heart, exhibited a chronic pancarditis with fibrosing chronic myocarditis involving mainly the interventricular septum and left ventricle. The heart conduction system showed slight to moderate exudative, inflammatory changes. Scattered foci of slight chronic periganglionitis and rare degenerative phenomena of ganglionic cells were found in intracardiac autonomic nervous, without neuronal depopulation.

Trypanosoma cruzi meningoencephalitis and myocarditis in a patient with acquired immunodeficiency syndrome

We report the case of a 52-year-old male heterosexual patient with acquired immunodeficiency syndrome (AIDS) and reactivation of Chagas' disease manifested by meningoencephalitis and myocarditis, diagnosed post-mortem. Unexplained reactivation of Chagas' disease should be included among the diagnostic criteria of AIDS in human immunodeficiency virus positive patients. On the other hand, AIDS should be considered in the differential diagnosis of patients with unexplained reactivation of Chagas' disease.

Immunocytochemical localization of surface and intracellular antigens recognized by human sera in microfilariae of Wuchereria bancrofti

Sera from patients with various clinical pictures of lymphatic filariasis, including tropical pulmonary eosinophilia (TPE), were used for the localization of surface and intracellular antigens in microfilariae of Wuchereria bancrofti embedded in Lowicryl K4M. Very few or no antigenic sites were located on the outer face of the sheath. The most inner layer, as well as the space between the cuticle and the sheath, was intensely labeled. Sera from TPE patients intensely labeled the cuticle and the cytoplasm of muscle cells.

Renal abnormalities in microfilaremic patients with Bancroftian filariasis

To determine the frequency of renal abnormalities occurring with Bancroftian filarial infections and to assess the effects of treatment on such abnormalities, we initiated a prospective, hospital-based study of 20 microfilaremic and five amicrofilaremic patients with Wuchereria bancrofti infections. Thorough clinical evaluations and detailed renal assessments were made prior to treatment and at multiple time points for 60 days following a standard twelve-day course of treatment with diethylcarbamazine (DEC). There were two important findings. First, even prior to DEC treatment, almost half of the microfilaremic patients had hematuria and/or proteinuria. Second, treatment with DEC induced these same abnormalities in almost all of the remaining microfilaremic patients. However, this DEC-induced hematuria and/or proteinuria was transient, and the long-term response to DEC in all of the microfilaremic patients was resolution of the abnormal renal findings during the two-month followup period. In the amicrofilaremic study patients, no hematuria or proteinuria was detected before, during, or after treatment with DEC.

Performance of Bos indicus-influenced bulls in serving capacity tests and multiple-sire breeding groups

Three experiments were conducted with Santa Gertrudis (SG) or F1 (Gelbvieh x SG or Red Angus x SG) bulls to assess factors that influence copulatory activity and fertility of Bos indicus-influenced genotypes. In Exp. 1, 3-yr-old SG bulls (n = 20) with sexual experience and 20-mo-old virgin SG bulls (n = 34) were allotted in a split-plot design (age, bull within age group, test day, and heifer treatment). Number of mounts (Mt), intromissions (I), and ejaculations (E) were measured 14 d apart during two 30-min serving capacity (SC) tests. Estrus was either induced via progesterone+estradiol cypionate (PE) injections or synchronized with Syncro-Mate B (SMB). There were more (P less than .05) I and E on Test d 2 than on Test d 1. Heifers treated with SMB received more (P less than .001) Mt, I, and E than did heifers treated with PE. Sixteen 20-mo-old bulls from Exp. 1 were allotted to breeding pastures at a bull:heifer ratio of 4:119 +/- 3 for 50 d in Exp. 2. Breeding pasture treatments either included or excluded low-SC bulls. Neither pregnancy rate nor least squares mean day of conception differed between treatments. Experiment 3 evaluated copulatory activity with a 2 x 2 factorial arrangement (breed and test day) in 14- to 16-mo-old SG (n = 45) and F1 (n = 16) bulls. The F1 bulls had more Mt, I, and E than did the SG bulls (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute fatal Trypanosoma cruzi meningoencephalitis in a human immunodeficiency virus-positive hemophiliac patient

A 37-year-old hemophiliac patient with known, asymptomatic human immunodeficiency virus infection and chronic Chagas' disease was admitted to the hospital complaining of fever and headache. A computed tomographic scan revealed multiple ring-enhancing lesions in both cerebral hemispheres. No antibodies to Trypanosoma cruzi were found in the cerebrospinal fluid. Treatment for toxoplasmosis of the central nervous system, which was considered the most likely diagnosis, was instituted, but the patient died after progressive neurologic deterioration. An autopsy revealed severe meningoencephalitis caused by T. cruzi.

[Evaluation of the indirect immunofluorescence test for the diagnosis of bancroftian filariasis using microfilariae W. bancrofti as the antigen, in Recife-PE, Brazil]

The authors analysed the indirect immunofluorescence assay, for the diagnosis of bancroftian filariasis using papain treated W. bancrofti microfilariae as antigen, widely used in Recife-Brazil. Sera from 50 patients with several clinical forms of the disease including asymptomatic carriers, tropical pulmonary eosinophilia, elephantiasis, filarial fever and chyluria were analysed. For the control group, 50 individuals were selected, living at least 5 years in endemic area, with neither previous DEC treatment nor clinical-laboratory evidences of the disease, called normals endemic. The sensitivity and specificity were analysed taking into account different cut off values. It was not possible to differentiate infected individuals from the control group. It was not even possible to establish any correlation with IMF titers among different clinical presentation of the disease. Crossed reactions with various intestinal helminths were considered, but no relationship was found.

[Prevalence of visceromegalies in necropsies carried out in Triângulo Mineiro from 1954 to 1988]

One thousand seven hundred and eight chronic chagasic post-mortem examinations studied from a total of 4690 autopsies performed at our Institution. Two hundred and seventy-three chagasic had megas. Megacolon was the most frequent, followed by megaesophagus. Megacolon associated with megaesophagus was the third most common finding. Our data are discussed and compared with the literature. Megacolon and megaesophagus were more prevalent in man, as shown by other workers. Higher parasitemia perhaps could explain this finding.

[Basic causes of death in elderly patients with Chagas' disease]

The main causes of death of 100 elderly Chagas' patients (group A), of 100 elderly non-Chagas' disease (group B) and of 100 non-elderly Chagas' disease patients (group C) were surveyed clinically and by postmortem data. Compared to B, the A group showed significantly more deaths due to chronic Chagas' heart disease and digestive "megas", and less frequently to malignant neoplasm. Deaths due to pulmonary emphysema and malignant neoplasms were significantly more common and deaths due to chronic Chagas' heart disease were significantly less common in the A group when compared to the C group. Chronic Chagas' heart disease caused 26 unexpected sudden deaths in the C group (the younger patients) and none in the A group (the eldest patients).

[Megas and cancer. Cancer of the large intestine in chagasic patients with megacolon]

This is a review of 4.690 necropsies and 24.209 surgical pathology specimens describing the association between megacolon chagasic and malignant tumors of the large bowel. The prevalence of malignant tumors of the large bowel was not higher in megacolon.

Human leptospirosis--a review of 50 cases

Epidemiological and clinical aspects of 50 consecutive patients, 47 adults and three children, hospitalized between 1977 and 1987 for human leptospirosis, were reviewed. 45 (90%) of the patients were from rural regions. 32 (64%) cases occurred in individuals at occupational risk for the infection. 35 (70%) cases were registered in the warm season. The source of infection was known in 34 (68%) cases. Weil's disease was diagnosed in 31 (62%) patients, aseptic meningitis in 12 (24%) and acute unexplained fever in seven (14%). Haemodialysis was required for 11 (35%) patients with Weil's disease. Three (6%) patients died. Cause of death was massive gastrointestinal haemorrhage in two and renal failure in one. Leptospira icterohaemorrhagiae was responsible for 39 (78%) cases, Leptospira canicola for six (12%), Leptospira grippotyphosa for two (4%), and Leptospira australis, Leptospira ballum and Leptospira sejroe, for one case each. A muscle biopsy was performed in six patients and a renal biopsy in three. Focal necrotic muscular changes, with mild mononuclear infiltrate, were found. Pigmented casts in distal convoluted tubules, mild interstitial inflammatory infiltrate and mesangial enlargement of some glomeruli were observed in kidney biopsies. A good knowledge of the protean clinical manifestations of leptospirosis and an accurate laboratory study are required for a correct diagnosis.

[Necroscopic study of a case of chronic form of Chagas disease with electrocardiogram and x-rays of normal thorax. Special reference to the excito-conductor system of the heart]

Descrevem-se as alterações anatomopatológicas observadas na necropsia de chagásico crônico, provavelmente, portador da forma indeterminada da doença. O coração mostrou lesões dos três folhetos e do sistema excito-condutor, traduzidas especialmente por pequenos focos inflamatórios. Havia discreta fibrose do miocárdio contrâtil, nódulo átrio-ventricular e origem do ramo esquerdo do feixe de His. Tais alterações, embora de leve intensidade, assemelham-se, qualitativamente, às relatadas nas demais formas crônicas da doença de Chagas e representam lesões ativas, com potencial evolutivo. No esôfago, observou-se entre outros fatos, despopulação neuronal acentuada.

[ELISA immunoenzymatic assay in the pericardial fluid: a new method for the post-mortem diagnosis of Chagas disease]

Realizou-se o teste imunoenzimático ELISA, paralelamente à reação de imunofluorescência, para a detecção de anticorpos antí-Trypanosoma cruzi, em 137 amostras de líquidos pericárdicos humanos, colhidos na necropsia. Os resultados foram cotejados com os achados anatomopatológicos. Observou-se que: (1) os dois testes foram positivos em 30 casos e negativos em 105; (2) o teste ELISA foipositivo em 2 casos nos quais a immofluorescència revelou-se negativa; num desses casos, havia sinais morfológicos de doença de Chagas; (3) a média geométrica dos títulos obtidos com o teste ELISA foi significativamente maior que a da imunofluorescência; (4) o índice de concordância entre os dois testes apresentou o valor de 0,985. O presente relato parece-nos inédito quanto ao uso do teste imunoenzimático no líquidoperícárdicopara o diagnóstico post- mortem da doença de Chagas.

[A case of indigenous polycystic hydatidosis in Minas Gerais, Brazil]

Relata-se um caso de hidatidosepolicistica, em homem de 22 anos, clinicamente manifestada por dor no hipocôndrio direito, icterícia obstrutiva, hepatoesplenomegalia, perda de peso e, em estágio final, ascite. O diagnóstico foi após laparotomia exploradora, com biópsia hepática e peritoneal. O paciente evoluiu para o óbito, a despeito de ter sido tratado com mebendazol na dose de 1200 mg/dia, durante um ano. A necrópsia, constatou-se hidatidose do fígado, omento maior e peritônio diafragmático. Não se conseguiu identificar, à microscopia óptica, a espécie de Echinococcus envolvida; com base nos dados epidemiológicos e morfológicos disponíveis, o parasita em apreço poderia ser o Echinococcus vogeli ou o E. oligarthrus. Este parece ser o quarto caso de hidatidose policistica na literatura nacional e é, com muita probabilidade, autóctone de Minas Gerais.

Spironolactone-reversible rickets associated with 11 beta-hydroxysteroid dehydrogenase deficiency syndrome

A 7-year-old girl had growth retardation, hypertension, and hypokalemic alkalosis. Baseline serum aldosterone concentration and plasma renin activity were low and unresponsive to sodium deprivation and to orthostatic changes. Baseline serum progesterone, 17-hydroxyprogesterone, 11-deoxycortisol, and cortisol levels were normal and adequately responsive to ACTH stimulation. No steroid was found abnormally elevated. A diagnosis of 11 beta-hydroxysteroid dehydrogenase deficiency was established on the basis of elevated urinary tetrahydrocortisol plus allotetrahydrocortisol/tetrahydrocortisone ratio, determined by gas chromatography-mass spectrometry. Evaluation of bone mineral metabolism and parathyroid function, and skeletal radiographs, revealed the presence of rickets and secondary hyperparathyroidism. Treatment with spironolactone alone for 2 months corrected hypertension, hypokalemic alkalosis, and all laboratory and radiologic evidence of rickets and hyperparathyroidism, resulting in acceleration of growth rate. The response to spironolactone suggests that a hypermineralocorticoid state is responsible for the hypertensive syndrome and that rickets and hyperparathyroidism could be a consequence of excess mineralocorticoid activity.

Physical examination of the reproductive organs of range beef bulls in Mozambique

Physical examinations were performed on 3991 bulls reared in subtropical (75%) and tropical (25%) Mozambique. A culling rate of 16.3% (651 sires) was found. The range of culling rate between farms varied from 3 to 44%. The main culling reasons were a) epididymitis, b) atrophy and/or hypoplasia, and c) testicular fibrosis (contributing to 30.4, 20.9, and 15.2%, respectively, of the culled bulls). Epididymitis-vaginitis (epivag) syndrome was considered the main reason for the high incidence of epididymitis and testicular fibrosis. A highly significant difference (P<0.001) in culling rate for Simmental (37.7%) and Brahman (13.1%) bulls was found. A more comprehensive investigation of culling rate of different breeds used in the country is needed, as well as a program for controlling epivag in the more affected areas. Examining the reproductive organs of the beef bulls in Mozambique before the breeding season is very important to improve fertility in the beef herds.

[Prevalence of cholelithiasis in necropsies of patients with chronic Chagas' disease in the mining triangle--correlation with megaesophagus, megacolon and cardiac insufficiency]

Retrospective analysis of the diagnosis of 2.517 autopsies performed in the western region of the State of Minas Gerais, Brazil, showed that cholelithiasis has significant association with megaesophagus and megacolon but not with Chagas' disease (when considered in all of its anatomo-clinic presentations) or with heart failure due to chronic chagasic cardiopathy. Possible explanations to these findings are discussed and the scanty pertinent literature is commented.

[Prevalence of Chagas' infection in necropsies in the Triangulo Mineiro area]

Analisou-se a prevalência da infecção chagásica em 2690 necrópsias realizadas no Triângulo Mineiro. Os resultados indicaram que 38,84% dos necropsiados eram chagásicos e que não houve declínio da infecção nos últimos anos. Discutiu-se tais resultados, comparando-os com os de outros Autores que analisaram a questão.

[Chagas' placentitis. Report of a case with optic and electronic microscopy study]

Novo caso de placentite chagásica no Triângulo Mineiro, observou-se, à mioroscopia óptica, o parasitismo de miócitos das paredes vasculares, fato não descrito anteriormente na literatura. O estudo à microscopia eletrônica revelou. (1) abundantes amastigotas do Trypanosoma cruzi em células de Hofbauer; (2) proliferação fibroblástica e colágena na parede de pequenas artérias e arteríolas, ocluindo-lhes, por vezes, o lume; (3) parasitas em células musculares degeneradas e fibroblastos da parede vascular. Este é o primeiro relato de placentite chagásica humana com análise ultra-estrutural.

Renal artery stenosis in transplant patients

Although hypertension appears not infrequently among recipients of kidney transplants, renal artery stenosis is relatively rare as a causative factor. A 23-year experience of patients receiving kidney grafts at the Brigham and Women's Hospital was reviewed to ascertain the incidence of renal artery stenosis and its surgical management. Risk factors leading to the condition and selection of patients for operation are emphasized. The incidence of arterial stenosis severe enough to require operation was 2.7% of 914 kidney transplants; the overall incidence in these patients is unknown, although operated patients comprise about one-half of those undergoing arteriography to diagnose hypertension. The mean time for development of the condition was 21.4 months from date of engraftment. A successful outcome as measured by fall in blood pressure and/or serum creatinine was achieved in 14 of 21 patients (67%) in whom surgical repair of the effected artery was undertaken. Reparative surgery was unsuccessful in seven patients, although hypertension was improved in one of these individuals following transplant nephrectomy. Surgery was never undertaken in four patients because of chronic rejection noted on biopsy. There was no mortality. Operative repair should be offered to patients with renal artery stenosis leading to unmanageable hypertension or renal dysfunction, but withheld from those with documented chronic rejection regardless of major arterial compromise.

[Sudden death and Chagas' disease--analysis of predisposing factors of sudden death in chronic Chagas' patients]

Com a finalidade de contribuir para o esclarecimento dos mecanismos da morte súbita na forma crônica da tripanossomose cruzi, foram analisados, de modo sistemático, os seguintes aspectos em 116 chagásicos falecidos subitamente: o sexo, a idade em que ocorreu o óbito, a profissão, o papel da emoção e do esforço físico no momento do desenlance fatal e a época da morte em relação às estações do ano. Todos estes tripanossomóticos, aparentemente, não manifestaram, em vida, sintomas e/ou sinais de insuficiência cardíaca. Para análise comparativa utilizou-se um grupo constituído por chagásicos crônicos falecidos com ou após manifestações de insuficiência cardíaca. Os resultados demonstram que o óbito acomete (tanto nos chagásicos falecidos subitamente como naqueles com insuficiência cardíaca) mais freqüentemente o homem que a mulher e que nos chagásicos do sexo masculino falecidos subitamente a morte ocorre mais cedo do que em tripanossomóticos cujo desenlace está asociado ou é precedido por quadro de insuficiência cardíaca. Finalmente, nossos dados sugerem que o esforço físico, os fatores emotivos e as variações sazonais não exercem papel essencial no desencadeamento do óbito do chagásico crônico.

[Pathological anatomy of hearts from asymptomatic Chagas disease patients dying in a violent manner]

Com finalidade de melhor conhecimento da forma indeterminada da doença de Chagas os autores realizaram estudo anatomopatólogico sistematizado de trinta corações de chagásicos assintomáticos falecidos de modo violento. Demonstram que nos portadores da forma em questão da tripanossomiase cruzi o coração e acometido por lesões da mesma natureza, porém de intensidade muito menor do que as observadas em chagásicos crônicos que falecem subitamente ou após periodo variável de insuficiência cardíaca. Baseados em seus achados e em outros dados da literatura, concluem que a infecção chagásica, sem inflamação do coração, se ocorre, é rara. Tecem ainda considerações a respeito do significado das lesões observadas no sistema nervoso autônomo intracardíaco no sistema de condução e sobre a gênese formal da cardite chagásica crônica humana.

Post-mortem diagnosis of chronic Chagas's disease comparative evaluation of three serological tests on pericardial fluid

In an attempt to improve the post-mortem diagnosis of Chagas's disease the authors performed haemagglutination tests (HAT), fluorescent Trypanosoma cruzi antibody tests (FAT), and complement fixation tests (CFT) on the pericardial fluid obtained at autopsy of 50 individuals with Chagas's heart disease, and 93 patients in whom this disease was not thought to be present. The results demonstrate that all three tests are efficient for the post-mortem diagnosis of Chagas's disease but suggest that their combined use would detect more cases than would one isolated reaction only.