Revista paulista de medicina最新文献

Two specimens containing clinically inapparent histologic features of acantholytic dyskeratosis (on the base of a fibrous papule of the nose and overlying a psoriatic lesion) are presented. The authors discuss the conduct to be followed by the pathologist in similar cases. The general pathologist should be well trained in dermatopathology since cutaneous biopsies account for 10 to 25% of the specimens submitted for histologic diagnosis or, even, form the major part of the workload (Berry). There is a wall between the physician who submits the skin biopsies (who may be or not a dermatologist) and the pathologist. The clinical information provided by dermatologists is scant and incomplete and physicians who are not dermatologists seldom submit any information. The histological pictures found in skin biopsies are, often, common to several nosological entities and an adequate understanding of their meaning is desirable for a thorough evaluation. We ought to assess it with the maximum scientific severity, searching to solve the puzzle without depreciating the information received. In this report the authors analyse the histopathological approach to the cutaneous lesions of two patients. They displayed the association between acantholytic dyskeratosis (AD) and another cutaneous pathology. Findings like these may obstruct the final diagnosis to be issued by the pathologist.(ABSTRACT TRUNCATED AT 250 WORDS)

The objective of this study is to decode the etiopathogenesis, the clinical feature, the diagnosis and the prognosis of the acute mediastinitis resulting of infectious processes of the cephalic segment. Three out of five patients studied presented focus of dental origin and two patients presented focus in the face area. One of them presented Ludwig's Angina before the suppurative process would spread over the mediastinum. In the others, there was fast expansion through the fascial spaces of the neck and, in two of them, besides the mediastinum, there was pleuropericardial involvement. Three patients died due to respiratory insufficiency and two survived with complications. The mediastinitis after cervical suppuration is a special and extremely serious kind of endothoracic infection. The pus reaches that area through the fascial spaces of the neck, taking the organism to an alarming toxemic feature. The rarity of the disease, the little is known about its physiopathology and the initial care of the patient in non-specialized services, which are not familiarized with this type of feature, are factors that can delay the diagnosis and worsen the prognosis.

A careful literature review of the use of vaginal fluid acid phosphatase levels as a means to estimate post-coital time disclosed several inconsistencies. In this study, acid phosphatase levels were determined in vaginal fluid samples obtained from 200 women whose post-coital time was known. No statistical significance (at 5% probability levels) was found when vaginal acid phosphatase levels were correlated with post-coital time.

We describe a case of primary lymphoma of the breast which clinically mimicked a phyllodes tumor. The diagnosis and treatment of this rare neoplasm are discussed. The lymphomas, neoplasias of the immune system, comprise a large group of proliferative diseases of the lymphoreticular tissue which are classified into two histological types, i.e., Hodgkin and non-Hodgkin. Primary lymphomas of the breast are quite rare, with an incidence ranging from 0.4 to 0.53% of all malignant breast tumors (2). They are characterized by uni- or bilateral involvement of the breast, with or without homolateral axillary lymphadenopathy, and by the absence of lymphatic disease at another site (7). We report here a case of primary non-Hodgkin lymphoma of the left breast and we discuss its clinical aspects and the treatment instituted.

Sydenham's chorea (chorea minor, St. Vitus dance, rheumatic encephalitis), described by Thomas Sydenham in 1686, is considered one of the major manifestations of rheumatic fever (1, 2, 3, 4). Clinically it is characterized by involuntary movements, hypotonia, dysarthria, emotional disorders, and less frequently, by other neurological manifestations such as weakness, headache, seizures and sensory abnormalities (1,4). The motor disorders may be generalized or unilateral, in this case constituting a hemichorea (3). Chorea may present associated to other rheumatic fever manifestations during an acute episode, or in isolated form, characterizing the so-called "pure" chorea (5, 6, 7). Its etiology and pathophysiological mechanisms are still unclear, although its relation with a previous pathophysiological group A Beta-hemolytic streptococcus infection is well established (8). There is also evidence of the participation of immunological mechanisms in its pathogenesis, such as the finding of serum anti-nucleus caudatus and anti-subthalamic antibodies (9) and increase in IgG levels in cerebrospinal fluid of patients with chorea (10). In developed countries due to the reduction in rheumatic fever incidence and decrease in frequency of chorea as its manifestation (3, 11), the latter has become rare. However, in developing countries rheumatic fever remains a public health problem. In Brazil, in the last years an increase in the incidence of chorea has been observed as part of the clinical picture of rheumatic fever (12). The present study reports the clinical and laboratory findings of 187 cases of Sydenham's chorea followed-up during the period of January 1980 to December 1990 in two university centers in the city of Sao Paulo, Brazil.

This report presents a twenty-year-old man with generalized digestive and urinary smooth muscle hypertrophy combined with somatic and sexual hypodevelopment. We could not find in the literature any report related to the disease of our patient. Congenital pyloric stenosis is the less rare obstructive syndrome due to smooth muscle hypertrophy. Morgagni described this syndrome in an adult patient, in the XVIII century (2). Pyloroplasty is the best treatment for this disease. Other congenital or acquired obstructive syndromes of the digestive system such as Chagas' aganglionosis and pseudo-obstruction of the small bowel are also important clinical and surgical challenges (1,3,4). Several obstructive illnesses due to smooth muscle dysfunction have been described. This report presents an apparently original syndrome urinary segmental obstruction following smooth muscle hypertrophy.

The objective of the present study was to determine the presence of risk factors for the occurrence of neural tube defects. Data for 33,535 births which occurred at Hospital do Servidor Público Estadual de São Paulo from July 1973 to December 1986 were collected in a prospective manner as recommended by "Estudo Colaborativo Latino-Americano de Malformações Congênitas" (ECLAMC, Collaborative Latin American Study on Congenital Malformations). Twenty-six cases of neural tube defects were detected (0.77/1000 births). Of these, 11 were cases of spina bifida (0.39/1000 births), 9 of anencephaly (0.27/1000 births) and 6 of encephalocele (0.18/1000 births). We observed a higher frequency of polyhydramnios, premature labor, Apgar scores of less than 7 at the first and fifth minutes, low birth weight and intrauterine growth retardation.

The authors studied the expression of estrogen receptor (ER) in tissues of breast carcinomas which were previously fixed in formalin and paraffin-embedded. The ER expression was correlated with several histological findings, namely grade of differentiation, tumor necrosis, desmoplasia, lymphocytic infiltration and elastosis. The ER was detected in tissues using the avidin-biotin immunoperoxidase technique associated with the H222 monoclonal antibody from Abbott. All 39 biopsies were of infiltrating ductal carcinoma of breast and 16 of them expressed ER. The statistical analysis showed that the expression of ER was correlated with histological findings of good prognosis as well differentiated carcinomas, no tumor necrosis, absence or mild lymphocytic infiltration around the tumor cells and severe elastosis.