Resultados Da Colpofixação Sacroespinal Associada A Colporrafia Anterior Para O Tratamento Do Prolapso De Cúpula Vaginal

To evaluate the results of sacrospinous colpopexy surgery associated with anterior colporrhaphy for the treatment of womeN with post-hysterectomy vaginal vault prolapse. Methods This prospective study included 20women with vault prolapse, PelvicOrgan Prolapse Quantification System (POP-Q) stage ≥ 2, treated between January 2003 and February 2006, and evaluated in a follow-up review (more than one year later). Genital prolapse was evaluated qualitatively in stages and quantitatively in centimeters. Prolapse stage < 2 was considered to be the cure criterion. Statistical analysis was performed using the Wilcoxon test (paired samples) to compare the points and stages of prolapse before and after surgery. Results Evaluation of the vaginal vault after one year revealed that 95% of subjects were in stage zero and that 5% were in stage 1. For cystocele, 50% were in stage 1, 10% were in stage 0 (cured) and 40% were in stage 2. For rectocele, three women were in stage 1 (15%), one was in stage 2 (5%) and 16 had no further prolapse. The most frequent complication was pain in the right buttock, with remission of symptoms in all three cases three months after surgery. Conclusions In this retrospective study, the surgical correction of vault prolapse using a sacrospinous ligament fixation technique associatedwith anterior colporrhaphy proved effective in resolving genital prolapse. Despite the low complication rates, there was a high rate of cystocele, which may be caused by posterior vaginal shifting due to either the technique or an overvaluation by the POP-Q system. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.382778

Cirurgia Com Tela Para Correção De Prolapso De Parede Anterior: Metanálise

Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6–8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: ‘anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)’ in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score ( > 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07–1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72–82,25]), longer surgery time (MD = 15,08 [0,48–29,67]), but less prolapse recurrence (OR = 0,22 [01,3–0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.38735636

Cirurgia com tela para correção de prolapso de parede anterior: metanálise

Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6–8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: ‘anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)’ in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score ( > 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07–1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72–82,25]), longer surgery time (MD = 15,08 [0,48–29,67]), but less prolapse recurrence (OR = 0,22 [01,3–0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.387356364Prolapso de órgãos pélvicos é problema de saúde públicas, sendo o mais comum o anterior. Para tratamento são utilizadas cirurgias, com ou sem telas. O uso de telas é para diminuir recidivas, mas não h á consenso. Métodos: Foi realizada revisão da literatura e metanálise, sobre uso de telas na correção do prolapso anterior. Base de dados foi PUBMED , com termos (MESH): “Anterior Pelvic Organ OR Cystocele AND Surgery AND (Mesh or Colporrhaphy)”. Critérios de exclusão foram: seguimento menor que 1 ano, telas biológicas ou absorvíveis. Resultados: foram avaliados 115 artigos. Após revisão dos títulos, 70 estudos foram descartados e 18 após leitura de resumos. Após critérios de Jadad (>2), 12 estudos foram incluídos. Análise estatística foi razão de risco ou diferença entre médias dos grupos, e as análises com grande heterogeneidade foram avaliadas através de análise de efeito aleatório. Resultados: Cura objetiva foi superior no grupo com tela - OR 1,28 (1,07-1,53, p ≤ 0,00001), maior perda sanguínea - diferença média (MD) 45,98 (9,72-82,25, p = 0,01), tempo cirúrgico mais longo - MD 15,08 (0,48-29,67, p = 0,04), porém menor recorrência - OR 0,22 (0,13-0,38, p = 0,00001), não apresentando maior resolução dos sintomas - OR 1,93 (0,83-4,51, p = 0,15). Dispareunia e taxa de reoperação também não foram diferentes entre grupos. Qualidade de vida não apresentou diferença. Conclusões: Cirurgia com tela para prolapso vaginal anterior apresenta melhor taxa de cura anatômica e menor recorrência, sem diferenças cura subjetiva, reoperação e qualidade de vida. Há maior tempo cirúrgico e perda sanguínea. Uso de telas deve ser individualizado

Measuring Electrical And Mechanical Properties Of Red Blood Cells With A Double Optical Tweezers

The fluid lipid bilayer viscoelastic membrane of red blood cells (RBC) contains antigen glycolproteins and proteins which can interact with antibodies to cause cell agglutination. This is the basis of most of the immunohematologic tests in blood banks and the identification of the antibodies against the erythrocyte antigens is of fundamental importance for transfusional routines. The negative charges of the RBCs creates a repulsive electric (zeta) potential between the cells and prevents their aggregation in the blood stream. The first counterions cloud strongly binded moving together with the RBC is called the compact layer. This report proposes the use of a double optical tweezers for a new procedure for measuring: (1) the apparent membrane viscosity, (2) the cell adhesion, (3) the zeta potential and (4) the compact layer's size of the charges formed around the cell in the electrolytic solution. To measure the membrane viscosity we trapped silica beads strongly attached to agglutinated RBCs and measured the force to slide one RBC over the other as a function of the relative velocity. The RBC adhesion was measured by slowly displacing two RBCs apart until the disagglutination happens. The compact layer's size was measured using the force on the silica bead attached to a single RBC in response to an applied voltage and the zeta potential was obtained by measuring the terminal velocity after releasing the RBC from the optical trap at the last applied voltage. We believe that the methodology here proposed can improve the methods of diagnosis in blood banks.6326Eylar, E.H., Madoff, M.A., Brody, O.V., Oncley, J.L., The contribution of sialic acid to the surface charge of the erythrocyte (1962) J. Biol. Chem., 237, pp. 1992-2000Pollack, W., Reckel, R.P., A reappraisal of the forces involved in Hemagglutination (1977) Int Archs Allergy Appl. Immun., 54, pp. 29-42Ashkin, A., Dziedzic, J.M., Bjorkholm, J.E., Chu, S., Observation of a single-beam gradient force trap for dielectric particles (1986) Opt. Lett., 11, pp. 288-290Ashkin, A., Dziedzic, J.M., Optical trapping and manipulation of viruses and bacteria (1987) Science, 235, pp. 1517-1520Grier, D.G., A revolution in optical manipulation (2003) Nature, 424, pp. 810-816Zhu, C., Bao, G., Wang, N., Cell Mechanics: Mechanical response, cell adhesion, and molecular deformation (2000) Annu. Rev. Biomed. Eng., 2, pp. 189-226Neuman, K.C., Block, S., Optical trapping (2004) Rev. Sci. Instrum., 75, pp. 2787-2809Saffman, P.G., Delbruck, M., Brownian motion in biological membranes (1975) Proc. Nat. Acad. Sci. USA, 72, pp. 3111-3113Dimova, R., Danov, K., Pouligny, B., Ivanov, I.B., Drag of a solid particle trapped in a thin film or at an interface: Influence of surface viscosity and elasticity (2000) J. Colloid and Interface Science, 226, pp. 35-43Hochmuth, R., Worthy, P., Evans, E., Red cell extensional recovery and the determination of membrane viscosity (1979) Biophys. J., 26, pp. 101-114Sze, A., Erickson, D., Ren, L., Li, D., Zeta-potential measurement using the Smoluchowski equation and the slope of the current-time relationship in electroosmotic flow (2003) J. Colloid and Interface Science, 261, pp. 402-410Hunter, R.J., (1981) Zeta Potential in Colloid Science, , Academic Press, New YorkPollack, W., Hager, H.J., Reckel, R., Toren, D.A., Singher, H.O., A study of the forces involved in the second stage of hemaggltination (1965) Transfusion, 5, pp. 158-183Chelidze, T., Dielectric spectroscopy of blood (2002) J. Non-crystalline Solids, 305, pp. 285-294Hymer, W.C., Barlow, G.H., Blaisdell, S.J., Continuous flow electrophoretic separation of proteins and cells from mammalian tissues (1987) Cell Biophys., 10, pp. 61-85Hashimoto, N., Fujita, S., Yokoyama, T., Cell electrophoretic mobility and glycerol lysis of human erythrocytes in various diseases (1998) Electrophoresis, 19, pp. 1227-123

Determination Of Fluid Viscosity And Femto Newton Forces Of Leishmania Amazonensis Using Optical Tweezers

The displacements of a polystyrene microsphere trapped by an optical tweezers (OT) can be used as a force transducer for mechanical measurements in life sciences such as the measurement of forces of living microorganisms or the viscosity of local fluids. The technique we used allowed us to measure forces on the 200 femto Newtons to 4 pico Newtons range of the protozoa Leishmania amazonensis, responsible for a serious tropical disease. These observations can be used to understand the infection mechanism and chemotaxis of these parasites. The same technique was used to measure viscosities of few microliters sample with agreement with known samples better than 5%. To calibrate the force as a function of the microsphere displacement we first dragged the microsphere in a fluid at known velocity for a broad range of different optical and hydrodynamical parameters. The hydrodynamical model took into account the presence of two walls and the force depends on drag velocity, fluid viscosity and walls proximities, while the optical model in the geometric optics regime depends on the particle and fluid refractive indexes and laser power. To measure the high numerical (NA) aperture laser beam power after the objective we used an integration sphere to avoid the systematic errors of usual power meters for high NA beams. After this careful laser power measurement we obtained an almost 45 degrees straight line for the plot of the optical force (calculated by the particle horizontal displacement) versus hydrodynamic force (calculated by the drag velocity) under variation of all the parameters described below. This means that hydrodynamic models can be used to calibrate optical forces, as we have done for the parasite force measurement, or vice-versa, as we did for the viscosity measurements.593017Ashkin, A., Dziedzic, J.M., Bjorkholm, J.E., Chu, S., Observation of a single-beam gradient force optical trap for dieletric particles (1986) Optics Letters, 11, pp. 288-290Ashkin, A., Dziedzic, J.M., Optical trapping and manipulation of viruses and bacteria (1987) Science, 235, pp. 1517-1520Greulich, K.O., (1999) Micromanipulation by Light in Biology and Medicine, , Basel, Boston, Berlin: BirkhäuserSakata-Sogawa, K., Direct measurement of DNA molecular length in solution using optical tweezers: Detection of looping due to binding protein interactions (1998) Eur. Biophys. J., 27, pp. 55-61Konig, K., Determination of motility forces of human spermatozoa using an 800 nm optical trap (1996) Cell. Mol. Biol., 42, pp. 501-509Barjas-Castro, M.L., Elastic properties of irradiated RBCs measured by optical tweezers (2002) Transfusion, 42, pp. 1196-1199Huruta, R.R., Mechanical properties of stored red blood cells using optical tweezers (1998) Blood, 92, pp. 2975-2977Felgner, H., Muller, O., Schliwa, M., Calibration of light forces in optical tweezers (1995) Appl. Optics, 34, pp. 977-982Svoboda, K., Block, S., Biological applications of optical forces (1994) Annu. Rev. Biophys. Biomolec. Struct., 23, pp. 247-285Henon, S., Lenormand, G., Richert, A., Gallet, F., A new determination of the shear modulus of the human erythrocyte membrane using optical tweezers (1999) Biophys. J., 76, pp. 1145-1151Konig, K., Determination of motility forces of human spermatozoa using an 800nm optical trap (1996) Cell. Mol. Biol., 42, pp. 501-509Who, Whorld Health Organization, 2001Herwaldt, B.L., Leishmanias (1999) Lancet, 354, pp. 1191-1199Killick-Kendrick, R., The life-cycle of Leishmania in the sandfly with special reference to the form infective to the vertebrate host (1990) Ann. Parasitol. Hum. Comp., 65 (1 SUPPL.), pp. 37-42Handman, E., Cell biology of Leishmania (2000) Adv. Parasitol, 44, pp. 1-39Happel, J., Brenner, H., (1991) Low Reynolds Number Hydrodynamics with Special Applications to Particulate Media, , Klumer, Dordrecht(1971) Handbook of Chemistry and Physics, , Chemical Rubber, ClevelandPurcell, E.M., Life at low Reynolds number (1977) Am. J. Phys., 45, pp. 124-13

Mechanical Properties Of Stored Red Blood Cells Using Optical Tweezers

We have developed a method for measuring the red blood cell (RBC) membrane overall elasticity μ by measuring the deformation of the cells when dragged at a constant velocity through a plasma fluid by an optical tweezers. The deformability of erythrocytes is a critical determinant of blood flow in the microcirculation. We tested our method and hydrodynamic models, which included the presence of two walls, by measuring the RBC deformation as a function of drag velocity and of the distance to the walls. The capability and sensitivity of this method can be evaluated by its application to a variety of studies, such as, the measurement of RBC elasticity of sickle cell anemia patients comparing homozygous (HbSS), including patients taking hydroxyrea (HU) and heterozygous (HbAS) with normal donors and the RBC elasticity measurement of gamma irradiated stored blood for transfusion to immunosupressed patients as a function of time and dose. These studies show that the technique has the sensitivity to discriminate heterozygous and homozygous sickle cell anemia patients from normal donors and even follow the course of HU treatment of Homozygous patients. The gamma irradiation studies show that there is no significant change in RBC elasticity over time for up to 14 days of storage, regardless of whether the unit was irradiated or not, but there was a huge change in the measured elasticity for the RBC units stored for more than 21 days after irradiation. These finds are important for the assessment of stored irradiated RBC viability for transfusion purposes because the present protocol consider 28 storage days after irradiation as the limit for the RBC usage.593016Ashkin, A., Dziedzic, J.M., Optical trapping and manipulation of viruses and bacteria (1987) Science, 235, pp. 1517-1520Barjas-Castro, M.L., Brandão, M.M., Fontes, A., Costa, F.F., Cesar, C.L., Saad, S.T.O., Elastic properties of irradiated red blood cell units measured by optical tweezer (2002) Transfusion, 42, pp. 1196-1199Brandão, M.M., Fontes, A., Barjas-Castro, M.L., Barbosa, L.C., Costa, F.F., Cesar, C.L., Saad, S.T.O., Optical tweezers for measuring red blood cell elasticity: Application to the study of drug response in sickle cell disease (2003) European Journal of Haematology, 70, pp. 207-211Williamson, L.M., Warwick, R.M., Transfusion-associated graft-versus-host disease and its prevention (1995) Blood Rev., 9, pp. 251-261Button, L.N., Dewolf, W.C., Newburger, P.E., The effecr of irradiation on blood components (1981) Transfusion, 21, pp. 419-426Platt, O.S., The sickle syndrome (1995) Blood: Principles and Practice of Hematology, , R. I Hadlin, S. E. Lux, T. P. Stossel, J. B. Lippincott, PhiladelphiaBallas, S.K., Dover, G.J., Charache, S., Effect of hydroxyurea on the rheological properties of sickle erythrocytes in vivo (1989) Am. J. Hematol, 32, pp. 104-111Groner, W., Mohandas, N., Bessis, M., New optical technique for measuring erythrocyte deformability with the ektacytometer (1980) Clin. Chem., 26, pp. 1435-1442De Franceschi, L., Bachir, D., Galacteros, F., Tchernia, G., Cynober, T., Alper, S., Platt, O., Brugnara, C., Oral magnesium supplements reduce erythrocyte dehydration in patients with sickle cell disease (1997) J Clin Invest, 100, pp. 1847-1852Hochmuth, R.M., Worthy, P.R., Evans, E.A., Red cell extensional recovery and the determination of membrane viscosity (1979) Biophys. J., 26, pp. 101-114Evans, E.A., La Celle, P.L., Intrinsic material properties of the erythrocyte membrane indicated by mechanical analysis of deformation (1975) Blood, 45, pp. 29-43Itoh, T., Chien, S., Usami, S., Effects of hemoglobin concentration on deformability of individual sickle cells after deoxygenation (1995) Blood, 85, pp. 2245-2253Evans, E.A., Mohandas, N., Membrane-associated sickle hemoglobin: A major determinant of sickle erythrocyte rigidity (1987) Blood, 70, pp. 1443-1449Dong, C., Chadwick, R.S., Schechter, A.N., Influence of sickle hemoglobin polymerization and membrane properties on deformability of sickle erythrocytes in the microcirculation (1992) Biophys. J., 63, pp. 774-783Suzuki, Y., Tateishi, N., Cicha, I., Decreased deformability of the X-ray irradiated red blood cells stored in manitol-adenine-phosphate medium (2000) Clin. Hemorheol. Micro-cire., 22, pp. 131-14

Pain and quality of life in leprosy patients in an endemic area of Northeast Brazil: a cross-sectional study

Background Pain emerges as a challenge in the treatment of leprosy patients. In this study, we describe the prevalence and type of pain in patients with leprosy, and its effect on patients’ quality of life in an endemic area of Northeast Brazil. Findings A cross-sectional survey of 260 patients attending leprosy reference centres in Sergipe, Northeast Brazil was conducted. Individuals were assessed for the presence and type of pain, skin sensory loss, peripheral nerve enlargement, touch and pinprick sensations, mechanical allodynia and nerve palpation. Participants completed the Douleur Neuropathique 4 questionnaire, and we also used the Brief Pain Inventory scale and the World Health Organization Quality of Life-BREF instrument to arrive at our results. One hundred and ninety-five (75 %) patients reported pain, mostly of the neuropathic type. Pain was moderate in 84 (43.1 %) and severe in 94 (48.2 %) participants. The presence of pain was associated with disability (p = 0.001), leprosy reactions (p = 0.004) and lower quality of life. Most patients with neuropathic pain were treated with steroids, despite their low efficacy for this type of pain. Conclusion Pain is highly prevalent among leprosy patients and is associated with low quality of life. Leprosy management should include a systematic assessment of the type of pain a patient experiences in order to provide adequate treatment

Hypercalcemia And Multiple Osteolytic Lesions In A Child With Disseminated Paracoccidioidomycosis And Pulmonary Tuberculosis

Objective: To describe the case of a child with paracoccidioido-mycosis who presented hypercalcemia with multiple osteolytic lesions. Description: A 6-year-old boy was admitted with a one-month history of fever and hepatosplenomegaly. On admission, he looked sick, pale, and had disseminated lymphadenopathy and hepatosplenomegaly. The laboratory findings included anemia (hemoglobin = 6.8 g/dl), eosinophilia (1,222/mm 3), thrombocytopenia (102,000/mm 3), and hypoalbumlnemia (serum albumin = 2.2 g/dl). Paracoccidioides brasiliensis was identified in bone marrow examination. In the second week after admission, the patient presented joint pain, poor activity and difficulty in walking. He presented hypercalcemia (maximum value = 14.9 mg%) and reduction in renal function, which lasted for two weeks. On the 42nd day after admission, his chest X-ray showed lytic lesions in clavicle, scapula, ribs, and humerus, with bilateral slipped capital humeral epiphysis. The patient presented nephrocalcinosis and nephrolithiasis, reduction in creatinine clearance and evidence of tubular lesions. At the end of the second month after admission, Mycobacterium tuberculosis was isolated in gastric lavage. The child received treatment for paracoccidioidomycosis and tuberculosis and has not had any sequelae for 3 years. Comments: The development of symptomatic hypercalcemia leading to renal lesion, associated with multiple osteolytic lesions, had never been described in paracoccidioidomycosis. Although pulmonary tuberculosis was diagnosed and could be related to hypercalcemia, the sudden onset of hypercalcemia and its normalization without specific treatment for tuberculosis suggests that bone lysis was the most important factor in the genesis of hypercalcemia. Copyright © 2005 by Sociedade Brasileira de Pediatria.814349352Brummer, E., Castaneda, E., Restrepo, A., Paracoccidioidomycosis: An update (1993) Clin Microbiol Rev, 6, pp. 89-117Bittencourt, A.L., Andrade, J.A., Filho, S.P., Paracoccidioidomycosis in a four-year-old boy (1986) Mycopathologia, 93, pp. 55-59Castro, R.M., Del Negro, G., Particularidades clínicas da paracoccidioidomicose na criança (1976) Rev Hosp Clin Fac Med, 31, pp. 194-198Hildebrando, T.M., Filho, N.A., Filho, F.Q., Costa, O., Miasaki, N., Mira, J.G., Paracoccidioidomicose na criança. Aspectos clínicos e laboratoriais em 25 casos (1987) J Pediatr, 63, pp. 92-97Londero, A.T., Melo, I.S., Paracoccidiodomycosis in childhood - A critical review (1983) Mycopathologia, 82, pp. 49-55Suva, A.F., (1976) Contribuição aos Estudos da Paracoccidioidomicose no Paraná e das Lesões Ósseas e Articulares Paracoccidióidicas [Tese de Livre Docência], , Curitiba (PR): Universidade Federal do ParanáPereira, R.M., Bucaretchi, F., Barison, E.M., Tresoldi, A.T., Paracoccidioidomycosis in children: Clinical presentation, follow-up and outcome (2004) Rev Inst Med Trop, 46, pp. 127-131. , S. PauloAdams, J.S., Gacad, M.A., Characterization of 1 α hydroxylation of vitamin D3 sterols by cultured alveolar macrophages from patients with sarcoidosis (1985) J Exp Med, 161, pp. 755-765Abbasi, A.A., Chemplavil, J.K., Muller, B.F., Arnstein, A.R., Hypercalcemia in active pulmonary tuberculosis (1979) Ann Intern Med, 90, pp. 324-328Bilezikian, J.P., Etiologies and therapy of hypercalcemia (1989) Endocrinol Metab Clin North Am, 18, pp. 389-414Murray, J.J., Heim, C.R., Hypercalcemia in disseminated histoplasmosis (1985) Am J Med, 78, pp. 881-884Silva, L.C., Ferrari, T.C., Hypercalcaemia and paracoccidioidomycosis (1998) Trans R Soc Trop Med Hyg, 92, p. 187Daher, R.R., Wasconcelos, W.M., Cardoso, V.M., Fígado e blastomicose sul-americana (1973) J Bras Med, 25, pp. 83-90Nahomi, N., Icterícia obstrutiva na doença de Lutz (1962) A Propósito de Dois Casos, 62, pp. 1243-1254. , Hospital (Rio de Janeiro)Pinto, W.P., (1980) Contribuição ao Estudo do Comprometimento Hepático na Paracoccidioidomicose [Dissertação], , São Paulo (SP): Universidade de São PauloDel Negro, G., Outras lesões. Formas de ocorrência rara e associações com outros processos (1982) Paracoccidioidomicose - Blastomicose Sulamericana, pp. 229-243. , Del Negro G, Lacaz CS, Fiorelo AM, editores. São Paulo: Savier - EduspHarrison, H.E., Harrison, H.C., Calcium and phosphate homeostasis (1979) Disorders of Calcium and Phosphate Metabolism in Childhood and Adolescence. 1st Ed., pp. 15-46. , Harrison HE, Harrison HC, editors. Philadelphia: W. B. SaundersKanis, J.A., Handy, M.A., Hypo-Hypercalcemia (1998) Oxford Textbook of Clinical Nephrology. 2nd Ed., pp. 225-249. , Oxford: Oxford University PressHarrison, H.E., Harrison, H.C., Hypercalcemic states (1979) Disorders of Calcium and Phosphate Metabolism in Childhood and Adolescence. 1st Ed., pp. 100-140. , Harrison HE, Harrison HC, editors. Philadelphia: W. B. SaundersAli, M.Y., Gopal, K.V., Llerena, L.A., Taylor, H.C., Hypercalcemia associated with infection by Criptococcus neoformans and Coccidioides immitis (1999) Am J Med Sci, 318, pp. 419-423Lawn, S.D., Macallan, D.C., Hypercalcemia: A manifestation of immune reconstitution complicating tuberculosis in an HIV-infected person (2004) Clin Infect Dis, 38, pp. 154-155Caldwell, J.W., Arsura, E.L., Kilgore, W.B., Reddy, C.M., Johnson, R.H., Hypercalcemia in patients with disseminated coccidioidomycosis (2004) Am J Med Sci, 327, pp. 15-1