A case of eosinophilic granuloma of the skull in an adult man: a case report

Eosinophilic granuloma is very rare benign bone tumor which presents in more than 90% in children under the age of ten. There is predominance for males. It is usually found at flat and long bones. The skull and vertebral spine is often affected. We report a case of 57 year-old man who gradually developed local pain at his skull and orbit. A soft, movable, palpable and tender mass was found at the left temporal bone. The pain deteriorated after an accidental injury at skull and remained so. The clinical examination revealed no pathological findings. The patient was a doctor who smoked and consumed alcohol daily. He had a history of cardial infraction and psoriatic arthritis. X-rays and CT revealed a round lytic defect at the skull. Its borders were sharp and its size was 1.6 × 1.8 cm. No periostic reaction or bone formation was noted. Scintigraphy depicted a lytic lesion without radionuclide enhancement. Thus we suspected an eosinophilic granuloma. An attempt to excise the tumor failed as it had already eroded the underlying temporal bone. The external meninga was affected but not the internal one. Histological diagnosis with dominance of Langerhans cells set the diagnosis. A second surgery was done and the eosinophilic granuloma was extracted. After eight months the gap was bridged with plastic heterologous transplant. After the curettage the patient received antibiotics and five cycles of radiotherapy. The aesthetic result was excellent. The patient's head has a normal hairy appearance. No tenderness, swelling or recurrence is recorded until now

Intraspecific crosses resulting in the first occurrence of eight and nine B chromosomes in Prochilodus lineatus (Characiformes, Prochilodontidae)

B chromosomes are supernumerary elements present in about 15% of eukaryotic species and are most frequently heterochromatic, behave parasitically, show a transmission rate higher than standard (A) chromosomes, and can provoke harmful effects on carriers. In the current work, Prochilodus lineatus individuals carrying eight and nine B chromosomes were obtained by induced crossing performed involving breeders with different B chromosome numbers in their cells. The high B chromosome numbers found in the offspring were recorded for the first time in this species. The use of cytogenetic techniques applied in the present study revealed that regardless of the increase in number of B chromosomes in the genome of these individuals, those elements did not presented active genes, and showed their normal heterochromatic characteristic

S-nitrosylation of NADPH oxidase regulates cell death in plant immunity

Changes in redox status are a conspicuous feature of immune responses in a variety of eukaryotes, but the associated signalling mechanisms are not well understood. In plants, attempted microbial infection triggers the rapid synthesis of nitric oxide and a parallel accumulation of reactive oxygen intermediates, the latter generated by NADPH oxidases related to those responsible for the pathogen-activated respiratory burst in phagocytes. Both nitric oxide and reactive oxygen intermediates have been implicated in controlling the hypersensitive response, a programmed execution of plant cells at sites of attempted infection. However, the molecular mechanisms that underpin their function and coordinate their synthesis are unknown. Here we show genetic evidence that increases in cysteine thiols modified using nitric oxide, termed S-nitrosothiols, facilitate the hypersensitive response in the absence of the cell death agonist salicylic acid and the synthesis of reactive oxygen intermediates. Surprisingly, when concentrations of S-nitrosothiols were high, nitric oxide function also governed a negative feedback loop limiting the hypersensitive response, mediated by S-nitrosylation of the NADPH oxidase, AtRBOHD, at Cys 890, abolishing its ability to synthesize reactive oxygen intermediates. Accordingly, mutation of Cys 890 compromised S-nitrosothiol- mediated control of AtRBOHD activity, perturbing the magnitude of cell death development. This cysteine is evolutionarily conserved and specifically S-nitrosylated in both human and fly NADPH oxidase, suggesting that this mechanism may govern immune responses in both plants and animals

Espondilite tuberculosa: uma revisão de 31 pacientes do Hospital Santa Marcelina Espondilitis tuberculosa: una revisión de 31 pacientes del Hospital Santa Marcelina Tuberculous spondylitis: a report of thirty one cases from Santa Marcelina Hospital

INTRODUÇÃO: a infecção da coluna vertebral pelo bacilo de Koch costuma ser devastadora, sendo necessários seu diagnóstico e tratamento precoce. OBJETIVO: avaliar o tratamento e o seguimento em relação à dor, cifose residual, imagem por ressonância magnética (RM), e a importância da biópsia correlacionando-a com o tratamento clínico. Métodos: estudo retrospectivo de 31 pacientes com diagnóstico de espondilite tuberculosa, fazendo uma análise estatística dos dados descritivos: sexo, idade, status neurológico, segmento vertebral acometido, presença de abscesso e cifose residual, e suas correlações clínicas importantes comparando nossos casos com a literatura e correlacionando seus dados, tais como sexo e faixa etária mais comum, se a presença do abscesso influencia no déficit neurológico ou na cifose residual. RESULTADOS: a amostra identificou uma incidência em 23 homens e 8 mulheres. Foi identificado abscesso frio em 4 pacientes, sendo os que apresentaram uma grave deformidade final: a biopsia percutânea foi realizada em 19 pacientes com positividade em 5, não influenciando o tratamento do paciente. A dor pós-tratamento clínico apresentou melhora importante; foi utilizado esquema tríplice por um ano. CONCLUSÃO: o tratamento clínico da tuberculose deve ser iniciado assim que se suspeitar da doença e tiver imagens compatíveis com: corpo vertebral, diminuição da altura do espaço discal e elevação do ligamento longitudinal anterior. Na presença de cifose, o uso de um colete rígido deve ser ponderado, sendo ele o de Boston ou um colete gessado. A avaliação neurológica deve ser acompanhada com um intervalo curto, quinzenalmente nos primeiros três meses, pois se o tratamento clínico for ineficaz e o paciente apresentar déficit neurológico, o tratamento cirúrgico deve ser considerado. A biopsia é um exame de alta especificidade, mas de baixa sensibilidade. Quando positiva, reforça o tratamento medicamentoso.<br>INTRODUCCIÓN: la infección de la columna vertebral por el bacilo de Koch acostumbra ser devastadora, siendo necesario el diagnóstico y tratamiento precoz. OBJETIVO: evaluar el tratamiento y el seguimiento en relación al dolor, cifosis residual, imagen en la resonancia magnética (RM) y la importancia de la biopsia correlacionándola con el tratamiento clínico. MÉTODOS: estudio retrospectivo de 31 pacientes con diagnóstico de espondilitis tuberculosa haciendo un análisis estadístico de los datos descriptivos: sexo, edad, estatus neurológico, segmento vertebral comprometido, presencia de absceso y cifosis residual, así como sus correlaciones clínicas importantes comparando nuestros casos con la literatura y correlacionando sus datos con lo referente al sexo y la tasa etaria donde fue más común, si la presencia del absceso influyó en el déficit neurológico o en la cifosis residual. RESULTADOS: la muestra identificó una incidencia en 23 hombres y 8 mujeres. Fue identificado absceso frío en cuatro pacientes, siendo los que presentaron una grave deformidad final; la biopsia percutánea fue realizada en 19 pacientes con positividad en 5, no influyendo en el tratamiento del paciente. El dolor post tratamiento clínico presentó una mejoría importante; fue utilizado un esquema triple por un año. CONCLUSIÓN: el tratamiento clínico de tuberculosis debe ser iniciado así que la enfermedad fuera sospechada y tuviera imágenes compatibles con: el cuerpo vertebral, la disminución de la altura del espacio discal, y con la elevación del ligamento longitudinal anterior. En la presencia del cifosis, el uso de un chaleco rígido debe ser ponderado, siendo un Chaleco de Boston o un chaleco de yeso. La evaluación neurológica debe ser acompañada de un intervalo pequeño, quincenalmente en los primeros tres meses, pues si el tratamiento clínico fuera ineficaz y el paciente presentara déficit neurológico, el tratamiento quirúrgico debería ser considerado. La biopsia es un examen de alta especificidad, pero de baja sensibilidad. Si fuera positiva, refuerza el tratamiento medicamentoso.<br>INTRODUCTION: the infection of the spine by the mycobacterium tuberculosis is often devastating, requiring early diagnosis and treatment. Objective: to assess the treatment and follow-up regarding the pain, residual kyphosis, image of magnetic resonance imaging (MRI), and importance of biopsy relating to the clinical treatment. METHODS: retrospective study of 31 patients with diagnosis tuberculous spondylitis making a statistical analysis, studying the data descrition: gender, age, neurological status, spinal segment and kyphosis abscess, presence of residual kyphosis and their clinical correlations, comparing our major cases with literature and relashionship, and if the presence of abscess can influence in on neurological deficit or residual kyphosis. RESULTS: the sample identified an incidence in 23 men and 8 women; cold abscess was identified in 4 patients, and how those with a severe deformity final percutaneous biopsy was performed in 19 patients with positivity in 5, with no influence patient treatment. The pain after treatment showed significant improvement and we used triple drug regimen for one year. CONCLUSIONS: the clinical treatment of tuberculosis should start once the disease is suspected and have compatible images with: vertebral body, decreased disc space height, and elevation of the anterior longitudinal ligament. In the presence of kyphosis using a weighted vest to be hard, being the Boston vest or a plaster cast. The neurological evaluation should be accompanied, and with a short interval, fortnightly during the first three months, because if the clinical treatment is ineffective and the patient has neurological deficit surgical treatment should be considered. The biopsy is a test of high specificity but low sensitivity. When the test is positive it reinforces drug treatment

An evaluation of factors influencing perceptual experiences and future plans of final-year medical interns in the Free State, 2013–2014

Background: Medical internship refers to the 24-month period of supervised training in an accredited facility, where newly qualified doctors rotate through all relevant medical domains before starting their community service as medical practitioners. The Free State province has one academic complex and three regional hospitals accredited for internship training.Objectives: To evaluate the experience and future plans of final-year interns enrolled in a two-year medical internship programme in the Free State, and whether they felt sufficiently prepared to be medical doctors. Methods: This study was a cross-sectional study. A questionnaire was distributed to all consenting interns from the Free State completing their second year of internship during 2013 and 2014.Results: A total of 80 second-year internship doctors from four healthcare facilities completed the questionnaire. The majority (87.2%) indicated that they believe internship prepared them well for community service and 65.0% were positive about the supervision they received. However, only 52.5% felt that they were properly orientated.Conclusion: Medical interns felt positive about their experiences at their allocated Free State healthcare facilities and acknowledged they were better prepared for their careers. In some domains, insufficient supervision and lack of orientation impacted on the internship experience. Workload, lack of resources, insufficient staff and work environment at institutions are the main push factors