Brain abscess nocardiosis: case report

Nocardiosis is an infection caused by Nocardia species, that are filamentous aerobic Gram-positive bacilli that belong to Actinomycetaceae family, it can cause a localized or a disseminated infection. Pulmonary disease is the most common presentation of nocardiosis in immunosuppressed patients and approximately one-third have a disseminated disease, that happens when lesions are found at two or more locations in the body. Nocardial brain abscesses are a rare central nervous system infection but has been highlighted as a differential diagnosis of brain tumors, due to the increase of the infection in deficient cell-mediated immunity patients. Even though nocardiosis represents only 2% of brain abscesses, it is an illness associated with significant mortality, present on 75% to 90% of cases. We present a case of central nervous system nocardiosis in a 59-year-old patient with a previous history of diabetes mellitus and alcoholic liver disease. The patient sought the emergency department with temporal occipital headache and mental confusion for 3 days. Imaging tests were performed that showed an oval lesion in the temporoparietooccipital region. Nocardiosis in the central nervous system was hypothesized and treatment was initiated. Despite medical support, the patient died. The lesion material was collected in which nocardiosis was diagnosed when analyzed histochemically.Nocardiose é uma infecção causada por espécies de Nocardia, que são bacilos gram-positivos aeróbicos que pertencem à família Actinomycetaceae, que podem causar uma infecção localizada ou disseminada. A doença pulmonar é a apresentação mais comum de nocardiose em pacientes imunossuprimidos e, aproximadamente, um terço tem uma doença disseminada, que acontece quando lesões são encontradas em dois ou mais locais do corpo. Os abscessos cerebrais causados por nocardiose são uma rara infecção do sistema nervoso central, mas tem sido destacado como um diagnóstico diferencial de tumores cerebrais, devido ao aumento de infecções em pacientes de imunidade mediada por células deficientes. Mesmo que a nocardiose em sistema nervoso central represente apenas 2% dos casos de abscesso cerebral é uma doença associada à mortalidade significativa, presente em 75% a 90% dos casos. Apresentamos um caso de nocardiose em sistema nervoso central em um paciente de 59 anos com história pregressa de diabetes mellitus e hepatopatia alcoólica. O paciente procurou o serviço de emergência com cefaléia temporoocciptal e confusão mental há 3 dias.Foram realizados exames de imagem que mostraram uma lesão oval na região temporoparietooccipital. Foi realizada a hipótese de nocardiose em sistema nervoso central e iniciado tratamento. Apesar do suporte médico, o paciente evoluiu para óbito. Foi feita coleta do material da lesão no qual ao ser análisada histoquimicamente houve o diagnóstico de nocardiose

Immunohistochemical expression of types I and III collagen antibodies in the temporomandibular joint disc of human foetuses

The objective was to study the morphology of the articular disc and analyse the immunohistochemical expression of types I and III collagen markers in the temporomandibular joint (TMJ) disc of human foetuses of different gestational ages. Twenty TMJ from human foetuses supplied by Universidade Federal de Uberaba with gestational ages from 17 to 24 weeks were studied. the gestational age of the foetuses was determined by measuring the crown-rump (CR) length. Macroscopically, the foetuses were fixed in 10% formalin solution and dissected by removing the skin and subcutaneous tissue and exposing the deep structures. Immunohistochemical markers of type I and III were used to characterize the existence of collagen fibres. Analysis of the immunohistochemical markers of types I and III collagen revealed the presence of heterotypical fibril networks.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Dept Morfol & Genet, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Patol, Lab Patol Mol, BR-04023900 São Paulo, BrazilSanta Casa São Paulo, Dept Ciencias Patol, São Paulo, BrazilUniv Complutense Madrid, Dept Anat & Embryol 2, E-28040 Madrid, SpainUniversidade Federal de São Paulo, Dept Morfol & Genet, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Patol, Lab Patol Mol, BR-04023900 São Paulo, BrazilWeb of Scienc

Granule cell dispersion is associated with memory impairment in right mesial temporal lobe epilepsy

Purpose: We analyzed the association of granule cell dispersion (GCD) with memory performance, clinical data and surgical outcome in a series of patients with mesial temporal lobe epilepsy (MILE) and mesial temporal sclerosis (MTS).Method: Hippocampal specimens from 54 patients with MTLE (27 patients with right MILE and 27 with left MTLE) and unilateral MTS, who were separated into CCD and no-GCD groups and thirteen controls were studied. Quantitative neuropathological evaluation was performed using hippocampal sections stained with NeuN. Patients' neuropsychological measures, clinical data, type of MTS and surgical outcome were reviewed.Results: CCD occurred in 28 (51.9%) patients. No correlation between GCD and MTS pattern, clinical data or surgical outcome was found. the presence of GCD was correlated with worse visuospatial memory performance in right MTLE, but not with memory performance in left MTLE.Conclusion: GCD may be related to memory impairment in right MTLE-MTS patients. However, the role of GCD in memory function is not precisely defined. (c) 2012 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Instituto Nacional de Neurociencia Translacional (INNT), BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, Escola Paulista Med, Unidade Pesquisa & Tratamento Epilepsias, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, Escola Paulista Med, BR-04024002 São Paulo, BrazilSanta Casa São Paulo, Dept Pathol, São Paulo, BrazilAFIP, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosci, Escola Paulista Med, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, Escola Paulista Med, Unidade Pesquisa & Tratamento Epilepsias, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, Escola Paulista Med, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosci, Escola Paulista Med, BR-04024002 São Paulo, BrazilWeb of Scienc

Encefalometria na face medial do hemisfério cerebral humano: estudo em necropsias

This study aims to evaluate the dimensions of the human brain, specifically in the frontal cortex, helping the analysis of neuroimaging. A form was made to register and describe encephalic measurements and 81 cerebral hemispheres (CH) were analyzed. Male individuals showed larger CH length; wider superior frontal gyrus in the right CH; bigger encephalic weight and corpus callosum (CC) width. The proportion of measurement from the frontal pole to the most anterior part of the CC genu, related to the CH length gets smaller with aging, whereas the average distance from the most posterior part of the splenum of the CC to the occipital pole was bigger in both male CHs and there was a tendency of decrease in this difference with aging.Este estudo visa avaliar as dimensões do cérebro humano, particularmente do córtex frontal, podendo colaborar para as análises de neuroimagem. Foi elaborado um formulário para registro e descrição das medidas encefálicas. A amostra foi constituída por 81 hemisférios cerebrais (HC) adultos. Os homens apresentaram maior comprimento do HC; giro frontal superior mais largo no HC direito; maior peso encefálico e largura do corpo caloso (CC). A proporção da medida do pólo frontal à parte mais anterior do joelho do CC, em relação ao comprimento do HC diminui com o avanço da idade. Já a da média da distância da parte mais posterior do esplênio do CC ao pólo occipital foi maior em ambos HC dos homens e houve tendência à diminuição desta proporção com o avanço da idade

Expression of cell adhesion proteins and proteins related to angiogenesis and fatty acid metabolism in benign, atypical, and anaplastic meningiomas

Most meningiomas are benign tumours of arachnoidal origin, although a small number have high proliferative rates and invasive properties which complicate complete surgical resection and are associated with increased recurrence rates. Few prognostic indicators exist for meningiomas and further research is necessary to identify factors that influence tumour invasion, oedema and recurrence. Paraffin sections from 25 intracranial meningiomas were analysed for expression of the proteins vascular endothelial growth factor (VEGF), VEGF receptors Flt1 and Flk1, E-cadherin, metalloproteinases 2 and 9 (MMP2, MMP9), CD44, receptor for hyaluronic acid-mediated motility (RHAMM), hyaluronic acid (HA), CD45, cyclooxygenase 2 (COX2), brain fatty acid binding protein (BFABP), Ki67, and proliferating cell nuclear antigen (PCNA). Correlations among protein expression were found for several markers of proliferation (Ki67, PCNA, MI) and microvessel density (MVD). COX2 expression increased with increasing with tumour grade and correlated with Ki67, PCNA, MI, MVD, and BFABP. BFABP expression also correlated with Ki67 and PCNA expression. Relationships were also identified among angiogenic factors (VEGF, Flt1, Flk1) and proliferation markers. Oedema was found to correlate with MMP9 expression and MMP9 also correlated with proliferation markers. No correlations were found for MMP2, E-cadherin, or CD44 in meningiomas. In conclusion Ki67, PCNA, MI, MVD, BFABP, and COX2 were significantly correlated with meningioma tumour grade and with each other. These findings, by correlating both intracellular fatty acid transport and eicosanoid metabolism with tumour proliferation, as determined by Ki67 labelling and mitotic index, suggest fatty acids are involved in the progression of meningiomas

Expressão de mediadores neurotróficos e pró-inflamatórios na endometriose de reto e sigmoide Expression of neurotrophic and inflammatory mediators in rectosigmoid endometriosis

OBJETIVO: Avaliar a expressão de mediadores neurotróficos (NGF, NPY E VIP) e pró-inflamatórios (TNF-&#945;) em fragmentos de reto e sigmoide comprometidos por endometriose. MÉTODOS: Foram selecionadas 24 pacientes submetidas ao tratamento cirúrgico de endometriose de reto e sigmoide com técnica de ressecção segmentar, seguido de anastomose mecânica término-terminal, com grampeador circular, no período de janeiro de 2005 a dezembro de 2007. Neste estudo incluímos mulheres no menacme que se submeteram a tratamento cirúrgico por endometriose profunda infiltrativa com acometimento do reto e sigmoide, atingindo o nível da camada muscular, submucosa ou mucosa. Para o grupo de estudo foram utilizados 24 fragmentos de reto e sigmoide com endometriose confirmada histologicamente, sendo um fragmento de cada uma das 24 pacientes selecionadas. Para o grupo controle, utilizou-se um fragmento da margem distal da ressecção, denominado anel de anastomose, de cada uma das 24 pacientes selecionadas e incluídas no estudo. As amostras foram agrupadas em blocos de Tissue Micro Array (TMA) e submetidas à reação imunoistoquímica para avaliar a expressão do fator de necrose tumoral alfa (TNF-&#945;), do fator de crescimento neural (NGF), do neuropeptídeo Y (NPY) e do peptídeo intestinal vasoativo P (VIP), e posterior análise semiquantitativa da imunomarcação por meio da leitura da densidade ótica relativa (DO). RESULTADOS: Observou-se maior densidade ótica relativa da imunomarcação para TNF-&#945; e NGF no grupo de estudo (amostras com endometriose intestinal), DO= 0,01, respectivamente, para as duas proteínas (p<0,05), em relação aos controles sem endometriose. Não houve diferença estatística na densidade ótica da imunomarcação do NPY e VIP. CONCLUSÃO: Identificou-se o aumento da imunomarcação dos anticorpos TNF-&#945; e NGF em fragmentos de reto e sigmoide comprometidos por endometriose em relação aos controles livres da doença. Não identificamos diferença estatística na imunomarcação das proteínas NPY e VIP.<br>PURPOSE: To evaluate the expression of neurotrophic (NGF, NPY and VIP) and pro-inflammatory (TNF-&#945;) mediators in the rectum and sigmoid fragments compromised by endometriosis. METHODS: Twenty-four patients were selected to undergo surgical treatment of endometriosis of the rectum and sigmoid colon with a segmental resection technique, followed by end-to-end anastomosis with a circular stapler from January 2005 to December 2007. The study included premenopausal women who underwent surgical treatment for deep endometriosis infiltrating the rectum with involvement of the rectum and sigmoid, reaching the level of the muscle layer, submucosa or mucosa. Twenty-four rectum and sigmoid fragments with histologically confirmed endometriosis, one from each of the 24 selected patients, were used for the study group. For the control group, we used a fragment of the distal resection margin called anastomosis ring from each of the 24 patients enrolled in the study. Samples were grouped into Tissue Micro Array (TMA) blocks and subjected to immunohistochemistry to evaluate the expression of tumor necrosis factor alpha (TNF-&#945;), nerve growth factor (NGF), neuropeptide Y (NPY) and P vasoactive intestinal peptide (VIP), followed by semiquantitative analysis of immunostaining by reading the relative optical density (OD). RESULTS: There was higher optical density relative to TNF-&#945; immunostaining and NGF in the study group (samples with intestinal endometriosis), DO=0.01, for the two proteins, respectively (p<0.05), compared to controls without endometriosis. There was no statistically significant difference in the optical density of immunostaining of NPY and VIP. CONCLUSION: We identified increased immunostaining of TNF-&#945; antibodies and fragments of NGF in the rectum and sigmoid compromised by endometriosis compared to disease-free controls. We did not identify any statistical difference in immunostaining of NPY and VIP proteins