Estudos imunopatológicos de biópsias de pacientes chagásicos crônicos ou com miocardiopatia dilatada idiopática

Foram estudadas biópsias de ventrículo direito de 30 pacientes, 15 com doença crônica de Chagas e 15 com miocardiopatia congestiva idiopática. Analisou-se também cinco fragmentos miocárdicos obtidos de pacientes chagásicos com menos de duas horas de óbito. Os Autores tentaram estabelecer, por meio de técnica de imunofluorescência direta, a presença de imunoglobulina G, A, e M, fibrinogênio e C3. Somente uma das 30 biópsias exibiu reação positiva para IgG que era de um paciente com miocardiopatia congestiva idiopática. Toods os fragmentos provenientes de pacientes chagásicos não apresentaram qualquer fluorescência com nenhum dos conjugados. Esses achados falam contra o conceito de que anticorpos antimiocárdio teriam importância patogenética na evolução das miocardiopatias chagásica ou dilatada idiopática.Right ventricular endomyocardial biopsies were studied in 30 patients, 15 with myocardiopathy from chronic Chagas'disease and 15 with idiopathic congestive myocardiopathy; five other myocardial samples were taken at necropsies of patients with chronic Chagas' disease. The authors tried to establish by means of direct immunofluorescence techniques whether there were immunoglobulins G, A and M, fibrinogen and C3 complement deposition in the myocardium; only one of these 30 patients exhibited a positive reaction to IgG, it was a patient with idiopathic congestive myocardiopathy. All fragments from patients with Chagas' disease showed no response to any of the fluorescent conjugates. These findings do not support the idea that anti-myoeardial antibodies have pathogenic importance in the evolution of dilated or chagasic myocardiopathies

Spontaneous Recanalization after Vasectomy

Vasectomy is the method most commonly used in men for voluntary sterilization purposes. We report two cases of early recanalization following vasectomies performed in 1085 men for sterilization purposes at a tertiary public institution between January 2000 and November 2003. Thus, the risk of 0.2% of failure due to early recanalization should be explained and the fertility implications stressed. Written documentation recording the clarification presented at consultation is essential. KEYWORDS: vasectomy, infertility, failure, sterile, sperm INTRODUCTION Of all the methods of contraception, vasectomy is the safest, easiest, cheapest, most effective, and most reliable. It is usually uncomplicated; the discomfort after surgery usually abates promptly and there are generally no sequelae. Further, few patients suffer from bleeding or infection at the vasectomy site. Testicular pain is the most common complication after vasectomy. Although these complications can be serious, the usual conservative management leads to spontaneous cure Vasectomy may fail to result in sterility for three reasons, i.e., by failure to divide either vas, by vasal recanalization caused by the formation of microchannels between the severed ends, and by unrecognized anatomic variation. Although definitions vary among investigators, early failure of the procedure is considered to have occurred when significant numbers of spermatozoa or any motile spermatozoa persist continuously later than 4 months after vasectomy The purpose of our study is to report our experience with vasectomy spontaneous recanalization among 1085 patients treated with vasectomy for sterilization purposes. METHODS Between January 2000 and November 2003, 1085 patients were submitted for vasectomy for sterilization purposes at a tertiary public institution. All patients were over 25 years old or had two or more children. Our institution has a standard protocol for the performance of vasectomy after referral that includes Lucon et al.: Spontaneous Recanalization after Vasectomy TheScientificWorldJOURNAL (2006) 6, 2366-2369 2367 counseling and informed consent. Vasectomy procedure was performed under local anesthesia by a single physician (EDSM). Two 1-cm transversal hemiscrotal incisions were made. A 1-cm vas deferens segment was excised, followed by ligature, but not cauterization, of the cut ends using polypropilene 4-0 transfixed suture. Interposition of fascia was not done. Although the segments excised were not sent for pathological confirmation, the surgeon confirmed it to be vas deferens by passing a suture through its lumen. After vasectomy, patients were advised to maintain their use of contraceptives until they were considered sterile. Sperm samples were obtained before and 2 months after the procedure, and at the 4 th month if the result was other than azoospermia. RESULTS Vasectomy early recanalization occurred in 2 out of 1085 patients (0.2%). The first patient was 40 years old, his wife was 38, and they had four children. The second was 34 years old, his wife 28, and they had two children. A seminal sample was obtained from each patient before the vasectomy procedure and two additional samples were taken 2 and 4 months, respectively, after the surgery. The data of the sperm analysis are summarized i

Leiomyoma of the bladder. Case report and literature review

We present a case of leiomyoma of the bladder consideringdiagnosis, treatment and literature review. A leiomyoma of thebladder was diagnosed in a 60-year-old woman based on physicalexamination, urinary tract imaging (ultrasonography, computedtomography and magnetic resonance imaging) andcystourethroscopy with biopsy of the lesion. Cystourethroscopyshowed a bladder tumor covered by normal epithelium.Management included complete transurethral resection with norelapse after a seven-month follow-up

Multicentric pheochromocytoma and involvement of the inferior vena cava

CONTEXT: Extension of pheochromocytomas to the inferior vena cava is rare. Multicentric tumors are rare as well, being present in up to 10% of cases. Surgery is the treatment of choice because of the long-term survival free of disease. DESIGN: Case report. CASE REPORT: We report on a case of right adrenal pheochromocytoma with extension to the supra-diaphragmatic vena cava, which underwent surgical excision through thoracophrenic laparotomy without the need for cardiopulmonary bypass. In a 6-year follow-up, another pheochromocytoma was found in the infra-renal Zuckerkandl's organ. Complete surgical excision of the tumor was performed by a median laparotomy and complete retroperitoneal dissection. In both cases, the total removal of the pheochromocytoma has been guaranteed by having margins free of tumor and a normal post-operative level of catecholamines. The pathological study revealed a malignant pheochromocytoma with margins free of neoplasia in both specimens

Multicentric pheochromocytoma and involvement of the inferior vena cava

CONTEXT: Extension of pheochromocytomas to the inferior vena cava is rare. Multicentric tumors are rare as well, being present in up to 10% of cases. Surgery is the treatment of choice because of the long-term survival free of disease. DESIGN: Case report. CASE REPORT: We report on a case of right adrenal pheochromocytoma with extension to the supra-diaphragmatic vena cava, which underwent surgical excision through thoracophrenic laparotomy without the need for cardiopulmonary bypass. In a 6-year follow-up, another pheochromocytoma was found in the infra-renal Zuckerkandl's organ. Complete surgical excision of the tumor was performed by a median laparotomy and complete retroperitoneal dissection. In both cases, the total removal of the pheochromocytoma has been guaranteed by having margins free of tumor and a normal post-operative level of catecholamines. The pathological study revealed a malignant pheochromocytoma with margins free of neoplasia in both specimens