Micetoma por Actinomadura madurae: relato de dois casos Actinomadura madurae mycetoma: report of two cases

São relatados dois casos de micetoma por Actinomadura madurae, atendidos no Hospital Universitário Clementino Fraga Filho (UFRJ), em 1990, e no Hospital Universitário Antonio Pedro (UFF), em 1984. Caso 1: paciente masculino, pardo, de 27 anos, iniciou o quadro em 1988, após traumatismo no pé esquerdo, com aumento de volume com nódulos apresentando fistulas drenando secreção e grãos branco-amarelados. A radiografia mostrou lesões líticas nos ossos do tarso e 2º e 3º metatarsianos do pé esquerdo. O exame histopatológico evidenciou grãos basofílicos recobertos por franja eosinofílica, arredondados, medindo até 1mm. Ao exame micológico foi isolado em cultivo A. madurae. Diante do fracasso de outras tentativas, foi instituida terapêutica com tetraciclina oral por 6 meses; contudo, como não houve resolução do quadro clínico-radiológico, foi indicada a amputação do membro. Caso 2: paciente masculino, branco, de 70 anos, iniciou quadro em 1974, após traumatismo no pé direito, que evoluiu com aumento de volume e fístulas. Ao exame histopatológico, grãos basofílicos com franjas eosinofílicas ao redor, tamanho grande, de 1 a 2mm de diâmetro, características de A. madurae. Discreta melhora com tetraciclina e sulfamídicos. Sem controle posterior. O primeiro caso adquiriu a infecção no Rio de Janeiro e o segundo caso a adquiriu em Pernambuco. Além de aspectos clínicos, diagnósticos e terapêuticos, é comentada a ocorrência dos micetomas nas Américas, destacando a freqüência dos actinomicetomas por A. madurae.<br>Actinomadura madurae mycetoma was diagnosed in two patients by the dermatologic outpatient clinic of the Clementino Fraga Filho University Hospital (UFRJ) and the Antonio Pedro University Hospital (UFF). The first case was a 27-year-old negro male from the out-skirsts of Rio de Janeiro, who was injured prior to the onset of the disease in 1988. The affected left foot showed swelling, nodules, sinus tracts, purulent discharge containing grains, and serious bone involvement with lytic lesions. Histo-logical examination showed deeply basophylic stained grains with typical widefringed borders. The mycological examination revealed an actinomycete identified as A. madurae by culture. Oral tetracycline for six months did not improve the clinical-radiological picture and the patient was submitted to amputation. The second case was a 70-year-old white male, with previous injury en 1974, which occurred in Pernambuco State. Enlargement of the right foot draining sinuses formation with discharge of pus and grains. In tissue sections the grains were large and surrounded by amorphous eos-inophylic clubs radially oriented. There was discrete improvement by tetracycline and sulfonamide. No follow-up

Gerontobiology of the Hair Follicle

NoThe word ¿gerontology¿ is familiar to most of us as a term that captures the study of the social, psychological, and biological aspects of aging. However, its derivative ¿gerontobiology¿ as applied to the hair follicle is more concerned with the latter aspect ¿ the biology of aging in the hair follicle mini-organ. As with any complex multicellular tissue system, the hair follicle is prone to broadly similar underlying processes that determine the functional longevity of organs and tissues. No matter how complex the tissue system is, it will contain cells that eventually lose functionality, reproductive potential and will ultimately die. The hair follicle is somewhat unusual among mammalian tissues in that it is a veritable histologic mélange of multiple cell types (e.g., epithelial, mesenchymal and neuro-ectodermal) that function contemporaneously in all stages of their life histories e.g., stem cells, transit-amplifying cells, and terminally differentiating cells. Some of these interactive cell systems appear to be nonessential for overall hair follicle survival (e.g., melanocytes). However, strikingly graying hair follicles may grow even more vigorously than their pigmented predecessors. Moreover, the hair follicle is unique in the adult mammal in that it follows a tightly regulated script of multiple lifelong cycles of cellular birth, proliferation, differentiation, and death. Powerful evolutionary selection ensures that the hair follicle is, in the main, hardwired against significant aging-related loss of function, even after 12 or more decades of life ¿ although some would argue with this view, if only on purely cosmetic grounds. Processes underlying aging in general, e.g., oxidative damage, telomere shortening, age-relating deficiencies related to nuclear/mitochondrial DNA damage and repair as well as age-related reductions in the cells¿ energy supply, will all impact on whether some follicular cell subpopulations will enter cellular senescence. This chapter will focus on how gerontobiology of the hair follicle may impact on certain aspects of hair fiber phenotype