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Biomedical subjects

N M de Souza

Publications and source records attributed to N M de Souza.

12 recordsLinked to original sources
PubMed1999

Hepatic capillariasis in children: report of 3 cases in Brazil.

Capillaria hepatica is a helminth that may cause an extremely rare condition of parasitic hepatitis. Only 29 cases have been published, 2 of them in Brazil. We report here 3 cases of children in Brazil with massive hepatic capillariasis who presented the characteristic triad of this type of infection, i.e., persistent fever, hepatomegaly, and eosinophilia. The diagnosis was made by liver biopsy. All children responded well after treatment with thiabendazole (case 1), albendazole (case 3), and albendazole in combination with a corticoid (case 2). Case 1 has been followed-up for 24 years, an event not previously reported in the literature.

Albendazole↗
PubMed1996

Endoscopic laser ablation of the prostate (ELAP): changes in magnetic resonance imaging and clinical outcome at 1 year.

OBJECTIVE: To assess the ability of magnetic resonance imaging (MRI) to detect tissue changes immediately after laser ablation of the prostate and to correlate these changes with clinical outcome by detecting changes that may improve the outcome by allowing the laser dosimetry to be adjusted during therapy by monitoring effects on gland morphology. PATIENTS AND METHODS: Eight men with proven bladder outlet obstruction had a standard four-quadrant laser ablation of the prostate with a side-firing non-contact fibre. MRI scans were performed before, during and immediately after treatment and again after one week, 3 months and one year. RESULTS: The clinical outcome was a decrease in the American Urological Association (AUA)-7 symptom score from a pre-operative mean of 21.3-12.0 1 year after treatment and a corresponding increase in peak urinary flow rates from a mean of 8.9 mL/s to 12.3 mL/s. Immediately after treatment, MRI showed marked swelling of the gland (mean increase in volume 34%, range 12-75) with the loss of internal architecture. A low-signal thin periurethral band was present in six of the eight patients after 1 week and was replaced by a wider periurethral ring at 3 months in four of the six patients. No patient had evidence of prostatic cavitation after treatment or a significant reduction in prostate volume at 1 year. CONCLUSION: MRI can detect tissue changes after laser ablation of the prostate. The marked swelling seen on MRI immediately after laser prostatectomy may explain the delayed improvement in symptoms. The periurethral ring may indicate the depth to which laser energy has an effect on the tissue and could delineate an area of necrosis. The lack of cavitation at one year questions the durability of the effect of laser treatment delivered in this way.

Aged↗
PubMed1995

Uterine junctional zone: function and disease.

The myometrium is usually thought of as a homogeneous mass of smooth muscle fibres. However, magnetic resonance studies of the uterus have revealed two distinct zones--the subendometrial myometrium or junctional zone and the outer myometrium. The junctional zone is not only structurally but also functionally different from the outer myometrium. For instance, myometrial contractions in a non-pregnant woman originate exclusively from the junctional zone, and their amplitude, frequency, and direction depend on the phase of the cycle. Irregular thickening of the junctional zone has been proposed as the magnetic resonance criterion for the diagnosis of diffuse adenomyosis. However, this magnetic resonance appearance relies on the disruption of the inner myometrial architecture secondary to smooth muscle hyperplasia but does not provide proof of mucosal invasion of the myometrium. We postulate that adenomyosis is a dichotomous disease characterised primarily by disruption of the inner myometrial architecture and function, with secondary infiltration of endometrial elements into the myometrium under certain circumstances. This hypothesis focuses on the inner myometrium and may explain the high incidence of superficial adenomyosis in dysfunctional uterine bleeding.

Endometriosis↗
PubMed1995

The potential value of magnetic resonance imaging in infertility.

The potential value of magnetic resonance imaging as a diagnostic tool in infertility was investigated. Twenty-six women with primary or secondary infertility and symptoms of dysmenorrhoea or menorrhagia were studied prospectively using conventional T1- and T2-weighted spin-echo techniques. Positive diagnoses were obtained in 20 of 26 (76.9%) patients. Of these, 18 (69.2%) had lesions likely to be significantly contributing to infertility. Adenomyosis was detected in 14 patients (53.8%) with 11 showing the diffuse pattern while three had discrete adenomyomas. Cystic lesions typical of endometriosis were detected in seven patients (26.9%), four of these also had evidence of adenomyosis. The endometriotic lesions were also seen at laparoscopy in each case. Five patients (19.2%) had leiomyomas, one in a patient with adenomyosis and endometriosis and one in a patient with endometriosis alone. Only one patient had submucous leiomyomas causing significant distortion of the endometrial mucosa likely to affect fertility. Magnetic resonance imaging is valuable in the investigation of unexplained infertility where it provides a high diagnostic yield particularly if uterine pathology is suspected.

Adult↗
PubMed1995

Endovaginal ultrasonography in the diagnosis of adenomyosis uteri: identifying the predictive characteristics.

OBJECTIVE: To evaluate prospectively the role of endovaginal ultrasonography in the diagnosis of adenomyosis and to identify predictive characteristics. SETTING: In Vitro Fertilisation Unit, Hammersmith Hospital. SUBJECTS: Fifty-six women with menorrhagia and dysmenorrhea. DESIGN: Endovaginal sonography was performed and uterine body morphometry and myometrial echogenicity were assessed. The sonographic suspicion of adenomyosis was scored high or low depending on the degree of uterine enlargement, uterine asymmetry not due to fibroids and heterogenicity of myometrial echoes. The sonographic diagnosis was compared either with the histological findings after hysterectomy (n = 34) or to the appearances on magnetic resonance imaging (n = 22). RESULTS: Adenomyosis was diagnosed in 28 patients: 15 by histology and 13 by magnetic resonance imaging. Endovaginal ultrasound demonstrated a sensitivity of 86%, a specificity of 50%, a positive predictive value of 86%, and a negative predictive value of 77%. Uterine morphometry alone did not predict adenomyosis: although the mean length of the longitudinal, anteroposterior and transverse axis was larger in uteri with, compared with those without, adenomyosis, this did not reach statistical significance. The uterine asymmetry ratio was 1.43 (SD 0.6) and 1.34 (SD 0.4) (P = 0.26) in uteri with and without adenomyosis, respectively, but in the presence of adenomyosis the mean posterior wall was significantly thicker than the mean anterior wall: 25.6 (SD 6.6) mm compared with 21.8 (SD 5.0) mm, P = 0.02. Therefore, adenomyosis was best predicted on the basis of ill-defined myometrial heterogeneity. However, leiomyomas and various echogenic shadows and artefacts often complicate subjective assessment of the myometrial echogenicity. CONCLUSION: Endovaginal sonography in symptomatic patients can be a sensitive but not a specific procedure for the diagnosis of adenomyosis.

Adult↗
PubMedDate not supplied

Myometrial zonal differentiation and uterine junctional zone hyperplasia in the non-pregnant uterus.

Human non-gravid myometrium differentiates in response to ovarian sex steroids into a subendometrial layer or junctional zone and an outer myometrial layer. Compared to the outer myometrial layer, the junctional zone myocytes are characterized by higher cellular density and lower cytoplasmic-nuclear ratio. These structural differences allow in-vivo visualization of the myometrial zonal anatomy by T2-weighted magnetic resonance (MR) imaging. The human myometrium is also functionally polarized. Video-vaginosonography studies have shown that propagated myometrial contractions in the non-pregnant uterus originate only from the junctional zone and that the frequency and orientation of these contraction waves are dependent on the phase of the menstrual cycle. The mechanisms underlying zonal myometrial differentiation are not known, but growing evidence suggests that ovarian hormone action may be mediated through cytokines and uterotonins locally released by the basal endometrial layer and endometrio-myometrial T-lymphocytes. Irregular thickening of the junctional zone due to inordinate proliferation of the inner myometrium, junctional zone hyperplasia, is a common MR finding in women suffering from menstrual dysfunction. Preliminary data suggest that junctional zone hyperplasia is further characterized by loss of normal inner myometrial function. Although irregular thickening of the junctional zone has been associated with diffuse uterine adenomyosis, the precise relationship between subendometrial smooth muscle proliferation and myometrial invasion by endometrial glands and stroma remains to be established.

Cell Differentiation↗
PubMedDate not supplied

[Morphological study of the small intestine in rats with experimental zinc deficiency].

Rats were maintained 4 weeks on a zinc deficient diet from the time of weaning. A control group received the same basic diet supplemented with zinc. Zinc deficiency, was indicated by poor weight gain, diarrhea, exudative vesicular dermatitis around ears, eyes, nose and extremities, and lowering of blood zinc levels. The morphometric study of the small intestine showed: 1) decreased thickness of the intestinal wall and of the mucosa; 2) significant decrease of the mean villies length and of the mean crypt depth; 3) no alterations in the height of the enterocytes from the middle one third of the villis and in the number of Paneth cells; 4) a decreased mitotic index; 5) a diminished number of epithelial cells living the ville, and 6) a decreased population of intraepithelial lymphocytes, both in the proximal jejunum and distal ileum. These findings are compatible with an impairment of cell replication in the small intestine in experimental zinc deficiency in rats, and allow us to speculate that the diarrhea usually seen in states of zinc malnutrition, at least in part, could be dependent on these changes.

Acrodermatitis↗
PubMedDate not supplied

[Zinc in protein-calorie malnutrition. I. Concentration in serum of children with the clinical types, kwashiorkor and marasmic kwashiorkor].

Zinc concentration was measured in the serum of 10 children with protein-energy malnutrition (eight with clinical signs of kwashiorkor, and two with marasmic-kwashiorkor) on the first, 15th and 30th day after admission. The zinc levels were significantly lower for these patients on the first day than those observed for children with good nutritional status. No significant increase in zinc concentration occurred in the serum of these patients during initial period of recovery of nutritional status. The possibility of zinc supplementation for malnourished children during recovery is discussed.

Child↗
PubMedDate not supplied

[Gastric emptying in children. II. Influence of the osmolarity of the hydration solution for oral use].

The gastric retention of three oral rehydration solutions whose osmolality was changed by means of varying glucose concentration (mean values: 224, 312 and 422 mOsm/kg) was studied in 12 children (6 low birthweight infants and 6 infants). The children were fed by a nasogastric tube. The 422 mOsm/k solution caused slower gastric emptying than the 224 mOsm/kg solution. Thus, the use of an oral rehydration solution with osmolality varying between 200-300 mOsm/kg is recommended.

Administration, Oral↗