RESUMO
In the present study, we characterized the phagocytic capacity, cytokine profile along with the FCγ-R and TLR expression in leukocytes from Chagas disease patients (indeterminate-IND and cardiac-CARD) before and one-year after Bz-treatment (INDT and CARDT). A down-regulation of IL-17, IFN-γ and IL-10 synthesis by neutrophils was observed in CARDT. The Bz-treatment did not impact on the expression of phagocytosis-related surface molecules or monocyte-derived cytokine profile in INDT. Although CARDT showed unaltered monocyte-phagocytic capacity, up-regulated expression of Fcγ-RI/III and TLR-4 may be related to their ability to produce IL-10 and TGF-ß. Down-regulation of lymphocyte-derived cytokine was observed in INDT whereas up-regulated cytokine profile was observed for lymphocytes in CARDT. Analysis of cytokine network revealed that IND displayed a multifaceted cytokine response characterized by strong connecting axes involving pro-inflammatory/regulatory phagocytes and lymphocytes. On the other hand, CARD presented a modest cytokine network. The Bz-treatment leads to distinct cytokine network: decreasing the links in INDT, with a pivotal role of IL-10(+) monocytes and expanding the connections in CARDT. Our findings highlighted that the Bz-treatment contributes to an overall immunomodulation in INDT and induces a broad change of immunological response in CARDT, eliciting an intricate phenotypic/functional network compatible with beneficial and protective immunological events.
Assuntos
Doença de Chagas/tratamento farmacológico , Neutrófilos/efeitos dos fármacos , Nitroimidazóis/administração & dosagem , Tripanossomicidas/administração & dosagem , Adolescente , Adulto , Doença de Chagas/imunologia , Estudos Controlados Antes e Depois , Citocinas/metabolismo , Feminino , Interações Hospedeiro-Patógeno/efeitos dos fármacos , Humanos , Imunomodulação , Mediadores da Inflamação/metabolismo , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Receptores de IgG/genética , Receptores de IgG/metabolismo , Receptor 4 Toll-Like/genética , Receptor 4 Toll-Like/metabolismo , Adulto JovemRESUMO
The distinct ability of phagocytes to present antigens, produce cytokines and provide co-stimulatory signals may contribute to the severity of the outcome of Chagas disease. In this paper, we evaluate the phenotypic features of phagocytes along with the cytokine signature of circulating T-cells from Chagas disease patients with indeterminate (IND) and cardiac (CARD) clinical forms of the disease. Our data demonstrated that neutrophils from IND patients displayed an impaired ability to produce cytokines. A lower Trypanosoma cruzi phagocytic index and higher nitric oxide levels were characteristics of monocytes from IND. The impaired phagocytic capacity did not reflect on the levels of anti-T. cruzi IgG, but was detectable in the downregulation of Fc-γR, TLR and CR1 molecules. The monocyte-derived cytokine signature demonstrated that a down-regulated synthesis of IL-12 and a modulatory state were evidenced by a positive correlation between IL-12 and IL-10 with a lower synthesis of TNF-α. The down-regulation of MHC-II and CD86 in monocytes supports the occurrence of particularities in the APC-activation-arm in IND, and may be involved in the T-cell pro-inflammatory pattern counterbalanced by a potent IL-10 response. Our findings support the hypothesis that differential phenotypic features of monocytes from IND may be committed to the induction of a distinct immune response related to low morbidity in chronic Chagas disease.
Assuntos
Doença de Chagas/imunologia , Citocinas/biossíntese , Monócitos/imunologia , Neutrófilos/imunologia , Fagocitose/imunologia , Anticorpos Antiprotozoários/sangue , Anticorpos Antiprotozoários/imunologia , Células Apresentadoras de Antígenos/imunologia , Células Apresentadoras de Antígenos/metabolismo , Antígenos de Protozoários/imunologia , Antígeno B7-2/metabolismo , Células Cultivadas , Doença de Chagas/metabolismo , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunomodulação , Monócitos/metabolismo , Neutrófilos/metabolismo , Óxido Nítrico/biossíntese , Receptores de Complemento 3b/metabolismo , Receptores de IgG/metabolismo , Linfócitos T/imunologia , Linfócitos T/metabolismo , Receptores Toll-Like/metabolismo , Trypanosoma cruzi/imunologiaRESUMO
The patient is a 54-year-old asymptomatic male with a tumor in the right atrium that was diagnosed on transesophageal echocardiography and confirmed as a lipoma of the right atrium on computerized tomography. The patient underwent surgical repair with extracorporeal circulation. The tumor was resected, and its base of implantation in the atrium was repaired with a flap of bovine pericardium. The diagnosis of lipoma was confirmed on histopathological examination. Locating of the tumor with the aid of transesophageal echocardiography was very useful in the strategy of cannulation of the venae cava for installation of the circuit of extracorporeal circulation. The patient had a good postoperative evolution.
Assuntos
Neoplasias Cardíacas/diagnóstico , Lipoma/diagnóstico , Átrios do Coração , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Lipoma/patologia , Lipoma/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Multiple gliomas are uncommon and may be classified according to: a) the time of presentation in early (at diagnosis) or late (during treatment); b) the characteristics of computed tomography or magnetic resonance imaging (CT/MRI) in multifocal (with evidence of spread) and multicentric (without evidence of spread). From 212 patients with histopathologic diagnosis of glioma evaluated from March/90 to September/99, 15 (7%) had multiple lesions. We describe 4 patients: early multicentric, late multicentric, early multifocal and late multifocal, with emphasis on characteristics of CT/MRI and possible differential diagnosis. The differential diagnosis of multiple lesions in the central nervous system includes mainly infectious/inflammatory diseases and metastasis, however multiple gliomas should always be considered, even in patients with known systemic cancer, as described by others. Considering that CT/MRI features are not definite, the diagnosis should always be confirmed by histopathologic examination.
Assuntos
Astrocitoma/diagnóstico , Neoplasias Encefálicas/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Adulto , Neoplasias Encefálicas/classificação , Diagnóstico Diferencial , Feminino , Glioblastoma/diagnóstico , Glioma/classificação , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/classificação , Estudos Prospectivos , Tomografia Computadorizada por Raios XRESUMO
Nine-year-old female patient presented with cianosis since she was born, fatique and dyspnea when sucking. The diagnosis was univentricular heart with left ventricular morphology, transposition of the great arteries, moderate pulmonary valve stenosis and atrial septal defect. Submitted to surgical correction with superior vena cava-right pulmonary artery anastomosis, inferior vena cava anastomosis using lateral tunnel, with cardiopulmonary bypass. After surgical correction, the clinical and laboratorial (echocardiogram and cardiac catheterization) evaluation showed Fontan operation with good surgical results. Total cavopulmonary connection was proposed as a modification of the Fontan procedure that might have greater benefits than previous proposed techniques. The results demonstrate that this modification provides excellent early definitive treatment, increasing hemodynamic profile, with low morbidity and mortality, for a variety of complex congenital heart lesions.
Assuntos
Técnica de Fontan/métodos , Cardiopatias Congênitas/cirurgia , Criança , Feminino , HumanosRESUMO
Two cases of lead poisoning from retained bullets in the hip region are reported. General considerations about lead intoxication are made and the intoxication caused by bullets retained in the body are specifically focused.