CONTEXTO: O diagnóstico correto e o tratamento eficaz da infecção pelo Helicobacter pylori são essenciais no controle desta infecção. OBJETIVO: Comparar o valor de três testes de diagnóstico baseado em biopsias gástricas endoscópicas: avaliação histopatológica com hematoxilina-eosina (H-E), teste da urease e cultura microbiológica para a detecção da infecção ativa pelo H. pylori, com a finalidade de recomendações para a clínica diária prática. MÉTODOS: Biopsias gástricas de 115 pacientes (85 mulheres e 30 homens) foram obtidas por endoscopia digestiva alta e estudadas por avaliação histopatológica com H-E (antro-corpo), teste de urease em 2 horas (antro) e cultura microbiológica (antro). RESULTADOS: Infecção ativa pelo H. pylori foi diagnosticada em 67% dos pacientes e detectada pela avaliação histopatológica com H-E, pelo teste de urease e pela cultura microbiológica em 87%, 79% e 70% dos casos positivos, respectivamente. Houve diferenças significativas quando a avaliação histopatológica com H-E e o teste rápido de urease quando comparadas com a cultura microbiológica (P<0,01). Não houve diferença significativa entre a avaliação histopatológica com H-E e o teste de urease (P = 0,7). O índice kappa para avaliação histopatológica com H-E/teste de urease foi de 0,56, avaliação histopatológica com H-E/cultura microbiológica 0,6, e teste de urease/cultura microbiológica 0,64. CONCLUSÕES: Em condições similares ao estudado, avaliação histopatológica com H-E e teste de urease são os testes mais recomendados para o diagnóstico de infecção ativa pelo H. pylori com base em biopsias endoscópicas. A avaliação histopatológica com H-E é essencial quando exigido o estudo de lesões gástricas. O teste de urease é obrigatório no caso de diagnóstico precoce rápido. A cultura microbiológica pode ser usada em casos de infecção persistente ou complicada, que podem exigir estudos sobre a virulência ou susceptibilidade do Helicobacter aos antimicrobianos. Os casos selecionados podem exigir a combinação de vários testes. Os três testes apresentam bom nível de concordância para o diagnóstico da infecção ativa pelo H. pylori.

CONTEXT: The correct diagnosis and effective treatment of Helicobacter pylori gastric infection are essential in controlling this infection. OBJECTIVE: To compare the diagnostic value of three tests based in endoscopic gastric biopsies histopathological evaluation with hematoxylin-eosin (H-E) staining, urease rapid test and microbiological culture for detecting Helicobacter pylori active infection, in order to make recommendations for daily clinical practice. METHODS: Gastric biopsies from 115 adult patients (85 female/30 male) were obtained by upper gastrointestinal endoscopy and studied by histopathological evaluation with H-E (antrum-corpus), urease test in 2 hours (antrum) and microbiological culture (antrum). RESULTS: Helicobacter pylori active infection was diagnosed in 67% of patients. Helicobacter pylori active infection was detected by histopathological evaluation with H-E, urease test and microbiological culture in 87%, 79% and 70% of the positive cases, respectively. There were significant differences when histopathological evaluation with H-E and urease test rapid test when compared with microbiological test (P<0.01). There was no significant difference between histopathological evaluation with H-E and urease test (P = 0.7). The kappa index of agreement for histopathological evaluation with H-E/urease test was 0.56, histopathological evaluation with H-E/microbiological culture 0.6, and urease test/microbiological culture 0.64. CONCLUSIONS: In a hospital setting like the one studied, histopathological evaluation with H-E and urease test are the most recommended tests for diagnosis of Helicobacter pylori active infection based in endoscopic biopsies. If pathological information of gastric lesions will be required, histopathological evaluation with H-E is essential. Urease test is mandatory if a prompt diagnosis is necessary. Microbiological culture can be used in cases of persistent or complicated infection, which may require studies on Helicobacter virulence or antimicrobial susceptibility. Selected cases might demand a combination of several tests. The three tests exhibit a good concordance level for Helicobacter pylori active infection diagnosis.

INTRODUCTION: given the importance of dengue in America, it is indispensable to know the cause of death of the infected people and to evaluate the few necropsy studies available. OBJECTIVE: to describe and to analyze the relevant clinical and pathological findings in fatal dengue cases of dengue in a Venezuelan endemic area. METHODS: eight fatal cases, according to clinical and epidemiological dengue criteria and/or confirmed by complete serological tests were studied after complete clinical necropsy. The tissues were processed by standard histopathological techniques. RESULTS: all these cases showed severe lung disease (diffuse alveolar damage, non cardiogenic pulmonary edema, thromboembolism, bronchopneumonia, pneumonitis, intralveolar hemorrhage). Six presented with pleural or abdominal effusion. Focal hepatic necrosis was found in two cases. The cause of death was related to respiratory failure in six cases secondary to lung disease; two with hypovolemic shock, and one developed liver failure. CONCLUSIONS: the studied dengue cases showed fatal severe pulmonary compromise leading to death, unlike those reported in other studies of autopsies in The Americas. They also developed multiple organ failure, which in most cases led to death not directly associated to hypovolemic shock. These findings in autopsies will allow designing therapeutic strategies to avoid mortality.

INTRODUCCIÓN: dada la importancia del dengue en América, es elemental conocer la causa de muerte de los infectados y evaluar los escasos estudios de necropsias. OBJETIVO: describir y analizar los hallazgos anatomopatológicos relevantes en casos fatales de dengue en un área endémica venezolana. MÉTODOS: se estudiaron 8 casos mortales con criterios clínico-epidemiológicos de dengue o comprobados mediante pruebas serológicas (o ambos), sometidos a necropsia clínica completa. Los tejidos se procesaron con técnicas histopatológicas habituales. RESULTADOS: todos los casos evidenciaron enfermedad pulmonar severa (daño alveolar difuso, edema pulmonar no cardiogénico, tromboembolismo, bronconeumonía, neumonitis, hemorragia intraalveolar); 6 mostraron derrame en cavidad pleural o abdominal, o en ambas. Necrosis hepática focal se presentó en 2 casos. La causa de muerte se relacionó con insuficiencia respiratoria en 6 casos secundaria a enfermedad pulmonar, 2 con choque hipovolémico y 1 desarrolló insuficiencia hepática. CONCLUSIONES: los casos mortales por dengue estudiados evidenciaron compromiso pulmonar severo relacionado con la muerte, a diferencia de lo reportado en otros estudios de necropsias en América. También desarrollaron afectación multiorgánica, que en la mayoría de los casos condujo a la muerte no vinculada directamente a choque hipovolémico. Estos hallazgos de necropsias permitirían proyectar estrategias terapéuticas en pro de evitar la mortalidad.

INTRODUCTION: Stroke in young adults has seldom been studied in a necropsy series. The objective of the present clinical necropsy-based investigation was to analyze stroke and its relationship with cardiovascular and renal pathology in young adults. MATERIALS AND METHODS:The protocols of 52 clinical necropsies with diagnoses of stroke in patients aged 18 - 49 years, performed between the years 1990-2006, were reviewed. RESULTS: Hemorrhagic stroke was diagnosed in 36 patients (69.3%), whereas the remaining 16 (30.7%) had ischemic stroke. Hypertensive cardiopathy was evident in 88.4% of the cases. Chronic renal pathology, directly or indirectly related to hypertension, was observed in 55.7% of the patients. Ischemic stroke as a result of occlusive atherosclerotic disease was seen in 50% of cases. Cardiogenic emboli were found in 25% of the cadavers. Hemorrhagic stroke was associated with hypertension in 43% of the cases, with ruptured vascular malformations in 29%, and coagulopathies in 17% of the cases. Hypertensive cardiopathy was present in patients with either ischemic or hemorrhagic stroke (81.2% and 91.6%, respectively). The most frequently observed renal ailments were chronic pyelonephritis (23%) and nephrosclerosis (21.1%). These were associated with ischemic stroke in 43.7%, and 12.5% of the cases, respectively, and with 13.8% and 25% of the hemorrhagic stroke cases. DISCUSSION: Hypertensive cardiopathy, occlusive atherosclerotic disease, chronic pyelonephritis and nephrosclerosis are among the pathophysiologycal mechanisms that apparently and eventually interact to induce a significant number of cases of stroke in young adults. A chronic systemic inflammatory state appears to be an important related condition because it possibly constitutes an accelerant of the pathophysiologycal process.

Resumen Los textos clásicos de patología plantean que la presencia de esplenitis aguda es reflejo de estados sépticos, pero está poco clara la evidencia en la que se basa tal asociación. Se evaluó la presencia de esplenitis aguda inespecífica como indicador de infección sistémica en casos de autopsia clínica. Se seleccionaron 34 casos que presentaron síndrome de disfunción de órganos secundario a sepsis como causa de muerte (Grupo A) y 37 casos fallecidos por procesos no infecciosos (Grupo B), de las 145 autopsias clínicas practicadas en el lapso 31 de enero de 1999 - 31 de diciembre de 2000 en el Departamento de Patología del Hospital General del Sur "Dr. Pedro Iturbe" de Maracaibo - Venezuela. El 79% de los casos del grupo A presentó esplenitis aguda mientras que en el grupo B ningún caso la desarrolló (p < 0,001). Treinta y tres casos del grupo A (97%) fallecieron en las primeras 24 horas de su ingreso y no recibieron terapia anti-microbiana. Los resultados sugieren que bajo una correlación clínico-patológica adecuada, la esplenitis aguda inespecífica es un hallazgo que indica de manera significativa la presencia de un estado séptico, al menos en los casos que no reciben terapia anti-microbiana.

Abstract Classic pathology textbooks claim that acute splenitis reflects septic states, nevertheless, the evidence upon which that association is based remains unclear. We assessed the occurrence of acute splenitis, as an indicator of systemic infection, in 34 autopsies performed in patients in whom the cause of death was due to multiple organ dysfunction syndrome, secondary to sepsis (group A); and in 37 cases of death by non-infectious causes (group B). These necropsies were done during the period January 31 1999 - December 31 2000, at the Pathology Department of the Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo, Venezuela. Acute splenitis was observed in 79% of the cases in group A, whereas it was absent in group B (p<0,001). Thirty three (97%) of the patients of group A did not receive antibiotic therapy, and died within the first 24 hours following admission. Our results suggest that based on a proper clinical-pathological correlation, non-specific acute splenitis constitutes a finding that reflects a septic state, at least in cases that do not receive anti-microbial therapy.