Despigmentação precoce em caso de ceratopigmentação / Early depigmentation in case of keratopigmentation

RESUMO A ceratopigmentação teve seu primeiro registro pelo filósofo Galeno há muitos séculos como uma estratégia utilizada para o tratamento estético de pacientes com leucomas. As córneas com leucoma são patológicas e, muitas vezes, intolerantes a lentes de contato cosméticas ou próteses oculares, sendo comum a queixa de desconforto excessivo, proporcionado pela superfície corneana irregular. Assim, a ceratopigmentação é uma alternativa para a melhora estética de pacientes com opacidades corneanas. Descrevemos o caso de um paciente do sexo masculino, 39 anos, que apresentou despigmentação precoce em caso de ceratopigmentação associado a quadro de ceratite herpética necrotizante. O paciente foi submetido ao tratamento com aciclovir 2g ao dia e doxiciclina 200mg ao dia, evoluindo com melhora do quadro clínico, apesar da má adesão medicamentosa.

ABSTRACT Keratopigmentation was first recorded many centuries ago by the philosopher Galeno, as a strategy used for the aesthetic treatment of patients with leukomas. Corneas with leucoma are pathological and often intolerant of cosmetic contact lenses or ocular prostheses, with complaints of excessive discomfort provided by the irregular corneal surface being common. Therefore, keratopigmentation is an alternative for the aesthetic improvement of patients with corneal opacities. We describe the case of a 39-year old male patient, who presented early depigmentation in a case of keratopigmentation associated with necrotizing herpetic keratitis. The patient was treated with Acyclovir 2g/day and Doxycycline 200mg/day, evolving with clinical improvement, despite poor medication adherence.

Patent blue V dye anaphylaxis: a case report and literature review / Anafilaxia por corante azul patente V: relato de caso e revisão da literatura

Abstract Background: Anaphylaxis is a constant perioperative concern due to the exposure to several agents capable of inducing hypersensitivity reactions. Patent blue V (PBV), also known as Sulfan Blue, a synthetic dye used in sentinel node research in breast surgery, is responsible for 0.6% of reported anaphylactic conditions. We present a case of a 49-year-old female patient who underwent left breast tumorectomy with sentinel lymph node staging using PBV and experienced an anaphylactic reaction. Methods: We conducted a literature search through PubMed for case reports, case series, review and systematic reviews since 2005 with the keywords "anaphylaxis" and "patent blue". We then included articles found in these publications' reference sections. Results: We found 12 relevant publications regarding this topic. The main findings are summarized, with information regarding the clinical presentation, management, and investigation protocol. Hypotension is the most common clinical manifestation. The presentation is usually delayed when compared with anaphylaxis from other agents and cutaneous manifestations are occasionally absent. Patients may have had previous exposure to the dye, used also as a food, clothes and drug colorant. Conclusion: The diagnosis of anaphylaxis in patients under sedation or general anesthesia may be difficult due to particularities of the perioperative context. According to the published literature, the presentation of the reaction is similar in most cases and a heightened clinical sense is key to address the situation appropriately. Finding the agent responsible for the allergic reaction is of paramount importance to prevent future episodes.

Resumo Introdução: A anafilaxia pode ocorrer durante o período perioperatório devido à exposição a diversos agentes capazes de induzir reações de hipersensibilidade. O corante sintético Azul Patente V (APV), também conhecido como Sulfan Blue, é usado na pesquisa de linfonodo sentinela em cirurgia de mama, e é responsável por 0,6% dos eventos anafiláticos relatados. Descrevemos o caso de uma paciente de 49 anos de idade submetida à tumorectomia de mama esquerda com estadiamento de linfonodo sentinela, em que se empregou o APV e que apresentou reação anafilática. Método: Por meio do PubMed, pesquisamos publicações que documentavam relatos de casos, séries de casos, revisões e revisões sistemáticas desde 2005, usando as palavras-chave "anaphylaxis" e "patent blue". Em seguida, incluímos artigos encontrados na lista de referências dessas publicações. Resultados: Encontramos 12 publicações relevantes sobre o tópico. Os principais achados estão resumidos, com informações do quadro clínico, tratamento e protocolo de investigação. A hipotensão foi a manifestação clínica mais frequente. De forma geral, o quadro clínico tem início tardio quando comparado à anafilaxia por outros agentes e, ocasionalmente, as manifestações cutâneas estão ausentes. Os pacientes podem ter tido exposição prévia ao APV, que também é usado como corante de alimentos, roupas e medicamentos. Conclusão: O diagnóstico de anafilaxia em pacientes sob sedação ou anestesia geral pode ser difícil devido às peculiaridades do contexto perioperatório. Segundo a literatura publicada, a apresentação da reação é semelhante na maioria dos casos e um discernimento clínico aguçado é fundamental para enfrentar o evento adequadamente. Encontrar o agente responsável pela reação alérgica é essencial para a prevenção de futuros episódios.

In vivo and ex vivo dermoscopy of lesions from implantation of human papillomavirus in tattoos: report of two cases

Abstract The number of individuals with tattoos has been increasing worldwide, alongside with reports of complications varying from reactions to the injected pigments to infections caused by agents inoculated in the pigmentation process. The diagnosis of such unwanted events can be obtained through complementary non-invasive methods, preserving the maximum of the tattoo design. The authors present two cases of patients with warts on tattooing, and correlate their clinical aspects to in vivo and ex vivo dermoscopy, and to the findings in the histopathological examination, aiming to determine patterns that aid the diagnosis of these lesions without performing biopsy.

Selladores de Superficie en Base a Resina: Potencial de Prevenir Tinción Exógena / Resin-based Surface Sealants: Potential to Prevent Exogenous Staining

RESUMEN: El objetivo del presente trabajo fue estudiar el potencial de los selladores de superficie basados en resinas de evitar cambios de color de resinas compuestas de restauración ante la acción de una bebida coloreada. Para ello, se confeccionó una muestra de 40 discos de resina nanocompuesta Filtek Z350 XT (3M- ESPE) color A2D de 7x2 mm, se pulieron en forma convencional con una serie de discos de óxido de aluminio y se distribuyeron aleatoriamente en 2 grupos de 20 especímenes. Al grupo 1 se le selló toda su superficie usando el agente sellador Fortify®, al grupo 2 se le dejó sin tratar. Se sometió a todos los discos (n=40) a un proceso de termociclado luego del cual se procedió a medir su color inicial mediante el espectrofotómetro de punto Vita Easyshadeµ®. Cada grupo de discos fue inmerso en recipientes metálicos de acero inoxidable en un medio que contenía a una infusión concentrada de té negro durante 7 días a 37 ºC. Finalmente, se midió el color final a cada uno de los grupos de discos luego del periodo de inmersión. Los resultados fueron sometidos al análisis estadístico con el programa Stata 12 y el test T-Student con una significancia de p<0,05. Los resultados indicaron un significativo cambio de color de ambos grupos de discos, siendo ligeramente menor en el grupo de discos sellados, sin embargo, no existió diferencia significativa entre ellos. Como conclusión se determinó que bajo las condiciones del presente estudio el uso del agente sellante de superficie Fortify® no evitó el cambio de color de la resina nanocompuesta de restauración.

ABSTRACT: The objective of the present work was to study the potential of surface sealers based on resins to avoid color changes of resin composite restoration before the action of a colored drink. Therefore, a sample of 40 discs of nanocomposite Filtek Z350 XT (3M-ESPE) color A2D of 7x2 mm was included, these were conventionally polished with a series of aluminum oxide discs and randomly distributed in 2 groups of 20 specimens. Group 1 was sealed with its entire surface using Fortify® sealant, group 2 was left untreated. All discs (n = 40) were subjected to a thermocycling process after which their initial color was measured by the Vita Easyshadem® point spectrophotometer. Each group of discs was immersed in metallic stainless steel containers, in a concentrated infusion of black tea for 7 days at 37 °C. Finally, the final color was measured in each of the disk groups following the immersion period. Results were subjected to the statistical analysis with the Stata 12 program and the T-Student test with a significance of p <0.05. The results indicated a significant color change in both groups of discs, being slightly lower in the group of sealed discs, however, there was no significant difference between them. In conclusion it was determined that under the conditions of the present study the use of the Fortify® surface sealant did not prevent the color change of the nanocomposite restoration resin.

Influence of different cosmetic vehicles in mechanical and physical properties of hair treated with oxidative hair dyes

ABSTRACT Hair care products play a significant role in the cosmetic market and aim at improving hair brightness, breakage resistance, and color change. In this study, we analyzed the possibility of the formulation of oxidative dyes in different vehicles impacting the hair's both mechanical and physical properties. Light brown and light blond dyes were prepared using eight different vehicles. Among these, four vehicles were emulsifying agents and four gelling agents. Each formulation was applied to two types of virgin Caucasian hair (light blond and dark brown). Physical, chemical, and organoleptic properties of each formulation were assessed, as well as changes in hair parameters after oxidative dyeing, such as staining intensity, brightness, and breaking strength. The parameters of color and brightness differed in some formulations, but the hair type also responded differently. Brightness parameter was increased in dark brown hair colored with both dyes, whereas light blond hair showed the opposite result. Regarding the breaking strength, there were no significant differences between the two kinds of tresses. Cosmetic formulations should adjust the consumer desired effects (e.g. color change) in order to present minimal drawbacks (e.g. decrease of hair brightness and strength). Thus, the study of different vehicles is important when establishing the best oxidative dye formulation.

Allergic reaction to patent blue dye in breast surgery - case report / Reação alérgica ao corante azul patente em cirurgia de mama - relato de caso

Abstract We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20 min after the dye injection, the patient developed hypotension (BP = 70 × 30 mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2 h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.

Resumo Os autores apresentam um caso de reação alérgica ao azul patente em uma paciente submetida à exérese de linfonodo em sentinela associada a uma ressecção segmentar de mama. Paciente apresentou aproximadamente pós 20 minutos da injeção do corante hipotensão (PA = 70 × 30 mmHg) associada a aumento da frequência cardíaca. Foi tratada satisfatoriamente com diminuição da fração inspirada do anestésico inalatório e reposição volêmica. No fim do procedimento apresentava placas urticariformes azuladas em cabeça, pescoço, membros superiores e tronco e foi usada hidrocortisona. Evoluiu, sem intercorrências, na sala de recuperação pós-anestésica e teve alta duas horas após o término do procedimento cirúrgico sem a presença das alterações cutâneas. Alta hospitalar na manhã seguinte à cirurgia. A incidência de reações alérgicas com o emprego do azul patente é muito superior às reações de hipersensibilidade observadas com drogas anestésicas e adjuvantes. Portanto, o anestesiologista deve ficar atento à instabilidade cardiovascular associada a alterações cutâneas quando do uso do azul patente para o diagnóstico precoce e tratamento adequado dessa reação de hipersensibilidade com o emprego do corante.

Methylene blue-related corneal edema and iris discoloration / Edema de córnea e descoloração de íris associados ao azul de metileno

ABSTRACT We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes.

RESUMO Paciente do sexo feminino com 70 anos de idade desenvolveu edema da córnea e descoloração da íris após o uso inadvertido de 1% de azul de metileno em vez de 0,025% de azul tripano para corar a cápsula anterior do cristalino durante a cirurgia de catarata por facoemulsificação. Foi realizada irrigação abundante quando detectou-se que o corante incorreto tinha sido usado. Edema da córnea e descoloração íris que ocorreu no período pós-operatório precoce persistiu durante 24 meses de seguimento; no entanto, a ceratoplastia não foi necessária. O uso intracameral de 1% de azul de metileno tem efeitos citotóxicos sobre o endotélio da córnea e epitélio da íris. A irrigação abundante durante pelo menos 30 minutos, utilizando um mantenedor de câmara anterior pode resultar em um prognóstico melhor.

Reacción a un tatuaje de henna negra tratado con furoato de mometasona y gel de silicona: Caso clínico / Reaction to a black henna tattoo treated with mometasone furoate and silicone gel: case report

Black henna tattoos have paraphenylenediamine (PPD), which contains a product of herbal origin, which due to its molecular characteristics is capable of inducing, in susceptible individuals, a type IV hypersensitivity reaction. It clinically manifests as a contact dermatitis that usually when it disappears, scarring and hypopigmentation are left in the injured area. Objective: To describe the case of a patient with hypersensitivity to henna tattoo and to present the most relevant phenomena associated with this condition. Case report: The case of a 6 year-old patient with a black henna tattoo on his right leg, who was diagnosed with contact dermatitis probably attributed to PPD, is presented. Mometasone furoate and topical silicone gel treatment was started with good response. Conclusion: Mometasone furoate and silicone gel are a good possible therapeutic option for treating contact dermatitis caused by PPD as the dermatosis was resolved without residual lesions.

Los tatuajes de henna negra son aquellos que contienen parafenilendiamina (PPD), que contienen un producto de origen herbal, que por sus características moleculares es capaz de inducir, en individuos susceptibles, una reacción de hipersensibilidad tipo IV. Se manifiesta clínicamente como una dermatitis de contacto, que generalmente al desaparecer, persiste de manera residual una cicatriz hipertrófica e hipopigmentación en la zona lesionada. Objetivo: Describir el caso de un paciente con hipersensibilidad al tatuaje de henna, y presentar los fenómenos más relevantes asociados a esta patología. Caso clínico: Paciente de 6 años de edad, que se realizó un tatuaje con henna negra en la pierna derecha, en quien se diagnosticó posteriormente una dermatitis de contacto atribuida probablemente a la PPD. Se comenzó tratamiento con furoato de mometasona y gel de silicona con buena respuesta por vía tópica. Conclusión: El furoato de mometasona y gel de silicona son una posible opción terapéutica de utilidad para tratar la dermatitis de contacto causada por el PPD, debido a que la dermatosis se resolvió sin lesiones residuales.

Comparative evaluation of Ziehl Neelsen staining and knowledge, attitudes and practices of laboratory personnel in relation to Ziehl Nielsen / Evaluación comparativa de la tinción de Ziehl Neelsen y los conocimientos, actitudes y prácticas (CAP) del personal de laboratorio en relación con Ziehl Nielsen

OBJECTIVE: To describe laboratory personnel's attitude and practices toward phenol exposure during Ziehl Neelsen (ZN) acid fast staining method and to evaluate the feasibility of an alternate modified Kinyoun cold (MKC) stain. METHOD: A total of 187 sputum samples were collected from suspected tuberculosis cases and stained by the MKC method and ZN stain and were read by an experienced microscopist and a researcher. A crosssectional questionnaire survey of 35 laboratory personnel was also conducted. RESULTS: Modified Kinyoun cold stain gave sensitivity, specificity, positive and negative predictive values of 100%, 99.4%, 94.1% and 100%, respectively. Both stains corresponded with an agreement rate of 99.5%. Almost 94.7%of respondents reported that they worked in a closed area when staining and 57.1% did the staining method without ventilation. Material safety data sheet (MSDS) of phenol was not known to 77.1% of laboratory personnel. All of the participants (100%) in this study welcomed a similar, non heating method for acid-fast bacillus (AFB). There was significant association between those not comfortable with phenol exposure (77.1%) and complaints of irritation (48.6%) and headache (2.9%) [χ² = 10.98, r = 0.55, p = 0.001]. CONCLUSIONS: The MKC is suitable for use as a substitute for the ZN method for the demonstration of AFB in the primary diagnosis and treatment assessment of pulmonary tuberculosis. Focus should be given on educating laboratory staff on the hazards, risks and precautions associated with the phenol/ZN method.

OBJETIVO: Describir las actitudes y prácticas del personal del laboratorio hacia la exposición al fenol durante la aplicación del método de tinción ácido-rápida de Ziehl Neelsen (ZN), y la viabilidad de la alternativa de una tinción de Kinyoun en frío modificada (MKC). MÉTODO: Un total de 187 muestras de esputo fueron recogidas de casos con sospecha de tuberculosis, y teñidas por el método MKC y la tinción de ZN, tras lo cual fueron leídas por un microscopista y un investigador con experiencia. También se realizó una encuesta transversal a manera de cuestionario, entre las 35 personas que conformaban el personal del laboratorio. RESULTADOS: La tinción de Kinyoun en frío modificada arrojó sensibilidad, especificidad, y valores predictivos positivos y negativos de 100%, 99.4%, 94.1% y 100%, respectivamente. Ambas tinciones se correspondieron con una tasa de acuerdo de 99.5%. Casi el 94.7% de los encuestados informó que trabajaban en un área cerrada en el momento de la tinción, y 57.1% tuvo el método de la tinción sin ventilación. La ficha de datos de seguridad (FDS) de fenol era desconocida para el 77.1% del personal de laboratorio. Todos los participantes (100%) en este estudio dieron la bienvenida a un método similar, sin calentamiento, para los bacilos acidoresistentes (BAR). Hubo una asociación significativa entre aquellos para quienes la exposición al fenol les era inconfortable (77.1%) y las quejas de irritación (48.6%) y dolor de cabeza (2.9%) [χ² = 10.98, r = 0.55, p = 0.001]. CONCLUSIONES: El MKC es adecuado para uso como sustituto del método de ZN para la demostración de BAR en el diagnóstico primario y la evaluación del tratamiento de la tuberculosis pulmonar. Debe centrarse la atención en educar al personal de laboratorio en los peligros, los riesgos, y la precaución asociados con el método de fenol/ZN.

Tatuajes de henna negra: revisión de la literatura a partir de un caso clínico / Black henna tattoos: case report and review of the literature

En la actualidad los tatuajes de henna negra se utilizan en forma muy frecuente, por lo que el número de reportes sobre reacciones adversas asociadas a su uso se ha incrementado. La Parafenilendiamina o PPD es el químico que más se adiciona a la henna para intensificar y prolongar la duración del color del tatuaje. Posee un gran poder sensibilizante y se le atribuyen la mayoría de las reacciones, desde dermatitis leve hasta reacciones generalizadas tipo eritema multiforme-like. Se presenta el caso de un paciente de 7 años con lesiones cutáneas frente a segunda exposición a tatuaje de henna. Con diagnóstico de dermatitis de contacto se maneja con corticoidestópicos con excelente respuesta clínica. Como prevención primaria planteamos la necesidad de programas que permitan educar a la comunidad en relación a los riesgos asociados a la exposición a PPD, recomendando el NO uso de tatuajes de henna negra.

Today, black henna tattoos are very commonly used, so the number of reports on adverse reactions associated with its use has increased. The paraphenylenediamine or PPD is the chemical that is most commonly added to henna to intensify and prolong the duration of the color tattoo. PPD act as sensitizer of most of the reactions, from mild dermatitis to generalized reactions erythema multiforme-like. We show a case of a 7 year old patient with skin lesions that appears during the second exposure to henna tattoos. We made the diagnosis of a contact dermatitis and we manage it with topical corticosteroids with excellent clinical response. As primary prevention we suggest the need of educational programs for the community regarding the risks associated with the exposure of PPD, and avoiding the use of black henna tattoos.

Reações aos diferentes pigmentos de tatuagens: relato de dois casos / Reactions to the different pigments in tattoos: a report of two cases

A tatuagem é definida como deposição de pigmento intencional ou acidental na pele. Os pigmentos têm sido associados a diversas dermatoses, como a dermatite de contato alérgica, a dermatite liquenoide e as reações fotoinduzidas, granulomatosas, sarcoídeas e pseudolinfomatosas. Enfocam-se os diversos tipos de reações aos pigmentos e a importância de reconhecê-los clinicamente. São relatados dois casos: um de dermatite liquenoide sobre o pigmento vermelho e outro de pseudolinfoma sobre os pigmentos vermelho e lilás e de reação fotoinduzida sobre o amarelo. A remoção geralmente requer múltiplos tratamentos, e a maioria não retira as cores completamente.

Tattoos are defined as the intentional or accidental deposit of pigment into the skin. These pigments have been associated with various dermatoses such as allergic contact dermatitis, lichenoid dermatitis, photoinduced reactions, and granulomatous, sarcoid and pseudolymphomatous reactions. The objective of this report was to describe the various types of reactions to pigments and the importance of recognizing them clinically. Two cases are reported: one of lichenoid dermatitis resulting from a reaction to the red pigment of a tattoo and the other of a pseudolymphoma resulting from a reaction to red and lilac pigments and a photo-induced reaction to a yellow pigment. Removal generally requires multiple forms of treatment, most of which fail to remove the colors completely.

Contact dermatitis with henna tattoo.

Allergic and irritant reactions to henna are rare. Para-phenylenediamine, which is sometimes added to obtain a dark, blackish henna, causes the majority of contact dermatitis reported related with tattoos. Allergic contact dermatitis due to temporary paint-on tattoo with black henna is described in two adolescents.

Complicaciones de los tatuajes decorativos: nuestra casuística / Complications of the decorative tattoos: our casuistry

Antecedentes. El tatuaje es un arte reconocido desde la antiguedad, popularizado desde los años ´90 y no exento de reacciones adversas. Objetivos. Clasificar las complicaciones de los tatuajes entre los pacientes que consultaron por reacciones adversas a ellos. Identificar patrones clínicos e histológicos y su distribución de frecuencias, así como la de los resultados del test del parche (TP) y del análisis químico de sus componentes. Diseño. Retrospectivo y prospectivo, observacional, realizado en la Unidad Dermatología del Hospital General de Agudos "Dr. Cosme Argerich" en el período 1º de marzo de 1998 a 30 de noviembre de 2006. Métodos. La metodología se llevó a cabo mediante la revisión de historias clínicas para recabar información acerca de: 1) examen físico, 2) estudios laboratoriales, 3) estudio histopatológico, 4) test del parche y 5) análisis químico del tinte. Resultados. En el período mencionado fueron atendidos 21 pacientes por complicaciones de sus tatuajes: 80,8% correspondieron a reacciones a los tintes decorativos, 9,6% a efecto adverso de la remoción, 4,8% a reacciones inflamatorias por la injuria de la inyección y 4,8% a localización de enfermedad cutánea coincidental. Conclusiones. La mayoría de complicaciones por tatuajes en nuestra casuística correspondió a reacciones al tinte. Ésta podría vincularse a la presencia del componente exógeno, a una predisposición individual o a la combinación de ambos factores. Pueden ser juzgadas como infrecuentes, pero alteran el resultado de un procedimiento que tiene fines estéticos.

Reação anafilática ao corante azul patente durante a biópsia do linfonodo sentinela em câncer de mama inicial: relato de caso / Anaphylactic reaction to patent blue dye during sentinel lymph node biopsy in early-stage breast cancer: a case report

A biópsia do linfonodo sentinela no tratamento do câncer de mama vem substituindo a linfadenectomia em casos iniciais. Este tratamento pode ser realizado com o corante azul vital e/ou radiofármaco. Há relatos de reações alérgicas ao corante com diferentes graus de severidade. Relata-se um caso de reação anafilática severa após injeção intradérmica do corante azul patente, em paciente com diagnóstico de carcinoma ductal in situ. O corante azul patente, apesar de facilitar a detecção do linfonodo, apresenta risco de desencadear reações anafilactóides. É necessário que a equipe envolvida tenha preparo para diagnosticar e tratar esta complicação.

Sentinel lymph node biopsy in the treatment of breast cancer has been replacing lymph node resection in early cases. This treatment may be performed with blue dye and/or radiopharmaceuticals. There are reports of allergic reactions to blue dye with different degrees of severity. A case of severe anaphylactic reaction after intradermal injection of patent blue dye was reported in a patient diagnosed with ductal carcinoma in situ. The patent blue dye facilitates the detection of the sentinel lymph node, but there is the risk of triggering anaphylactic reactions. It is recommended the team involved to be very knowledgeable and prepared to diganose and treat this complication.

Fatal pulmonary oedema following laparoscopic chromopertubation.

The body of a 30-year-old woman was received for autopsy. The available medical case records mentioned that she had been married for the past 3 years and had had primary infertility. She had undergone a diagnostic-cum-operative laparoscopy under general anaesthesia in a private nursing home. On laparoscopy, the internal genital organs were normal except for a fimbrial cyst on each side. Chromopertubation was done using methylene blue dye along with diagnostic dilatation and curettage. The patient was extubated and shifted to the recovery room. About 15 minutes later she developed cyanosis and became unconscious. She died despite sustained efforts at resuscitation.

Impregnacão inadvertida da cápsula posterior do cristalino com azul de tripano durante a facectomia extracapsular: relato de caso / Unintentional staining of lens posterior capsule with trypan blue during extracapsular cataract extraction: case report

Relato de complicacão relacionada ao uso do azul de tripano 0,1 por cento ocorrida ao corar a cápsula anterior do cristalino em facectomia extracapsular com implante de lente intra-ocular. O corante foi injetado sob alta pressão utilizando a técnica de bolha de ar ocasionando a migracão deste através da zônula e conseqüente perda do reflexo vermelho no peroperatório dificultando os passos subseqüentes à extracão da catarata e comprometendo temporariamente a acuidade visual no pós-operatório. Tendo como objetivo evitar esta complicacão, os autores descrevem ainda, o uso da "Técnica de bolha de ar modificada" no qual o viscoelástico dispersivo é injetado no espaco iridolenticular 360º para compor uma barreira de protecão.

Protective role of Spirulina feed in a freshwater fish (Poecilia reticulata Peters) exposed to an azo dye-methyl red.

Acute toxicity of an azo dye-methyl red (5-40 ppm) was examined under starving conditions, on two groups of Poecilia reticulata--a freshwater fish, fed on different diets prior to their exposure to dye. Besides natural feed, fish of group-1 also received Spirulina feed for one month (feed population), whereas those of group-2 received only natural feed (non-feed population). The mortality data revealed non-feed population to be more tolerant to feed stress during acute toxicity study, whereas feed population exhibited better tolerance to the combined stress of both feed and methyl red; especially at higher concentrations of the latter. RBCs in methyl red treatments acquired different shapes (poikilocytosis) and an increase in their size (anisocytosis) was also noticed. Percentage of such abnormal RBCs was almost equal in both feed and non-feed populations, except at a lower concentration (5 ppm), at which percentage of poikilocytic RBCs was lesser in the feed population. RBC counts in the control non-feed fish (34.5 x 10(4)/mm3) were significantly lower than control feed population (50.0 x 10(4) /mm3). Their number decreased with an increase in methyl red concentrations in non-feed population (9-26%), but percent reduction in RBC counts was almost similar (20-26%) at various concentrations of methyl red (5-30 ppm) in the feed population. Despite reduction in RBC counts, feed population did not suffer from anemia in methyl red treatments, as evident by their RBC counts which were almost equal to control fish of non-feed population. The results suggest that Spirulina feed improves tolerance of test organism towards methyl red manifested by noticeable reduction in the cytotoxic effects on RBCs and a lower mortality rate at higher concentrations of dye.