Correlation between the histopathology of chronic urticaria and its clinical picture

Abstract BACKGROUND: Chronic urticaria is characterized by transient, pruritic lesions of varying sizes, with central pallor and well-defined edges, with disease duration longer than six weeks. Its cellular infiltrate consists of neutrophils, lymphocytes and eosinophils. There is a subgroup of patients with eosinophilic or neutrophilic urticaria, resistant to the treatment with antihistamines, but that respond to a combination of antihistamine with other drugs. OBJECTIVE: To evaluate the present infiltration in chronic urticaria biopsies and correlate it with the clinical disease activity and response to treatment. METHODS: Forty-one patients with chronic urticaria were classified according to the score of severity of the disease, response to treatment and type of perivascular infiltrate. Inflammatory infiltrates were divided in eosinophilic (46.30%), neutrophilic and mixed. RESULTS: An association was found between the eosinophilic infiltrate and clinical scores of greater severity (p = 0.002). CONCLUSION: This association shows that the eosinophilic inflammatory infiltrates denote high clinical activity, which means more severe and exuberant clinical pictures of the disease.

Cocaine abuse that presents with acute scrotal pain and mimics testicular torsion

ABSTRACT Report case (s) relevant aspects: Man, 27 years old, complaining of acute testicular pain by 2 hours in the remaining left testicle. Denies fever, lower urinary tract symptoms such as dysuria, urinary frequency, concommitant or prior urethral discharge to the painful condition. He underwent right orchiectomy 13 years ago by testicular torsion. He is a chronic user of cocaine for 15 years and during the last three days the drug use was continuous and intense. Proposed premise substantiating case (s) description: Initial diagnostic hypothesis: Syndromic: Acute Scrotum Syndrome (SEA) Main Etiologic (testicular torsion) Secondary Etiologic (acute orchiepididymitis) Briefly delineates what might it add? Lines of research That Could be Addressed: In this challenging clinical case we presented an alternative and new etiologic diangosis for the acute scrotum which the main etiologic factor remains testicular torsion. This new diangosis is acute testicular ischemia as a complication of cocaine abuse.

Urticária crônica e comorbidades mais frequentemente relacionadas / Chronic urticaria and more frequently related comorbidities

Objetivo: Avaliar a associação entre urticária crônica e doenças sistêmicas (síndrome metabólica, artropatias, doença vascular periférica e do trato gastrintestinal). Métodos: Estudo transversal, descritivo, de base clínica. Foi realizado um levantamento de dados por meio de prontuários de 95 pacientes, que estiveram em tratamento ambulatorial de rotina de abril de 2014 a abril de 2015, mediante assinatura de um Termo de Consentimento Livre e Esclarecido pelo paciente durante suas consultas de rotina no Ambulatório de Urticária. Para analisar a associação das doenças, foi utilizado o teste estatístico qui quadrado, considerando sexo feminino e masculino, e a doença. Consideraram- se relevância estatística as relações com p abaixo de 0,05 (p<0,05). O nível de significância adotado foi de 95%. O programa utilizado foi o Stata 11.0. Resultados: Artropatias foram positivas em aproximadamente 55% das mulheres do estudo e 17% dos homens (p=0,001 e p<0,05, respectivamente). Houve significância estatística na relação entre doença vascular e urticária crônica (p=0,022 e p<0,05, respectivamente). Conclusão: Não foi encontrada associação relevante estatisticamente para afirmar que houve confiança na associação entre diabetes e urticária crônica (p=0,801 e p>0,05, respectivamente). Não se obteve relevância na relação com doenças do trato gastrointestinal (p=0,437/p>0,05). relevância na relação com doenças do trato gastrointestinal (p=0,437/p>0,05).

Objective: To evaluate the association between Chronic urticaria and systemic diseases such as metabolic syndrome, arthropathies, peripheral vascular disease, and gastrointestinal diseases. Methods: a cross-sectional, descriptive study of clinical basis. A survey of data was performed through the medical records of 95 patients who underwent routine outpatient treatment from April 2014 to April 2015, and signed na Informed Consent during their routine appointments in the Urticaria Clinic. To analyze the diseases associations we used the statistical Chi-square test, considering male and female patients, and the disease. Relations with p lower than 0.05 (p<0.05) were considered statistically relevant. Significance level was 95%. The software used was Stata 11.0. Results: Arthropathies were positive in approximately 55% of women in the study, and 17% of men (p=0.001 and p<0.05, respectively).There was a statistically significant relationship between vascular disease and chronic urticaria (p=0.022 and p<0.05, respectively). Conclusion: No statistically significant association was found to state that there was confidence in the association between diabetes and Chronic urticaria (p=0.801 and p>0.05, respectively). No relevant relation was observed with gastrointestinal diseases (p=0.437/ p>0.05).

Hanseníase virchowiana difusa e o diagnóstico diferencial com outras doenças sistêmicas / Lepromatous leprosy and the differential diagnosis with other systemic diseases

A Hanseníase é uma doença causada pelo Mycobacterium leprae, com manifestações cutâneas acompanhadas de perda da sensibilidade e envolvimento de sistema nervoso periférico, podendo acometer vísceras e mucosas. O Brasil ocupa o 2° lugar no ranking de prevalência da doença. A classificação própria da hanseníase evidencia sua complexidade clínica e polimorfismo; e possibilita intersecções com patologias como o linfoma não Hodgkin. Este é uma neoplasia maligna de linfonodos, e pode manifestar-se primariamente na pele. Paciente masculino, 51 anos. Procurou o serviço com queixa de “pele rachada”, lesões em boca e língua, e emagrecimento. Ao exame físico, presença de placas em palato, formações esbranquiçadas em dorso de língua e infiltração em lóbulo de orelha. Identificaram-se ainda, alterações sensitivas em extremidades, rash cutâneo eritemato-descamativo generalizado, tumoração em cotovelo, e lesões eritemato-infiltradas com exulcerações em membros inferiores. As hipóteses diagnósticas foram: hanseníase, leishmaniose cutâneo-mucosa, SIDA, Sífilis secundária e linfoma não Hodgkin. Durante a investigação, obtiveram-se resultados negativos para todas as sorologias, exceto a pesquisa de BAAR e biópsia sugerindo Hanseníase Virchowiana. Iniciou-se tratamento poliquimioterápico e houve remissão completa das lesões. Na hanseníase virchowiana, notam-se lesões sólidas papulosas, nodulares, ou em placas com características variáveis. Além disso, é possível encontrar espessamento de pavilhão auricular, madarose e obstrução nasal. Lesões em cavidade oral, também são descritas nestes casos. Os linfomas não Hodgkin de apresentação cutânea primária, podem se assemelhar a formas difusas de Hanseníase virchowiana, pois são neoplasias linforreticulares que se manifestam durante a história natural da doença em tecidos extranodais, dentre eles, a pele.

Leprosy is a disease caused by Mycobacterium leprae, with skin manifestations accompanied by loss of sensation and involvement of the peripheral nervous system that can also affect mucous membranes and viscera. Brazil ranks 2nd in the ranking of disease prevalence. The classification of leprosy itself shows its clinical polymorphism; and allows intersections with diseases such as non-Hodgkin lymphoma. This is a malignant neoplasm of lymph nodes, and may manifest primarily inthe skin. A 51 years-old male patient came to us complaining of “chapped skin”, lesions in the mouth and the tongue and weight loss. On physical examination there was the presence of plaques on the palate, whitish formations on back of tongue and ear lobe infiltration. We identified sensory changes, widespread erythematous rash, a tumor in the elbow, and infiltrated erythematous lesions with exulcerations in lower limbs. The diagnostic hypotheses were: mucocutaneous leishmaniosis, AIDS, secondary syphilis, leprosy and non-Hodgkin lymphoma. During the investigation, all serological test were negative, however, acid fast bacilli staining and biopsy suggested lepromatous leprosy. After multidrugtherapy treatment there was complete resolution of the lesions. In lepromatous leprosy solid nodular, papular lesions or plaques with variable characteristics may be noticed. Additionally, thickening of the pinna, madarosis and nasal obstruction can be found. Lesions in the oral cavity are also described in cases of lepromatous leprosy. Non-Hodgkin lymphomas with primary cutaneous presentation, may resemble indeterminate forms of leprosy, since they are characterized as lymphoreticular neoplasms that arise during the natural history of the disease, in extranodal tissues, including the skin.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part II

Objective To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). Materials and Methods One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and “de novo” urinary symptoms after 12 months of surgery in both groups. Results Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and “de novo” urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. Conclusion There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and “de novo” urinary symptoms between both groups after 12 months of surgery. .