Reacciones vasculonecróticas en la lepra. Descripción de dos casos de fenómeno de Lucio / Vasculonecrotic reactions in leprosy. Two cases of Lucio’s phenomenon

El Fenómeno de Lucio (FL), probablemente mediado por inmunocomplejos, se caracteriza por una reacción cutánea necrosante grave que ocurre en pacientes portadores de Lepra no nodular[1]. La literatura revisada muestra inadecuado uso de esta definición. Muchos autores identifican como Fenómeno de Lucio las reacciones vasculonecróticas que ocurren en formas distintas a la Lepra difusa [2, 9]. Presentamos dos casos clínicos de pacientes con formas difusas de Enfermedad de Hansen que desarrollaron fenómenos vasculonecróticos (AU)

The Lucio’s phenomenon (LP), probably mediated by immune complexes, is a severe necrotizing skin reaction that occurs mainly in patients with non nodular lepromatous leprosy. The literature review shows that there is an inadequate use of this definition. Several authors identify as LP the vasculonecrotic reactions that occur in other forms than the diffuse leprosy. We present two cases of patients with Hansen’s disease, who developed vasculonecrotic reactions (AU)

Ectima gangrenoso. Comunicación de tres casos / Gangrenous ecthyma. Presentation of three cases

El ectima gangrenoso es una lesión cutánea producida por una infección, generalmente por Pseudomona aeruginosa. Las infecciones de piel producidas por esta bacteria son: paroniquia, foliculitis de piletas de natación, infección secundaria de dermatosis o heridas, vesículas, flictenas, placas y nòdulos, ectima gangrenoso, celulitis gangrenosa. El ectima gangrenoso aunque puede aparecer en individuos previamente sanos, principalmente lactantes, es más frecuente en inmunocomprometidos, grandes quemados, neutropénicos, diabéticos, portadores de neoplasias malignas, SIDA, y trasplantados.

Lepra hoy: consideraciones epidemiológicas del Hospital Nacional / Leprosy today: epidemiologycal considerations of the National Hospital

La lepra o enfermedad de Hansen, enfermedad infectocontagiosa producida por el Mycobacterium leprae, sigue siendo un problema de salud pública en países como el nuestro. Se estudian aspectos epidemiológicos de la lepra en los casos registrados en el Servicio de Dermatología . Estudio retrospectivo observacional y descriptivo de los casos de Consultorio Externo e interconsultas hospitalarias registrados en el periodo de 1999 al 2009. La lucha contra la lepra, a pesar de algunas fortalezas como la distribución gratuita de los fármacos, sigue presentando grandes desafíos como el elevado número de abandono del tratamiento y el escaso y el escaso control de las personas contactantes, máxime considerando que el 80% son bacilíferos...

The role of age in the development of Schneiderian symptoms in patients with a first psychotic episode.

OBJECTIVE: The likelihood of developing psychotic symptoms greatly increases after puberty. In acute psychotic disorders, first rank symptoms (FRS) are prevalent and considered useful for the diagnostic process. The aim of this study was to test for a linear association between age and the probability of occurrence of FRS in patients with a first psychotic episode (FPE). METHOD: A total of 112 patients, consecutively admitted with an FPE, were included at baseline and evaluated yearly over a 3-year period using SCID-I and a checklist of 11 items of FRS. RESULTS: FRS were documented for 65.2% patients at baseline. There was a dose-response relationship in the association between age and FRS. There was no interaction with sex or with final diagnostic category. CONCLUSION: Variation in the expression of the core positive symptoms of psychosis is subject to the influence of underlying age-dependent maturational processes both in terms of occurrence and level of severity.

Principal components of mania.

OBJECTIVE: An alternative to the categorical classification of psychiatric diseases is the dimensional study of the signs and symptoms of psychiatric syndromes. To date, there have been few reports about the dimensions of mania, and the existence of a depressive dimension in mania remains controversial. The aim of this study was to investigate the dimensions of manic disorder by using classical scales to study the signs and symptoms of affective disorders. METHODS: One-hundred and three consecutively admitted inpatients who met DSM IV criteria for bipolar disorder, manic or mixed were rated with the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS-21). A principal components factor analysis of the HDRS-21 and the YMRS was carried out. RESULTS: Factor analysis showed five independent and clinically interpretable factors corresponding to depression, dysphoria, hedonism, psychosis and activation. The distribution of factor scores on the depressive factor was bimodal, whereas it was unimodal on the dysphoric, hedonism and activation factors. Finally, the psychosis factor was not normally distributed. LIMITATIONS: Patients of the sample were all medicated inpatients. CONCLUSIONS: Mania seems to be composed of three core dimensions, i.e. hedonism, dysphoria and activation, and is frequently accompanied by a psychotic and a depressive factor. The existence of a depressive factor suggests that it is essential to evaluate depression during mania, and the distribution of the depressive factor supports the existence of two different states in mania.

Age-dependence of Schneiderian psychotic symptoms in bipolar patients.

Psychotic symptoms frequently occur in bipolar disorder, especially in younger patients. However, whether the association with younger age also extends to psychotic symptoms that have traditionally been associated with schizophrenia, such as Schneiderian first-rank symptoms (FRSs), is unclear. This study examined FRSs in bipolar I patients and their relationship to age and gender. The sample comprised 103 consecutive inpatients who met DSM IV criteria for bipolar disorder, manic or mixed. FRSs were rated with the Scale for the Assessment of Positive Symptoms (SAPS). Interaction between FRSs and gender and FRSs and age was assessed using logistic regression. A high rate of FRSs in manic and mixed patients was found with a higher frequency in men (31%) than in women (14%; P=0.038). A monotonic increase in the association between FRSs and younger age was apparent (odds ratios (OR) over five levels: 1.42; 1.00-2.01). These results confirm previous findings that FRSs are not specific to schizophrenia and suggest in addition that a dimension of nuclear psychotic experiences of developmental origin extends across categorically defined psychotic disorders.

Inability to sneeze as a manifestation of medullary neoplasm.

A young man with headache was unable to sneeze despite a strong sensory urge to do so. Magnetic resonance imaging revealed a cystic neoplasm in the medulla oblongata that presumably interrupted the efferent arc of the sneezing reflex.

Mycotic vasculitis with repeated intracranial aneurysmal hemorrhage. Case report.

A case of repeated intracranial aneurysmal rupture occurring despite successful treatment of infective endocarditis is reported. While the valvular source of emboli was eradicated and serial angiograms documented no further aneurysms after resection of the primary lesion, the formation and rupture of multiple septic aneurysms occurred 9 months later in the opposite hemisphere. A relationship to damage of the cerebral vasculature by immune complexes is suggested as one possible explanation for this unusual occurrence. This implies that some patients with infective endocarditis may be at permanent risk for the formation and rupture of mycotic intracranial aneurysms, despite successful treatment of the primary cardiac lesion.

Arterial blood flow and resistance in the forearm of arteriosclerotic patients.

Twenty patient with severe atherosclerotic affection of the lower limbs, but without any symptoms of involvement of their upper extremities, and twenty healthy controls were examined. The investigation included measurement of arterial blood flow and resistance in the left forearm at rest and after a three-minute circulatory arrest, using a strain-gauge venous occlusion plethysmograph. Comparison of the results obtained in each group showed statistically significant differences in haemodynamic parameters such as maximal blood flow, resting resistance, and minimal resistance which suggested the presence of vascular changes also in the upper extremities. Arterial resistance proved to be a more sensitive indicator of circulatory disorder than blood flow.