Use of Photography in Dermatology: Ethical and Legal Implications. / Implicaciones bioéticas y médico-legales del uso de la fotografía en dermatología.

Photographs are necessary in the clinical practice of dermatology, but there are ethical implications to consider. Moreover, dermatologists must be aware of and comply with certain legal requirements affecting the use of photographs. The main ethical principles are respect for patient autonomy and the physician's obligation to do no harm. The law differentiates between 2 bases for protection: one concerns the photographed person's rights over the image and the other protects personal data. Recent legislation places restrictions on taking photographs and exhibiting them. Photographs taken to be stored with a medical history have not been called into question, but the physician is recommended to inform the patient that they exist. When a photograph is exhibited for the purpose of teaching or illustrating concepts, it is necessary to determine whether or not the patient can be identified. If the answer is yes, the patient must give explicit permission. Caution should be exercised when publishing medical photographs on social media.

Medical Malpractice Issues in Dermatology: Clinical Safety and the Dermatologist. / La dermatología y sus aspectos médico-legales: seguridad clínica y dermatología.

Clinical safety and medical liability are first-order concerns in today's medical practice. It is important to understand the circumstances under which medical acts fail to live up to the accepted standard of care and to recognize the impact that malpractice claims have on physicians. Practitioners must also grasp the concept of medical error, studying malpractice claims in order to identify the areas where improvement is needed. The risk of accusations of malpractice in dermatology is comparatively low, both in Spain and worldwide. However, a great variety of clinical scenarios in dermatology can potentially give rise to a claim, and malignant melanoma is most susceptible to risk. Dermatologists should know which actions during clinical consultation merit particular attention and care. Clinical practice carries inherent risk of malpractice claims, but taking certain recommended precautions can prevent them.

Expression and functional activity of the very late activation antigen-4 molecule on human natural killer cells in different states of activation.

In the present study we describe the expression and functional activity of the alpha4beta1 heterodimer molecule on human natural killer (NK) cells. Flow cytometric analyses showed that fresh and activated NK cells expressed high levels of very late activation antigen-4 (VLA-4) molecules. These cells bound to fibronectin (FN) and to its 38 000-MW proteolytic fragment through the VLA-4 integrin that was blocked with HP2/1 anti-alpha4 monoclonal antibodies (mAbs) and with the FN peptide fragment CS1. No inhibitory effects were observed in the presence of anti-alpha5 mAb, FN peptide fragment CS2 or other irrelevant mAb. Fresh NK cells were unable to aggregate, despite their expression of VLA-4, and only activated (cultured and lymphocyte-activated killer cells) NK cells showed homotypic aggregation with HP1/7 and HP2/4 anti-alpha4 mAb related to cellular activation. These results underline new evidence of how NK cells in different states of activation maintain different constitutive levels of alpha4beta1 integrin activity, and highlight the possibility of a different functional regulation by the cells bearing VLA-4, in the expression of these epitopes and their ability to interact with their ligands.

Hypothermia: an easy-to-miss, dangerous disorder in winter weather.

A variety of age-related physiologic factors and disease states predispose older patients to hypothermia. These include a decreased ability to produce heat, malnutrition, medications, infections, and social factors such as isolation and poverty. The subtle clinical signs and symptoms of mild hypothermia may mimic cognitive decline, cerebral vascular accident, hypothyroidism, or myxedema coma. The challenge for the physician is to clinically recognize hypothermia and provide prompt diagnosis and treatment. Medical management of the older patient with moderate to severe hypothermia requires in-hospital intensive care, as life-threatening conditions may arise during stabilization and resuscitation.

[Antineutrophil cytoplasmic antibodies in patients with sickle cell anemia]. / Anticuerpos anti citoplasma de neutrófilos en pacientes con anemia drepanocítica.

PURPOSE: To determine whether anti neutrophil cytoplasmic antibodies (ANCA): anti myeloperoxidase (anti MPO) and anti proteinase 3 (anti PR3), are present in patients with sickle cell anaemia (SCA) during painful crisis. PATIENTS AND METHODS: 55 patients with SCA were included in this study, 35 of them had painful crisis and the rest were in steady state. We determined levels of anti MPO and anti PR3 by two enzyme immunoassays commercially available (Progen Biotechnik GMBH). RESULTS: A significant increase of anti MPO in the group of patients with painful crisis was found in comparison with steady state patients and controls. CONCLUSIONS: Our results suggest the possibility that anti MPO interacting with MPO on primed neutrophils lead to neutrophil activation, enhanced neutrophil adhesion and amplification of endothelial cell damage.

Correlación entre sialografía y la ecografía en el estudio de las glándulas salivales / Sialography and ultrasonography in the diagnosis of salivary gland diseases

Se estudiaron 90 pacientes con supuesta patología de las glándulas salivales mediante sialografía y ecografía. El objetivo del estudio fue establecer la capacidad diagnóstica de cada método en particular, en distintas patologías: litiasis extra e intraglandular, afecciones inflamatorias de los conductos excretores y de las glándulas y tumores. Se determinó además la incidencia de la patología por sexo y grupo etario. Se establecieron las indicaciones de cada método cuya eficiencia es semejante en algunos casos y absolutamente complementaria en otros. Ambos no pueden reemplazarse entre sí ni excluyen otros medios de diagnóstico por imágenes a los que se deberá apelar en circunstancias definidas como la TC y la RNM

Correlación entre sialografía y la ecografía en el estudio de las glándulas salivales / Sialography and ultrasonography in the diagnosis of salivary gland diseases

Se estudiaron 90 pacientes con supuesta patología de las glándulas salivales mediante sialografía y ecografía. El objetivo del estudio fue establecer la capacidad diagnóstica de cada método en particular, en distintas patologías: litiasis extra e intraglandular, afecciones inflamatorias de los conductos excretores y de las glándulas y tumores. Se determinó además la incidencia de la patología por sexo y grupo etario. Se establecieron las indicaciones de cada método cuya eficiencia es semejante en algunos casos y absolutamente complementaria en otros. Ambos no pueden reemplazarse entre sí ni excluyen otros medios de diagnóstico por imágenes a los que se deberá apelar en circunstancias definidas como la TC y la RNM

Dengue haemorrhagic fever in Cuba. II. Clinical investigations.

Clinical and serological studies were carried out on 114 patients admitted to hospital in Havana, Cuba with Dengue Haemorrhagic Fever and Dengue Shock Syndrome (DHF/DSS). Serological confirmation of dengue was obtained in 90% of cases, with 5% of cases primary and 95% secondary. Fever, haemorrhagic manifestations, vomiting and headache were the most frequent signs and symptoms. Among haemorrhagic manifestations, petechiae and vaginal bleeding were reported in a larger number of patients. 21 patients presented shock and, of these, 20 were secondary infections. The disease appeared more frequently in white persons and in women. The aetiopathogenicity of the syndromes is discussed. 95% of the cases could be explained on the basis of the secondary infection hypothesis.

Circulating immune complexes in paroxysmal nocturnal hemoglobinuria.

Circulating immune complexes were investigated in sera of 13 patients with paroxysmal nocturnal hemoglobinuria. A significant inhibition was observed in the complement-dependent rosette formation (EAC) in 6 cases; 2 patients presented an increased anticomplementary activity; antilymphocyte antibodies were demonstrated in 2 patients. The levels of C3d and immunoconglutinins were also increased; there were no differences in the total hemolytic complement between patients and normal controls. There was a significant correlation between C3d and immunoconglutinins with the inhibition of the EAC rosette formation test. These results provide evidence for the presence of circulating immune complexes in paroxysmal nocturnal hemoglobinuria.

Cell-mediated immunity in chronic myelocytic leukemia.

14 patients with chronic myelocytic leukemia were evaluated immunologically; no difference was found in mean lymphocyte percentage and absolute number between patients and healthy subjects. 4 cases (28.5%) showed decreased percentage of T lymphocytes, while only 2 cases (14.2%) had decreased absolute T lymphocyte values. PHA transformation was decreased in 57% of the patients. Spontaneous transformation in the short-term cultures exceeded the normal range in 65% of the cases. All patients skin tested were found to be reactive. Most of the patients had defective cellular immune response in vitro, probably related with a qualitative defect in T lymphocyte subpopulations. It cannot be completely excluded that part of the observed lymphocyte depression was due to the busulfan.

Sarcoidosis associated with autoimmune haemolytic anaemia and paroxysmal nocturnal haemoglobinuria red cell abnormality.

A 29-year-old male with sarcoidosis autoimmune haemolytic anaemia and paroxysmal nocturnal haemoglobinuria is described. Throughout his illness the chest films showed fibrosis in the right hilar region and he had had several pneumonias in the right lung. He had had massive splenomegaly and a splenectomy was performed. He was treated with prednisone and cyclophosphamide. Because his blood group was initially confused, several incompatible blood transfusions were given. Two types of antibody were detected: an autoantibody with "s" specificity and an alloantibody with Rh "D" specificity. Other interesting features in this case revealed at autopsy were a viral pneumonia and Toxoplasma gondii infection of the brain. As far as we know, this is the first reported patient with this unusual association.