Viral encephalitis associated with reversible asystole due to sinoatrial arrest.

We report a case of sinoatrial node block associated with syncopal episodes that required a temporary pacemaker. Magnetic resonance imaging (MRI) of the brain showed lesions of both temporal lobes consistent with viral encephalitis, presumably due to herpes simplex virus (HSV). The patient quickly recovered with intravenous acyclovir (Zovirax) therapy. Patients with presumed encephalitis might benefit from cardiac monitoring for possible associated cardiac arrhythmia. A permanent pacemaker is rarely required, since recovery is spontaneous in the majority of these cases.

Multi-centre double-blind trial on the efficacy and safety of sertaconazole 2% cream in comparison with miconazole 2% cream on patients suffering from cutaneous mycoses.

The efficacy and tolerance of 7-chloro-3-[1-(2,4-dichlorophenyl)-2- (1H-imidazol-1-yl)ethoxy-methyl]benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2) 2% dermatological cream in two daily applications compared with miconazole 2% cream in two daily applications were studied on 631 patients suffering from superficial cutaneous mycosis (sertaconazole n = 317, miconazole n = 314), in a double-blind, controlled multicentre trial with parallel groups. The therapeutic efficacy was evaluated by clinical assessment of the improvement of the lesion and symptoms, a microscopic test on the presence of hyphae or mycelia in the affected area and a culture test on the presence of active infection. Tolerance and safety were evaluated by a general blood analysis and interrogation of the patient on adverse effects. The rate of clinical cures for both treatments at the end of the follow-up was 95.6% for sertaconazole and 88.1% for miconazole, with the difference being statistically significant. In the comparative analysis of the actuarial curve, it was observed that the patients treated with sertaconazole were cured earlier and in a higher proportion than those treated with miconazole, with the difference being significant. The negative result of the microscope examination and culture test confirmed the superiority of sertaconazole over miconazole, already after 14 days of treatment. At the end of the follow-up, 98.6% of the patients in the sertaconazole group obtained a negative culture test result, as opposed to 91.7% in the miconazole group, with the difference being highly significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Etiological variety of balanopreputial pigmentations]. / Variedad etiológica de las pigmentaciones balanoprepuciales.

The authors report 17 cases with a similar clinical pattern but corresponding to different processus: lentigo simplex, dermal and junction nevus, lichen planus, lentigo premalignant, secondary Incontinentia pigmenti. The diagnosis of the disorders was made by microscopical study.

[Merkel-cell tumor]. / Tumor de células de Merkel.

A Merkel cell tumor of the preauricular region in a seventy-seven years old woman is described. Histological, electronmicroscopic and tissular hormonal studies, were made. From the pathological point of view, a nodular and trabecular pattern of oval or elongated cells with poor basophilic cytoplasma is characteristic. Large nuclei with irregular, oval prominent nucleoli are also present. Electron microscopy shows oval and polygonal cells of irregular nuclei with one or multiple prominent nucleoli. In the cytoplasm of these cells, microfilaments and dense core granules with clear halo are found. The tissular hormonal determinations were normal. Two years after the surgical treatment, the patient remains asymptomatic.

[Self-healing childhood histiocytosis X (Illig-Fanconi disease). Comments on ultrastructural aspects and etiopathogenic classification of histiocytosis]. / Histiocitosis X infantil autoinvolutiva (enfermedad de Illig-Fanconi). Comentarios acerca de los aspectos ultraestructurales y la clasificación etiopatogénica de las histiocitosis.

Two cases of cutaneous self-healing histiocytosis X in a 6 and a 16 months-old children, are reported. Clinically, the lesions were characterized by few, small, translucent and confluent papules, sometimes purpuric. The scalp lesions were seborrheic eczema-like; the elements on the groins were erosive. Systemic examinations, laboratory data and general development were completely normal. The histological pattern, in both cases, were identical of that in histiocytosis X (atypic mononuclear cells with glassy eosinophilic cytoplasm and excentric kidney-shaped nucleus). Electron microscopy of the second case showed a proliferation of histiocytes containing Langerhans bodies. Ten per cent of these cells showed multivesicular, myelin and dense laminar bodies. The latest had been specially described in other selfhealing histiocytic syndromes: congenital reticulohistiocytosis (Hashimoto-Pritzker) and generalized eruptive histiocytoma. Since the clinical behaviour and prognosis of the histiocytic proliferations can not be assumed on clinical and histological data, an attempt, of classification and understanding of these processes is presented. The possibility that histiocytosis represent a proliferation of the mononuclear-phagocytic system at different levels of cellular maturation, is considered. So it would be possible to consider: 1) Acute malignant processes: xantholeukaemia, malignant histiocytosis syndromes (histiocytic medullary reticulosis . . .), and Letterer-Siwe disease; 2) Chronic and severe processus: xanthoma disseminatum, necrobiotic xanthogranuloma, disseminated plane xanthoma, multicentric reticulohistiocytosis, localized reticulohistiocytoma of Crosti and Hand-Schüller-Christian disease; and 3) Benign processus, some of them being involutive: juvenile xanthogranuloma, regressing atypical histiocytosis, eosinophilic granuloma of the bone, Illig-Fanconi disease, Hashimoto-Pritzker disease, benign cephalic histiocytosis and generalized eruptive histiocytoma. These groups include classic X-histiocytosis, self-healing X-histiocytosis, non-X malignant histiocytosis and non-X benign or auto involutive-histiocytosis (some with intracellular lipid storage: xanthohistiocytosis) (see table II). The ultrastructural cytoplasmic markers of histiocytosis (table I) are consistent features in the accuracy of diagnosis of these conditions.