Disseminated blue naevus and malignant blue naevus associated with excessive aromatase syndrome.

We report a case of a 17-year-old boy who had a giant congenital blue naevus with multiple satellite pigmented lesions. Later the patient developed melanoma arising in the pre-existing lesion. He also had gynaecomastia and was diagnosed as having aromatase excess syndrome. To our knowledge, the association of these two rare conditions has not been previously reported. Further studies should be performed to investigate this unusual combination, which may have a genetic, endocrine or local cutaneous link leading to its occurrence.

Evaluation of serological diagnostic indices for mucocutaneous leishmaniasis: immunofluorescence tests and enzyme-linked immunoassays for IgG, IgM and IgA antibodies.

The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of immunofluorescence (IF) and enzyme-linked immunoassays (ELISA) for IgG, IgM and IgA antibodies were assessed on sera from mucocutaneous leishmaniasis patients and controls. The sensitivity of the IgG-ELISA test was 93.3% with 95% confidence interval higher than what could be due to a random test not associated with the disease. The specificity of all tests, except the IgM-ELISA, gave indices that could not have been due to chance. The IgG-ELISA and IgG-IF had the highest positive predictive value and the kappa statistic showed that the strength of agreement between the disease and the test was strongest for IgG-ELISA. The IgG-ELISA had a negative predictive value with 95% confidence limits that were not due to chance alone. Efficiency was highest for IgG-ELISA and IgG-IF. These results were obtained using sera from patients with severe or long-standing disease and from controls in whom the disease was ruled out by a negative Montenegro skin test. In field surveys where the differences between cases and controls are less easy to define the diagnostic indices of these tests may vary with the disease prevalence.

Evaluation of serological diagnostic indices for mucocutaneous leishmaniasis: immunofluorescence tests and enzyme-linked immunoassays for IgG, IgM and IgA antibodies

The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of immunofluorescence (IF) and enzyme-linked immunoassays (ELISA) for IgG, IgM and IgA antibodies were assessed on sera from mucocutaneous lieshmaniasis patients and controls. The sensitivity of the IgG-ELISA test was 93.3 per cent with 95 per cent confidence interval higher than what could be due to a random test not associated with the disease. The specificity of all tests, except the IgM-ELISA, gave indices that could not have been due to chance. The IgG-ELISA and IgG-IF had the highest positive predictive value and the kappa statistic showed that the strength of agreement between the disease and the test was strongest for IgG-ELISA. The IgG-ELISA had a negative predictive value with 95 per cent confidence limits that were not due to chance alone. Efficiency was highest for IgG-ELISA and IgG-IF. These results were obtained using sera from patients with severe or long-standing disease and from controls in whom the disease was ruled out by a negative Montenegro skin test. In field surveys where the differences between cases and controls are less easy to define the diagnostic indices of these tests may vary with the disease prevalence(AU)

[Stable solution of fuchsin--a new method for preparation of Ziehl-Neelsen staining]. / Solução estável de fucsina--novo método de preparação para coloração de Ziehl-Neelsen.

The fuchsin salts currently available in Latin American market have shown some instability when in solution, according to the classic Ziehl-Neelsen method, resulting in a total precipitation of the salt. The authors indicate a new technique for the preparation of this solution, in order to minimize the action of interfering factors responsible for the precipitation, obtaining thus a greater solubility of the salt, as well as the solution stability. The method effectiveness is reinforced by the utilization of a smaller amount of the salt and the attainment of a larger storage period for the solution.

Thiamphenicol in the treatment of male gonococcal urethritis: a study of 1,230 cases.

Thiamphenicol, an aminic derivative of hydrocarbilsulfonylpropandiol, was used for the treatment of acute, uncomplicated, gonococcal urethritis in 1,446 male patients. Each patient received one oral dose of 2.5 g of thiamphenicol, which was readministered after 48-72 hr if Neisseria gonorrhoeae continued to be present in urethral smears. Of the 1,446 patients treated, 1,230 patients underwent posttreatment evaluation at 48-72 hrs and at seven days. Twenty-eight patients (2.3%) did not respond to treatment; treatment was successful in 1,140 patients (92.7%) after only one dose, and in 62 (5.0%) after two doses. The overall rate of treatment success was 97.7%. Of 352 patients evaluated one month after treatment, serologic tests in 41 (12.6%) were positive for syphilis.

Minute treatment with thiamphenicol in water for acute gonococcal urethritis in male patients.

Eighty-two male patients with acute gonococcal urethritis were given a single oral dose of 2.5 g of granulated thiamphenicol dissolved in water, and the results of treatment were evaluated after 48-72 hr and one week. Of the 76 patients who returned for the first follow-up examination, 75 (98.7%) no longer had Neisseria gonorrhoeae in urethral smears or cultures. Five of these patients did not return for the second follow-up examination, and another four who did return were found to be reinfected as a result of reexposure. Of the remaining 67 patients, 66 (98.5%) no longer had N. gonorrhoeae in urethral smears or cultures. Thus, the overall success rate among the 71 patients who completed the study (with the four cases of reinfection considered instances of failure of therapy) was 93%. The ease of administration, absence of adverse reactions, low failure rate, and low incidence of residual urethral secretions (4.5%) justify the use of thiamphenicol as the drug of choice for the treatment of acute gonococcal urethritis in male patients.

[Modification of the basic stain of the Ziehl-Neelsen technic in the identification of Mycobacterium leprae]. / Modificação da coloração de fundo da técnica de Ziehl-Neelsen na identificação do Mycobacterium leprae.

Authors analyse the counterstain with methylene blue solution in the usual Ziehl-Neelsen method. Considerations are made on the characteristics of the dye substance. A technique alteration is proposed: a "concomitant alkalization" of the classic aqueous methylene blue solution, by adding some drops of sodium hydroxide solution, 1:500, on the slide at the moment of the staining. By this technique it was observed: a) a larger validity period of the solution; b) an absence of precipitate in the slides; c) an easier visualization of the substrate; d) a larger contrast among the substrate and the bacilli.

[Aspects of Hansen's disease in the urban area of the municipality of São Paulo - undifferentiated Hansen's disease, 1963-1977]. / Aspectos da hanseníase na área urbana do município de São Paulo - Hanseníase indiferenciada, 1963-1977.

The purpose of this work is to analyze the epidemiological changes that have occurred in São Paulo due to geographical and historical influences. This research was made during the period of 1963 to 1977, covering 6,664 cases and two main aspects: origin and age. In 1977, Sao Paulo presented 5,179 inhabitants per square kilometer and a percentage of 5,3 hanseniasis patients per square kilometer. The data compiled during the research have led to the following conclusions: São Paulo has become an important economical center and as such a point of attraction to intense migratory currents; this increase has caused the formation of unplanned and outnumbered populational centers in the outskirts which are obstacles to medical and social welfare assistance and to diagnosis and control as well; changes in the social and economical structures leading to a poorer family life; increase in the possibilities of transmission of hanseniasis either by non-intimate or long-termed contacts; decrease in the number of cases in the same family and, finally, the characterization of hanseniasis as a grown-up and urban disease.

Cell mediated immunity in patients with Virchowian hanseniasis before and after treatment with transfer factor.

Cell mediated immunity (CMI), bacterial index (BI), morphological index (MI), skin and lymph nodes biopsies were evaluated in 15 patients with virchowian hanseniasis before and after treatment with transfer factor (TF) obtained from human spleens. The patients were divided in 3 groups: group I (control) received only sulfone, group II received sulfone plus TF and group III received only TF. There was no difference in the numbers of peripherical T and B lymphocytes of patients and normal controls. Before the treatment with TF, there was an impaired response of the patient's peripheral lymphocytes to PHA stimulus, in the presence of autologous or homologous plasma. This depressed response was corrected after treatment with TF in the patients of group III. In none of the patients a positive Mitsuda reaction was observed before and after treatment with TF. The improvement of the MI observed in group III, treated only with TF was remarkably similar to the patients treated only with sulfone. This work points out that TF has a role in the treatment of patients with virchowian hanseniasis, based on the improvement of CMI, MI, on histopathology of skin biopsies and clinical conditions.