Tratamento de púrpura actínica com hidroxiapatita de cálcio / Treatment of actinic purpura with calcium hydroxyapatite

A púrpura actínica é caracterizada por máculas roxas escurecidas localizadas, principalmente nas áreas fotoexpostas das faces extensoras dos braços e das mãos de indivíduos idosos. Até o momento, não há tratamento satisfatório. Relatamos o caso de um paciente de 80 anos que foi submetido ao tratamento com duas sessões de preenchimento dos antebraços com hidroxiapatita de cálcio, apresentando bom resultado.

Actinic purpura is characterized by dark purple patches, mainly on photoexposed areas of the extensor surfaces of the arms and hands of elderly individuals. Thus far, there is no satisfactory treatment. We report the case of an 80-year-old patient who underwent treatment with two sessions of calcium hydroxyapatite filler application in the forearms, with good results.

Scleroderma en coup de sabre treated with polymethylmethacrylate - Case report.

The scleroderma en coup de sabre is a variant of localized scleroderma that occurs preferentially in children. The disease progresses with a proliferative and inflammatory phase and later atrophy and residual deformity, which are treated with surgical techniques such as injectable fillers, transplanted or autologous fat grafting and resection of the lesion. Among the most widely used fillers is hyaluronic acid. However, there are limitations that motivate the search for alternatives, such as polymethylmethacrylate, a permanent filler that is biocompatible, non-toxic, non-mutagenic and immunologically inert. In order to illustrate its application, a case of scleroderma en coup de sabre in a 17-year-old patient, who was treated with polymethylmethacrylate with excellent aesthetic results, is reported.

Scleroderma en coup de sabre treated with polymethylmethacrylate - Case report

Abstract The scleroderma en coup de sabre is a variant of localized scleroderma that occurs preferentially in children. The disease progresses with a proliferative and inflammatory phase and later atrophy and residual deformity, which are treated with surgical techniques such as injectable fillers, transplanted or autologous fat grafting and resection of the lesion. Among the most widely used fillers is hyaluronic acid. However, there are limitations that motivate the search for alternatives, such as polymethylmethacrylate, a permanent filler that is biocompatible, non-toxic, non-mutagenic and immunologically inert. In order to illustrate its application, a case of scleroderma en coup de sabre in a 17-year-old patient, who was treated with polymethylmethacrylate with excellent aesthetic results, is reported.

Soft tissue augmentation with PMMA-microspheres for the treatment of HIV-associated buttock lipodystrophy.

Progression of lipodystrophy syndrome is a big challenge in HIV treatment. Nowadays, fat loss at the lower part of buttocks has become another problem as patients have started to complain that it is painful to be seated for a long time and/or on hard surfaces. We developed a method for buttock lipoatrophy treatment with PMMA-microspheres, as silicone prostheses and autologous fat transplant were not completely efficient. The treatment consisted of net-crossed injections, in the subcutaneous layer, of a 30% PMMA-microspheres solution on the atrophic areas of the buttock. One hundred and fifty-four patients were included. The amount of PMMA-microspheres used to treat buttock lipoatrophy depended on the degree of atrophy and size of the area to be treated. Patients were satisfied with this treatment and reported to be more comfortable to be seated for longer period of time. We demonstrated that soft tissue augmentation with PMMA-microspheres is safe and efficient for the treatment of buttock lipoatrophy associated with HIV lipodystrophy.

Epidemiology of melasma in Brazilian patients: a multicenter study.

BACKGROUND: Melasma is an acquired, irregularly patterned, light to dark-brown hypermelanosis, with symmetric distribution mostly over the face. The aim of this study was to evaluate clinical characteristics and factors related to melasma in Brazilian patients. METHODS: This was a cross-sectional, multicenter study performed in Brazil. Investigators examined and questioned 953 patients over 18 years of age on clinical characteristics and other factors related to their melasma. RESULTS: Melasma was more prevalent in women (97.5%) and in Fitzpatrick skin phototypes II (12.8%), III (36.3%), and IV (39.7%). Skin phototypes II and III and family history of melasma had early onset of the disorder when compared with skin phototypes IV, V, and VI (P<0.0001). Similar results were also observed when these same groups were compared with the absence of family history (P<0.0001). Extra-facial melasma was more frequent in postmenopausal women compared with those who were not experiencing menopause (14.2% vs. 3.5%, P<0.0001). CONCLUSIONS: Data suggested that the age of melasma onset are related to skin phototypes and family history. Additionally, extra-facial melasma was more common in menopausal women. This is the first study on the epidemiology of melasma in Brazil involving a large sample of the population. These data can be a source of new relevant research on the cause and development of melasma.

Qualidade microbiológica da água de escolas públicas do município de Rosário, MA / Microbiological water quality of public schools in the city of Rosario, MA

A água potável é um suprimento indispensável para a qualidade de vida de qualquer indivíduo. O objetivo deste estudo foi avaliar a qualidade microbiológica da água das Escolas Públicas do município de Rosário – MA, de agosto de 2007 a janeiro de 2008, utilizando a técnica do Número Mais Provável (NMP/mL) de coliformes totais, coliformes termotolerantes, Pseudomonas aeruginosa e contagem de bactérias heterotróficas mesófilas, segundo a metodologia recomendada pela CETESB, 1996. Os resultados das análises evidenciaram que, em quatro (57,14%) escolas a água estava contaminada por coliformes totais, duas (28,57%) por termotolerantes, cinco (71,42%) por Pseudomonas, enquanto uma (14,28%) apresentou contagem de bactérias heterotróficas acima do limite aceitável.

Case for diagnosis. Cutaneous metastases of visceral cancer.

Cutaneous metastases of visceral cancers are relatively rare, with an incidence of 0.7 to 10%. The most frequent primary sites are breast, lung and colon tumors. They generally occur after the primary cancer is diagnosed and signify a poor prognosis. They may occur as the first manifestation in 20% of cancers in general. The most common manifestations are single or multiple asymptomatic nodules, most often located on the chest, abdomen, head and neck, sometimes with unusual clinical features which present a challenge to clinical diagnosis.

Reação reversa atípica em paciente com hanseníase dimorfa co-infectado pelo HIV / Atypical reversal reaction in a borderline leprosy patient co-infected with HIV

A infecção pelo HIV não altera a história natural da hanseníase. Observa-se maior incidência de estados reacionais nos pacientes co-infectados, além de casos mais graves de neurite. Paciente soropositiva com hanseníase dimorfa tuberculóide manifestou reação reversa exuberante. Lesões cutâneas atípicas e raras surgiram após a introdução da terapia anti-retroviral que promoveu o início da recuperação imunológica com aumento de linfócitos T CD4+ e queda da carga viral. A restauração da imunidade celular nos pacientes soropositivos pode precipitar reações reversas, descritas recentemente como uma das manifestações da síndrome inflamatória de reconstituição imunológica associada à hanseníase.

HIV infection does not modify the natural course of leprosy. However, HIV co-infection seems to be associated with an increased rate of reactional states and more severe cases of neuritis. The authors describe a case of borderline tuberculoid leprosy in a HIV-positive patient who developed a marked reversal reaction. Atypical and rare skin manifestations, such as verrucous lesions and ulcers, appeared after highly active antiretroviral therapy, which resulted in increased CD4+ T-lymphocyte count and drop in viral load. The restoration of the cellular immunity in HIV-seropositive patients can trigger reversal reactions that are one of the manifestations of the immune reconstitution inflammatory syndrome. Only recently the syndrome has been associated with leprosy.

Phosphatidylcholine in the treatment of localized fat.

Phosphatidylcholine was initially used in emergencies and in the treatment of atheroma plaques in cardiac diseases. Recently, it has also been used in the treatment of localized fat deposits. We report on the authors' clinical experience of the use of 250 mg/ml phosphatidylcholine injections in the treatment of subcutaneous fat deposits, showing the clinical response and side-effects. Volunteers received phosphatidylcholine injections in several areas of localized fat deposits, with a minimum interval of one week and mean interval of 15 days between applications. Laboratory tests were performed during the period of the drug use. Clinical results reflect that phosphatidylcholine was efficacious in reducing the fatty pads in the treated areas, with few side effects. From the authors' point of view, the off-label use of phosphatidylcholine in the treatment of fatty pads and small areas of localized fat is safe, low cost, and effective.

Hemobilia pós-trauma / Hemobilia post trauma

Our objective is to report a case of a patient, with a thoraco-abdominal gunshot wound with right hemothorax and liver lesion in the right lobe. The liver and the diafragm were sutured and the chest was drained. On the 9th post operative day the patient had hematemesis, jaundice and pain in the right upper quadrant of the abdomen. The abdominal ultrasound image with Doppler, revealed arteriobiliary fistulae. The diagnosis of hemobilia was made and the patient underwent embolization of the fistulae by liver arteriography.

Cinco anos de corticoterapia em paciente com pênfigo foliáceo e Aids / Five years of corticotherapy in a patient with pemphigus foliaceus and Aids

Os autores apresentam um caso de pênfigo foliáceo em pacientes com Aids que, a despeito da corticoterapia prolongada empregada, näo apresentou aceleraçäo em sua doença de base. E discutem, principalmente, o uso de corticosteróides sistêmicos em pacientes HIV-positivos

Implicaçöes da desnutriçäo em cirurgia / Implications of malnutriotion in surgery

A desnutricao esta associada a um aumento dos indices de morbimortalidade nas enfermarias de cirurgia. Os autores pretendem com este estudo ampliar as informacoes relativas a avaliacao do estado nutricional e correlaciona-las com a incidencia de infeccoes e mortalidade pos-operatoria, alem de outras variaveis. Em 241 pacientes do Servico de Cirurgia Geral do Hospital Universitario Julio Muller, submetidos a cirurgias eletivas e estudados prospectivamente, a taxa de desnutricao observada foi de 31,5% (76 pacientes). Entre os desnutridos, verificou-se um maior taxa de mortalidade (p<0,05) e de infeccao pooperatoria (p= 0,05). Alem disso, observou-se uma maior incidencia de desnutricao no sexo masculino (p< 0,01), e ela foi associada a um maior tempo de internacao total (p<0,01) e pre-operatoria (p<0,001) e, tambem, a portadores de patologias neoplasicas (p<0,05). Conclui-se que a desnutricao deve ser considerada como um dos fatores de risco de complicacoes pos-operatorias, e, em consequencia, a avaliacao do estado nutricional deve sempre ser incluida na determinacao do risco cirurgico pre-operatorio