Tumid Lupus Erythematosus Presenting as Patchy Alopecia: A Discussion of Alopecia Associated With Lupus Erythematosus.

Tumid lupus erythematosus (TLE), a subtype of chronic cutaneous lupus erythematosus (CCLE), presents with firm erythematous plaques that lack surface changes such as follicular plugging or scale. These lesions most commonly occur on the face and other photosensitive areas but may also present on the scalp as recurrent circumscribed patches of non-cicatricial alopecia. Including TLE as part of the differential for non-cicatricial alopecia can prove helpful in patients who fail to improve with empiric first-line treatments for more common causes of hair loss. We report a case of TLE that clinically mimicked alopecia areata and seek to highlight the relevant clinical and histological features to promote earlier diagnosis of this entity. A discussion of improved diagnostic and treatment modalities, as well as identifying the uncommon but possible association of TLE with underlying systemic disease, adds to the importance of maintaining clinical suspicion for TLE. Finally, we provide an overview to discriminate TLE from other forms of cutaneous lupus and their unique patterns of alopecia when presenting on the scalp.

Tratamiento endovascular de lesiones de arteria femoral superficial, TASC II B-C mediante stents de nitinol autoexpandibles extra largos (> 120 mm). Evaluación de la permeabilidad a los 6, 12, 24 y 36 meses post implante. / Tratamento endovascular de lesões da artéria femoral superficial, TASC II B-C com o uso de stents de nitinol auto-expansíveis extra longos (> 120mm). Avaliação da permeabilidade após 6, 12, 24 e 36 meses pós implante. / Endovascular treatment of TASC II B-C lesions of the superficial femoral artery with ultra long self expandable nitinol stents (> 120 mm). Assessment of patency at 6, 12, 24 and 36 months post-stenting

Objetivos: evaluación de la permeabilidad de los stents de Nitinol autoexpandibles extra largos(> 120 mm de longitud) en lesiones de arteria femoral superficial TASC II B-C, a los 6, 12, 24 y 36 meses post implante.Pacientes y Métodos: Entre junio de 2007 y diciembre de 2008, fueron tratados 7 miembros inferiores en 6 pacientes con lesiones de arteria femoral superficial tipo TASC II B-C mediante stents extra largos auto expandibles. Utilizamos stents autoexpandibles de Nitinol de 120-140 mm largo (Large SMART CONTROL) (Cordis). Utilizamos la vía percutánea ipsilateral anterógrada y, en aquellos pacientes que presentaron enfermedad de la cámara femoral, realizamos tratamiento hibrido: endarterectomía femoral, angioplastia con balón y colocación de stent. Se realizó elseguimiento mediante Ecodoppler y Rx de miembro inferior a los 6, 12, 24 y 36 meses post implante. Resultados: Se intervino a 5 pacientes del sexo femenino (84%) con un promedio de edad de 74 años +/- 5; 1 paciente de sexo masculino (16%) cuya edad fue de 60 años. 3 procedimientos fueron por vía percutánea ipsilateral anterógrada. Se realizaron 4 procedimientos híbridos (endarterectomía cámara femoral, angioplastia con balón y colocación de stent). La permeabilidad inicial fue del 100%, permeabilidad a los 6 meses: 100% de los casos, permeabilidad a los 12 meses: 86% de los casos, permeabilidad a los 24 meses: 86% de los casos con detección de Reestenosisen una paciente del 60%, siendo asintomática, permeabilidad a los 36 meses: 72 % de los casos. No se observaron fracturas de stent durante el estudio. Conclusiones: El stent largo de (> 120 mm longitud) es un buen instrumento para el tratamientode lesiones tipo TASC II B-C, comparables con la cirugía convencional, los cirujanos vascularesdeben conocer y aplicar todas las técnicas disponibles (cirugía, bioingeniería, endovascular, etc.) al tratar enfermedad arterial periférica encontrando la mejor opción para cada paciente...

Objetivo: avaliaçãó da permeabilidade dos stents de Nitinol auto expansíveis extra longos (> 120 mm de longitude) em lesões da artéria femoral superficial TASC II B-C, após 6, 12, 24 e 36 mesespós implante. Pacientes e Métodos: Entre junho de 2007 e dezembro de 2008, foram tratados 7 membrosinferiores em 6 pacientes com lesões da artéria femoral superficial tipo TASC II B-C com o uso de stents extra longos auto expansíveis. Utilizamos stents auto expansíveis de Nitinol de 120-140mm de comprimento (Large SMART CONTROL) (Cordis). Utilizamos a via percutânea ipsilateral anterógrada e, nos pacientes que apresentaram problemas na câmara femoral, realizamos um tratamento híbrido: endarterectomia femoral, angioplastia com balão e colocação de stent. Oseguimento foi realizado com a utilização de Ecodoppler e Rx de membro inferior após 6, 12, 24 e 36 meses pós implante. Resultados: Dos pacientes tratados, 5 eram do sexo feminino (84%) com uma média de idade de 74 anos +/- 5; 1 paciente do sexo masculino (16%) de 60 anos de idade. Com relação aos procedimentos, 3 foram por via percutãnea ipsilateral anterógrada. Foram realizados 4 procedimentos híbridos (endarterectomia câmara femoral, angioplastia com balão e colocação de stent). A permeabilidade inicial foi de 100%, após 6 meses, também de 100%, após 12 meses a permeabilidadefoi de 86% e 24 meses depois, de 86% com detecção de Reestenosis em uma paciente em 60%, sendo assintomática,apresentando uma permeabilidade após 36 meses de 72%. Não foram observadas fraturas de stent durante o estudo realizado. Conclusões: O stent longo de (> 120 mm de comp.) é um bom instrumento para o tratamentode lesões tipo TASC II B-C, comparáveis com a cirurgia convencional, os cirurgiões vasculares devem conhecer e aplicar todas as técnicas disponíveis (cirurgia, bioengenharia, endovascular, etc.) no tratamento da doença arterial periférica, encontrando a melhor opção para cada paciente...

Objetives: Evaluation of self-expanding large nitinol (> 120mm) stents patency in the treatments of TASC II B-C of SFA lesions at 6, 12 , 24 and 36 months after implantation. Patients and Methods: Between June 2007 to December 2008, we have treated 7 legs in 6 patients with TASC II B-C of Superficial Femoral Artery lesions with large nitinol stent, SMART (Cordis). The procedures was with percutaneous ipsilateral antegrade approach and when the patients had femoral common disease had made hybrid approach (open femoral endarterectomy+ balloon angioplasty & stent placement). We used nitinol stents of 120-140 mm large (Large SMART CONTROL) ( Cordis). The follow-up of patency was studied with Dupplex Scan and RX of the legs at 6, 12, 24 and 36 months after the initial treatment.Results: 5 ( five) Female patients (84%) mean age 74 years +/- 5; 1 (one) Male patient (16%) mean age 60 years. 3 procedures was with percutaneous ipsilateral antegrade approach. 4 was hybrid approach ( open femoral endarterectomy + balloon angioplasty & stent placement). Initial patency was of 100%, Restenosis in one case (14%) of 60% asintomatyc patient at 24 months and distal to stent placement; Ocluded one case (14%) at 12 month (man with reestenosiscarotid stent to). Don´t observed stent fracture in this study. Conclusions: Large Nitinol stents (> 120 mm length) are a good instrument to the treatment of superficial artery lesion with a comparable patency with surgery approach in lesions TASC II B-C. Vascular Surgeons needs to learn and use all of the technics (conventional surgery, Bio Ingeneering, Endovascular) to treat periphereal arterial disease and found the best options for each patients...

Papuloerythroderma 2009: two new cases and systematic review of the worldwide literature 25 years after its identification by Ofuji et al.

BACKGROUND: Even after the description of papuloerythroderma of Ofuji (PEO) in 1984, little is known about this clinical entity. OBJECTIVE: To report on 2 new cases of PEO and review of the worldwide literature on this topic. METHODS: Article citations were searched on several biomedical search engines (PubMed, EMBASE, SCOPUS, Google Scholar). Papers were retrieved either online or in print. RESULTS: A grand total of 170 PEO cases were identified. Most patients were older than 55 years and of Asian or white descent, with an overall male/female ratio of 4.0. Itch and the deck-chair sign were observed in all patients. Peripheral eosinophilia, lymphocytopenia and increased serum IgE were common findings. Histopathology mostly showed aspecific inflammation, while 17 showed histological features of cutaneous T-cell lymphoma (CTCL). Atopy, malignancies, infections and drugs were rarely linked to PEO. CONCLUSION: PEO represents a rather monomorphous entity both clinically and, with the remarkable exception of CTCL, also histologically. Nonetheless, no causative factor could be identified in the vast majority of cases. An etiological classification and diagnostic criteria are proposed in the attempt to contribute framing this puzzling clinical entity.

Psoriasis remission after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

BACKGROUND: Psoriasis is a chronic skin disease characterized by epithelial hyperplasia and an accelerated rate of epithelial turnover affecting approximately 1-3% of the population. Exogenous and endogenous factors including morbid obesity can increase the morbidity of psoriasis. CASE REPORT: A 55-year-old male, who weighed 131 kg with BMI 41 kg/m2, underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP). He had a 15-year duration of severe psoriasis and was being medically treated. At 12 months after LRYGBP, he had lost 39 kg (68% EWL), and had complete resolution of the psoriasis and had discontinued all preoperative medications related to the disease. At 2 years after LRYGBP, psoriasis has not recurred. CONCLUSION: Weight loss after LRYGBP should be considered as a strategy in the treatment of severe psoriasis in morbidly obese patients.

The implications of a broken needle in the pterygomandibular space: clinical guidelines for prevention and retrieval.

The implication of a broken anesthetic injection needle in the posterior part of the oral cavity is described. Needle breakage is preventable if proper preventive measures are used during local anesthesia administration. A broken needle should be removed immediately after a thorough localization and not left in the tissue, as previously believed. Computerized tomography (CT) scan is the proper diagnostic device to locate a broken needle. A careful surgical approach under general anesthesia is recommended to retrieve the needle. Clinical preventive guidelines are described and presented to the pediatric dentist.

Sepsis por fusarium en un paciente con anemia aplásica: reporte de un caso con implicaciones terapéuticas / Sepsis by fusarium in a patient with aplastic anemia: report of a case with therapeutic implications

Informamos sobre un caso de sepsis diseminada por fusarium solani en paciente venezolano tratado por los Estados Unidos por anemia aplástica severa. El cuadro séptico comenzó con una lesión cutánea en la región inguinocrual izquierda. La evolución y el manejo del paciente y su deceso final pese al tratamiento con Anfotericina B liposomal y transfusiones de neutrófilos, ilustran lo complejo y peligroso de la evolución de estos casos

Mecanismos de hiperbilirrubinemia y clasificación de las ictericias / Mechanisms of hyperbilirubinemia and classification of jaundice

Se definen los términos ictericia y colestasis. Luego se mencionan los posibles mecanismos por los cuales se puede alterar la vía normal de transporte, conjugación y eliminación de la bilirrubina para que pueda producirse una ictericia. Así desde un punto de vista didáctico, mencionaremos nueve mecanismos cuya alteración puede producir ictericia: excesiva producción de bilirrubina; dificultad en atravesar la membrana del hepatocito; dificultad de ser transportada hasta el microsoma; alteraciones del microsoma; dificultad del transporte de la bilirrubina ya conjugada hasta el capilar biliar; dificultad de atravesar la membrana del capilar biliar; dificultad de la bilirrubina (y de toda la bilis) en circular por el árbol biliar intrahepático; dificultad en la circulación de la bilis por el árbol biliar extrahepático; reabsorción tisular de bilirrubina. Consecuentemente, clasificaremos a las ictericias en: 1) premicrosomales, las cuales son todas a predominio de bilirrubina no conjugada; 2) posmicrosomales, con hiperbilirrubinemia a predominio conjugada. A su vez las premicrosomales las subdividiremos en prehepáticas y hepáticas, y las posmicrosomales en hepáticas y poshepáticas (o subhepáticas) (AU)

Mecanismos de hiperbilirrubinemia y clasificación de las ictericias / Mechanisms of hyperbilirubinemia and classification of jaundice

Se definen los términos ictericia y colestasis. Luego se mencionan los posibles mecanismos por los cuales se puede alterar la vía normal de transporte, conjugación y eliminación de la bilirrubina para que pueda producirse una ictericia. Así desde un punto de vista didáctico, mencionaremos nueve mecanismos cuya alteración puede producir ictericia: excesiva producción de bilirrubina; dificultad en atravesar la membrana del hepatocito; dificultad de ser transportada hasta el microsoma; alteraciones del microsoma; dificultad del transporte de la bilirrubina ya conjugada hasta el capilar biliar; dificultad de atravesar la membrana del capilar biliar; dificultad de la bilirrubina (y de toda la bilis) en circular por el árbol biliar intrahepático; dificultad en la circulación de la bilis por el árbol biliar extrahepático; reabsorción tisular de bilirrubina. Consecuentemente, clasificaremos a las ictericias en: 1) premicrosomales, las cuales son todas a predominio de bilirrubina no conjugada; 2) posmicrosomales, con hiperbilirrubinemia a predominio conjugada. A su vez las premicrosomales las subdividiremos en prehepáticas y hepáticas, y las posmicrosomales en hepáticas y poshepáticas (o subhepáticas)