Conduta na dor e prurido vulvar / Pain and pruritus vulvae management

Prurido e dor são as principais manifestações clínicas das doenças vulvares. Estes sintomas podem estar associados a processos inflamatórios, imunológicos, distúrbios metabólicos e neoplasias. Na dúvida, é sempre recomendável o estudo histopatológico. Quando não há definição etiológica, várias opções terapêuticas estão disponíveis: cremes tópicos, fármacos sistêmicos, operações de dessensibilização nervosa da vulva. A conduta terapêutica deve ser individualizada quando não há etiologia definida. São escassos os trabalhos científicos, com metodologia adequada, que abordam o tema. Portanto, anamnese e exame físico cuidadosos irão definir a melhor abordagem terapêutica

Pruritus and pain are common manifestations of vulvae diseases. The symptoms can be associated with inflammatory, immunologic, metabolic or neoplastic diseases. Undoubtedly, the histopathological exam is always recommended. When there is no etiologic definition, many therapeutic options are available: creams, systemic drugs, and surgical neural desensitization of the vulvae. When there is no precise etiology, therapeutical approach must be individualized. Scientific studies, with good methodology, are rare. Therefore, careful anamnesis and physical exam will point to the best therapeutical approach

Did the first virus self-assemble from self-replicating prion proteins and RNA?

DNA is the molecule responsible for storing and processing genetic information today. In Earth's primeval environmental conditions, RNA was probably more suited for this function, due to its capability to act also as a catalytic enzyme. Some proteins are stable and reliable molecules even in extreme conditions, and under certain circumstances, proteins may play a role in transmitting certain phenotypes that are inherited in a non-Mendelian manner. When the dominant native state of a prion protein is replaced by a misfolded one, the resultant infective protein is associated with several neurological diseases in mammals. The misfolded proteins are remarkably resistant to even the most extreme environments. Prions are also associated with the transmission of certain fungal traits epigenetically, supporting the hypothesis that prions are a possible relic of an early stage of peptide evolution. The primitive world probably contained both self-replicating RNA molecules and prions, and prions attach easily to nucleic acids, and also fold and cause other proteins to fold in the same way. Consequently, a capsid could form from prion protein, enclosing the RNA, and perhaps creating the first RNA virus. A capsid originating from prion proteins would be a versatile and effective protection to RNA and could also explain some characteristics of virus self-assembly that are not well understood.

Enxertia de pele em oncologia cutânea / Skin grafts in cutaneous oncology

Em oncologia cutânea depara-se freqüentemente com situações em que a confecção de um enxerto é uma boa alternativa para o fechamento do defeito cirúrgico. Conhecer aspectos referentes à integração e contração dos enxertos é fundamental para que os cirurgiões dermatológicos procedam de maneira a não contrariar princípios básicos do transplante de pele. Os autores fazem uma revisão da classificação e fisiologia dos enxertos de pele, acrescendo considerações cirúrgicas determinantes para o sucesso do procedimento.

In cutaneous oncology, there are many situations in which skin grafts could be a good alternative for closing surgical defect. Dermatological surgeons should have enough knowledge about graft integration and contraction in order to not contradict the basic principles of skin transplantation. The authors review skin graft classification and physiology and make some surgical considerations on successful procedures.

Are prions related to the emergence of early life?

DNA and RNA are the modern cellular molecules related to the storage and processing of the genetic information. However, in the Earth primeval environment conditions, these two molecules are far from being the best option for this function due to their great complexity and sensibility to heat. Experiments have been showing that proteins are very stable and reliable molecules even in very extreme conditions and, under certain circumstances, could be related to the transmission of certain phenotypes that are inherited in a non-Mendelian manner. Prions, infective proteins that are associated to several neurological diseases among mammals by replacing their dominant native state of prion protein by a misfolded one, are remarkably resistant to even the most extreme environments. Furthermore, prions are also associated to the transmission of certain fungal traits in an epigenetical model. These two characteristics support the hypothesis that prions are a possible relic of early stage peptide evolution and may represent the reminiscence of a very ancient analogical code of biological transmission of information rather than the digital one represented by modern nucleic acids.

Estudo comparativo entre a aplicação tópica de sulfadiazina de prata + nitrato de cério e aciclovir no tratamento do herpes labial / Comparative trial of topical aplication of silver sulphadiazine + ceium nitrate and acyclovir in labial herpes simplex lesions

Objetivos: Comparar os efeitos de sulfadiazina de prata + nitrato de cério e aciclovír no tratamento tópico de lesões de,herpes labial Métodos: Estudo prospectivo duplo- cego realizado em pacientes adultos do Hospital Universitário Clementino Fraga Filho (HUCFF), de maio de 2001 a dezembro de 2002. Resultados: Particíparam do estudo 28 pacientes e as evoluções foram documentadas a partir de critérios objetivos e subjetivos e comparadas através dos testes de Friedman e Wilcoxon. Conclusão: Na maioria dos parâmetros analisados os índices de melhora foram superiores, tanto em relação à sintomatología quanto em relação às manifestações clínicas, quando comparados ao tratamento considerado padrão. Houve boa toferabilidade, ausência de efeitos colaterais lo cais ou sistêmicos e nenhum caso de complicação.(au)

Cutis verticis gyrata secondary to a cerebriform intradermal nevus.

We report the case of a 30-year-old black man with a large mass consisting of longitudinal parallel ridges and furrows on the left parietal region. A small, single, hyperpigmented macule was present at birth and gradually grew and extended over the years. Cutis verticis gyrata was suspected, and an investigation was performed to discharge the possibility of pachydermoperiostosis. However, results of biopsies obtained from 3 different lesional areas showed the same histopathologic features--deep-seated hair follicles and clusters of nevus cells concentrated in the dermis. Cerebriform intradermal nevus is a rare cause of cutis verticis gyrata. Early diagnosis is extremely important to prevent the development of malignant melanoma.

Leishmaniose: métodos diagnósticos / Leishmaniasis: diagnostic methods

Os autores analisam os métodos laboratoriais clássicos e os mais modernos empregados no diagnóstico das formas cutânea, cutâneo-mucosa e cutâneo-difusa da leishmaniose. Discutem sua metodologia e indicação no curso evolutivo da doença. O achado da Leishmania no esfregaco, fragmentos de biópsia e/ou na cultura, e o teste de Montenegro permanecem como os melhores parâmetros na decisão terapêutica, em especial em locais de infra-estrutura sanitária e laboratorial precária. Os métodos mais sensíveis e específicos para a detecção de formas amastigotas, entre eles a hibridizacão e a PCR, podem ser aplicados, particularmente, nos casos de dúvida. Os recentes avanços na biologia molecular vêm possibilitando o diagnóstico cada vez mais preciso da espécie da Leishmania, cuja caracterização tem implicações epidemiológicas, prognósticas e terapêuticas. Contudo os critérios clínico-epidemiológicos permanecem fundamentais para o diagnostico dessa dermatozoonose.