Acoustic imaging of stable double diffusion in the Madeira abyssal plain.

Sub-mesoscale and mesoscale (i.e., 1-10 km and 10-200 km, respectively) ocean processes are highly relevant for the understanding of global circulation, mixing of water masses and energy exchange between ocean layers. However, the processes happening at these scales are hard to be characterized using direct measurements of temperature and salinity. Direct measurements are obtained from vertical probes and/or autonomous vehicles, which, despite their high vertical resolution, are sparsely located in space and therefore unable to capture spatial details at these scales. Seismic oceanography (SO) data have been successfully used to imaging and characterize the ocean at these spatial scales. These data represent indirect measurements of the ocean temperature and salinity along kilometric transects with high horizontal resolution (i.e., a near-synaptic view of the system under investigation), but lower vertical resolution when compared with direct observations. Despite its complex oceanographic setting, the Madeira Abyssal Plain is still largely uncharacterized due to the lack of direct observations. We show for the first time a comprehensive processing, modelling and interpretation of three 2-D seismic oceanography sections from this region. The data show coherent seismic reflection in space, depth and time and shed light into this oceanographic setting with an unprecedent horizontal resolution. The SO modelling and interpretation are combined with existing direct measurements and a quantitative method to correlate thermohaline staircases interpreted from conductivity-temperature-depth casts and seismic reflections is proposed. The results show the relatively stable presence of thermohaline staircases in simultaneously time and space between 1200 and 2000 m of water depth and their spatial variability and contribute to the generalization of SO in physical oceanography.

Efficiency and Safety of Tocilizumab for the Treatment of Thyroid Eye Disease: A Systematic Review.

PURPOSE: To review existing literature concerning the effectiveness and safety of tocilizumab (TCZ) for managing thyroid eye disease. METHODS: A systematic search was conducted across the PubMed and Embase databases to identify studies on TCZ therapy, from inception to May 2023. The search included the keywords "Graves orbitopathy," "thyroid ophthalmopathy," "thyroid eye disease," "thyroid-associated orbitopathy," "thyroid-associated ophthalmopathy," "Graves ophthalmopathy," "endocrine ophthalmopathy," and "Tocilizumab." Only articles written in English, Spanish, or French were considered. RESULTS: Among the 1,013 articles initially screened, a total of 29 fulfilled the eligibility criteria and were selected. Most studies were case reports or case series, and only one randomized clinical trial was found. TCZ has been used mainly in glucocorticoid-resistant or relapsing cases, with a dosage ranging from 4 or 8 mg/kg every 4 weeks when intravenous or a weekly subcutaneous dose of 162 mg. Treatment duration is usually adjusted to the clinical response. TCZ is mostly effective in reducing inflammatory signs during the active phase of thyroid eye disease, with an improvement of at least 3 points in clinical activity score and an overall relapsing rate of 8.2%. Numerous studies have shown marked reductions in proptosis; although the only available randomized controlled trial reported a nonstatistically significant improvement 6 months after treatment, a recent meta-analysis indicated that TCZ seems to be the most effective treatment for reducing proptosis. No severe side effects related to intravenous or subcutaneous TCZ administration were reported. DISCUSSION: Despite these promising findings, randomized clinical trials to directly compare the efficacy and safety of TCZ and other currently available therapeutic options are needed.

CO2 laser treatment of a kissing nevus of the penis: an alternative solution for a rare condition.

Divided or kissing nevi are a rare clinical variant of congenital melanocytic nevi developing in adjacent areas of the skin that undergo cleavage during embryogenesis. Penile lesions are even rarer, with only few cases described in the literature. Typically, they present as two opposing dark colored macular or papular lesions on the glans and prepuce, exhibiting a mirror-image symmetry relative to the coronal sulcus. The proposed management ranges from clinical follow-up to surgical excision. However, in this particularly sensitive location the risk of functional and esthetical complications is high, so an alternative treatment option was proposed. We report a case of a penile kissing nevus with its dermoscopic and histopathological characteristics as well as its successful treatment with the carbon dioxide (CO2) laser.

Clinical ABCDE rule for early melanoma detection.

BACKGROUND: The ABCDE rule systematizes warning signs for malignant melanoma (MM). OBJECTIVES: To evaluate whether the ABCDE signs are associated with early detection of MM. MATERIALS & METHODS: Based on a retrospective study over 11.5 years, we assessed whether ABCDE signs are associated with early diagnosis of MM. RESULTS: In total, 144 MM were included; 52 (36.1%) in situ and 92 (63.9%) invasive lesions. For 23.6%, the MM were first suspected by an individual other than a dermatologist. The "E sign" was significantly less frequent among in situ lesions (32.7% versus 50.0%; p = 0.044). Based on adjusted analyses, the probability of MM being first suspected by a non-dermatologist consistently increased with the number of ABCDE signs of the lesion, ranging from 8% for a neoplasm with no ABCDE signs to 32% for a lesion with five signs (OR = 1.6; 95% CI: 1.2-2.2; p = 0.004). CONCLUSION: A higher number of ABCDE signs were associated with a greater chance of MM being first suspected by a non-dermatologist, but not in situ MM diagnosis. Relying on the ABCDE rule alone might result in missing early MM lesions.

Nail melanoma in situ: clinical, dermoscopic, pathologic clues, and steps for minimally invasive treatment.

BACKGROUND: Nail unit melanoma (NUM) is a variant of acral lentiginous melanoma. The differential diagnosis is wide but an acquired brown streak in the nail of a fair-skinned adult person must be considered a potential melanoma. Dermoscopy helps clinicians to more accurately decide if a nail apparatus biopsy is necessary. OBJECTIVE: Detailed evaluation of clinical and dermoscopy features and description of conservative surgery of in situ NUM. METHODS: Retrospective study of in situ NUM diagnosed and treated with conservative surgical management in the authors' center from 2008 to 2013. RESULTS: Six cases of NUM were identified: 2 male and 4 female patients, age range at diagnosis of 44 to 76 years. All patients underwent complete nail unit removal with at least 6-mm security margins around the anatomic boundaries of the nail. The follow-up varies from 4 to 62 months. CONCLUSION: Nail unit melanomas pose a difficult diagnostic and therapeutic challenge. Wide excision is sufficient, whereas phalanx amputation is unnecessary and associated with significant morbidity for patients with in situ or early invasive melanoma. Full-thickness skin grafting or second-intention healing after total nail unit excision is a simple procedure providing a good functional and cosmetic outcome.

Granuloma faciale with subglottic eosinophilic angiocentric fibrosis: case report and review of the literature.

Granuloma faciale (GF) is an uncommon inflammatory dermatosis that usually presents on the face as reddish brown or violaceous papules and nodules that may coalesce into plaques. Eosinophilic angiocentric fibrosis (EAF) is a rare fibrosing condition that shares many histologic characteristics with GF and is regarded by some authors as a mucosal counterpart of GF. We present a case of GF with concurrent EAF in a subglottic location with excellent response to an intralesional corticosteroid on the GF lesion, CO2 laser on the EAF lesion, and oral dapsone treatment.

[Pyoderma gangrenosum--clinical, laboratory and therapeutic approaches. Review of 28 cases]. / Pioderma gangrenoso - Abordagem clínica, laboratorial e terapêutica: Revisão de 28 casos.

Pyoderma gangrenosum is an uncommon neutrophilic dermatosis, idiopatic in 25-50 percent of cases. We present a retrospective study of 28 patients, admitted to Hospital de São João, EPE, between January of 1990 and June of 2008. Pyoderma gangrenosum was observed more frequently in middle age adults, in the ulcerated form, and predominantly localized in the lower limbs. Pediatric presentation was very rare. In 50 percent of these cases a systemic disease was present and the most frequent was Crohn disease (14% of patients).

Whitish bullae on the fingers: what is the diagnosis? Tophaceous gout.

A 56-year-old woman presented with a 6 month history of bullae and whitish plaques of the fingers. She had chronic renal failure, but no joint pains or evidence of arthritis. An aspirate of fluid from a bulla revealed uric acid crystals and serum uric acid was elevated at 16.2 mg/dL. A diagnosis of tophaceous gout was made.

Pellagra associated with esophageal carcinoma and alcoholism.

Pellagra is a nutritional disease caused by the deficiency of niacin. It presents with a photodistributed rash, gastrointestinal symptoms, and neuropsychiatric disturbances. In the Western world, this disease is mostly confined to alcoholics or the impoverished. However, this condition must be recognized in other clinical settings because it is easily treated and can be fatal if not identified. We describe a case of pellagra caused by esophageal carcinoma and alcoholism; we also review the literature.

Unknown: bilateral symmetrical papules on the eyelid.

Eyelid lesions frequently are a diagnostic challenge. We report a case of a 46-year-old woman with a 5-year history of yellowish symmetric progressively growing papules on the eyelids, resembling xanthelasma. A skin biopsy was performed that revealed the rare variant of clear cell syringoma. The lesions were treated with CO2 laser and surgical excision; there was no evidence of recurrence after 6 months of follow-up.

Unilateral laterothoracic exanthem and primary Epstein-Barr virus infection: case report.

Unilateral laterothoracic exanthem is a self-limited disease that occurs most commonly in children. It is characterized by unilateral exanthem, often in axillary region. The etiology is unknown, but a viral agent is suspected. We report a 1-year-old white girl with unilateral laterothoracic exanthem associated with Epstein Barr virus infection, suggesting this virus has a possible etiologic role.