Mínima mácula en párpado: ¿picotazo de cigüeña o algo más? / Small Macule on the Eyelid: Stork Bite or Something Else?

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Unusual Interface Dermatoses Distributed Along Blaschko's Lines in Adult Patients.

Linear dermatoses are unusual entities whose distribution reflects cutaneous mosaicism, even when they occur in adult life. Adult blaschkitis (AB) and lichen striatus (LS) always follow this peculiar distribution. Although usually referred to as distinct entities, the clinical and histopathological presentation of lichen striatus in adults may be similar to those of adult blaschkitis. Moreover, some cases with overlapping features between lichen striatus and linear lichen planus have been published, making precise diagnosis very difficult. Recently, the concept of a wide spectrum of blaschkolinear dermatoses with AB and LS located somewhere within it has been proposed but it has not gained general recognition. We report three cases of dermatoses following the lines of Blaschko in adults (two women and one male, ages 35, 50 and 56, respectively). They involved the upper extremity in two cases and the lower in the third. Clinically, they were interpreted as linear lichen planus or blaschkitis but, histopathologically, they showed features consistent with lichen striatus. Lesions subsided with topic steroids and/or tacrolimus ointment, they are an example of the significant overlapping between these three entities, demonstrating that they may exist on a spectrum both clinically and histopathologically and clinico-pathologic correlation is essential to achieve an accurate final diagnosis. A detailed review of previously published cases has also been made.

Paciente joven con nódulos pulmonares / Young patient with pulmonary nodules

Describimos el caso de una paciente de 33 años que ingresó por dolor centrotorácico de características pleuríticas, tos, disnea y síndrome constitucional. En la radiografía de tórax se observaron infiltrados pulmonares nodulares bilaterales. Tras la realización de una biopsia pulmonar se llegó al diagnóstico de micosis pulmonar causada por Cryptococcus neoformans.La criptococosis pulmonar es una entidad poco habitual, que puede afectar tanto a individuos inmunodeprimidos como a inmunocompetentes, aunque con menor frecuencia en estos últimos.Este caso demuestra la importancia de considerar causas in-fecciosas en el diagnóstico diferencial de nódulos pulmonares. Destacamos a su vez lo poco habitual de la infección por Cryp-tococcus en pacientes inmunocompetentes

The case of a 33 year-old patient is described; she was admitted to hospital due to pleuritic chest pain, cough, dyspnoea and constitutional syndrome. Infiltrated bilateral lung nodules were observed in the chest x-ray. After performing a lung biopsy, the diagnosis was lung micosis due to Cryptococcus neoformans. Lung cryptococcus is an uncommon entity that can affect both immunodeficient and immunocompetent individuals, although less frequent in these latter. This case demonstrates the importance of considering infec-tious causes in the differential diagnosis of pulmonary nodules. At the same time, it must be noted that infections due to cryptococcus is in immunocompetent patients are rare

Tomato paste rich in lycopene protects against cutaneous photodamage in humans in vivo: a randomized controlled trial.

BACKGROUND: Previous epidemiological, animal and human data report that lycopene has a protective effect against ultraviolet radiation (UVR)-induced erythema. OBJECTIVES: We examined whether tomato paste--rich in lycopene, a powerful antioxidant--can protect human skin against UVR-induced effects partially mediated by oxidative stress, i.e. erythema, matrix changes and mitochondrial DNA (mtDNA) damage. METHODS: In a randomized controlled study, 20 healthy women (median age 33 years, range 21-47; phototype I/II) ingested 55 g tomato paste (16 mg lycopene) in olive oil, or olive oil alone, daily for 12 weeks. Pre- and postsupplementation, UVR erythemal sensitivity was assessed visually as the minimal erythema dose (MED) and quantified with a reflectance instrument. Biopsies were taken from unexposed and UVR-exposed (3 × MED 24 h earlier) buttock skin pre- and postsupplementation, and analysed immunohistochemically for procollagen (pC) I, fibrillin-1 and matrix metalloproteinase (MMP)-1, and by quantitative polymerase chain reaction for mtDNA 3895-bp deletion. RESULTS: Mean ± SD erythemal D(30) was significantly higher following tomato paste vs. control (baseline, 26·5 ± 7·5 mJ cm(-2); control, 23 ± 6·6 mJ cm(-2); tomato paste, 36·6 ± 14·7 mJ cm(-2); P = 0·03), while the MED was not significantly different between groups (baseline, 35·1 ± 9·9 mJ cm(-2); control, 32·6 ± 9·6 mJ cm(-2); tomato paste, 42·2 ± 11·3 mJ cm(-2)). Presupplementation, UVR induced an increase in MMP-1 (P = 0·01) and a reduction in fibrillin-1 (P = 0·03). Postsupplementation, UVR-induced MMP-1 was reduced in the tomato paste vs. control group (P = 0·04), while the UVR-induced reduction in fibrillin-1 was similarly abrogated in both groups, and an increase in pCI deposition was seen following tomato paste (P = 0·05). mtDNA 3895-bp deletion following 3 × MED UVR was significantly reduced postsupplementation with tomato paste (P = 0·01). CONCLUSIONS: Tomato paste containing lycopene provides protection against acute and potentially longer-term aspects of photodamage.

Mioma del músculo dartoico / Dartos musclemyoma

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Actualización en el tratamiento de la tuberculosis / No disponible

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[What is special about adalimumab?]. / Qué tiene de singular adalimumab?

Adalimumab is the first fully human anti-tumor necrosis factor (TNF-alpha) monoclonal antibody and it binds to both soluble and cell-bound TNF-alpha, modulating biological responses linked to this cytokine. Different trials have probed the efficacy of adalimumab even after one week, and accumulated experience in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease shows adalimumab as a safe drug sharing a similar adverse effects profile with the other anti-TNF-alpha molecules. Specific features of adalimumab are revised.

Telangiectasia esencial progresiva / Essential progressive telangiectasia

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¿Qué tiene de singular adalimumab? / What is special about adalimumab?

Adalimumab es el primer anticuerpo monoclonal anti-factor de necrosis tumoral alfa (TNF-α) completamente humano que se une con una alta afinidad tanto a la forma soluble como a la forma unida a células del TNF-α, modulando su actividad biológica. Varios ensayos clínicos han demostrado la eficacia y rapidez de acción de adalimumab en pacientes con psoriasis, y la experiencia de uso en enfermedades como la artritis reumatoide, artritis psoriásica, espondilitis anquilosante y enfermedad de Crohn lo posicionan como un fármaco seguro, con un perfil de efectos secundarios similar a otros fármacos anti-TNF-α. Las peculiaridades específicas de esta molécula son revisadas en este artículo (AU)

Adalimumab is the first fully human anti-tumor necrosis factor (TNF-α) monoclonal antibody and it binds to both soluble and cell-bound TNF-α, modulating biological responses linked to this cytokine. Different trials have probed the efficacy of adalimumab even after one week, and accumulated experience in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Crohn´s disease shows adalimumab as a safe drug sharing a similar adverse effects profile with the other anti-TNF-α molecules. Specific features of adalimumab are revised (AU)

Síndrome de Sweet: ¿primera manifestación de infección por el virus de la inmunodeficiencia humana? / Sweet syndrome as a possible ìnitial manifestation of human immunodeficiency virus infection

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Degeneración maligna de un hidroacantoma simple de disposición lineal / Malignant degeneration of linear hidroacanthoma simplex

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Beneficios de la ventilación no invasora en la insuficiencia respiratoria crónica / Benefits of non invasive ventilation in chronic respiratory insufficiency

OBJETIVO: Describir las características clínicas, funcionalesy parámetros ventilatorios de los pacientes con insuficiencia respiratoriacrónica de origen extrapulmonar tratados mediante ventilaciónmecánica no invasora (VMNI) y valorar la eficacia del tratamientoen la mejoría gasométrica y su repercusión en ingresoshospitalarios y retirada de oxigenoterapia.PACIENTES Y MÉTODO: Estudio retrospectivo de lospacientes sometidos a VMNI por insuficiencia respiratoria crónica(IRC) de origen extrapulmonar en el año 2003 analizando la mejoríagasométrica y disminución del número de ingresos hospitalariostras el tratamiento. Los pacientes incluidos al menos cumplíanuno de los siguientes criterios: clínica de hipoventilación o presiónparcial de dióxido de carbono (pCO2) >45 mmHg en vigilia o saturaciónnocturna de O2 <90 % más del 10-20% del tiempo de registroo <88% durante 5 minutos consecutivos o capacidad vital forzada(FVC) <50% del teórico. A los pacientes se les realizóespirometría forzada, estudio poligráfico o polisomnográfico nocturnoy monitorización de la saturación nocturna mediante pulsioximetría.Se utilizaron en todos los casos ventiladores de presiónbinivel (BiPAP).RESULTADOS: Se incluyeron 16 pacientes cuya patologíamas prevalente fue la obesidad en 7 casos. La situación funcionalfue (media ± desv. típica): FVC 48.7% ± 19.4, FEV1 50% ± 19.4 yFEV1/FVC 82% ± 13. Los parámetros ventilatorios empleadosfueron de expiratory positive airway pressure (EPAP) 2.7 cm H2O ±0.8 y de inspiratory positive airway pressure (IPAP) 15 cm H2O ±1.4. Se observaron diferencias estadísticamente significativas en ladisminución de la pCO2 antes y después del tratamiento conVMNI (p=0.006) y en la mejoría de la saturación (p<0.001). Laestancia media hospitalaria del tratamiento fue de 6,25 días, y en 6casos se retiró la oxigenoterapia crónica domiciliaria (OCD). Elgrupo tratado presentó en el año anterior 11 ingresos por IRC reagudizaday ninguno en el año siguiente al tratamiento.CONCLUSIONES: Los pacientes con IRC de origen extrapulmonartratados con VMNI presentaron mejoría gasométrica,con retirada de la OCD en algunos casos y disminución de losingresos hospitalarios

OBJECTIVE: To describe the clinical, functional and ventilatoryparameter characteristics of (the) patients with chronic respiratoryinsufficiency of extra-pulmonary origin treated by means ofnon invasive mechanical ventilation (NIMV), and to evaluate theefficacy of the treatment in gasometric improvement and its repercussionsin terms of hospital admissions and removal of oxygentherapy.PATIENTS AND METHOD: Retrospective study of thepatients submitted to NIMV for chronic respiratory insufficiency(CRI) of extra-pulmonary origin in the year 2003, analyzing (the)gasometric improvement and (the) decrease in the number of hospitableadmissions after the treatment. The included patients fulfilledat least one of the following criteria: symptoms of hypoventilation,partial pressure of carbon dioxide (pCO2)> 45 mmHg whenconscious, nocturnal saturation of O2 <90% for more than 10-20%of the time of measurement, O2 <88 % during 5 consecutive minutesor forced vital capacity (FVC) <50 % of the theoretical. Thesepatients underwent forced spirometry, polygraphy, nocturnalpolysomnography and monitoring (of) the night saturation bymeans of pulse oximetry. Bi-level positive airway pressure (BiPAP)ventilators were used in all the cases.RESULTS: Sixteen patients were included, seven of whomshowed obesity which was the most prevalent pathology. (The)Functional situation was (mean ± standard deviation): FVC 48.7% ± 19.4, FEV1 50 % ± 19.4 and FEV1/FVC 82 % ± 13. The ventilatoryparameters used were expiratory positive airway pressure(EPAP) 2.7 cm H2O ± 0.8 and inspiratory positive airway pressure(IPAP) 15 cm H2O ± 1.4. Statistically significant differences wereobserved in the decrease of pCO2 before and after the treatmentwith NIMV (p=0.006) and in the improvement of saturation (p<0.001). (The) Average hospitable stay for treatment was 6.25 days,and in 6 cases the chronic home oxygen therapy (CHO) was withdrawn.In the year previous to treatment, the treated group presented11 admissions for worsening CRI and none in the year followingthe treatment.CONCLUSIONS: (The) Patients with CRI of extra-pulmonaryorigin treated with NIMV presented improved gasometry,with withdrawal of (the) CHO in some cases and decrease hospitaladmissions

[Incidence of bronchopulmonary carcinoma in Extremadura in 1998]. / Incidencia de carcinoma broncopulmonar en Extremadura durante el año 1998.

OBJECTIVES: Our main objective was to determine the incidence of bronchopulmonary cancer in Extremadura (Spain). We also studied the presence of risk factors such as smoking and exposure to other carcinogens. MATERIAL AND METHODS: This prospective study used a protocol followed by all hospitals in Extremadura; enrolled were patients with a diagnosis of bronchopulmonary carcinoma in 1998 who lived habitually in the region. Cyto-histological confirmation of the diagnosis was sought or, when such confirmation was unavailable, diagnostic agreement among researchers was based on clinical, radiological and/or endoscopic data. RESULTS: The incidences adjusted to world population were 53.4, 2.16 and 25.3 per 100,000 inhabitants for men, women and the entire population sample, respectively. Patterns in the provinces of Cáceres and Badajoz were very similar. Of 433 cases recorded, 95% were men and 78% were aged 60 years or older. Cyto-histological confirmation of diagnosis was available for 92.2%. Most tumors were epidermoid (41.1%). The time between the start of smoking and diagnosis was significantly shorter in heavier smokers.