The role of ultrasound in rheumatic skin and nail lesions: a multi-specialist approach.

The skin and nails are commonly involved in rheumatic conditions, both by the primary disease and/or long-term immunosuppressive treatments. These superficial affections may also imply a worsening of the quality of life in patients and cosmetic sequels. The latest advances in ultrasound technology show that skin and nail abnormalities are now recognizable and therefore susceptible to follow-up non-invasively. Thus, an ultrasound examination of these superficial tissues may be an adjunct tool for evaluating the progression and/or severity of rheumatic diseases in their primary or secondary manifestations.

Benign tumors and pseudotumors of the nail: a novel application of sonography.

OBJECTIVE: The purpose of this study was to determine the scope of high-resolution sonography in the detection of benign tumors and pseudotumors of the nail unit. METHODS: We performed a retrospective study of the sonographic findings in 103 consecutive patients with benign tumors and pseudotumors of the nail that were medically derived and confirmed histologically. Statistical analysis (Student t test) was performed comparing clinical and sonographic diagnoses. RESULTS: Common benign tumors and pseudotumors of the nail can be detected on sonography, and they present different sonographic morphologic characteristics. According to origin, the lesions were considered ungual in 73% (n = 75) and periungual in 27% (n = 28) of the cases. Sonography showed their nature (solid or cystic), location, and extension as well as regional blood flow. In 35% of the cases, the use of sonography modified the clinical diagnosis, although the detailed anatomic information provided by sonography was useful in the planning of surgery in all cases. The addition of sonography was significant (P < .001) for the diagnosis of subungual exostosis and granulomas in comparison to clinical diagnosis. CONCLUSIONS: Sonography is a noninvasive imaging method that can reliably detect common benign tumors and pseudotumors of the nail and provide precise data about their characteristics. This imaging modality can support diagnosis and surgery and can allow a better definition and improvement of the cosmetic outcome of the treatment.

Follow-up of pregnant women at high risk of transmitting herpes simplex virus

Prospects for neonatal herpes transmission were studied in a group of pregnant Chilean women at high herpetic risk- including 59 with a history of genital herpes, 11 with a first genital herpes episode during observed pregnancy, and 16 whose sexual partners had a history of genital herpes. Each women completed a survey questionnaire, provided serologic samples for detection of herpes simplex virus (HSV), and provided periodic samples taken with cotton swabs for HSV isolation. The 86 women who completed the study had an average age of 28 years; most (58.8 percent) were primiparas. Only 21 of the 86 subjects yielded HSV isolates (predominantly HSV-2) from weekly cotton swab samples taken from the 34th week of pregnancy onward. HSV-2 predominance was found both in the symptomatic cases and in the three asymptomatic ones. Of six subjects found to be shedding HSV at the time of delivery, only one exhibited asymptomatic shedding. These findings are consistent with the following conclusions derived from studies in developed countries: (1) Isolation of HSV in pregnancy does not define a greater risk of shedding HSV during childbirth. (2) In nearly all (five of six) cases, HSV shedding during childbirth involved symptomatic episodes of herpes that clearly defined the steps to be taken by the physicians. (3) Despite this, the finding of one asymptomatic case demostrates that the physician should reques a test for HSV isolation at the time of delivery by a woman at high perpetic risk

Seguimiento de embarazadas en alto riesgo de infección por virus del herpes simple / Follow-up pregnant women at high risk of infection from herpes simplex virus

El objetivo de este estudio fue investigar el comportamiento de la infección por el virus del herpes simple durante el período final del embarazo y el parto en embarazadas chilenas en alto riesgo de infección herpética. En la investigación, que se efectuó entre 1988 y 1990, participaron 123 embarazadas atendidas en la Clínica Virológica de la Facultad de Medicina de Santiago, Chile. A cada una se le realizó una encuesta epidemiológica, para detectar casos de seroconversión y diagnosticar casos de primoinfección herpética. A partir de la semana 34 de embarazo, o en el momento del parto, a las que tenian antecedentes de primoinfección se les practicaron pruebas para aislar el virus. En total, 86 mujeres completaron el seguimiento. En 59 mujeres, la calificación de alto riesgo de infección se basó en la existencia de herpes genital; en 16, en antecedentes herpéticos; y en 11, en el desarrollo de un primer episodio de herpes genital durante el embarazo. Después de la semana 34 de embarazo, 21 embarazadas padecieron algún tipo de episodio herpético y en 65 no se aislaron virus. Se recomienda practicar el parto vaginal en las embarazadas asintomáticas y cesárea en las sintomáticas o con manifestaciones prodrómicas. Durante el parto es preciso aislar el virus en las asintomáticas y en las que se encuentran en alto riesgo, para identificar a los recién nacidos en riesgo y elegir el tratamiento más adecuado en cada caso

Seguimiento de embarazadas en alto riesgo de infección por virus del herpes simple / Follow-up pregnant women at high risk of infection from herpes simplex virus

El objetivo de este estudio fue investigar el comportamiento de la infección por el virus del herpes simple durante el período final del embarazo y el parto en embarazadas chilenas en alto riesgo de infección herpética. En la investigación, que se efectuó entre 1988 y 1990, participaron 123 embarazadas atendidas en la Clínica Virológica de la Facultad de Medicina de Santiago, Chile. A cada una se le realizó una encuesta epidemiológica, para detectar casos de seroconversión y diagnosticar casos de primoinfección herpética. A partir de la semana 34 de embarazo, o en el momento del parto, a las que tenian antecedentes de primoinfección se les practicaron pruebas para aislar el virus. En total, 86 mujeres completaron el seguimiento. En 59 mujeres, la calificación de alto riesgo de infección se basó en la existencia de herpes genital; en 16, en antecedentes herpéticos; y en 11, en el desarrollo de un primer episodio de herpes genital durante el embarazo. Después de la semana 34 de embarazo, 21 embarazadas padecieron algún tipo de episodio herpético y en 65 no se aislaron virus. Se recomienda practicar el parto vaginal en las embarazadas asintomáticas y cesárea en las sintomáticas o con manifestaciones prodrómicas. Durante el parto es preciso aislar el virus en las asintomáticas y en las que se encuentran en alto riesgo, para identificar a los recién nacidos en riesgo y elegir el tratamiento más adecuado en cada caso

Publicado en inglés en Bull. Pan Am. Health Organ. 28(1), 1994

Follow-up of pregnant women at high risk of transmitting herpes simplex virus

Prospects for neonatal herpes transmission were studied in a group of pregnant Chilean women at high herpetic risk- including 59 with a history of genital herpes, 11 with a first genital herpes episode during observed pregnancy, and 16 whose sexual partners had a history of genital herpes. Each women completed a survey questionnaire, provided serologic samples for detection of herpes simplex virus (HSV), and provided periodic samples taken with cotton swabs for HSV isolation. The 86 women who completed the study had an average age of 28 years; most (58.8 percent) were primiparas. Only 21 of the 86 subjects yielded HSV isolates (predominantly HSV-2) from weekly cotton swab samples taken from the 34th week of pregnancy onward. HSV-2 predominance was found both in the symptomatic cases and in the three asymptomatic ones. Of six subjects found to be shedding HSV at the time of delivery, only one exhibited asymptomatic shedding. These findings are consistent with the following conclusions derived from studies in developed countries: (1) Isolation of HSV in pregnancy does not define a greater risk of shedding HSV during childbirth. (2) In nearly all (five of six) cases, HSV shedding during childbirth involved symptomatic episodes of herpes that clearly defined the steps to be taken by the physicians. (3) Despite this, the finding of one asymptomatic case demostrates that the physician should reques a test for HSV isolation at the time of delivery by a woman at high perpetic risk

This article will also be published in Spanish in the BOSP. Vol. 116(2), Feb. 1994

Endemia chagásica familiar detectada a consecuencia de un caso de infección congénita / Household chagasic endemia detected as a consequence of a case of congenital infection

During a study on prevalence of parasitic and viral serological markers in pregnant adolescents, a 17-years-old primipara from Polpaico, village near Santiago, gave birth to a normal male newborn in a Santiago hospital. As both of them presented positive an indirect hemaglutination test (IHAT) for Chagas's disease and the corresponding xenodiagnosis (XD), the infection in the infant was considered to be acquired through the placental route. According to recent epidemiologiacal surveys Polpaico is an endemo-enzootic chagasic rural settlement, where 14.7% of dwellings were infested with Triatoma infestans, while triatominae, persons and domestic mammals were found infected with Trypanosoma cruzi. One month later the adolescent mother, her son and other 11 consanguineous members of the family were visited in their homes in order to submit each of then to a physical examination and to IHAT for Chagas' disease, and XD to those whose IHAT resulted positive. Thus, in 7 (53.8%) the IHAT was positive and in 4(57.1%) out pf these 7 presented positive the XD, results that as a whole yelded a household chagasic endemics

Loxoscelismo en Chile: estudios epidemiologicos, clínicos y experimentales / Loxoscelism in Chile: epidemiological, clinical and experimental studies

Se presenta un enfoque panorámico de estudios epidemiológicos, clínicos y experimentales referentes a Loxosceles laeta y loxocelismo efectuados en 1955-1988 en Santiago, Chile. Se estudiaron 216 casos de loxoscelismo. Los hechos más relevantes fueron: 52,8% correspondió a mujeres; edad entre 7 meses y 78 años; 84,3% fué loxoscelismo cutáneo (LC) y 15,7% loxoscelismo cutáneo-visceral (LCV); 73,6% sucedió en época calurosa; en 86,6% el accidente ocurrió en la vivienda, especialmente en dormitórios, mientras la persona dormía o se vestía. La araña fué vista en 60,2% de los casos e identificada en laboratório como L. laeta en 17,7% (10,6%) de los 216 casos). Los sitios más frecuentemente afectados fueron las extremidades con 67,6%, lancetazo urente fué el síntoma inicial más frecuente. Dolor, edema y placa livedoide, la cual posteriormente se transformaría en escara necrótica, fueron las manifestaciones locales predominantes. En LCV hematuria y hemoglobinuria fueron constantes, ictericia, fiebre y compromiso de conciencia se presentaron en la mayoría de los casos. Tratamiento: LC con antihistamínicos o corticoides inyectables, LCV con corticoides inyectables. La condición de los pacientes en el último control fué: curación completa en 75,5%, curación con secuela cicatrizal en 8,3%, muerte en 3,7% (todos con LCV) y abandono en 12,5%. Adicionalmente, se ha efectuado una serie de estudios experimentales, tanto in vivo como in vitro para esclarecer aspectos básicos sobre el veneno de L. laeta y el tratamiento del loxoscelismo

Tipos viricos del herpes simple asociados a infecciones genitales primarias y recurrentes en Chile / Viral types of herpes simplex associated with primary and recurrent genital infections in Chile

In view of the different biological behavior of the two types of herpes simplex virus (HSV-1 and HSV-2) that may cause genital infection, it is important to identify the virus strain carried as a means of prognosticating evolution of the disease. The new methods of viral typing with specific monoclonal antibodies represent a significant advance in identifying and gaining improved knowledge of these viral agents. This article presents the results obtained in typing virus strains isolated from 75 middle-class patients of both sexes who in 1985 and 1986 sought dermatological treatment at the Clinical Hospital of the University of Chile for genital lesions which were diagnosed as genital herpes. Approximately 75 percent of the patients were in the 20-39 years age group, with a predominance of females in the 20-39 year subgroup and of males in 30-39 year group. Of the cases studied, 81 percent showed recurrent infection and 19 percent primary infections. Associates with the HSV-1 type was found in 29 percent of primary and in 10 percent of recurring episodes, whereas 90 percent of the cases of recurring herpes and 71 percent of the primary cases were associated with the HSV-2 type. Comparison of the results obtained with data from other countries indicates that the epidemiological situation of herpes genital infection in Chile appears to occupy and intermediate point between that of the U.S. and Japan

Seguimiento de embarazadas de alto riesgo herpético / Follow-up study of pregnant women with high herpetic risk

Se investigó, en un grupo de 25 embarazadas con historia de herpes genital, la frecuencia de reactivaciones de la infección herpética durante el embarazo y la presencia de virus en el canal genital, mediante aislamientos virales periódicos desde las 34 semanas, para decidir la conducta de parto. En 17 casos se originaron episodios genitales herpéticos (15 recurrencias y dos primeiros episodios). En siete embarazadas se aisló virus del canal genital después de las 34 semanas: dos correspondieron a aislamientos en la última semana, y fueron indicación de cesárea. Ochenta por ciento de las cepas aisladas de estas mujeres fueron tipificadas como HSV-2, utilizando anticuerpos monoclonales

Tipos viricos del herpes simple asociados a infecciones genitales primarias y recurrentes en Chile / Viral types of herpes simplex associated with primary and recurrent genital infections in Chile

In view of the different biological behavior of the two types of herpes simplex virus (HSV-1 and HSV-2) that may cause genital infection, it is important to identify the virus strain carried as a means of prognosticating evolution of the disease. The new methods of viral typing with specific monoclonal antibodies represent a significant advance in identifying and gaining improved knowledge of these viral agents. This article presents the results obtained in typing virus strains isolated from 75 middle-class patients of both sexes who in 1985 and 1986 sought dermatological treatment at the Clinical Hospital of the University of Chile for genital lesions which were diagnosed as genital herpes. Approximately 75 percent of the patients were in the 20-39 years age group, with a predominance of females in the 20-39 year subgroup and of males in 30-39 year group. Of the cases studied, 81 percent showed recurrent infection and 19 percent primary infections. Associates with the HSV-1 type was found in 29 percent of primary and in 10 percent of recurring episodes, whereas 90 percent of the cases of recurring herpes and 71 percent of the primary cases were associated with the HSV-2 type. Comparison of the results obtained with data from other countries indicates that the epidemiological situation of herpes genital infection in Chile appears to occupy and intermediate point between that of the U.S. and Japan