Photorejuvenation with topical methyl aminolevulinate and red light: a randomized, prospective, clinical, histopathologic, and morphometric study.

BACKGROUND: Photodynamic therapy (PDT) is an option for skin rejuvenation. Although many studies report clinical improvement with PDT in photodamaged skin, histologic and morphometric evidence is not documented in most cases. OBJECTIVE: To evaluate clinical and histopathologic changes induced by methyl aminolevulinate (MAL)-PDT and to morphometrically quantify collagen and elastic fibers in skin remodeling induced by MAL-PDT in photodamaged skin. METHODS AND MATERIALS: Fourteen patients were treated with two sessions of MAL-PDT. The light source was a light-emitting diode: 635 nm, 37 J/cm(2). Skin biopsies were performed before and 3 and 4 months after treatment. All fragments were stained using the hematoxylin-eosin, orcein, and picrosirius techniques. Morphometric studies were done of three samples from each patient. RESULTS: Global clinical improvement was observed in 10 of 14 patients. The histopathologic study showed increased collagen fibers 3 and 6 months after treatment. The decrease in the amount of elastic fiber was statistically significant 3 (p=.016) and 6 (p=.008) months after treatment. The increase in the amount of collagen fiber was statistically significant 6 months after treatment (p=.048). CONCLUSION: Clinical improvement with regard to texture, firmness, wrinkle depth, skin coloration, and clearance of actinic keratoses was observed. Histopathologic and morphometric studies were consistent with the clinical findings.

[Factors associated with necrotizing enterocolitis]. / Fatores associados à enterocolite necrosante.

OBJECTIVE: To evaluate the features of clinical presentation of neonatal necrotizing enterocolitis and its associated factors. METHODS: Retrospective study of the cases of neonatal necrotizing enterocolitis (n = 56) diagnosed at Neonatal Intensive Care Unit Lagoa (NICU), between December 1986 and July 1992. Diagnosis and stages of the disease followed the modified Bell's criteria. Diagnosis and follow-up of all cases were evaluated. The cases of enterocolitis - degrees II and III (n = 44) - were subsequently selected and compared to a case-control group (n = 44), selected according to birthweight (+/- 250 g) and hospitalization period (+/- 2 weeks). The statistically significant analysis was considered as p < 0.05. RESULTS: Out of 2,447 newborns admitted to the NICU, 56 (2.3%) presented enterocolitis. Mean weight was 1908.5 g; mean gestational age was 35 weeks and 1 day; mean period for diagnosis was 10.7 days; 51 (91.1%) patients were fed before diagnosis; 18 (32.1%) needed urgent surgery; nine (16.9%) hemocultures were positive; 10 (17.8%) patients died. Four clinical standards were observed: fulminant, acute with pneumatosis, insidious and suspect. Comparatively to the case-control group, three factors were significantly associated with enterocolitis: apnea (p = 0.045), rapid increase of food intake (< 20 ml/kg/day) - (p = 0.048) and presence of infectious agent (p = 0.000). CONCLUSIONS: Significant factors associated with enterocolitis were occurrence of apnea, rapid increase of food intake and identification of the infectious agent.

Fatores associados à enterocolite necrosante / Factors associated with necrotizing enterocolitis

Objetivo: avaliar as formas de apresentação clínica da enterocolite necrosante neonatal e os fatores associados à doença. Métodos: estudo retrospectivo dos casos de enterocolite necrosante neonatal (ECN) (n=56) ocorridos na UTI Neonatal Lagoa, entre dezembro de 1986 e julho de 1992. O diagn6stico e o estadiamento da doença seguiram o critério de Bell modificado. Foram avaliados o diagn6stico e a evolução de todos os casos. Posteriormente, foram selecionados os casos de enterocolite grau II e III(n=44) e comparados com um grupo controle (n=44), selecionado pelo peso de nascimento (250g) e época de internação (2 semanas). Para a análise estatística, foi considerado significante p<0,05. Resultados: dos 2.447 recém-natos internados na UTI, 56 (2,3po cento ) evoluíram com enterocolite. O peso médio dos pacientes foi de 1.908,5g; a idade gestacional média, de 35 semanas e um dia; a idade média do diagn6stico foi de 10, 7 dias; 51 (91,1por cento ) pacientes foram alimentados anteriormente ao diagnóstico; 18 (32, 1por cento) necessitaram de cirurgia de urgência; em 9 (16,9por cento) as hemoculturas foram positivas; 10 (17,8) pacientes faleceram. Observaram-se quatro padrões evolutivos da doença: aguda fulminante, aguda com pneumatose, insidiosa e suspeita. Comparativamente ao grupo controle, três fatores associaram-se significativamente à enterocolite: apnéia(p=0,045), a progressão rápida da dieta (acima de 20 ml/kg/dia)(p=0,048) e a presença de agente infeccioso (p=0,000).Conclusões: os fatores associados significativamente à enterocolite foram a ocorrência de apnéia, a progressão rápida da dieta e a identificação do agente infeccioso