The effect of patch testing on surgical practices and outcomes in orthopedic patients with metal implants.

OBJECTIVE: To determine the effect of patch testing on surgical decision making and outcomes in patients evaluated for suspected metal hypersensitivity related to implants in bones or joints. DESIGN: Medical chart review. SETTING: Tertiary care academic medical center. PARTICIPANTS: All patients who had patch testing for allergic contact dermatitis related to orthopedic implants. INTERVENTION: Patch testing. MAIN OUTCOME MEASURES: The surgeon's preoperative choice of metal implant alloy compared with patch testing results and the presence of hypersensitivity complications related to the metal implant on postsurgical follow-up. RESULTS: Patients with potential metal hypersensitivity from implanted devices (N = 72) were divided into 2 groups depending on timing of their patch testing: preimplantation (n = 31) and postimplantation (n = 41). History of hypersensitivity to metals was a predictor of positive patch test results to metals in both groups. Positive patch test results indicating metal hypersensitivity influenced the decision-making process of the referring surgeon in all preimplantation cases (n = 21). Patients with metal hypersensitivity who received an allergen-free implant had surgical outcomes free of hypersensitivity complications (n = 21). In patients who had positive patch test results to a metal in their implant after implantation, removal of the device led to resolution of associated symptoms (6 of 10 patients). CONCLUSIONS: The findings of this study support a role for patch testing in patients with a clinical history of metal hypersensitivity before prosthetic device implantation. The decision on whether to remove an implanted device after positive patch test results should be made on a case-by-case basis, as decided by the surgeon and patient.

Facial papules in frontal fibrosing alopecia: evidence of vellus follicle involvement.

BACKGROUND: Frontal fibrosing alopecia is considered a particular clinical form of lichen planopilaris that primarily involves the scalp hair over the frontal hairline. Concomitant involvement of vellus at different body sites has recently been reported. To our knowledge, this is the first report on the involvement of facial vellus by effects of the inflammatory process. Unlike the usual noninflammatory clinical presentation of vellus involvement over other body areas, facial vellus involvement can lead to surface changes that may be recognized both by patients and dermatologists. OBSERVATIONS: Four patients with typical clinical features of frontal fibrosing alopecia presented with noninflammatory follicular papules over the face, most often inside the temporal area, and described as "roughness" by the patients. Histologic samples showed lichen planopilaris features involving the facial vellus. CONCLUSIONS: The new concept of frontal fibrosing alopecia as a generalized disease is important for treatment planning and research. Dermatologists must learn to recognize facial surface changes and discuss these with the patients, who may attribute this roughness to aging or hormonal changes associated with menopause. Further studies are needed to determine the prevalence of this involvement in patients with frontal fibrosing alopecia.

Molluscum contagiosum on tattoo.

Molluscum contagiosum is a disease caused by a poxvirus characterized by benign self-limited eruption of single or multiple cutaneous spherical and pearly papules. Transmission usually occurs by direct contact with infected hosts. It is reported the case of a 22-year-old Caucasian male who presented characteristic pearly and umbilicated papules strictly located on the region of a tattoo. Histopathologic exam confirmed the diagnosis of molluscum contagiosum. The authors describe an uncommomn manifestation of dissemination of this virus in tattoos and also present a literature review emphasizing the transmission pathways and treatment of Molluscum contagiosum.

Molusco contagioso em tatuagem / Molluscum contagiosum on tattoo

Molusco contagioso é uma dermatovirose causada por poxvírus e caracterizada por erupção benigna e autolimitada de uma ou múltiplas pápulas esféricas e brilhantes. A transmissão habitualmente ocorre por contato direto com indivíduos infectados. Relata-se caso de doente masculino, 22 anos, com história de surgimento de numerosas pápulas umbilicadas localizadas estritamente sobre a região de uma tatuagem. Exame histopatológico de uma das pápulas confirmou a hipótese clínica de molusco contagioso. Os autores descrevem uma manifestação pouco frequente da disseminação desse vírus em tatuagens e apresentam uma revisão da literatura, enfatizando as vias de transmissão e a terapêutica do molusco contagioso.

Molluscum contagiosum is a disease caused by a poxvirus characterized by benign self-limited eruption of single or multiple cutaneous spherical and pearly papules. Transmission usually occurs by direct contact with infected hosts. It is reported the case of a 22-year-old Caucasian male who presented characteristic pearly and umbilicated papules strictly located on the region of a tattoo. Histopathologic exam confirmed the diagnosis of molluscum contagiosum. The authors describe an uncommomn manifestation of dissemination of this virus in tattoos and also present a literature review emphasizing the transmission pathways and treatment of Molluscum contagiosum.

Contact dermatitis from acrylics in a histology laboratory assistant.

The use of acrylics has expanded enormously, resulting in a vast range of products for both occupational and non-occupational purposes. Acrylics reported to cause allergic contact dermatitis in histology technicians are 2-hydroxyethyl methacrylate and 2-hydroxyethel acrylate.

[An analyze the opportunities of early detection of breast cancer]. / Análise das oportunidades de diagnóstico precoce para as neoplasias malignas de mama.

PURPOSE: The study tried to identify and to analyze the opportunities of early detection of breast cancer available for the women of Botucatu County. METHODS: A sample of 261 women, 30 year-old or more was interviewed by telephone. RESULTS: The age average was of 51 years; 49.45% of them studied at least 9 year; 80% received general orientations about breast cancer prevention and 86,9% specific orientations on self breast exam; 78.9% of the interviewers made the self breast exam, but only 27% made it correctly. The physician breast examination was made in 76.2% of the women and mammography in 35.6%; if physicians requested mammography exam and if it was available for all of them, 83.1% of the women would like to do it. CONCLUSION: The breast cancer prevalence and the mortality are higher in old women. This study showed that these women presented a smaller rate of opportunities for early detection, because they were less informed about the right periodicity of the self breast exam and they had less mammography and physician breast examination frequency than the younger. The school degree was also related, because the women with more years of study had better opportunities than the ones with less years of study.

Análise das oportunidades de diagnóstico precoce para as neoplasias malignas de mama / An analyze the opportunities of early detection of breast cancer

OBJETIVOS: O estudo procurou identificar e analisar as oportunidades de diagnóstico precoce para neoplasias malignas de mama, disponíveis para as mulheres do município de Botucatu. MÉTODOS: Foram entrevistadas por telefone, segundo sorteio aleatório, 261 mulheres com idade de 30 anos ou mais. RESULTADOS: A média de idade foi de 51 anos e 49,45 por cento das entrevistadas apresentaram escolaridade de nove anos ou mais; 80 por cento receberam orientações gerais sobre prevençäo do câncer de mama e 86,9 por cento orientações específicas sobre autopalpaçäo; 78,9 por cento das mulheres realizaram o auto-exame das mamas e destas somente 27 por cento o fizeram corretamente. O exame clínico das mamas foi realizado em 76,2 por cento das entrevistadas e a mamografia em 35,6 por cento; se o exame de mamografia fosse solicitado por médicos e estivesse disponível, 83,1 por cento das mulheres estariam dispostas a realizá-lo. CONCLUSÄO: A prevalência e a mortalidade da doença säo maiores nas mulheres idosas. Neste estudo observou-se que estas apresentaram uma taxa menor de oportunidades de diagnóstico precoce, pois eram menos informadas sobre a periodicidade correta da autopalpaçäo e apresentaram uma menor freqüência de mamografia e de exame clínico das mamas do que as mais jovens. O grau de escolaridade mostrou também significância estatística, visto que as mulheres com mais anos de estudo tiveram melhores oportunidades do que as com pouco estudo