[Churg-Strauss syndrome: a disabling disease]. / Síndrome de churg-strauss: uma doença incapacitante.

Churg-Strauss syndrome (CSS) is an infrequent vasculitis that affects small to medium-sized vessels. We describe a 51 year-old-female admitted to our inpatient unit with bullae on her right foot and forearm with pain, paresthesias and impotence of the foot. There was rapid clinical deterioration with lost of gait and peripheral eosinophilia. Histopathology showed many extravascular eosinophils. Bone marrow had an increased number of eosinophils and their precursors with no neoplastic cells infiltration. Electromyogram revealed mononeuritis multiplex with bilateral sciatic and right femoral nerve involvement. She fulfilled the eligibility criteria of American College of Rheumatology (ACR) and Chapell Hill Conference Consensus (CHCC) of CSS so corticosteroids and cyclophosphamide and rehabilitation program were begun with good clinical and laboratorial response. This report illustrates the importance of identifying atypical cutaneous features of CSS for the early diagnosis of this rare condition and the role of a multidisciplinary team in this multissystemic disease.

Stratum corneum is an effective barrier to TiO2 and ZnO nanoparticle percutaneous absorption.

BACKGROUND: There is increasing concern over the local and systemic side effects of TiO(2) and ZnO coated nanoparticles widely used in sun blockers. OBJECTIVE: To determine the localization and possible skin penetration of TiO(2) and ZnO nanoparticles, dispersed in 3 sunscreen formulations, under realistic in vivo conditions in normal and altered skin. METHODS: Nuclear microscopy techniques provided spatially resolved quantitative analysis of Ti and Zn nanoparticle distributions in transversal cryosections of skin obtained by biopsy with no further treatment. A test hydrophobic formulation containing coated 20-nm TiO(2) nanoparticles and 2 commercial sunscreen formulations containing TiO(2) alone or in combination with ZnO were tried, taking into account realistic use conditions by consumers and compared with the recommended standard condition for the sun protection factor test. The protocols consisted of an open test. RESULTS: Following a 2-hour exposure period of normal human skin to TiO(2)- and ZnO-containing sunscreens, detectable amounts of these physical blockers were only present at the skin surface and in the uppermost stratum corneum regions. Layers deeper than the stratum corneum were devoid of TiO(2) or exogenous ZnO, even after 48 h of exposure to the sunscreen, under occlusion. Deposition of TiO(2) and ZnO nanoparticles in the openings of the pilosebaceous follicles was also observed, suggesting a preferential fixation area. Penetration of nanoparticles into viable skin tissue could not be detected. CONCLUSIONS: TiO(2) or ZnO nanoparticles are absent or their levels are too low to be tested under the stratum corneum in human viable epidermal layers. Therefore, significant penetration towards the underlying keratinocytes is unlikely.

[Tuberculosis. Future perspectives]. / Tuberculose. Perspectivas futuras.

Tuberculosis remains a major health problem around the world and its incidence is growing 0.4% each year. There are 2 billions of infected, 8.4 millions new cases every year and 16 million patients. The association of VIH and tuberculosis, the increasing number of multidrug resistance, failure of health systems, greater mobility of people, poverty, wars and social exclusion, are the major causes of the epidemiological situation. Faster, more specific and sensible diagnostic methods are being investigated. Some of them use molecular biology techniques, some uses radioisotopes and some others are based on colour and fluorescence modifications of dyes. New drugs, new routes of administration and ways for increasing compliance are under investigation. More potent drugs, with greater biodisponibility and adequate pharmacokinetics for shorter treatments for multidrug and latent forms of bacilli are needed. New vaccines are under investigations, namely Adjuvant Subunits Vaccines, DNA Vaccines DNA, no micobacterianos vectors, and attenuated living vaccines are being tested. Finally some considerations are made concerning the need of global committement to win the fight against tuberculosis in the near future.

[Churg-Strauss allergic granulomatosis]. / Granulomatose "alérgica" de Churg-Strauss.

A 65 year old female patient with a 2 year history of bronchial asthma disseminated petechial, papulopustular and ulceronecrotic eruption and an isolated episode of intestinal bleeding. Chest X rays showed bilateral pulmonary infiltrates and laboratory examination revealed eosinophilia (17%) leucocytosis (22.900) and a severe renal insufficiency. Cutaneous biopsy revealed a necrotizing, leucocytoclastic vasculitis of the small blood vessels in the dermis as well as the hypodermis. The patient died 2 days after diagnosis and corticosteroid therapy had been started. Necropsy showed granulomatous and/or vasculitic lesions of the lungs, spleen, kidneys and skin. The clinical and laboratory aspects are discussed and the relevant literature is reviewed.