Intravenous Ketamine Infusion as an Adjunctive Pain Treatment for Erythromelalgia: A Pediatric Case Report.

Erythromelalgia is a rare neurovascular pain condition characterized by erythematous, warm, and painful extremities. Symptoms are exacerbated by heat and relieved by cooling. Treatment is challenging and focuses on symptom control with various medications and therapies targeted toward eliminating destructive cooling behaviors. This pediatric case was notable because the patient's pain dramatically improved after a short-term, low-dose ketamine infusion, allowing her to finally wean off detrimental cooling practices of her extremities. Intravenous ketamine has rarely been described as an adjunctive analgesic strategy for erythromelalgia.

Polarized transilluminating dermoscopy: Bedside trichoscopic diagnosis of trichothiodystrophy.

Trichothiodystrophy is a rare autosomal recessive disorder resulting in a broad range of systemic abnormalities. Polarizing microscopy of the hair reveals the pathognomic "tiger tail" of alternating light and dark bands, but the need for a microscope prevents rapid bedside diagnosis. We describe a new technique for the bedside diagnosis of trichothiodystrophy using a handheld polarizing dermatoscope, precluding the need for microscopic examination.

Validation of a serodiagnostic test for sporotrichosis: a follow-up study of patients related to the Rio de Janeiro zoonotic outbreak.

The gold standard for the diagnosis of sporotrichosis consists of the isolation and identification of the fungus from clinical exudates and/or biopsy specimens. However, new technologies offer several advantages over the traditional methods because they are noninvasive and more sensitive in the differential diagnosis of infectious diseases. In the present study, we performed a validation, impact evaluation, and analysis of the applicability of an enzyme-linked immunosorbent assay (ELISA) for the diagnosis of sporotrichosis in different groups of patients in comparison with the reference protocols for the evaluation of diagnostic tests for infectious diseases. We used 177 serum samples that were collected between 1998 and 2008 from patients in a geographic area related to the Rio de Janeiro outbreak of sporotrichosis. The ELISA had a low rate of cross-reactivity based on the reference values for diagnostic tests, and the analysis of the receiver operating characteristic curve revealed an area under the curve of 0.9154. Furthermore, higher accuracy was observed in the serodiagnosis of infections in special groups of patients such as pediatric and human immunodeficiency virus-positive patients. We concluded that this ELISA had a good clinical serological correlation and, therefore, can be considered a new diagnostic tool applicable to all clinical presentations of sporotrichosis.

Análise da incidência de colelitíase no pós-operatório tardio de pacientes submetidos à bypass gástrico em y de Roux para o tratamento da obesidade mórbida / Analysis of the incidence of cholelithiasis in the late postoperative period in patients undergoing gastric bypass Roux-en-y for the treatment of morbid obesity

A obesidade é considerada uma doença crônica e corresponde, atualmente, a uma epidemia global. Segundo a OMS, umas das classificações da obesidade considera o índice de massa corpórea (IMC) implicando no risco de mortalidade, independente do sexo e idade. A doença biliar é a terceira doença mais freqüente associada à obesidade mórbida, sendo a obesidade maior fator de risco no desenvolvimento de cálculos de colesterol. Este trabalho tem como objetivo avaliar a incidência de colelitíase no pós-operatório tardio (superior a 1 ano) de pacientes submetidos a cirurgia bariátrica com BGYR, no serviço de Cirurgia Bariátrica do HSPM, bem como avaliar a incidência de complicações decorrentes da colelitíase nesses pacientes.A colelitíase possui elevada incidência em pacientes submetidos ao BGYR. Sintomas biliares ocorrem em grande parte dos pacientes que formam cálculos na vesícula biliar, sendo a cólica biliar o sintoma mais comum. Complicação potencialmente grave também ocorre, como a colangite

Coexistence of generalized morphea and lichen sclerosus et atrophicus mimicking systemic disease.

A 70-year-old white housewife presented with a rare presentation of coexistent generalized morphea and lichen sclerosus et atrophicus with unusual clinical aspects. The patient had disseminated erythematous lesions that evolved into indurated large plaques. Hypopigmentation and hyperpigmentation developed later, in addition to ivory, white, and shiny plaques on the trunk (Figure 1). The skin of the arms and legs showed a wavy contour (Figure 2). Various areas were markedly sclerotic and some had edematous papules (Figure 3). Multiple indurated, ivory, white, shiny, large, and hypochromic plaques were seen on the trunk Laboratory examinations showed increased immunoglobulin A and antinuclear antibodies 1:200 speckled. Scl-70, anti-centromere, anti-ribonucleoprotein, and anti-DNA tests were negative. Esophageal manometry and abdominal and pelvic ultrasound findings were all normal. Complete blood cell count, blood profile, and urinalysis were also within normal limits. Skin biopsy of an arm lesion showed an atrophic epidermis with orthokeratotic hyperkeratosis and follicular plugging. A broad area of homogenization and edema was seen in the papillary dermis with dilated capillaries and a perivascular lymphocytic infiltration. There was also collagen sclerosis throughout the reticular dermis, and thickened, homogenized collagen bundles replaced the subcutaneous fat. Vessel walls showed proliferated intima with mucin deposition and sclerosis, as well as multiplied elastic layers. There was edema of the papillary dermis in some areas and incipient deposition of calcium (Figures 4-7).

The nasal crease sign in segmental facial hemangioma--an early sign of cartilage destruction.

Although the majority of hemangiomas of infancy do not require treatment, a subset of patients have complications such as ulceration, functional impairment or severe disfigurement that necessitate intervention. It is often difficult to predict which hemangiomas will lead to permanent disfigurement and medical complications. We present three patients with segmental facial hemangiomas involving the nose which resulted in nasal cartilage destruction. All three patients had a linear gray atrophic crease in the inferior columella visualized on clinical examination prior to the onset of nasal collapse. We propose that this ''nasal crease sign'' in infants with segmental facial hemangioma involving the nose and philtrum may be a premonitory clinical finding of impending nasal cartilage destruction. Dermatologists should be aware of this clinical sign which may help identify patients at high risk of nasal destruction. Unfortunately, aggressive medical intervention may not always prevent devastating disfigurement.

Tacrolimus ointment is effective for psoriasis on the face and intertriginous areas in pediatric patients.

Children with psoriasis often have involvement of the face and intertriginous areas. While corticosteroids have been the mainstay of treatment for plaque-type psoriasis, the face and intertriginous areas are more sensitive to local effects of topical steroid use such as cutaneous atrophy. Topical tacrolimus has shown promise in adult patients as an alternative antiinflammatory without the cutaneous side effects of steroids. Eleven patients between 6 and 15 years of age with facial or inverse psoriasis were evaluated in a 6-month, single-center, open-label trial. Clinical evaluations were made at baseline and days 30, 90, and 180. Severity was assessed using the physician's global assessment of improvement relative to baseline, a 6-point rating scale for signs of disease (erythema, infiltration, desquamation), and an overall severity score. Within the first 30 days of treatment, every patient had cleared or achieved excellent improvement with the use of tacrolimus ointment. Statistically significant improvement was achieved in each sign of disease and the overall severity score. The only adverse event reported in 6 months of observation was significant pruritus in one patient. We therefore conclude that tacrolimus ointment is an effective treatment for psoriasis on the face or intertriginous areas in children.

O impacto da conduta cirúrgica ou conservadora no trauma hepático / The impact of surgical or nonsurgical management in liver trauma

Racional- O fígado é a víscera sólida intra-abdominal mais comumente lesionada no trauma. De todos os traumatismos abdominais fechado, cerca de 15 por cento a 20 por cento o lesam. Dúvidas existem sobre qual método de tratamento é melhor. Objetivo - Analisar a conduta tomada no trauma hepático, cirúrgica ou conservadora, e determinar quais...

Backgound - The liver is the most traumatized organ of the abdominal cavity. Till nowadays its management is controversial. aim- The purpose of this research was to compare the management in liver trauma, surgical or conservative, and to look for the factors associated...

Case for diagnosis

Descrição de um caso de paciente do sexo feminino, 26 anos de idade, parda, solteira, telefonista, natural do Rio de Janeiro, queixando-se de machucado na face, paciente negava trauma no local. Em relação a história patológica pregressa , familiar, social e epidemiológica, não existiam dados relevantes. Ao exame dermatológico, observou-se lesão crostosa, acastanhada, com halo eritematoso, na região infrapalperal esquerda

Case for diagnosis

Paciente de 15 anos, do sexo masculino, pardo, solteiro, estudante, natural do Rio de Janeiro, foi atendido com queixa de feridas e inchaço no rosto. Referia aparecimento há um ano de lesão papuloeritematosa assintomática que evoluiu para lesão de forma eritêmato-infiltrada localizada na região frontal direita, na glabela, no dorso do nariz, nas regiões periorbital e malar esquedas, além de edema palpebral homolateral e adenomegalia submandibular acompanhada de dor, sem manifestações sistêmicas, fez tratamento para tuberculose cutânea, sem resposta clínica

Case for diagnosis

Paciente de 43 anos de idade, sexo feminino, branca, casada, roupeira, natural do Rio de Janeiro, com queixa de lesões nas palmas das mãos. Referia aparecimento de pápulas eritematosas e pruriginosas, há aproximadamente 2 meses. Relatou alergia à sabão de côco e picada de inseto. Mãe com diabetes mellitus, fez uso de corticóide tópico e hidroxizine com melhora apenas do prurido. O exame histopatológico revelou hiperceratose discreta e acantose, observando-se na derme superior e média infiltrado granulomatoso consituído por céluas gigantes tipo Langerhans em torno de vasos com paredes espessadas. Há focos de dissociação e fragmentação de fibras colágenas e intensa elastose. O dignóstico de granuloma anular foi feito através de exame histopatológico, após o qual ocorreu regressão significativa das lesões