Six-Month Comparative Analysis Monitoring the Progression of the Largest Diameter of the Sweating Inhibition Halo of Different Botulinum Toxins Type-A.

BACKGROUND: Excessive sweating is a clinical condition that can be improved with type-A botulinum toxin (BTX-A). OBJECTIVES: To evaluate and compare the largest diameter of sweating inhibition halo (SIH) of 5 different commercially available BTX-A, in five different doses, in a 6-month-long clinical evaluation. METHODS: Twenty-five adult female volunteers were injected in the dorsal trunk area with both 100 units (100UI) and 500 units (500UI) BTX-A products, reconstituted in a ratio of 1:2.5 IU, respectively. Products were applied in five different concentrations (1:2.5U, 2:5U, 3:7.5U, 4:10U, and 5:12.5U). After 30, 60, 90, 120, 150, and 180 days, a starch-iodine test was performed to obtain the largest diameter of each SIH. RESULTS: The higher the number of units used, the larger the SIH p < 0.05 for all BTX-A. However, Botox®, Botulift®, Dysport®, and Prosigne® have pretty likewise SIH along the study, with some few differences for some doses and months between one and another. However, Xeomin® is the BTX-A with the smallest SIH, in comparison with all others, in any dose and period. CONCLUSIONS: Differences were observed among all brands of BTX-As, based on dose and time after injection. Xeomin® provides the smallest SIH in comparison with others BTX-A.

Evaluation of the Quantitative and Qualitative Alterations in the Fatty Acid Contents of the Sebum of Patients with Inflammatory Acne during Treatment with Systemic Lymecycline and/or Oral Fatty Acid Supplementation.

Background. Acne is a dermatosis that involves an altered sebum pattern. Objectives. (1) To evaluate if a treatment based on antibiotics (lymecycline) can alter fatty acids contents of the sebum of patients with acne; (2) to evaluate if oral supplementation of fatty acids can interfere with fatty acids contents of the sebum of patients with acne; (3) to evaluate if there is any interaction in fatty acids contents of the sebum of patients with acne when they use both antibiotics and oral supplementation of fatty acids. Methods. Forty-five male volunteers with inflammatory acne vulgaris were treated with 300 mg of lymecycline per day, with 540 mg of γ-linolenic acid, 1,200 mg of linoleic acid, and 510 mg of oleic acid per day, or with both regimens for 90 days. Every 30 days, a sample of sebum from the forehead was collected for fatty acids' chromatographic analysis. Results. Twelve fatty acids studied exhibited some kind of pattern changes during the study: C12:0, C14:0, C15:0, C16:1, C18:0, C18:1n9c+C18:1n9t, C18:2n6t, C18:3n6, C18:3n3, C20:1, C22:0, and C24:0. Conclusions. The daily administration of lymecycline and/or specific fatty acids may slightly influence some fatty acids levels present in the sebum of patients with inflammatory acne vulgaris.

Melanoma cutâneo: pacientes do complexo hospitalar Edmundo Vasconcelos em comparação com outros serviços de referência / Cutaneous melanoma: Edmundo Vasconcelos hospital complex patients in comparison with other reference services

Introdução: O melanoma é a mais agressiva das neoplasias cutâneas. O entendimento de seu comportamento e o correto diagnóstico permitindo tratamento precoce pode atuar para diminuir a mortalidade. Objetivos: Entender a incidência e o comportamento histopatológico do melanoma maligno cutâneo em quatro hospitais da cidade de São Paulo, sendo um privado e três públicos. Métodos: Comparou-se as características clínicas e anatomopatológicas de 42 pacientes com diagnóstico de melanoma procedentes de serviços do Complexo Hospitalar Edmundo Vasconcelos (CHEV) com outros três serviços de referência em São Paulo: Santa Casa de São Paulo, Hospital do Servidor Público Estadual de São Paulo, Hospital A.C. Camargo. As variáveis analisadas foram: sexo, tipo histológico da neoplasia; o nível de Clark na peça do anatomopatológico e a profundidade de Breslow. Resultados: 54,76% eram do tipo extensivo superficial, 26,19% nodular, 4,76% acral e 2,38% lentigo maligno. Quanto ao nível de Clark, 16,66% nível I, 42,85% nível II, 19,07% nível III e 7,14% nível IV. Quanto ao Breslow, 66,66% nível I, 11,90% níveI II, 7,14% nível III e 14,28% nível IV. Na amostra estudada as mulheres significaram 61,91%. Conclusão: O tipo extensivo superficial foi o mais prevalente, de espessura Breslow nível I e nível de Clark II.

Refluxo gastroesofágico participando da cascata cognitiva do pânico / Gastroesophageal reflux participating on panic cognitive cascade

O transtorno do pânico (TP) é um transtorno ansioso não-fóbico que acomete de 1,5% a 4% da população mundial. É caracterizado por ataques imotivados de mal-estar psíquico e sintomas somáticos, além de ansiedade antecipatória à crise, com prejuízo funcional ao indivíduo. O objetivo deste relato de caso é descrever a associação entre transtorno do pânico e doença do refluxo gastroesofágico (DRGE). MCL, 25 anos, apresentava crises de pânico frequentes, pouco responsivas ao tratamento durante 6 meses, mesmo com readequação da farmacoterapia. Iniciou-se investigação, sendo fechado o diagnóstico de DRGE, cujo tratamento culminou em remissão das crises de pânico. A dor torácica aguda da DRGE era interpretada como ameaça proximal, ocasionando dúvidas sobre passar mal e hiperventilação, servindo como gatilho da cascata cognitiva do pânico, no mesencéfalo dorsal. A inflamação da mucosa esofágica funciona como ameaça distal, estimulando a amígdala e causando ansiedade antecipatória, mantendo a elevação dos hormônios de estresse. Segundo o modelo de Deakin-Graeff, embora a 5-HT iniba o ataque de pânico e facilite a ansiedade antecipatória, no TP esta última é estimulada por meio do núcleo dorsal da rafe. Portanto, casos que incluem a associação TP e DRGE devem ser mais bem examinados, para que haja diagnóstico e tratamento adequados.

Panic disorder (PD) is a non phobic anxiety disorder that affects 1,5 to 4% worldwide. It is characterized by unmotivated acute attacks, with mental and somatic symptoms, and by an anxiety which precedes the crises, resulting in functional disturbance. The objective of this case study is to describe the association between PD and gastroesophageal reflux (GR). MCL, 25 years, presented with frequent panic crises, with low response to the therapy for 6 months, even after modification of medication doses. Investigation was carried out and diagnoses defined as GR. The treatment resulted with elimination of the panic crises. The acute thoracic pain of the GR is interpreted as a near threat, causing uncertainty regarding an unwell feeling with hyperventilation, acting as a trigger of the panic cognitive cascade, in the dorsal mesencephalon. The esophagic mucosa inflammation is interpreted as a distal threat, stimulating the amygdale and generating anticipated anxiety, increasing stress hormones. According to Deakin-Graeff model, even though 5HT inhibits the panic attack and stimulates the anticipated anxiety, the panic disorder stimulates the latter through dorsal raphe nucleus. In conclusion, the association between PD and GR should be better identified in order that the correct diagnosis and adequate treatment is achieved.