Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society.

BACKGROUND: Over the last few years, several articles on dermoscopy of non-neoplastic dermatoses have been published, yet there is poor consistency in the terminology among different studies. OBJECTIVES: We aimed to standardize the dermoscopic terminology and identify basic parameters to evaluate in non-neoplastic dermatoses through an expert consensus. METHODS: The modified Delphi method was followed, with two phases: (i) identification of a list of possible items based on a systematic literature review and (ii) selection of parameters by a panel of experts through a three-step iterative procedure (blinded e-mail interaction in rounds 1 and 3 and a face-to-face meeting in round 2). Initial panellists were recruited via e-mail from all over the world based on their expertise on dermoscopy of non-neoplastic dermatoses. RESULTS: Twenty-four international experts took part in all rounds of the consensus and 13 further international participants were also involved in round 2. Five standardized basic parameters were identified: (i) vessels (including morphology and distribution); (ii) scales (including colour and distribution); (iii) follicular findings; (iv) 'other structures' (including colour and morphology); and (v) 'specific clues'. For each of them, possible variables were selected, with a total of 31 different subitems reaching agreement at the end of the consensus (all of the 29 proposed initially plus two more added in the course of the consensus procedure). CONCLUSIONS: This expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This tool, if adopted by clinicians and researchers in this field, is likely to enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology. What's already known about this topic? Over the last few years, several papers have been published attempting to describe the dermoscopic features of non-neoplastic dermatoses, yet there is poor consistency in the terminology among different studies. What does this study add? The present expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This consensus should enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology.

Dermoscopic nevus patterns in skin of colour: a prospective, cross-sectional, morphological study in individuals with skin type V and VI.

BACKGROUND: Most of the knowledge on the prevailing dermoscopic patterns of acquired melanocytic nevi (AMV) is based on studies in Caucasians, while little research focuses on the dermoscopic variability in nevi in skin of colour. OBJECTIVE: To analyse the prevalent dermoscopic nevus patterns in subjects with a skin type (ST) V and VI. METHODS: Prospective, cross-sectional, morphological study was conducted in six clinics with enrolment of consecutive individuals with a ST V or VI. Digital dermoscopic images of selected representative AMN were assessed for dermoscopic colours, morphological patterns and pigment distribution. RESULTS: Analysis of 300 nevi from subjects with ST V and VI revealed significant differences in the nevus pattern between these two groups. The majority of nevi in ST V revealed a reticular pattern, whereas persons with ST VI more frequently exhibited a structureless pattern. Black, blue and grey were more frequent in ST VI, whereas the vast majority of nevi in ST V individuals showed dark brown colour. CONCLUSIONS: Our study provides new insights into the nevus pattern in individuals with a dark pigmentary trait, which may aid the diagnosis and management of nevi in this patients group.

European ancestry and cutaneous melanoma in Southern Brazil.

BACKGROUND: Similar to other countries, incidence and mortality rates for cutaneous melanoma (CM) are increasing in Brazil. Resulting from centuries of ethnic mixture, the skin of the Brazilian population presents all phototypes, being progressively lighter following the increase of the latitude toward the South, where the highest incidence of melanoma is observed. Studies from the United States and Argentina in whites suggest that European ancestry could represent an important risk factor for CM in those regions. METHODS: Questionnaires from a case-control study involving 119 melanoma patients and 177 controls were reviewed for age, gender, phototype, sun exposure, photoprotection and ancestry. The patients reported the countries of ancestry of their grandparents. Data were tabulated and converted into scores that would reflect the proportion of ancestry for each country in individuals. RESULTS: Patients with German and Italian ancestry presented higher risk for CM [odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.8-6.7 and OR, 9.7; 95% CI, 3.9-24.2, respectively]. Conversely, Brazilian indigenous ancestry showed a protective effect for the development of the disease, with an OR of 0.16 (95% CI, 0.04-0.7). CONCLUSIONS: Some European ancestries, especially German and Italian, seem to be associated to a higher risk of CM in this sample from Southern Brazil. On the other hand, Brazilian indigenous ancestry presented as a protection factor against developing the tumour.

Evaluation of the autonomic cardiovascular response in Arnold-Chiari deformities and cough syncope syndrome.

OBJECTIVE: To study the autonomic control of heart rate in patients with Arnold-Chiari deformity types I and II who exhibit the signs and symptoms of cough syncope syndrome. DESIGN: Prospective, clinical descriptive study. SETTING: University clinical research center. PATIENTS: Nine patients with Arnold-Chiari deformity and cough syncope syndrome. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Changes in heart rate, blood pressure, and electrocardiograms for power spectral analysis of heart rate variability were studied in the supine and standing positions, preoperatively (n = 9) and postoperatively (n = 5). RESULTS: Preoperatively, 8 (89%) of 9 patients increased their heart rate after postural change from supine to standing (mean +/- SD delta = 13 +/- 13 beats per minute [bpm]). Postoperatively, 4 (80%) of the 5 patients exhibited a greater increase in standing heart rate (mean delta = 19 +/- 16 bpm) compared with preoperative values. Changes in systolic, diastolic, and mean blood pressure with postural change were variable. Preoperatively, all patients exhibited abnormal control of heart rate in response to postural change. Three patients (33%) showed an abnormal decrease in low-frequency heart rate power (mean delta = -27 +/- 35 bpm2); the remaining 6 (67%) demonstrated an abnormal increase in high-frequency heart rate power (mean delta = 25 +/- 41 bpm2). All patients were clinically asymptomatic at 2 months after surgery. A normal spectral response to postural change was demonstrated in heart rate power in all 5 patients who were reevaluated postoperatively, with an increase in low-frequency power (mean delta = 33 +/- 21 bpm2) and a decrease in high-frequency power (mean delta = -21 +/- 23 bpm2). CONCLUSIONS: Patients with cervicomedullary anatomic abnormalities caused by Arnold-Chiari deformities may exhibit abnormal autonomic control of heart rate, and the autonomic control of their heart rate returns to a normal pattern after surgical palliation in conjunction with resolution of clinical symptoms.

[Significance of the CO2-laser angle, oral cavity endoscopes]. / A CO2-lasersugár beesési szögének jelentösége, szájüregi endoszkópok.

The CO2-laser ray guided at 90 degrees to the surface creates a crater of typical "v" shape. If the guide angle of the ray deviates therefrom and the smaller the angle of incidence than 90 degrees, destruction becomes the more astymmetric, the crater takes an ever more flattened eliptical shape. The lack of tissue becomes even more superficial, thus removal of a circumscribed pathological area requires the sacrifice of more ambient healthy tissue. Consterning the possible angle of incidence of the laser ray instrumental measurements were carried out. It has been ascertained that in the pharinx third of the mouth cavity behind the plain corresponding to the premolars, as a rule, only guide angles below 50 degrees, in the middle third of the mouth cavity corresponding to the area between the front teeth and the molars guide angles between 50-70 degrees, and in the front third mostly a ray guiding below 90 degrees are possible. In the middle and rear third of the mouth cavity the ideal rey-guiding at 90 degrees can be obtained but with reflection, certain areas even cannot be treated directly, are visible but in mirrors. By transforming the hand piece of the laser apparatus endoscopes with fixed mirror and rotating mirror have been constructed. By means of the endoscope with fixed mirror already all parts of the mouth cavity have been rendered accessible while the rotating mirror model became suitable even to admit the laser ray to the surfaces at the ideal angle of incidence of 90(2).

pH oscillations in the hemin-hydrogen peroxide-sulfite reaction.

Oscillatory behaviour in the pH value has been observed during the oxidation of sulfite by hydrogen peroxide mediated by hemin, a well known enzyme model compound, in a continuous-flow stirred tank reactor. The dynamics of this reaction has been studied for a variety of flow rates of the reactants. As the flow rates increase, the oscillations evolve from relaxation oscillations to more complex shapes, displaying, among others, bursting behaviour. A reaction mechanism is proposed that involves the autocatalytic oxidation of HSO3- by H2O2, while slow equilibria between different pH-dependent forms of hemin account for the feedback loop which gives rise to oscillatory dynamics. It is shown in experiments that no participation of CO2 is required for oscillations to occur.