Intralymphatic Histiocytosis: A Report of 2 Cases. / Histiocitosis intralinfática, a propósito de 2 casos.

Intralymphatic histiocytosis is a benign condition characterized by poorly defined erythematous plaques (sometimes forming a reticular pattern) as well as the presence of nodules and vesicles. Its etiology and pathogenesis appear to be related to chronic inflammation in the affected area, prior surgery, or systemic disease, particularly rheumatoid arthritis. We report on 2 new cases, both associated with joint surgery in the affected area and osteoarticular disease (primary synovial osteochondromatosis and rheumatoid arthritis). This is a chronic disease and there is no specific treatment. Different treatment options were chosen in the 2 cases described. A spectacular response to treatment with oral pentoxifylline and topical tacrolimus was observed in 1 of the patients.

Hair-follicle Transplant Into Chronic Ulcers: A New Graft Concept. / Trasplante de folículos pilosos en úlceras crónicas: un nuevo concepto de injerto.

Chronic venous leg ulcers are a major therapeutic challenge in clinical practice, and the search for new approaches to improve wound healing is essential. Many ulcers do not heal with traditional treatment using compression, debridement, and dressings. Skin-grafts variants, such as pinch grafts, punch grafts, split- or full-thickness skin grafts, and grafts derived from cells cultured in the laboratory, are among the most widely used options in ulcers that do not heal. In recent years, numerous studies have brought to our attention the important role of the hair follicle in the healing process of cutaneous wounds. Putting knowledge into practice, hair follicles from the scalp have been used in punch-type grafts transplanted to the base of chronic ulcers to stimulate healing. Results appear to be better than those with traditional hairless punch grafts, opening new lines of treatment for recalcitrant chronic venous ulcers.

[How far reaches earliness of optical coherence tomography in cognitive impairment]. / Hasta donde llega la precocidad de la tomografia de coherencia optica en el deterioro cognitivo?

INTRODUCTION: Alzheimer's disease (AD) is the leading cause of dementia in the world today. Increasingly greater efforts are being made to be able to detect cognitive impairment in earlier stages, and diagnostic entities such as mild cognitive impairment (MCI) and subjective memory complaints (SMC) are appearing. The number of biomarkers studied with the aim of reaching this goal continues to rise, and include optical coherence tomography. SUBJECTS AND METHODS: The study conducted employed optical coherence tomography to measure the macular thickness and the retinal nerve fibre layer in patients diagnosed with AD (n = 36), in patients with MCI (n = 33), in individuals with SMC (n = 24) and in control subjects (n = 45). RESULTS: Statistically significant differences have been found in terms of the macular thickness among all the groups studied (SMC: 261.8 ± 25.88 µm; MCI: 259.19 ± 22.582 µm; mild AD: 258.53 ± 14.804 µm; moderate AD: 249.32 ± 18.467 µm) and control subjects (271.96 ± 15.57 µm). The same occurs as regards the retinal nerve fibre layer and the difference is statistically significant compared with the control group (94.51 ± 9.203 µm) of all the groups (SMC: 90.44 ± 9.059 µm; MCI: 89.4 ± 10.421 µm; mild AD: 87.12 ± 10.279 µm; moderate AD: 82.25 ± 10.636 µm). CONCLUSION: Optical coherence tomography could be a future biomarker and support tool to facilitate the early diagnosis of cognitive impairment and AD.

TITLE: Hasta donde llega la precocidad de la tomografia de coherencia optica en el deterioro cognitivo?Introduccion. La enfermedad de Alzheimer (EA) es la primera causa de demencia mundial. Cada vez son mas los esfuerzos para lograr una deteccion temprana del deterioro cognitivo y surgen en el panorama cientifico entidades diagnosticas como el deterioro cognitivo leve (DCL) y las quejas subjetivas de memoria (QSM). Debido a ello, aparecen numerosos biomarcadores estudiados para conseguir dicho objetivo, entre ellos la tomografia de coherencia optica. Sujetos y metodos. Se ha realizado un estudio que utiliza la tomografia de coherencia optica para medir el grosor macular y la capa de fibras nerviosas de la retina en pacientes diagnosticados de EA (n = 36), pacientes con DCL (n = 33), en individuos con QSM (n = 24) y en sujetos control (n = 45). Resultados. Se han encontrado diferencias estadisticamente significativas en cuanto al grosor macular entre todos los grupos estudiados (QSM: 261,8 ± 25,88 µm; DCL: 259,19 ± 22,582 µm; EA leve: 258,53 ± 14,804 µm; EA moderada: 249,32 ± 18,467 µm) y sujetos control (271,96 ± 15,57 µm). Respecto a la capa de fibras nerviosas de la retina, ocurre de igual manera, y la diferencia es estadisticamente significativa frente al grupo control (94,51 ± 9,203 µm) de todos los grupos (QSM: 90,44 ± 9,059 µm; DCL: 89,4 ± 10,421 µm; EA leve: 87,12 ± 10,279 µm; EA moderada: 82,25 ± 10,636 µm). Conclusion. La tomografia de coherencia optica podria situarse como un futuro biomarcador y una herramienta de apoyo para facilitar el diagnostico precoz del deterioro cognitivo y de la EA.

[Anti-fungal resistant hypopigmented macules in an adolescent]. / Máculas hipopigmentadas en un adolescente resistentes a tratamiento antifúngico.

Progressive macular hypomelanosis of the trunk is a disease of unknown origin that often goes unrecognized in the clinical setting. We present an adolescent with this condition initially diagnosed as tinea versicolor. She was asymptomatic, with hypopigmented macules located on the trunk and with no previous history of inflammation, infection or injury. Progressive macular hypomelanosis is a common disorder that has frequently been misdiagnosed, probably because it is often considered a post-inflammatory hypopigmentation or pityriasis versicolor.

Granulomatous cheilitis: a report of 6 cases and a review of the literature.

INTRODUCTION: Granulomatous cheilitis (Miescher cheilitis), a condition characterized by recurrent swelling of the lips, is the most common monosymptomatic form of the Melkersson-Rosenthal syndrome. The aim of this study was to study the characteristics of patients diagnosed with granulomatous cheilitis at the dermatology department of our hospital over a period of 17 years. MATERIAL AND METHODS: We performed a descriptive study of patients diagnosed with granulomatous cheilitis at our hospital between January 1993 and January 2010. RESULTS: The condition was diagnosed in 6 patients (4 women and 2 men), with a mean age of 49 years at the time of diagnosis. All the patients had recurrent swelling of the upper lip and 2 also had swelling in other parts of the face. The mean time from the onset of symptoms to the initial visit was approximately 16 months. There were no cases of facial palsy, and just 1 patient had a fissured tongue. None of the patients developed Crohn disease or any other granulomatous disorders during follow-up. CONCLUSIONS: Granulomatous cheilitis is a rare disease. None of the patients in our series had gastrointestinal or neurologic symptoms. Accordingly, we believe that granulomatous cheilitis is an independent orofacial granulomatous disease which most often presents without accompanying signs or symptoms.

[Dermatology consultations in an emergency department prior to establishment of emergency dermatology cover]. / Consultas dermatológicas en el Servicio de Urgencias: situación previa a la instauración de guardias de la especialidad.

BACKGROUND AND OBJECTIVE: an increasing number of patients seek emergency treatment for dermatologic complaints. The aim of this study was to assess the characteristics of skin complaints seen in an emergency department prior to establishment of specialist dermatology cover. MATERIALS AND METHODS: a retrospective, descriptive study was undertaken using data on urgent dermatology cases seen by nonspecialist physicians in the emergency department of Hospital General Universitario de Albacete, Spain, in 2008. RESULTS: a total of 3662 patients with skin diseases were seen (2.59% of all emergency cases; approximately 10 patients per day). The mean age was 27.73 years and there was a slight predominance of female patients. Children and adolescents accounted for 5.85% of cases. A total of 96 different conditions were diagnosed and 84% of cases corresponded to one of 21 different diagnostic entities, urticaria being the most frequent (19.27%). The 96 diagnoses were grouped into 16 categories to facilitate analysis. According to this classification, most patients had infectious diseases (47.49%), followed by urticaria and angioedema (20.13%), "nonspecific diagnosis" (11.93%), and "descriptive diagnosis" (6.49%). In 4.8% of cases, the patient was admitted, most frequently for cellulitis. CONCLUSIONS: in nonspecialist emergency services, the number of different diagnoses is small in relation to the number of patients seen and the proportion of nonspecific and descriptive diagnoses is relatively large. In our opinion, an on-call dermatologist should be made available within emergency departments in order to offer a higher quality of care to patients with skin conditions.

[Referrals to dermatology: proportion of banal disorders]. / Demanda derivada a Dermatología: peso de la patología banal.

BACKGROUND AND OBJECTIVE: Skin diseases account for a large number of consultations in primary care. The objective of this study was to determine the characteristics and cost of referrals from primary care to a dermatology clinic. MATERIAL AND METHODS: Descriptive cross-sectional study of referrals from a primary care health center to a dermatology clinic. The dermatology clinic was situated in the same health center and was attended by a dermatologist from Complejo Hospitalario Universitario in Albacete, Spain. The study was performed on 10 days selected at random between April 21, 2009, and June 26, 2009. The data gathered included age, sex, use of cryotherapy, and diagnostic group. Patients were divided into 4 diagnostic groups: A) benign degenerative disease or trivial disorders whose treatment may not merit involvement of the national health service, B) diseases resolved with a single dermatology consultation at the health center, C) diseases requiring evaluation in hospital-based dermatology outpatients, and D) diseases referred for surgical treatment. RESULTS: Data were gathered on 257 patients with a mean age was 41.18 years and there was a slight female predominance. The majority of patients were in diagnostic group B (53.7%), followed by groups A (19.1%), C (19.1%), and D (8.2%). The total estimated cost of these 257 visits was €29 750.32, of which €5672.24 was for trivial disorders. CONCLUSIONS: The current high prevalence of trivial disorders in the caseload of dermatology clinics by trivial disorders makes it necessary to control referrals from primary care more strictly.

[Seroprevalence of hepatitis C virus infection at the time of entry to prison in the prison population in the north-east of Spain]. / Seroprevalencia de infección por virus C de la hepatitis en población reclusa del noroeste de España a su ingreso en prisión. Grupo Noroeste para el estudio de la Hepatitis por Virus C en el medio penitenciario.

BACKGROUND: Spanish prisons have a high number of inmates whose behaviour puts them at risk of being infected by hepatitis C virus (HCV). The object of this study was to establish the prevalence of this infection and its associated factors in the prison population of the north-east of Spain. METHODS: Inmates in seven prisons in the north-east of Spain were studied. Socio-demographic and prison variables were gathered, as well as risk factors for infection by HCV. Antibodies against HCV were determined (EIA and INNO-LIA HCV III), Hepatitis B virus (VHB) (EIA), and human immunodeficiency virus (HIV) (EIA and Western-Blott). The analysis of associated factors was based on logistic regression. RESULTS: Of the total number of inmates studied, 47.9% presented HCV antibodies. There was greater prevalence in the case of the following: UDVP (89.6%); those who shared needles (94%); those infected by HIV (92.7%); carriers of Australia antigen (65.1%) and antibodies to the HBV core antigen (79.8%); those who had been in prison before (60.9%); unmarried men (54.8%); gypsies (52%); unqualified workers (50.4%); those who had no basic school qualifications (50.9%); those with tattoos (66.7%); and those with a background of self-inflicted injuries (79.3%). In the logistic regression analysis the variables associated to infection by HCV were: UDVP (OR = 33.3; I.C. 95% = 25-50), HBcAc (+) (OR = 4.1; I.C. 95% = 1.1-5.3), age (OR = 0.98; I.C. 95% = 0.96-1.00), months in prison (OR = 1.011; I.C. 95% = 1.004-1.019) and a background of previous prison sentences (OR = 2.3; I.C. 95% = 1.5-3.6). CONCLUSIONS: The prevalence of infection by HCV in prison inmates is very high. It is therefore recommended that preventive measures be increased (harm reduction programmes) and that clinical and analysis protocols be drawn up for those infected and for treatment in cases of chronic active hepatitis in order to control this serious public health problem.