Dermoscopy of glomus tumour: a cross-sectional study of 86 cases.

BACKGROUND: Glomus tumours (GTs) are benign cutaneous neoplasms derived from the neuromyoarterial apparatus with a strong predilection for acral sites, especially the subungual space. Current data regarding dermoscopy of these lesions are very limited. OBJECTIVES: To analyse the dermoscopic structures and patterns seen in a large series of subungual (SUGTs) and extraungual glomus tumours (EUGTs) and to determine their diagnostic significance. METHODS: Clinical and dermoscopic images of 86 histopathologically proven cases of GTs (47 SUGTs and 39 EUGTs) collected from 9 hospitals in Spain, France, Italy, and Brazil were evaluated for the presence of dermoscopic structures and patterns. Similarly, 189 and 185 dermoscopic images of other ungual tumours and other extraungual non-pigmented tumours, respectively, were evaluated for the same structures and patterns. Finally, we evaluate diagnostic testing accuracy calculating sensitivity (S), specificity (Sp), and positive and negative predictive values of the different patterns for the diagnosis of GT. RESULTS: Regarding SUGTs, four patterns were built from the combination of different structures. The pattern composed of a structureless purplish/red subungual spot with or without vessels reached the highest S (S1, 78.8%). The combination of a structureless purplish/red subungual spot and longitudinal erythronychia (LE) (S2) is highly specific (96.3%). Patterns S3 (proximal purplish/red subungual spot, LE, and distal notch) and S4 (bed subungual spot and onycholysis) are the most specific and exclusive of matrix and bed tumours, respectively. The most consistent pattern in EUGTs is composed of a structureless purplish-white to reddish-white homogeneous area and linear unfocused vessels (E) (S: 61.5%, Sp: 95.7%). EUGTs did not show lacunae, unlike other vascular tumours. CONCLUSIONS: Dermoscopy is helpful in improving the diagnostic accuracy of GTs, not only in SUGTs but also when these lesions arise out of the ungual apparatus.

Effect of antimony in soils of an Sb mine on the photosynthetic pigments and antioxidant system of Dittrichia viscosa leaves.

Antimony is a toxic element whose concentration in soil and water has been rising due to anthropogenic activities. This study focuses on its accumulation in leaves of Dittrichia viscosa growing in soils of an abandoned Sb mine, and the effect on oxidant/antioxidant systems and photosynthetic efficiency. The results showed leaves to have a high Sb accumulation capacity. The amount of total chlorophyll decreased depending on Sb concentration and of carotenoids increased slightly, with a consequent increase in carotenoid/chlorophyll ratio. Photosynthetic efficiency was unaffected. The amount of O 2 .- rose, although there was no increase in cell membrane damage, with lipid peroxidation levels being similar to normal. This response may be due to considerable increases that were observed in total phenolics, PPO activity, and enzymatic antioxidant system. SOD, POX, and DHAR activities increased in response to increased Sb amounts in leaves. The ascorbate/glutathione cycle was also affected, with strong increases observed in all of its components, and consequent increases in total contents of the ascorbate and glutathione pools. However, the ratio between reduced and oxidized forms declined, reflecting an imbalance between the two, especially that between GSH and GSSG. Efficient detoxification of Sb may take place either through increases in phenolics, carotenoids, and components of the glutathione-ascorbate cycle or through the enzymatic antioxidant system. Since Dittrichia viscosa accumulates large amounts of Sb without suffering oxidative damage, it could be used for phytoremediation.

Dermoscopy of cutaneous smooth muscle neoplasms: a morphological study of 136 cases.

BACKGROUND: A variety of cutaneous smooth muscle neoplasms may arise in the skin and are frequently unrecognized by clinicians. There is sparse data relating to the dermoscopy of piloleiomyomas (PL), and nothing has been published about the dermoscopy of angioleiomyomas (AL) and leiomyosarcomas (LS). OBJECTIVES: To evaluate the morphological findings of a large series of cutaneous PL, AL and LS under dermoscopic observation, comparing these findings among them. METHODS: Digital dermoscopic images of 136 histopathologically confirmed cases of cutaneous smooth muscle neoplasms (114 PL, 13 AL and 9 LS) collected from 10 Hospitals in Spain, Austria and Italy were evaluated for the presence of dermoscopic structures and patterns. RESULTS: The pattern composed of a symmetric, total delicate pigment network with the variable presence of multiple hypopigmented areas in a painful lesion is the most common dermoscopic pattern associated with PL. This pattern was found in 69.3% of PL and in no cases of AL and LS. The most common and characteristic pattern associated with AL was the one composed of symmetric pink-reddish tumour with vessels, white structures and the absence of ulceration, which was found in 46.2% of AL, but also in 3.5% of PL, and in 22.2% of LS. Finally, the most common pattern associated with LS was the one composed of an asymmetric, multilobulated tumour with linear-irregular or polymorphic-atypical vessels and white structures, which was found in 44.4% of cases, but also in 0.9% of PL and in 15.4% of AL. CONCLUSION: Dermoscopy is helpful in improving the diagnostic accuracy of PL. The dermoscopic patterns associated with AL and LS were more variable and less specific.

Infección severa por Strongyloides stercoralis en líquido ascítico / Severe infection by Strongyloides stercoralis in ascitic liquid

La estrongiloidiosis es una infección cuyos agentes responsables son Strongyloides stercoralis y S. fuelleborni. Estos nematodos son de localización intestinal, el factor de riesgo principal es el andar descalzo en lugares contaminados con las larvas filariformes. El estudio presenta a un paciente varón de 23 años de edad, residente de San Juan de Lurigancho, presentó 14 meses de enfermedad con signos de meteorismo, náuseas, vómitos y permaneció afebril, se indica también que 28 días antes presentó dolor del epigastrio irradiado a la espalda de duración constante. Al examen físico se encontró un abdomen distendido, blando timpánico doloroso a la palpación, el informe de ecografía abdominal evidenció dilatación de las asas intestinales, meteorismo, con presencia abundante de líquido libre en la cavidad abdominal (ascitis) y en los exámenes parasitológicos del líquido se observó larvas rabditoides L1, L2 y filariformes L3 de Strongyloides stercoralis; por lo que recibió tratamiento con Ivermectina, obteniéndose la recuperación del paciente.

The strongyloidiasis is an infection whose responsible agents are Strongyloides stercoralis and S. fuelleborni. These nematodes have an intestinal location; the main risk factor is to be barefoot in places contaminated with filariform larvae. The study presents a male 23-year-old resident of San Juan de Lurigancho, with 14 months of illness with signs of bloating, nausea, vomiting and wasafebrile,also indicates that 28 days before he had epigastric pain irradiated to the back. On physical examination a distended abdomen was found, soft painful tympanic tenderness, the abdominal ultrasonography showed dilated bowel loops, bloat, with abundant presence of free fluid in the abdominal cavity (ascites) and parasitological examinations observed, rabditoides larvae L1 and L2 and filariform L3 of Strongyloides stercoralis. He received Ivermectin, obtaining the patient's recovery.

Influencia de la Actividad Física en la Sintomatología del Síndrome Premenstrual en universitarias / Influence of Physical Activity on Symptoms of the Syndrome Premenstrual in college girls

RESUMEN Objetivo: Determinar la influencia de la actividad física en la sintomatología del síndrome premenstrual en un grupo de mujeres de la Facultad de Medicina de la Universidad de Concepción. Métodos: Estudio observacional, descriptivo, transversal, realizado en 340 mujeres escogidas al azar de edades entre 18 a 27 años, estudiantes de la Facultad de Medicina de la Universidad de Concepción. Se utilizaron instrumentos validados para población chilena, como los criterios para el diagnóstico del trastorno disfórico premenstrual DSM-IV-TR, la Escala Visual Análoga (EVA) para la medición del dolor y el Cuestionario Internacional de Actividad Física (IPAQ) para la intensidad de esta. Los datos se obtuvieron por medio de encuestas autoadministradas y los resultados se analizaron mediante pruebas estadísticas. Resultados: Un 55,9% (n=190) presenta Síndrome premenstrual según los criterios utilizados. Los principales síntomas manifestados fueron: fatiga y falta de energía en un 64,7% (n=220), hipersensibilidad mamaria, cefalea e hinchazón en un 62,9% (n=214) y ansiedad, tensión, agobio y colapso en un 60,9% (n=207). Del total de encuestadas, el mayor porcentaje (42,6%) (n=145) realiza actividad física moderada. Al cruzar las variables de actividad física y la sintomatología del síndrome premenstrual se estableció que no existía relación entre ellas (valor p=0,605). Conclusiones: la actividad física no tiene influencia sobre la disminución de la sintomatología del síndrome premenstrual en la población estudiada.

ABSTRACT Objectives: Determine the influence of physical activity on the symptoms of premenstrual syndrome in females students of the Faculty of Medicine, Universidad de Concepción, Concepción Campus in 2014 Methods: A cross sectional study was applied to 340 randomly selected women aged between 18-27 years old belonging to the Faculty of Medicine of the Universidad de Concepción. Data were obtained through self-administered surveys and the results were analyzed by the respective statistical techniques. Results: Of the sample (n = 340), 55.9% (n = 190) had premenstrual syndrome according to the canon used. The main symptoms manifested were fatigue and lack of energy in 64.7% (n = 220), breast tenderness, headache and swelling in 62.9% (n = 214) and anxiety, stress, overwhelm and collapse into a 60.9% (n = 207). Of the total of the participants, the highest percentage (42.6%) (n = 145) performs moderate physical activity. When the variables of physical activity and premenstrual syndrome were crossed, was established that it did not exist relationship between them (p value = 0.605). Conclusions: With the obtaining and analyzing of the results, it seems that physical activity does not have major influence on the symptoms of premenstrual syndrome in the population studied.

Amelanotic naevoid melanoma in a 16-month-old albino infant.

Melanoma in individuals with oculocutaneous albinism has been reported in the literature to be rare compared with the more common occurrence of squamous cell carcinoma and basal cell carcinoma. We present a singular case of amelanotic naevoid melanoma arising from a small congenital naevus in a 16-month old albino boy, the youngest reported to date.

Síndrome antifosfolípido catastrófico: caso clínico / Catastrophic antiphospholipid syndrome: clinical case

El síndrome antifosfolípido (SAF) fue descrito y caracterizado durante la segunda mi-tad del siglo XX inicialmente como un fenómeno protrombótico secundario en con-texto de otras enfermedades del tejido conectivo, principalmente lupus. Sin embargo, el estudio de pacientes con enfermedad primaria impulsó a distintos consensos, tan-to clínicos como de laboratorio para su correcta identificación. Entre los pacientes con SAF destaca la forma de presentación catastrófica, de baja prevalencia, pero impor-tante por su mal pronóstico, caracterizada por el compromiso de múltiples sistemas en corto tiempo. Presentamos el caso de una paciente del Hospital Clínico San Borja-Arriarán con diag-nóstico de SAF primario, que presentó en su evolución la forma catastrófica. Este caso sirve de base para una revisión del proceso diagnóstico del SAF en relación a otras patologías reumatológicas y las características propias del SAF catastrófico.

Antiphospholipid syndrome (APS) was described and characterized during the second half of the 20th century initially as a secondary prothrombotic phenome-non in the context of other connective tissue diseases, mainly lupus. However, the study of patients with primary disease prompted different consensus, both clin-ical and laboratory for their correct identification. Among patients with APS, the catastrophic presentation is of low prevalence, but important because of its poor prognosis, characterized by the commitment of multiple systems in a short time. We present the case of a patient from the San Borja-Arriaran Clinic Hospital with di-agnosis of primary APS, which presented the catastrophic form in its evolution. This case serves as a basis for a review of the diagnostic process of APS in relation to other rheumatologic pathologies and the characteristics of catastrophic APS.

Cost-Effectiveness and Cost-Utility Analysis of Ingenol Mebutate Versus Diclofenac 3% and Imiquimod 5% in the Treatment of Actinic Keratosis in Spain. / Análisis de coste-efectividad y coste-utilidad de ingenol mebutato versus diclofenaco 3% e imiquimod 5% en el tratamiento de la queratosis actínica en España.

OBJECTIVE: To perform a cost-effectiveness and cost-utility analysis of ingenol mebutate in the treatment of actinic keratosis in Spain. METHODS: We used an adapted Markov model to simulate outcomes in a cohort of patients (mean age, 73 years) with actinic keratosis over a 5-year period. The comparators were diclofenac 3% and imiquimod 5%. The analysis was performed from the perspective of the Spanish National Health System based on direct costs (2015 retail price plus value added tax less the mandatory discount). A panel of experts estimated resources, taking unit costs from national databases. An annual discount rate of 3% was applied. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The effectiveness of ingenol mebutate-with 0.192 and 0.129 more clearances gained in treatments for face and scalp lesions and trunk and extremity lesions, respectively-was superior to diclofenac's. The total costs of treatment with ingenol mebutate were lower at € 551.50 (face and scalp) and € 622.27 (trunk and extremities) than the respective costs with diclofenac (€ 849.11 and € 844.93). The incremental cost-effectiveness and cost-utility ratios showed that ingenol mebutate was a dominant strategy vs diclofenac. Ingenol mebutate also proved to be more effective than imiquimod, based on 0.535 and 0.503 additional clearances, and total costs of € 551.50 and € 527.89 for the two drugs, respectively. The resulting incremental cost-effectiveness ratio was € 728.64 per clearance gained with ingenol mebutate vs imiquimod. CONCLUSIONS: Ingenol mebutate was a dominant treatment option vs diclofenac and was efficient vs imiquimod (i.e., more effective at a higher cost, achieving an incremental cost-utility ratio of<€30000/quality-adjusted life-years).

Dermoscopy of tumours arising in naevus sebaceous: a morphological study of 58 cases.

BACKGROUND: Naevus sebaceous is a congenital hamartoma commonly associated with the development of secondary neoplasms. There are sparse data relating to the dermoscopy of tumours arising in naevus sebaceous. OBJECTIVES: To evaluate the dermoscopic features of a large series of neoplasms arising in naevus sebaceous. METHODS: Digital dermoscopic images of 58 histopathologically confirmed cases of secondary neoplasms arising in naevus sebaceous collected from 11 hospitals in Spain, France, Italy and Austria were evaluated for the presence of dermoscopic structures and patterns. RESULTS: The most frequent tumours collected were: trichoblastoma (39.6%), basal cell carcinoma (20.7%) and syringocystadenoma papilliferum (15.6%). The most remarkable findings were: (i) the pattern composed of asymmetrical large blue-grey ovoid nests was more common in basal cell carcinomas than in trichoblastoma (58.3% vs. 4.3%; P < 0.001) and the pattern composed of a symmetrical total large blue-grey ovoid nest (a blue-grey homogeneous area which occupies the whole lesion) was more common in trichoblastoma (82.6% vs. 16.6%; P < 0.001); (ii) the most frequent pattern associated with syringocystadenoma papilliferum was a symmetric, erythematous lesion with exophytic papillary structures, ulceration and vessels (55.5%); (iii) the most common pattern associated with apocrine hidrocystomas was a total symmetric homogeneous area and arborizing telangiectasias (60%). CONCLUSIONS: Benign adnexal tumours associated with naevus sebaceous are dermoscopic mimickers of basal cell carcinomas. A pigmented nodule arising in a naevus sebaceous with a total blue large ovoid nest on dermoscopy could be a trichoblastoma, basal cell carcinoma, hidrocystoma or hidradenoma. Dermoscopy can be a useful diagnostic tool which generates a more accurate preoperative diagnosis.

Dermoscopy of acral melanoma: a multicenter study on behalf of the international dermoscopy society.

BACKGROUND: Most studies on dermoscopy of acral lesions were conducted in Asian populations. In this study, we analyzed these features in a predominantly Caucasian population. OBJECTIVE: Estimate the prevalence of dermoscopic features in acral lesions, and assess their level of agreement between observers. METHODS: In this retrospective multicenter study, 167 acral lesions (66 melanomas) were evaluated for 13 dermoscopic patterns by 26 physicians, via a secured Internet platform. RESULTS: Parallel furrow pattern, bizarre pattern, and diffuse pigmentation with variable shades of brown had the highest prevalence. The agreement for lesion patterns between physicians was variable. Agreement was dependent on the level of diagnostic difficulty. CONCLUSION: Lesions with a diameter >1 cm were more likely to be melanoma. We found as well that a benign pattern can be seen in parts of melanomas. For this reason one should evaluate an acral lesion for the presence of malignant patterns first.

Tumor sólido-pseudopapilar del páncreas presentación de 3 casos clínicos / Solid-pseudopapillary tumor of the pancreas presentation of 3 clinical cases

El tumor sólido-pseudopapilar del páncreas (TSPP) es una neoplasia infrecuente (1-2% de los tumores exocrinos), que afecta predominantemente a mujeres jóvenes, con bajo potencial de malignidad (15% da metástasis). Su diagnóstico preoperatorio es difícil, principalmente debido a que a la imagenología no tiene una característica que la pueda diferenciar de otros quistes pancreáticos, por lo que generalmente es un hallazgo histopatológico. El tratamiento quirúrgico presenta buena sobrevida, incluso en presencia de metástasis. Presentamos 3 casos con cuadro clínico, imagenología, tratamiento e histopatología, con el fin de aportar más información, sobre esta infrecuente patología.

The solid-pseudopapillary tumors of the pancreas (TSPP) are a uncommon neoplasm (1-2% of exocrine tumors). Are more frequent in young women and presents a low malignant potential (15% develop metastases). Its preoperative diagnosis is very difficult, because these tumors haven`t radiological features that makes distinguish from the other pancreatic cysts tumors. Usually are a histopathological finding. Surgical therapy provides good survival, even in the presence of metastases. We present 3 cases with clinical, imaging, treatment and histopathology to provide more information about this rare disease.

[Usefulness of cholestanol levels in the diagnosis and follow-up of patients with cerebrotendinous xanthomatosis]. / Utilidad de los niveles de colestanol en el diagnóstico y seguimiento de los pacientes con xantomatosis cerebrotendinosa.

INTRODUCTION: cerebrotendinous xanthomatosis (CTX) is an autosomal recessive disease caused by a deficiency of mitochondrial enzyme sterol 27-hydrolylase. Such a deficiency results in a reduced production of chenodeoxycholic acid and in an increased formation of cholestanol. It is clinically characterized by cataracts, diarrhoea, xanthomas, premature arteriosclerosis and a number of progressive neurological symptoms. Although cholestanol levels are used for the diagnosis of CTX, their correlation with the clinical symptoms and their prognostic usefulness have not been assessed so far. METHODS: we reviewed 14 CTX patients diagnosed between 1995 and 2008 in two reference centres for the genetic diagnosis of this disorder, whose cholestanol levels had been recorded. We studied the main demographic, clinical and therapeutical data and their correlation with plasma cholestanol levels. RESULTS: the average cholestanol level at diagnosis was 105.8 µmol/l. These levels did not correlate with any neurological symptoms or with disability at diagnosis scored by the EDSS. After treatment, all patients achieved a significant reduction in plasma cholestanol levels (average reduction of 91 µmol/l in an average follow-up of 34 months), although only one patient remained clinically stable. CONCLUSIONS: high cholestanol levels are very useful for diagnosis of CTX but they do not have a prognostic value (they do not correlate with severity). Normalisation of cholestanol levels is not always associated with clinical stabilisation. However, follow-up of cholestanol levels can be useful for the dose adjustment.

[Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the Network of Catalan and Balearic Melanoma Centers]. / Valoración inicial, diagnóstico, estadificación, tratamiento y seguimiento de los pacientes con melanoma maligno primario de la piel. Documento de consenso de la "Xarxa de Centres de Melanoma de Catalunya i Balears"

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society.

Tumor sólido-pseudopapilar del páncreas: presentación de 3 casos clínicos / Solid-pseudopapillary tumor of the pancreas: presentation of 3 clinical cases

El tumor sólido-pseudopapilar del páncreas (TSPP) es una neoplasia infrecuente (1-2 por ciento de los tumores exocrinos), que afecta predominantemente a mujeres jóvenes, con bajo potencial de malignidad (15 por ciento da metástasis). Su diagnóstico preoperatorio es difícil, principalmente debido a que a la imagenología no tiene una característica que la pueda diferenciar de otros quistes pancreáticos, por lo que generalmente es un hallazgo histopatológico. El tratamiento quirúrgico presenta buena sobrevida, incluso en presencia de metástasis. Presentamos 3 casos con cuadro clínico, imagenología, tratamiento e histopatología, con el fin de aportar más información, sobre esta infrecuente patología.

Pemphigus-like lesions induced by imiquimod.

Imiquimod is an immunomodifier recently approved for the treatment of superficial basal cell carcinomas (sBCC). Although local adverse events (AEs) are the most commonly reported, systemic AEs have also been described. We present the case of a 60-year-old woman who, after the application of two sachets of imiquimod cream per day for 5 days/week to two large sBCCs, developed pemphigus-like lesions both at and distant from the application site. Histological examination of a skin biopsy found intraepidermal acantholytic blistering but results of direct immunofluorescence examination were negative. The lesions resolved after cessation of imiquimod. Two previous cases of imiquimod-induced pemphigus have been reported, but this is the first case with lesions distant from the site of application. We suggest that systemic absorption of the drug or greatly increased synthesis of cytokines could explain this reaction and recommend the use of low doses of imiquimod in the treatment of large or multiple sBCCs.