RESUMEN
Phrenology is the pseudoscience in which practitioners claim that they can discern one's character and personality traits by studying the structure of the skull. Long before "head bumps" were viewed as determinants of character, skin lines were analyzed to provide similar information and to divine one's future. Palmistry, also called chiromancy, is the interpretation of the lines of the palms and is one of the oldest forms of divination. A similar pseudoscience, metoposcopy, suggests that facial lines and marks, mainly forehead lines, can reveal one's personality and foretell events in one's future. Metoposcopy was first practiced by the ancient Chinese and was popularized during the Renaissance by Girolamo Cardano and later by Richard Saunders. Metoposcopy is a largely forgotten form of skin-based pseudoscience that is no longer practiced today, unlike palmistry.
Asunto(s)
Personalidad , Piel , HumanosRESUMEN
The clinical and histopathological diagnosis of pityriasis rubra pilaris (PRP) can be difficult because clinical findings are often subtle in early stages, and microscopic findings can overlap with those of other skin diseases. Focal acantholytic dyskeratosis (FAD) can rarely be seen in PRP and can mimic Darier's disease, Grover's disease or other disorders characterized by these histopathologic features. Kaposi's varicelliform eruption is a widespread infection due to herpes simplex virus (HSV) types 1 and 2, coxsackievirus A16 or vaccinia virus, occurring in a preexisting dermatosis; only one case has been reported in PRP. We report a patient with PRP whose biopsies showed both herpes simplex infection and FAD. A complete understanding of the mechanism behind this eruption evolved gradually, aided in great measure by the histopathologic findings.
Asunto(s)
Enfermedad de Darier/diagnóstico , Herpes Simple/patología , Erupción Variceliforme de Kaposi/patología , Pitiriasis Rubra Pilaris/diagnóstico , Acantólisis/diagnóstico , Aciclovir/análogos & derivados , Aciclovir/uso terapéutico , Anciano , Antivirales/uso terapéutico , Enfermedad de Darier/tratamiento farmacológico , Enfermedad de Darier/virología , Diagnóstico Diferencial , Herpes Simple/complicaciones , Herpes Simple/tratamiento farmacológico , Humanos , Ictiosis/diagnóstico , Erupción Variceliforme de Kaposi/tratamiento farmacológico , Erupción Variceliforme de Kaposi/virología , Masculino , Metotrexato/uso terapéutico , Pitiriasis Rubra Pilaris/tratamiento farmacológico , Pitiriasis Rubra Pilaris/virología , Valaciclovir , Valina/análogos & derivados , Valina/uso terapéuticoRESUMEN
INTRODUCTION: The primary objective of this study was to determine whether variability in warfarin dose requirements is determined by common polymorphisms in genes whose products are involved in the pharmacodynamics and pharmacokinetics of warfarin, namely, the coagulation factors, vitamin K epoxide reductase complex subunit 1 (VKORC1), and cytochrome P450 (CYP) 2C9. METHODS: Patients (N = 350) receiving stable doses of warfarin at 3 consecutive visits were enrolled, and a deoxyribonucleic acid sample was collected. Samples were genotyped for polymorphisms in the factor II, factor VII, factor X, VKORC1, and CYP2C9 genes. A stepwise linear regression analysis was used to determine the independent effects of genetic and nongenetic factors on mean warfarin dose requirements. RESULTS: Variables associated with lower warfarin dose requirements were VKORC1 3673 AA genotype (P < .0001), VKORC1 3673 GA genotype (P < .0001), 1 variant CYP2C9 allele (P < .0001), 2 variant CYP2C9 alleles (P = .0004), increasing age (P = .0005), concomitant CYP2C9 inhibitors (P = .0005), and goal international normalized ratio (P = .01). Variables associated with higher warfarin dose requirements were weight (P < .0001), current smoker status (P = .0009), mean international normalized ratio (P = .001), concomitant CYP2C9 inducers (P = .006), factor X insertion/deletion genotype (P = .01), factor X insertion/insertion genotype (P = .04), factor VII deletion/deletion genotype (P = .04), and calculated vitamin K intake (P = .05). The linear regression model explained 51.4% of the variability in warfarin dose requirements. CONCLUSION: Polymorphisms in warfarin drug target and metabolizing enzyme genes, in addition to nongenetic factors, were important determinants of warfarin dose requirements.
Asunto(s)
Anticoagulantes/metabolismo , Hidrocarburo de Aril Hidroxilasas/genética , Factores de Coagulación Sanguínea/genética , Oxigenasas de Función Mixta/genética , Warfarina/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Citocromo P-450 CYP2C9 , Cartilla de ADN , Factor VII/genética , Factor X/genética , Femenino , Genotipo , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Polimorfismo Genético , Protrombina/genética , Vitamina K Epóxido Reductasas , Warfarina/administración & dosificación , Warfarina/uso terapéuticoRESUMEN
Patients presenting with congenital melanocytic nevi (CMN) need individualized treatment based upon nevus size, thickness, location, risk for developing melanoma, and psychological characteristics of the patient and family. The present authors review CMN types and prognoses, as well as absolute and relative indications for treatment. Risks and benefits of several treatment options are discussed, including surgical options, such as excision, chemical peels, dermabrasion and curettage, and laser therapy. The main focus of treatment is, in all cases, to address the concern for developing melanoma, at the same time optimizing the aesthetic and functional outcomes.