Tuberculose cutanea indurativa de Bazin. / Bazin's erythema enduratum

Foi nossa proposta a etiologia controvertida do eritema indurado de Bazin e, para isto, realizamos revisao do material existente nos Servicos de Dermatologia da Policlinica Geral do Rio de Janeiro, da Santa Casa de Misericordia, da Universidade Federal do Rio de Janeiro de da Universidade Federal Fluminense. Incluimos no nosso material o metodo tintorial proposto por NYKA, a fim de comprovar sua sensibilidade na evidenciacao de mycobacterias.Os criterios de tuberculose foram revistos e comparados com aqueles adotados para o diagnostico de outras infeccoes principalmente da hanseniase. Os criterios presuntivos de diagnostico da tuberculose cutanea propostos por F.E. Rabello foram analisados e aplicados a nossa causistica

[Analysis of inter and intrapathologist concordance and discordance in a comparative study of the Madrid and Ridley-Jopling classifications of leprosy]. / Analyse de la concordance et de la discordance interet intrapathologistes dans une étude comparative des classifications de la lèpre de Madrid et de Ridley-Jopling.

Eighty-six patients of leprosy have been examined by three leprologists; they have been classified according to the Madrid classification and their lesions biopsied and sent to two pathologists for independent histopathological examination. The pathologists have not received any information regarding the cases. Firstly the "senior" pathologist (A) utilized the Madrid classification and the "junior" pathologist (B) the Ridley-Jopling classification. In a second phase, the "senior" pathologist utilized the Ridley-Jopling classification and the "junior" pathologist the Madrid classification. Both pathologists did not know their own previous histopathological diagnosis at the second phase. The analysis of concordance and discordance between the histopathological diagnosis of the two pathologists and for the same pathologist, on utilizing the two classifications, have elicited the following conclusions: 1. There has been more concordance between the two pathologists on utilizing the Madrid classification than the Ridley-Jopling classification for the lepromatous, borderline and tuberculoïd in reaction patients. 2. The comparison of the two classifications for each pathologist on "blindly" examination of the material, has shown more concordance for the "senior" pathologist than for the "junior" pathologist. 3. These observations have convoyed to the final conclusion that the Ridley-Jopling classification brings some difficulties to the pathologists with limited experience in leprology and therefore it should be utilized only by experienced pathologists. 4. This preliminary study shows the necessity of performing another one with larger number of patients, in the active phase, with larger number of pathologists, preferably from different countries, and by utilizing the same methodology of "blind" examination of the material.

[Comparative analysis of the clinical diagnosis of hanseniasis and the histopathological examinations performed according to the criteria of the Madrid and Ridley-Jopling classifications]. / Análise comparativa entre o diagnóstico clínico da hanseníase e os exames histopatológicos realizados segundo os critérios da classificação de Madrid e a de Ridley-Jopling.

A comparative study of the Ridley-Jopling's (RJ) and of the Congress of Madrid's (CM) pathological criteria was made in the different clinical types and groups of hanseniasis. A concordance between both criteria was found in the Indeterminate group and in the regressive phases of the Virchowian (V), Tuberculoid (T) and Reactional tuberculoid (RT) types. Clinical RT was confirmed by pathology in 81.2% of the cases according to CM, whereas 46.2% were considered "Borderline" according to RJ. Out of the 48 clinically V patients, 17 (35.4%) were "Borderline" (BL-2, BL-1 and BB), but practically all were also pathologically V according to CM. It is concluded that there is no practical convenience in the establishment of histopathological sub-groups that do not perfectly agree with clinical criteria. The Authors stress the importance of the study of the plasmocytes in the V infiltrates, of the lymphocytes in all granulomas and of the differences in the involvement of the neural ends, specially between the T and V poles. The dyeing of lipids by the Sudan III is useful to perfectly characterize the V pole, recognize residual V structures, separate the sub-groups BT, BB and BL, help in the early diagnosis of V infiltrations and differentiate the edematous, diffuse, non-granular cytoplasmatic vacuolization of RT.

Estudo comparativo entre a neuropatia hansenotica e as neuropatias perifericas mais frequentes no nosso meio / Comparative study between the hansenic neuropathie and the more frequent peripheral neuropathies in our way

No diagnóstico diferencial da Neuropatia Hansenótica com as demais Neuropatias Periféricas verificamos que o distúrbio da sensibilidade objetiva e o espessamento do nervo periférico, representam os elementos mais importantes para o diagnóstico.

A reação lepromínica em cobaios após prévia inoculação do BCG e de Mycobacterium tuberculosis morto por irradiação

Os autores estudaram nessa experiência a capacidade dos cobaios se tornarem lepromino-positivos; após a inoculação da vacina Parke Davis (Mycobacterium tuberculosis morto por irradiação) ou do BCG. I)- Cobaios inoculados subcutâneamente com a vacina Parke Davis (1 dose de 0,5 ml., semanalmente, durante 3 semanas) e testados com a lepromina integral mostraram os seguintes resultados: 80% de negatividade 3 20% de reações duvidosas. II)- Cobaios inoculados com BCG., por via oral, testados com lepromina integral, forneceram percentuais de positividade variáveis com as doses: a) com 60 mg. de BCG., por kg. de peso, os resultados foram: 47,0% reações positivas; 41,2% reações duvidosas; 11,8% negativas. b) com 120 mg. de BCG. por kg. de peso, os resultados foram: 25,0% reações positivas; 33,3% reações duvidosas; 41,7% reações negativas. c) o grupo contrôle fornecau os seguintes resultados: 12,5% reações duvidosas; 87,5% reações negativas. Os resultados desta experiência mostram: I)- A vacina Parke Davis preparada com Mycobacterium tuberculosis mortos por irradiação não induz positividade leprom¡nica, no cobaio. II)- O BCG administrado oralmente ‚ capaz de provocar a positividade lepromínica, no cobaio. III)- A julgar pelos resultados de experiência anteriores dos autores mostrando que a dose de 30 mg. de BCG por kg. de peso provocou, no cobaio, a mais elevada positividade lepromínica (87,5%) e doses maiores e menores do que 30 mg. (experiência anterior e atual) forneceram percentuais mais baixos de positividade, os autores pensam que aquela dose deve ser a ideal. IV- É interessante referir que a dose de 30 mg. por kg. de peso ‚ muito próxima da usada no Brasil (28 mg. por kg. de peso) para a premunição de recem-nascidos.

Comportamento do teste lepromínico em cobaios becegeizados por via oral

1.¦- BCG was inoculated by mouth in guinea-pigs. 2.¦- The inoculated animals were tested intradermically with lepromin antigen. 3.¦- The positivity of reaction to lepromin varied according the dose of BCG. 4.¦- The highest percentage of positivity (87,5%) appeared in the group that took 30 mg by Kilogran of weight, that is the same ammont of BCG that is commonly used to newborn children in Brazil.