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1.
Indian J Lepr ; 83(1): 15-22, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21638979

RESUMO

Involvement of peripheral nerves in patients with leprosy results in sensory, motor and autonomic dysfunctions along with deformities and disability. Pattern of nerve involvement is different for different forms of leprosy. In this study, we evaluated and compared the nerve conduction parameters of paucibacillary leprosy with that of multibacillary leprosy. In this study, 40 consecutive patients of leprosy (19 cases of paucibacillary and 21 cases of multibacillary leprosy) were included. Nerve conduction studies were performed according to the standard procedure described in the manual of the machine. We observed that patients with multibacillary leprosy had significantly more severe changes in nerve conduction parameters as compared to that of paucibacillary leprosy. In paucibacillary leprosy, the dominant pattern of nerve involvement was that of mononeuropathy, however, in 6 paucibacillary cases the nerve involvement was in form of mononeuritis multiplex. Electrophysiological assessment also revealed involvement of clinically uninvolved nerves. Nerve conduction parameters were suggestive of mixed axonal as well as demyelination of the peripheral nerves.


Assuntos
Hanseníase Multibacilar/fisiopatologia , Hanseníase Paucibacilar/fisiopatologia , Condução Nervosa/fisiologia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Artigo em Inglês | MEDLINE | ID: mdl-17675730

RESUMO

BACKGROUND: Combination antibiotic regimens are effective in the treatment of actinomycetoma but many treatment schedules require supervised parenteral therapy for prolonged periods. We describe a schedule that includes parenteral medication in an initial, short phase followed by a longer phase of oral medication. METHODS: Sixteen patients with clinically diagnosed mycetoma, who did not show any evidence of a fungal etiology, were treated presumptively for actinomycetoma. Evidence of actinomycotic infection was found on microscopy of granules / discharge and / or histopathological examination in eight (50%) patients. The treatment consisted of an intensive phase (Step 1) with gentamicin, 80 mg twice daily, intravenously and cotrimoxazole, 320/1600 mg twice daily orally for four weeks. This was followed by a maintenance phase with cotrimoxazole and doxycycline, 100 mg twice daily till all sinuses healed completely. The treatment was continued for 5-6 months. RESULTS: Treatment response was assessed monthly. At the end of the intensive phase, there was a significant improvement in all 16 patients. Nine patients who continued the maintenance phase of the regimen had complete healing of sinuses with marked reductions in swelling and induration in 2.4 +/- 1.7 months. Maintenance treatment was continued for a mean of 9.1 +/- 4.3 months in these patients. Six patients have remained free of disease activity during a follow-up period of 11.1 +/- 4.2 months after treatment was stopped. Two patients developed leucopenia and thrombocytopenia necessitating withdrawal of cotrimoxazole. CONCLUSION: This regimen was effective in treating actinomycetoma. The short duration of the phase requiring parenteral therapy makes it convenient to administer.


Assuntos
Actinomicose/tratamento farmacológico , Antibacterianos/administração & dosagem , Doxiciclina/administração & dosagem , Gentamicinas/administração & dosagem , Micetoma/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Actinomicose/microbiologia , Adolescente , Adulto , Idoso , Antibacterianos/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/microbiologia , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/patologia , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos
3.
Indian J Lepr ; 78(4): 329-37, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17402345

RESUMO

UNLABELLED: Leprosy still remains a public health problem mainly in Asia, Africa and South America. The WHO Expert Committee on Leprosy recommended, in 1997, the simplified treatment of leprosy for multibacillary (MB) cases, by reducing the duration of treatment from 24 to 12 months. From the operational point of view even this reduced duration is still long and monthly supervised drug administration may not always be practical in those areas where the accessibility is difficult and health infrastructure weak. The present study was carried out to compare the safety and efficacy of a new fixed duration regimen consisting of four bactericidal drugs with WHO/MDT (MB). METHODS: Thirty adult patients were randomly allocated to two groups. Group 1 (18 patients) received a new regimen of daily rifampicin 600 mg, sparfloxacin 200 mg, clarithromycin 500 mg and minocycline 100 mg for 12 weeks. Group 2 (12 patients) received WHO/MDT (MB) for 12 months. A detailed clinical evaluation and laboratory investigations, BI and MI were done at the baseline, every 4 weeks for 12 weeks, and thereafter every 8 weeks till 48 weeks. Skin biopsies were taken and chest X-rays were done at 0, 12 and 48 weeks. RESULTS: At 48 weeks, the net percentage clinical improvement in group 1 was 73.92% and in group 2 it was 66.66%. The net percentage reduction (NPR) in BI in group 1 was 19.17% and in group 2 it was 18.87% (p = 0.09). NPR in MI in both groups was 100% by 8 weeks, and somewhat faster in group 1. In group 1, 8 patients had mild gastrointestinal side-effect, and 16 had minocycline-induced hyperpigmentation. Three patients in group 1 developed type I reversal reactions. CONCLUSION: The regimen containing daily doses of rifampicin 600 mg, sparfloxacin 200 mg, minocycline 100 mg and clarithromycin 500 mg for 12 weeks was found to be an acceptable, effective and safe alternative regimen for MB leprosy with an additional operational advantage of shorter duration of treatment.


Assuntos
Antibacterianos/uso terapêutico , Quimioterapia Combinada , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Adolescente , Adulto , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Feminino , Humanos , Hansenostáticos/administração & dosagem , Hansenostáticos/efeitos adversos , Hanseníase/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-17642933

RESUMO

Chilblain lupus erythematosus with depigmentation is a rare presentation of lupus erythematosus that may simulate vitiligo. A 52-year-old lady with such a manifestation is being reported.

5.
Artigo em Inglês | MEDLINE | ID: mdl-17656919

RESUMO

A 59-year-old man developed gradually appearing and slowly progressive tender papulo-nodular lesions in a naevoid distribution on the left side of the trunk since the age of 49 years. The histopathological features were classical of leiomyoma.

6.
Diagn Cytopathol ; 24(5): 317-21, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11335960

RESUMO

The role of fine-needle aspiration cytology (FNAC) in the diagnosis of benign skin lesions has been restricted primarily to the evaluation of bacteriologic and morphologic indices in leprosy. This study was undertaken to evaluate the efficacy of FNAC in the diagnosis and classification of lepromatous lesions. Aspirates of 94 newly diagnosed cases of leprosy were studied, and the bacterial load was determined by modified Ziehl-Neelsen (ZN) stain. A skin biopsy was taken from the same site at the same sitting. Frozen and paraffin sections stained with hematoxylin-eosin (H&E) and ZN stains were examined from the biopsy specimen. In 61 of 94 cases (64.9%), the aspirates were satisfactory. Both diagnosis and classification of leprosy were possible in 40 of these 61 cases; the rest of the aspirates showed nonspecific chronic inflammation. The 39 cases of leprosy where a biopsy was available from the same site were classified on FNAC into tuberculoid (TT and BT), lepromatous (LL and BL), and midborderline (BB) subtypes. Taking the histologic diagnosis and Ridley-Jopling classification to be the gold standard, a strong concordance in tuberculoid leprosy cases (18 of 20 cases, 90%) and in lepromatous cases (15 of 16 cases, 93.7%) was observed. Midborderline cases of leprosy posed a problem, and a correct cytohistological correlation was observed in only one of the three cases.


Assuntos
Hanseníase/classificação , Hanseníase/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Criança , Diagnóstico Diferencial , Eritema Nodoso/classificação , Eritema Nodoso/patologia , Feminino , Humanos , Hanseníase Dimorfa/classificação , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/classificação , Hanseníase Virchowiana/patologia , Hanseníase Tuberculoide/classificação , Hanseníase Tuberculoide/patologia , Masculino , Pessoa de Meia-Idade , Mycobacterium leprae/isolamento & purificação
7.
Artigo em Inglês | MEDLINE | ID: mdl-17664705

RESUMO

A 26-year-old woman had multiple itchy persistent gradually progressive papular lesions on the forearms and shins for 10 and 4 years respectively. She also noticed similar lesions on both the ears for 4 years. There were no systemic symptoms. Cutaneous examination revealed multiple 2-3 mm discrete firm hyperpigmented papules on the extensors of forearms, shins and earlobes. Skin biopsy from all sites demonstrated deposits of amyloid in the papillary dermis. The patient was treated with cyclophosphamide 50 mg daily orally. There was more than 50% improvement in her lesions.

9.
Artigo em Inglês | MEDLINE | ID: mdl-20877092

RESUMO

An 89-year old patient had mycosis fungoides with extensive skin involvement and palpable but pathologically uninvolved lymph nodes. He was successfully treated with PUVA combined with topical 0.1% fluocinolone acetonide ointment. PUVA therapy is highly effective in the treatment of mycosis fungoides confined to the skin, especially in the elderly where more aggressive therapy may not be tolerated.

10.
Artigo em Inglês | MEDLINE | ID: mdl-20877121

RESUMO

We describe two cases in which syringocystadenoma papilliferum was present in extremely unusual locations.

11.
Artigo em Inglês | MEDLINE | ID: mdl-20921672

RESUMO

A 19-year-old married man presented with multiple, bright-red and reddish-blue papular lesions on glans and prepuce with intermittent bleeding on maceration since 6 months duration. Histopathological study revealed features of angiokeratoma.

12.
Artigo em Inglês | MEDLINE | ID: mdl-20921689

RESUMO

Hypopigmented lesions are rarely encountered in mycosis fungoides. We here report a 22-year old female patient who presented with a 5-year history of asymptomatic progressively increasing discrete and confluent hypopigmented macules and a 1-year history of a few itchy erythematous, scaly, indurated plaques. The histological features were consistent with a clinical diagnosis of mycosis fungoides. She was successfully treated with PUVA therapy.

14.
Diagn Cytopathol ; 19(3): 198-200, 1998 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9740995

RESUMO

Fine-needle aspiration cytology is now routinely used in the diagnosis of cervical lumps. We report on a case of leprous neuritis which presented as a cervical swelling. A diagnosis of leprosy was suggested on the basis of globi within histiocytes. These histiocytes differed from those classically described in leprosy. Retrospective review demonstrated the presence of occasional nerve fragments, and some of these closely resembled granulomas. The possible close resemblance of this lesion to tuberculosis and a histiocytic proliferative disorder is highlighted. Recognition of nerve fragments along with histiocytes should suggest the diagnosis.


Assuntos
Hanseníase Dimorfa/diagnóstico , Linfonodos/inervação , Linfadenite/diagnóstico , Neurite (Inflamação)/diagnóstico , Adulto , Biópsia por Agulha , Diagnóstico Diferencial , Granuloma/patologia , Histiócitos/microbiologia , Histiócitos/patologia , Humanos , Hanseníase Dimorfa/microbiologia , Linfadenite/microbiologia , Masculino , Mycobacterium leprae/isolamento & purificação , Pescoço/patologia , Fibras Nervosas/microbiologia , Fibras Nervosas/patologia , Neurite (Inflamação)/microbiologia , Sistema Nervoso Periférico/patologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-28150664

RESUMO

A classical case of lipoid proteinosis in a 17 year old girl presenting with hoarseness of voice, thickened tongue, bullous lesions predominantly on pressure areas and varioliform scarring on the face and the extremities is reported. Her x-ray skull showed typical bean-shaped calcification in the limbic area. Histopathology revealed PAS stained amorphous deposits in the dermis and around the sweat glands.

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