Trabecular bone score in women with differentiated thyroid cancer on long-term TSH-suppressive therapy.

INTRODUCTION: Thyrotropin stimulating hormone (TSH) suppression in patients with differentiated thyroid cancer (DTC) aims to decrease the growth and proliferation of thyroid cancer cells. However, the effect of TSH-suppressive therapy on bone microarchitecture remains undefined. METHODS: Cross-sectional study including 43 women with DTC undergoing TSH-suppressive therapy (sTSH) compared to 20 women also on levothyroxine (LT4) therapy but with TSH in the low-normal range (nTSH) since the thyroid surgery. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA), and trabecular bone score (TBS) was evaluated using the TBS iNsigth software. Fracture risk assessed by FRAX, with and without TBS, was calculated. The relationship between suppressive therapy-related parameters and bone parameters was investigated. RESULTS: The TBS mean values were not significantly different in the sTSH and nTSH groups (1.273 ± 0.12 vs 1.307 ± 0.14, p = 0.7197). In both groups, postmenopausal women had degraded microarchitecture (TBS 1.216 ± 0.11 vs 1.213 ± 0.09, p = 0.9333), while premenopausal women had normal microarchitecture (1.328 ± 0.11 vs 1.401 ± 0.12, p = 0.195). The percentage of all postmenopausal women with degraded TBS was 54.7%, while the percentage of osteoporosis diagnoses was 16.1%. The TBS-adjusted FRAX-probability of fracture was similar in sTSH and nTSH groups. Body mass index (BMI) and menopausal status were the only variables associated with TBS and BMD. CONCLUSION: Trabecular microarchitecture assessed by TBS was similar between women on long-term suppressive therapy in DTC and those on LT4 replacement therapy aiming at a TSH level within the low-normal reference range. Low TBS values were observed in postmenopausal women of both groups, suggesting that not only suppressed TSH levels but also a low-normal TSH is associated with deteriorated bone microarchitecture in postmenopausal women following total thyroidectomy.

Clinical Features and Disease Management in Adult Patients With Atopic Dermatitis Receiving Care at Reference Hospitals in Brazil: the ADAPT Study.

BACKGROUND: Atopic dermatitis is a chronic inflammatory skin disease with a prevalence of 0.02% to 8.1% in adults. Adult patients with moderate-to-severe atopic dermatitis are affected by frequent relapses and a significant disease burden. Objective: To determine the clinical, immunological, and therapeutic profile of Brazilian adults with atopic dermatitis. METHODS: A multicenter, observational, retrospective, descriptive registry-based study was conducted at reference hospitals between December 2016 and October 2017. The data collected were demographics, personal and family history of atopic diseases, clinical manifestations, laboratory tests, disease severity and management. RESULTS: Of the 187 patients included in the analysis, 56.1% were female and 71.7% were White, with a mean age of 24.7 years. Mean follow-up was 9 years. Asthma or other allergic diseases were reported by 80.2% of patients. The main comorbidity was hypertension (10.2%), and common disease manifestations included pruritus and erythema. Lesions generally affected flexural and nonflexural areas, with typical morphology. Around 83% of patients had moderate-to-severe disease, and 8.6% reported at least 1 hospitalization. Most patients received topical and/or systemic pharmacological therapies, including omalizumab (5.9%); 4.3% received phototherapy. Moreover, 66.8% of patients received adjuvant therapy, and 79.1% changed or discontinued treatment for atopic dermatitis due to remission (46.5%), poor effectiveness (33.7%), or lack of adherence (12.9%). Most patients presented characteristics of type 2 inflammation, with immunoglobulin E levels above 100 IU/mL (94.4%) and peripheral blood eosinophils above 5% (55.9%). CONCLUSION: Brazilian adult patients with severe atopic dermatitis need treatment to efficiently control the disease and improve quality of life.

Ductus venosus Doppler velocimetry in the first trimester: a new finding.

OBJECTIVES: To establish reference curves for ductus venosus blood flow velocities during the first trimester and compare them with previously published curves. METHODS: This was a cross-sectional and retrospective study performed between January 1998 and January 2003. The following inclusion criteria were used: singleton pregnancy, velocity measurements taken when the crown-rump length (CRL) was between 34 and 84 mm, absence of fetal anomalies, full-term pregnancy and newborn birth weight appropriate for gestational age. The following variables of the ductus venosus were measured: peak velocity during ventricular systole (S-wave) and diastole (D-wave), nadir during atrial contraction in late diastole (A-wave), time-averaged maximum velocity (TAMXV) and pulsatility index for veins (PIV). RESULTS: A total of 843 fetuses were included. The mean CRL was 62 (range, 34-84) mm. The S-wave, D-wave, TAMXV and PIV were normally distributed, and logarithmic transformation was performed to achieve a normal distribution for the A-wave. S-wave, D-wave and A-wave and TAMXV increased with CRL. PIV increased up to a CRL of 63 mm and decreased thereafter. Regression analysis revealed a significant quadratic relationship between PIV and CRL. CONCLUSIONS: S-wave, D-wave, A-wave velocities and TAMXV in the ductus venosus increase with CRL between 34 and 84 mm. The reference range for PIV has a biphasic pattern, with an initial non-significant increase up to a CRL of 63 mm and a fall thereafter.

Non-influence of fetal gender on ductus venosus Doppler flow in the first trimester.

OBJECTIVES: Recent findings have suggested that ductus venosus blood flow may be influenced by fetal gender. The aim of this study was to investigate further the influence of fetal gender on ductus venosus Doppler flow in the first trimester. METHODS: This was a cross-sectional and retrospective study performed between January 1998 and January 2003. A total of 932 fetuses at between 10 and 14 weeks' gestation were included. The following inclusion criteria were used: singleton gestation; crown-rump length between 39 and 84 mm; and absence of fetal anomalies. The following variables of the ductus venosus were evaluated: peak velocity during ventricular systole (S-wave) and diastole (D-wave); nadir during atrial contraction in late diastole (A-wave); pulsatility index for veins (PIV); peak velocity index for veins (PVIV); and time-averaged maximum velocity (TAMXV). RESULTS: Four hundred and forty-eight (48.1%) female and 484 (51.9%) male fetuses were included in the study. Comparing males and females at between 10 and 14 weeks' gestation, there was no statistically significant difference in S-wave, D-wave, A-wave, PIV, PVIV or TAMXV. CONCLUSIONS: Our study suggests that fetal gender does not influence ductus venosus blood flow in the first trimester.

Gnatophyma: a rare variant of phyma.

We report a case of a 44-year-old woman with an 8-year history of gnatophyma. Rosacea is a facial dermatosis that may present as flushing, erythema, telangiectases, papules, pustules and phyma. Phyma is considered the final evolution stage of rosacea and is a rare variant. Treatment of phyma with atypical localization may be a challenge for dermatologists in clinical practice.

Allergic contact dermatitis to temporary tattoo by p-phenylenediamine.

Temporary tattoos are widely applied today all over the world. The tattoo makers explain that they use "natural henna paint," although in fact they use "black henna," which includes a mixture of many substances, among them p-phenylenediamine (PPD). There have recently been many reports of allergic contact dermatitis because of temporary tattoo with PPD sensitization. We are adding a new case of temporary tattoo with black henna with an extensive reaction, in which a 12-year-old white boy showed contact dermatitis from PPD, followed by cutaneous eruption after corticosteroid topical treatment.

[Histopathologic findings for the research of acid-fast bacilli in erythema nodosum]. / Características histopatológicas necessárias para a pesquisa de bacilos álcool-ácido resistentes no eritema nodoso.

It was possible to prove, by means of retrospective histopathological studies of 51 glass slides of common erythema nodosum (EN) and 39 glass slides of erythema nodosum leprosum (ENL), that the histopathological features of the two groups differed in several ways. It was found that the most prominent divergent findings between these two diseases was the presence of a lepromatous granulomatous infiltrate in the ENL; the predominant location of the inflammatory infiltrate was derma-hypodermal in ENL and hypodermal in common EN; there was a preferential septa attack in common EN and lobular in ENL; foreign giant cells occurred only in common EN; the lymphocyte cell infiltration in common EN and of neutrophils in ENL and the presence of inflammatory infiltrate around nerves in ENL. Our study has proved that the search for M. leprae does not have to be made in all cases of EN as there are histological differences in the routine histopathological exam between common EN and ENL that can alert to the real need for this procedure. This search must be performed when during the routine histopathological exam of sections stained by hematoxilin-eosin the ENL histopathological characteristics delineated herein are observed.

[Neurocutaneous melanosis. Case report of a malignant melanoma of the central nervous system]. / Melanose neurocutânea. Relato de caso com melanoma maligno do sistema nervoso central.

The neurocutaneous melanosis is a rare syndrome in which the congenital melanocytic nevi and excessive melanosis are the main features. The syndrome seems to be a morphogenesis error of the embryonic neuroectoderm. A clinical case with necroscopy in a 19 year-old man who had developed malign melanoma in his central nervous system is reported.

[Urticaria and systemic diseases]. / Urticária e doenças sistêmicas.

Chronic urticaria and concurrent angioedema are disappointing problems for both physicians and patients. The disease can result from multiple causes and probably does not have a single etiology. Several factors have been identified that appear to be important in the pathogenesis of individual cases, some drugs, food additives, physical factors and internal diseases. In some cases no pathogenesis are identified and those cases are classified as idiopathic. In recent years several articles has emphasized autoimmunity and infections due to Helicobacter pylori. Our article reviewed the etiology of chronic urticaria at current concepts.

[Hypereosinophilic syndrome. Cutaneous picture of "erythema annulare centrifugum"--comparison with ultrastructural study]. / Síndrome hipereosinofílica. Quadro cutâneo "Erythema annulare centrifugum"--símile com estudo ultraestructural.

The authors present the third case in the literature of hypereosinophilic syndrome with "erythema annulare centrifugum" like lesions. Cutaneous manifestations were the first sign of the disease. Laboratory investigation including ultrastructural study of cutaneous lesions. This kind of investigation has been done before in only one instance. Clinical and laboratory features of the case are fully discussed taking into account literature findings.

[Pseudo-atrophoderma colli and Gougerot-Carteaud confluent reticulated papillomatosis (shining atrophy)]. / Pseudo-atrofoderma colli e papilomatose confluente e reticulada de Gougerot e Carteaud (atrofia brilhante).

The authors discuss about one case of pseudo-atrophoderma colli and its relationship with reticular and confluent papillomatosis of the skin.

[Lichen striatus. Epidemiologic study]. / Lichen striatus. Estudo epidemiológico.

The authors are showing a retrospective study of 53 cases of lichen striatus concerning sex, colour, age, place of lesions, associated diseases and period of the year of occurrence of the dermatosis. There was a larger number of cases in females of white race and age-between 2 and 5 years old. A greater occurrence was observed in the months of September and March which correspond to spring and summer. Adding the fact that there have been more cases in children, at times in brothers and the trend to spontaneous involution, the authors suggest the possibility of a virus as etiology to this entity.

Comparative study of patch test using traditional method vs. prior skin abrading.

BACKGROUND: The patch test is an essential procedure for the investigation of aetiologic diagnosis of allergic contact dermatitis, although it is not yet able to fully reproduce the events of the initial site of contact with the allergen. OBJECTIVES: The aims of the present study are (i) to assess whether removal of the superficial corneous layer results in test positivity differences vs. the traditional technique, (ii) to assess the probable and/or possible and past and/or present sensitivity and relevance for each method, and (iii) to compare specific relevance of nickel sulphate for each method. RESULTS: Concordance of positive reactions was 75.9% (66 of 87), with 21.8% (19 of 87) positivity results on the abraded side only and 2.3% (2 of 87) on the unabraded side (P < 0.05). Concordance of the substances with probable and/or possible and past and/or present relevance was 77.3% (58 of 75) for the abraded side and 21.3% (16 of 75) and 1.3% (1 of 75) for the unabraded side (P < 0.05). Analysis of isolated relevance for nickel sulphate showed 95.6% (22 of 23) concordance. CONCLUSIONS: (i) We found a greater number of positive substances on the abraded side, and when only the 2 + and 3 + reactions were considered, greater relative discordance was also observed; (ii) relevance analysis revealed a statistically significant difference between the two methods; (iii) differences in nickel sulphate test positivity and relevance for the two methods did not reach statistical significance.

Reactivity of anti-Blomia tropicalis IgG and IgE in patients with atopic dermatitis.

Patients with atopic dermatitis (AD) commonly develop antibodies of subclasses IgG and IgE to house dust mites, such as Dermatophagoides pteronyssinus and D. farinae. The domestic mite Blomia tropicalis is prevalent in Brazil and can cause the exacerbation of AD. The objectives of this study were to assess skin reactivity to B. tropicalis extracts of AD patients and a control group of nonallergic subjects, and to determine the in vitro reactivity of anti-B. tropicalis IgG and IgE in the serum of AD patients and a control group of nonallergic individuals. Subjects were 36 patients with confirmed AD and the controls were 25 nonallergic individuals. Skin sensitivity to B. tropicalis extracts was tested by the prick-test, and anti-B. tropicalis IgG reactivity in the serum was detected by the Western blot. Anti-B. tropicalis IgE reactivity in the serum was measured by RAST. Patients with AD reacted 7.12 times more often to extracts from B. tropicalis than the control group. A positive association was observed between the presence of anti-B. tropicalis IgG and IgE and AD. AD patients showed a high degree of sensitization to B. tropicalis; it can thus be considered a risk factor for the development of AD exacerbations in patients exposed to this mite species.

Determination of Blomia tropicalis-specific IgE and IgG subclasses in atopic dermatitis patients.

BACKGROUND: To verify the importance of Blomia tropicalis in atopic dermatitis (AD), we determined the cutaneous reactivity and the serum level of B. tropicalis-specific IgE and IgG subclasses in AD patients. METHODS: B. tropicalis-specific IgE and IgG subclasses were determined in AD patients and compared with bronchial asthma (BA) patients and a control group (CG) of nonatopic subjects. Specific IgE was obtained by skin prick test and RAST. B. tropicalis-specific IgG subclasses were determined by ELISA. The data were statistically analyzed by chi-square test (Mantel-Haenszel) and odds ratio (OR). RESULTS: We detected positive skin prick tests in 61.76% of AD and 83.33% of BA patients, and in 12.5% of the CG. RAST was positive in 44.12% of AD and in 61.90% of BA patients, but not in the CG. B. tropicalis-specific IgG1 and IgG2 subclasses showed no significant differences between the three groups. IgG3 subclass positivity was statistically significant in AD patients (41.17%) when compared to BA patients (14.29%) and the CG (16.67%). The determination of B. tropicalis-specific IgG4 was positive in 32.35% of AD patients, 21.43% of BA patients, and 8.33% of the CG. CONCLUSIONS: These results confirm that the storage mite B. tropicalis is an important allergen in AD. It is possible that IgG3 activates the complement in AD patients, releasing vasoactive amines that further amplify the allergic reaction. The positive results of the B. tropicalis-specific IgG4 found in AD and BA were probably due to chronic exposure to this storage mite in the home environment.

Rhinofacial zygomycosis caused by Conidiobolus coronatus. A case report.

A case of rhinofacial zygomycosis with of years duration, caused by Conidiobolus coronatus is described. The patient, a 72-years-old woman, presented with a bilateral distortion of the subcutaneous tissue and disfigurement of the face. Treatment with ketoconazole and potassium iodide did not prevent several relapses. At present she is still under treatment with fluconazole with clinical healing. Histopathological and mycological examination confirmed the dermatological diagnosis. An increasing number of cases of zygomycosis caused by fungi of the order Entomophthorales have also been reported in the Northern and Northeastern States of Brazil.