RESUMEN
BACKGROUND AND OBJECTIVES: There are no clinical guidelines on the management of dysplastic nevus (DN). The aims of this study were to determine the percentage of dermatologists in the center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV) who would manage a histologically confirmed DN with a watch-and-wait approach or with wider surgical margins and to investigate whether their attitudes would vary depending on whether or not the patient had a personal and/or family history of melanoma. MATERIAL AND METHODS: We collected data from an anonymous survey sent to 738 dermatologists between June 15 and July 31, 2022. The independent variables were degree of dysplasia (low vs. high), margin status (positive vs. negative), and a personal or family history of melanoma (yes vs. no in both cases). The dependent variables were attitude towards management (watch-and-wait vs. re-excision with a surgical margin of 1 to 4mm or re-excision with a surgical margin of 5 to 10mm). RESULTS: We obtained 86 responses to the questionnaire. When pathology indicated a low-grade DN, 60.5% of dermatologists stated they would obtain a surgical margin of 1 to 4mm if the first margins were positive, and 97.7% would watch and wait if the report described negative margins. For high-grade DNs, 1.2% of dermatologists would watch and wait to manage DN with positive margins; 68.8% would use this approach for negative margins. A family or personal history of melanoma had no influence on most of the dermatologists' attitudes. CONCLUSIONS: Management strategies for DN among dermatologists from the center-Spain section of the AEDV varied, particularly when faced with low-grade DN with positive margins and high-grade DN with negative margins. A family or personal history of melanoma did not influence clinical attitudes in most cases.
Asunto(s)
Dermatología , Síndrome del Nevo Displásico , Melanoma , Neoplasias Cutáneas , Venereología , Humanos , Síndrome del Nevo Displásico/cirugía , Síndrome del Nevo Displásico/patología , Márgenes de Escisión , España , Dermatólogos , Melanoma/cirugía , Melanoma/patología , Encuestas y Cuestionarios , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patologíaAsunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Isquemia/tratamiento farmacológico , Fármacos Neuromusculares/uso terapéutico , Enfermedad de Raynaud/complicaciones , Esclerodermia Sistémica/complicaciones , Dedos del Pie/irrigación sanguínea , Úlcera/tratamiento farmacológico , Adulto , Femenino , Humanos , Isquemia/etiología , Resultado del Tratamiento , Úlcera/etiologíaAsunto(s)
Edema/parasitología , Leishmaniasis Mucocutánea/diagnóstico , Enfermedades de los Labios/parasitología , Anfotericina B/uso terapéutico , Antiprotozoarios/uso terapéutico , Enfermedad Crónica , Edema/patología , Humanos , Leishmaniasis Mucocutánea/tratamiento farmacológico , Leishmaniasis Mucocutánea/patología , Enfermedades de los Labios/tratamiento farmacológico , Enfermedades de los Labios/patología , Masculino , Persona de Mediana EdadRESUMEN
Mondor's disease (MD) is a rare condition, which is considered a thrombophlebitis of the subcutaneous veins. It commonly occurs on the anterolateral thoracoabdominal wall, but it can also occur on the penis, groin, antecubital fossa and posterior cervical region. The clinical features are a sudden and typically asymptomatic onset of a cord-like induration, although some patients report a feeling of 'strain'. It is a self-limiting process that lasts a short period of time, which may be the reason why there are few reports about its diagnosis and treatment. Its pathogenesis has remained unclear, because of the lack of methods to reliably differentiate between veins and lymphatic vessels. Immunohistochemical staining for CD31 and D240 has been identified recently as the best method to distinguish small veins from lymphatic vessels, making it a valuable technique in diagnosing not only MD, but also many other diseases in which veins or lymphatic vessels are affected. MD has been associated with several systemic diseases such as breast cancer and hypercoagulability states, thus laboratory studies are recommended to exclude any possible systemic disorders. As this condition is usually a benign and self-limiting process, vigorous treatment is only recommended when the process is symptomatic or recurrent.
Asunto(s)
Tromboflebitis/diagnóstico , Pared Abdominal/patología , Diagnóstico Diferencial , Humanos , Vasos Linfáticos/patología , Tromboflebitis/etiología , Tromboflebitis/terapia , Venas/patologíaRESUMEN
Mondor's disease of the penis is usually a benign, self-limiting process of acute onset. To date, there have been few studies about its diagnosis and treatment. It is difficult to differentiate MD of the penis from sclerosing lymphangitis of the penis, because the symptoms, epidemiology and aetiology are similar, and because veins are histologically very similar to lymphatics. We report a case of MD in which immunochemical markers such as CD31 and D240 allowed us to specifically discriminate between the small vein and lymphatic vessels. This is important not only for the recognition of MD at any site, but for many other diseases in which veins or lymphatic vessels are affected.
Asunto(s)
Linfangitis/patología , Enfermedades del Pene/patología , Tromboflebitis/patología , Adulto , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Vasos Linfáticos/patología , Masculino , Pene/irrigación sanguínea , Pene/patología , Abstinencia Sexual , Venas/patologíaRESUMEN
Angiolymphoid hyperplasia with eosinophilia (AHE) is a benign reactive vascular lesion characterized by a proliferation of small to medium sized vascular structures lined by epithelioid endothelial cells. We report a 75-year-old woman with a 1-month history of a painful ulcer on the tongue. Histopathological findings confirmed a diagnosis of angiolymphoid hyperplasia with eosinophilia. The tongue is an unusual site for this lesion. The treatment of choice for AHE is surgical excision.
Asunto(s)
Hiperplasia Angiolinfoide con Eosinofilia/patología , Eosinofilia/patología , Enfermedades de la Lengua/patología , Anciano , Hiperplasia Angiolinfoide con Eosinofilia/cirugía , Eosinofilia/cirugía , Femenino , Humanos , Enfermedades de la Lengua/cirugía , Resultado del TratamientoRESUMEN
Antecedentes y objetivos No existen guías clínicas para el manejo del nevus displásico (ND). Determinaremos el porcentaje de dermatólogos de la sección Centro de la Academia Española de Dermatología y Venereología (AEDV) que ampliarían márgenes o tendrían actitud conservadora en un ND, y si los antecedentes personales (AP) y/o familiares (AF) de melanoma modificarían la actitud tomada frente a un paciente sin antecedentes de interés. Material y métodos Se difundió la encuesta a 738 dermatólogos y se recogieron datos de forma anónima del 15 de junio de 2022 al 31 de julio de 2022. Las variables de exposición fueron el grado de displasia (bajo/alto), los márgenes (afecto/libre) y los antecedentes de melanoma (sin antecedentes/AF/AP). Las variables dependientes (actitud) incluyeron observación/márgenes de 1-4mm /márgenes 5-10mm. Resultados Se recibieron 86 respuestas. Si el patólogo informase bordes afectos en un ND de bajo grado, el 60,5% ampliarían márgenes de 1 a 4mm, mientras que si los márgenes están libres el 97,7%, tendrían una actitud conservadora. Si el patólogo informara bordes afectos en un ND de alto grado, solo el 1,2% tendrían una actitud conservadora, porcentaje que se incrementa notablemente si los márgenes están libres (68,6%). El AF o el AP de melanoma no influirían en la actitud de la mayoría. Conclusiones El manejo del ND no es uniforme entre los dermatólogos de la sección centro de la AEDV, especialmente en el caso de ND de bajo grado con bordes afectos y ND de alto grado con bordes libres. El AF o el AP de melanoma no modifican en la mayor parte de los casos la actitud clínica (AU)
Background and objectives There are no clinical guidelines on the management of dysplastic nevus (DN). The aims of this study were to determine the percentage of dermatologists in the center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV) who would manage a histologically confirmed DN with a watch-and-wait approach or with wider surgical margins and to investigate whether their attitudes would vary depending on whether or not the patient had a personal and/or family history of melanoma. Material and methods We collected data from an anonymous survey sent to 738 dermatologists between June 15 and July 31, 2022. The independent variables were degree of dysplasia (low vs. high), margin status (positive vs. negative), and a personal or family history of melanoma (yes vs. no in both cases). The dependent variables were attitude towards management (watch-and-wait vs. re-excision with a surgical margin of 1 to 4mm or re-excision with a surgical margin of 5 to 10mm). Results We obtained 86 responses to the questionnaire. When pathology indicated a low-grade DN, 60.5% of dermatologists stated they would obtain a surgical margin of 1 to 4mm if the first margins were positive, and 97.7% would watch and wait if the report described negative margins. For high-grade DNs, 1.2% of dermatologists would watch and wait to manage DN with positive margins; 68.8% would use this approach for negative margins. A family or personal history of melanoma had no influence on most of the dermatologists attitudes. Conclusions Management strategies for DN among dermatologists from the center-Spain section of the AEDV varied, particularly when faced with low-grade DN with positive margins and high-grade DN with negative margins. A family or personal history of melanoma did not influence clinical attitudes in most cases (AU)
Asunto(s)
Humanos , Masculino , Femenino , Encuestas de Atención de la Salud , Síndrome del Nevo Displásico/diagnóstico , Síndrome del Nevo Displásico/terapia , Pautas de la Práctica en Medicina , Dermatólogos , Estudios Transversales , Sociedades Médicas , EspañaRESUMEN
Background and objectives There are no clinical guidelines on the management of dysplastic nevus (DN). The aims of this study were to determine the percentage of dermatologists in the center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV) who would manage a histologically confirmed DN with a watch-and-wait approach or with wider surgical margins and to investigate whether their attitudes would vary depending on whether or not the patient had a personal and/or family history of melanoma. Material and methods We collected data from an anonymous survey sent to 738 dermatologists between June 15 and July 31, 2022. The independent variables were degree of dysplasia (low vs. high), margin status (positive vs. negative), and a personal or family history of melanoma (yes vs. no in both cases). The dependent variables were attitude towards management (watch-and-wait vs. re-excision with a surgical margin of 1 to 4mm or re-excision with a surgical margin of 5 to 10mm). Results We obtained 86 responses to the questionnaire. When pathology indicated a low-grade DN, 60.5% of dermatologists stated they would obtain a surgical margin of 1 to 4mm if the first margins were positive, and 97.7% would watch and wait if the report described negative margins. For high-grade DNs, 1.2% of dermatologists would watch and wait to manage DN with positive margins; 68.8% would use this approach for negative margins. A family or personal history of melanoma had no influence on most of the dermatologists attitudes. Conclusions Management strategies for DN among dermatologists from the center-Spain section of the AEDV varied, particularly when faced with low-grade DN with positive margins and high-grade DN with negative margins. A family or personal history of melanoma did not influence clinical attitudes in most cases (AU)
Antecedentes y objetivos No existen guías clínicas para el manejo del nevus displásico (ND). Determinaremos el porcentaje de dermatólogos de la sección Centro de la Academia Española de Dermatología y Venereología (AEDV) que ampliarían márgenes o tendrían actitud conservadora en un ND, y si los antecedentes personales (AP) y/o familiares (AF) de melanoma modificarían la actitud tomada frente a un paciente sin antecedentes de interés. Material y métodos Se difundió la encuesta a 738 dermatólogos y se recogieron datos de forma anónima del 15 de junio de 2022 al 31 de julio de 2022. Las variables de exposición fueron el grado de displasia (bajo/alto), los márgenes (afecto/libre) y los antecedentes de melanoma (sin antecedentes/AF/AP). Las variables dependientes (actitud) incluyeron observación/márgenes de 1-4mm /márgenes 5-10mm. Resultados Se recibieron 86 respuestas. Si el patólogo informase bordes afectos en un ND de bajo grado, el 60,5% ampliarían márgenes de 1 a 4mm, mientras que si los márgenes están libres el 97,7%, tendrían una actitud conservadora. Si el patólogo informara bordes afectos en un ND de alto grado, solo el 1,2% tendrían una actitud conservadora, porcentaje que se incrementa notablemente si los márgenes están libres (68,6%). El AF o el AP de melanoma no influirían en la actitud de la mayoría. Conclusiones El manejo del ND no es uniforme entre los dermatólogos de la sección centro de la AEDV, especialmente en el caso de ND de bajo grado con bordes afectos y ND de alto grado con bordes libres. El AF o el AP de melanoma no modifican en la mayor parte de los casos la actitud clínica (AU)
Asunto(s)
Humanos , Masculino , Femenino , Encuestas de Atención de la Salud , Síndrome del Nevo Displásico/diagnóstico , Síndrome del Nevo Displásico/terapia , Pautas de la Práctica en Medicina , Dermatólogos , Estudios Transversales , Sociedades Médicas , EspañaAsunto(s)
Alopecia/patología , Enfermedad de Darier/patología , Cejas , Dermatosis Facial/patología , Adulto , Femenino , HumanosAsunto(s)
Acantoma/virología , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/virología , Adyuvantes Inmunológicos/administración & dosificación , Adyuvantes Inmunológicos/uso terapéutico , Administración Tópica , Aminoquinolinas/administración & dosificación , Aminoquinolinas/uso terapéutico , ADN Viral/aislamiento & purificación , Femenino , Humanos , Imiquimod , Persona de Mediana Edad , Reacción en Cadena de la PolimerasaAsunto(s)
Enfermedades de la Piel , Adolescente , Femenino , Humanos , Enfermedades de la Piel/patologíaAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/diagnóstico por imagen , Adulto , Sulfato de Bario , Encefalopatías/diagnóstico por imagen , Diagnóstico Diferencial , Enfermedades del Sistema Digestivo/diagnóstico por imagen , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The terms verrucous hemangioma and angiokeratoma circumscriptum have been used interchangeably in the literature to define clinically similar lesions. From a histologic perspective, however, angiokeratoma circumscriptum is limited to the papillary dermis whereas verrucous hemangioma extends as far as the hypodermis. We describe the case of a 38-year-old woman who consulted for a lesion on the right thigh that was initially diagnosed as angiokeratoma; magnetic resonance imaging, however, led to a final diagnosis of verrucous hemangioma.
Asunto(s)
Hemangioma/diagnóstico , Imagen por Resonancia Magnética , Adulto , Femenino , Hemangioma/patología , Humanos , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patologíaRESUMEN
Based on the in vitro and in vivo data suggesting synergistic cytolysis by the combination of 5-fluorouracil and interferon-gamma against a variety of malignant cell lines including a human colon carcinoma cell line (HT-29), we initiated studies in patients with advanced colon or rectal carcinoma. Forty-six patients received 5-fluorouracil as an intravenous injection on days 1-5 and recombinant human interferon-gamma as an intramuscular injection on days 1-14, followed by a rest period of 14 days; courses were repeated every 28 days. In the phase I study, cohorts of two patients received a stepwise dose level increase to achieve the maximum tolerated dose (MTD), at which a total of six patients were studied. The dose levels constituting the MTD were as follows: 5-fluorouracil (500 g/m2/day) and recombinant gamma-interferon (0.5 mg/m2/day). Four patients achieved a partial response in the phase I study. In the phase II study, 30 patients received therapy at the MTD. Among 29 evaluable patients in the phase II study, two patients achieved a partial response. Common toxicities included malaise, fever, anorexia, nausea and vomiting, and diarrhea. Transient severe myelosuppression was common but did not result in significant morbidity. Our data suggest that the combination of 5-fluorouracil and recombinant gamma-interferon did not have the same antitumor effect in patients as it had in the preclinical experiments.
Asunto(s)
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/terapia , Neoplasias del Colon/terapia , Fluorouracilo/administración & dosificación , Interferón gamma/administración & dosificación , Neoplasias del Recto/terapia , Adenocarcinoma/tratamiento farmacológico , Adulto , Anciano , Carcinoma/tratamiento farmacológico , Neoplasias del Colon/tratamiento farmacológico , Evaluación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteínas Recombinantes , Neoplasias del Recto/tratamiento farmacológicoRESUMEN
UNLABELLED: The mechanism underlying the Niteroi, Rio de Janeiro sedative effect of clonidine, an alpha2-adrenoceptor agonist, remains uncertain. Because activation of alpha2-adrenoceptors induces release of nitric oxide (NO), we tested the hypothesis that the sedative effect of clonidine depends on NO-related mechanisms. The effect of 7-nitro indazole on the sleeping time induced by clonidine was studied in Wistar rats. In addition, we examined the effect of clonidine, alpha-methyldopa, and midazolam on the thiopental-induced sleeping time in rats pretreated with N(G)-nitro-L-arginine-methyl-ester (L-NAME). The sleeping time induced by clonidine was significantly decreased by 7-nitro indazole. Thiopental sleeping time was increased by clonidine, alpha-methyldopa, and midazolam. L-NAME reduced the prolongation effect of clonidine and alpha-methyldopa, but did not alter the effect of midazolam on the thiopental-induced sleeping time. The inhibitory effect of L-NAME on clonidine-dependent prolongation of thiopental-induced sleeping time was reversed by L-arginine. These results suggest that NO-dependent mechanisms are involved in the sedative effect of clonidine. In addition, this effect seems to be specific for the sedative action of alpha2-adrenoceptors agonists. IMPLICATIONS: Clonidine, an antihypertensive drug, is also a sedative. This sedative effect, although an adverse event in the treatment of hypertensive patients, can be helpful for sedation of surgical patients. The mechanism of this effect, however, is unknown. In this study, we show that the sedative effect of clonidine is mediated by nitric oxide, because it could be prevented by pretreatment with nitric oxide synthase inhibitors.