Unusual Interface Dermatoses Distributed Along Blaschko's Lines in Adult Patients.

Linear dermatoses are unusual entities whose distribution reflects cutaneous mosaicism, even when they occur in adult life. Adult blaschkitis (AB) and lichen striatus (LS) always follow this peculiar distribution. Although usually referred to as distinct entities, the clinical and histopathological presentation of lichen striatus in adults may be similar to those of adult blaschkitis. Moreover, some cases with overlapping features between lichen striatus and linear lichen planus have been published, making precise diagnosis very difficult. Recently, the concept of a wide spectrum of blaschkolinear dermatoses with AB and LS located somewhere within it has been proposed but it has not gained general recognition. We report three cases of dermatoses following the lines of Blaschko in adults (two women and one male, ages 35, 50 and 56, respectively). They involved the upper extremity in two cases and the lower in the third. Clinically, they were interpreted as linear lichen planus or blaschkitis but, histopathologically, they showed features consistent with lichen striatus. Lesions subsided with topic steroids and/or tacrolimus ointment, they are an example of the significant overlapping between these three entities, demonstrating that they may exist on a spectrum both clinically and histopathologically and clinico-pathologic correlation is essential to achieve an accurate final diagnosis. A detailed review of previously published cases has also been made.

Tomato paste rich in lycopene protects against cutaneous photodamage in humans in vivo: a randomized controlled trial.

BACKGROUND: Previous epidemiological, animal and human data report that lycopene has a protective effect against ultraviolet radiation (UVR)-induced erythema. OBJECTIVES: We examined whether tomato paste--rich in lycopene, a powerful antioxidant--can protect human skin against UVR-induced effects partially mediated by oxidative stress, i.e. erythema, matrix changes and mitochondrial DNA (mtDNA) damage. METHODS: In a randomized controlled study, 20 healthy women (median age 33 years, range 21-47; phototype I/II) ingested 55 g tomato paste (16 mg lycopene) in olive oil, or olive oil alone, daily for 12 weeks. Pre- and postsupplementation, UVR erythemal sensitivity was assessed visually as the minimal erythema dose (MED) and quantified with a reflectance instrument. Biopsies were taken from unexposed and UVR-exposed (3 × MED 24 h earlier) buttock skin pre- and postsupplementation, and analysed immunohistochemically for procollagen (pC) I, fibrillin-1 and matrix metalloproteinase (MMP)-1, and by quantitative polymerase chain reaction for mtDNA 3895-bp deletion. RESULTS: Mean ± SD erythemal D(30) was significantly higher following tomato paste vs. control (baseline, 26·5 ± 7·5 mJ cm(-2); control, 23 ± 6·6 mJ cm(-2); tomato paste, 36·6 ± 14·7 mJ cm(-2); P = 0·03), while the MED was not significantly different between groups (baseline, 35·1 ± 9·9 mJ cm(-2); control, 32·6 ± 9·6 mJ cm(-2); tomato paste, 42·2 ± 11·3 mJ cm(-2)). Presupplementation, UVR induced an increase in MMP-1 (P = 0·01) and a reduction in fibrillin-1 (P = 0·03). Postsupplementation, UVR-induced MMP-1 was reduced in the tomato paste vs. control group (P = 0·04), while the UVR-induced reduction in fibrillin-1 was similarly abrogated in both groups, and an increase in pCI deposition was seen following tomato paste (P = 0·05). mtDNA 3895-bp deletion following 3 × MED UVR was significantly reduced postsupplementation with tomato paste (P = 0·01). CONCLUSIONS: Tomato paste containing lycopene provides protection against acute and potentially longer-term aspects of photodamage.

Mínima mácula en párpado: ¿picotazo de cigüeña o algo más? / Small Macule on the Eyelid: Stork Bite or Something Else?

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[Incidence of bronchopulmonary carcinoma in Extremadura in 1998]. / Incidencia de carcinoma broncopulmonar en Extremadura durante el año 1998.

OBJECTIVES: Our main objective was to determine the incidence of bronchopulmonary cancer in Extremadura (Spain). We also studied the presence of risk factors such as smoking and exposure to other carcinogens. MATERIAL AND METHODS: This prospective study used a protocol followed by all hospitals in Extremadura; enrolled were patients with a diagnosis of bronchopulmonary carcinoma in 1998 who lived habitually in the region. Cyto-histological confirmation of the diagnosis was sought or, when such confirmation was unavailable, diagnostic agreement among researchers was based on clinical, radiological and/or endoscopic data. RESULTS: The incidences adjusted to world population were 53.4, 2.16 and 25.3 per 100,000 inhabitants for men, women and the entire population sample, respectively. Patterns in the provinces of Cáceres and Badajoz were very similar. Of 433 cases recorded, 95% were men and 78% were aged 60 years or older. Cyto-histological confirmation of diagnosis was available for 92.2%. Most tumors were epidermoid (41.1%). The time between the start of smoking and diagnosis was significantly shorter in heavier smokers.

[What is special about adalimumab?]. / Qué tiene de singular adalimumab?

Adalimumab is the first fully human anti-tumor necrosis factor (TNF-alpha) monoclonal antibody and it binds to both soluble and cell-bound TNF-alpha, modulating biological responses linked to this cytokine. Different trials have probed the efficacy of adalimumab even after one week, and accumulated experience in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease shows adalimumab as a safe drug sharing a similar adverse effects profile with the other anti-TNF-alpha molecules. Specific features of adalimumab are revised.

[Abbreviated diurnal polysomnographic records in the diagnosis of sleep obstructive apnea syndrome]. / Análisis de los registros polisomnográficos cortos diurnos en el diagnóstico del síndrome de apnea obstructiva del sueño.

OBJECTIVE: To demonstrate the validity of diurnal polysomnography for the diagnosis of obstructive sleep apnea syndrome (OSAS). METHODS: Twenty-five patients with suspect of OSAS were studied with two serial polysomnographic recordings: one during nighttime-nocturnal polysomnography (NPLS) and then a second polysomnographic study during the following morning (DPLS). In both recordings the Sensor Medic Polysomnograph 4250 was used. The certainty OSAS diagnosis was considered when an apnea-hypopnea index (AHI) > or = 10 in the nocturnal recording was obtained. The statistical study was performed with the R-Sigma Horus SA software and sensitivity and specificity values following formulas next indicated. RESULTS: The male/female ratio was 72%/28%. All patients were snorers and 64% had diurnal hypersomnia. Fourteen out of the 25 patients were true positive, five true negative, five false negative and one false positive patients. The specificity and sensitivity of DPLS were 83% and 73%, respectively, with a positive predictive value of 93% and a negative predictive value of 50%. CONCLUSIONS: Abbreviated diurnal polysomnographic recordings, performed with conventional polysomnography, have a good sensitivity and specificity for the diagnosis of OSAS. Given the possibility of false negative results in DPLS, a NPLS should be performed in the patient with presumed OSAS and negative diurnal polysomnographic study.

Paciente joven con nódulos pulmonares / Young patient with pulmonary nodules

Describimos el caso de una paciente de 33 años que ingresó por dolor centrotorácico de características pleuríticas, tos, disnea y síndrome constitucional. En la radiografía de tórax se observaron infiltrados pulmonares nodulares bilaterales. Tras la realización de una biopsia pulmonar se llegó al diagnóstico de micosis pulmonar causada por Cryptococcus neoformans.La criptococosis pulmonar es una entidad poco habitual, que puede afectar tanto a individuos inmunodeprimidos como a inmunocompetentes, aunque con menor frecuencia en estos últimos.Este caso demuestra la importancia de considerar causas in-fecciosas en el diagnóstico diferencial de nódulos pulmonares. Destacamos a su vez lo poco habitual de la infección por Cryp-tococcus en pacientes inmunocompetentes

The case of a 33 year-old patient is described; she was admitted to hospital due to pleuritic chest pain, cough, dyspnoea and constitutional syndrome. Infiltrated bilateral lung nodules were observed in the chest x-ray. After performing a lung biopsy, the diagnosis was lung micosis due to Cryptococcus neoformans. Lung cryptococcus is an uncommon entity that can affect both immunodeficient and immunocompetent individuals, although less frequent in these latter. This case demonstrates the importance of considering infec-tious causes in the differential diagnosis of pulmonary nodules. At the same time, it must be noted that infections due to cryptococcus is in immunocompetent patients are rare

Mioma del músculo dartoico / Dartos musclemyoma

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¿Qué tiene de singular adalimumab? / What is special about adalimumab?

Adalimumab es el primer anticuerpo monoclonal anti-factor de necrosis tumoral alfa (TNF-α) completamente humano que se une con una alta afinidad tanto a la forma soluble como a la forma unida a células del TNF-α, modulando su actividad biológica. Varios ensayos clínicos han demostrado la eficacia y rapidez de acción de adalimumab en pacientes con psoriasis, y la experiencia de uso en enfermedades como la artritis reumatoide, artritis psoriásica, espondilitis anquilosante y enfermedad de Crohn lo posicionan como un fármaco seguro, con un perfil de efectos secundarios similar a otros fármacos anti-TNF-α. Las peculiaridades específicas de esta molécula son revisadas en este artículo (AU)

Adalimumab is the first fully human anti-tumor necrosis factor (TNF-α) monoclonal antibody and it binds to both soluble and cell-bound TNF-α, modulating biological responses linked to this cytokine. Different trials have probed the efficacy of adalimumab even after one week, and accumulated experience in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Crohn´s disease shows adalimumab as a safe drug sharing a similar adverse effects profile with the other anti-TNF-α molecules. Specific features of adalimumab are revised (AU)

Telangiectasia esencial progresiva / Essential progressive telangiectasia

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Síndrome de Sweet: ¿primera manifestación de infección por el virus de la inmunodeficiencia humana? / Sweet syndrome as a possible ìnitial manifestation of human immunodeficiency virus infection

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Actualización en el tratamiento de la tuberculosis / No disponible

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