Dermatitis de contacto alérgica por fragancias. Parte II / Allergic Contact Dermatitis to Fragrances: Part 2

La dermatitis de contacto alérgica por fragancias suele presentarse clínicamente como un eczema subagudo o crónico debido a la ubicuidad de este alérgeno en los productos de uso cotidiano y el contacto repetido. El paciente típico es una mujer de edad media con afectación de las manos y la cara, aunque la localización de las lesiones variará dependiendo del alérgeno y del producto causante. Dentro de la batería estándar del Grupo Español en Investigación de Dermatitis de Contacto y Alergia Cutánea (GEIDAC) están incluidos 4 marcadores de fragancias: el bálsamo del Perú, la mezcla de fragancias I, la mezcla de fragancias II y el lyral. En caso de que alguno de estos marcadores sea positivo está indicada la utilización de una serie de fragancias específicas para el diagnóstico. Esto, unido a la nueva legislación que obliga a la industria a notificar qué ingredientes y fragancias utiliza en sus productos, nos ayudará a la resolución de la dermatitis de pacientes alérgicos (AU)

Allergic contact dermatitis due to fragrances usually manifests as subacute or chronic dermatitis because fragrances are found in a wide range of products to which patients are repeatedly exposed. The typical patient is a middle-aged woman with dermatitis on her hands and face, although other sites may be affected depending on the allergen and the product in which it is found. The standard patch test series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) contains 4 fragrance markers: balsam of Peru, fragrance mix I, fragrance mix II, and lyral. Testing with a specific fragrance series is recommended in patients with a positive result to any of these 4 markers. The use of a specific fragrance series and new legislation obliging manufacturers to specify the fragrances used in their products, will help to improve the management of allergic contact dermatitis due to fragrances (AU)

Allergic contact dermatitis to fragrances: part 2.

Allergic contact dermatitis due to fragrances usually manifests as subacute or chronic dermatitis because fragrances are found in a wide range of products to which patients are repeatedly exposed. The typical patient is a middle-aged woman with dermatitis on her hands and face, although other sites may be affected depending on the allergen and the product in which it is found. The standard patch test series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) contains 4 fragrance markers: balsam of Peru, fragrance mix i, fragrance mix ii, and lyral. Testing with a specific fragrance series is recommended in patients with a positive result to any of these 4 markers. The use of a specific fragrance series and new legislation obliging manufacturers to specify the fragrances used in their products, will help to improve the management of allergic contact dermatitis due to fragrances.

Dermatitis de contacto alérgica por fragancias. Parte I / Allergic Contact Dermatitis to Fragrances. Part 1

Las fragancias son un grupo amplio de sustancias que representan la segunda causa más frecuente de dermatitis de contacto alérgica en nuestro medio. Son alérgenos ubicuos en nuestra sociedad a los cuales nos exponemos de manera continua y diaria. Actualmente, la batería estándar española tiene buenos marcadores para su detección, pero no ideales. En los últimos años han surgido nuevos marcadores que han sido incluidos en baterías de otros países y han demostrado ser rentables. El diagnóstico de esta entidad adquiere mayor importancia a partir de la entrada en vigor de la ley que obliga a la industria a especificar una lista de 26 ingredientes considerados fragancias en productos comerciales. El objetivo de este artículo es realizar una actualización en la dermatitis de contacto alérgica a fragancias. Revisamos las principales fuentes de exposición, las manifestaciones clínicas y proponemos un protocolo de diagnóstico y manejo terapéutico de estos pacientes (AU)

Fragrances are a large group of substances and the second most common cause of allergic contact dermatitis in Spain. These potential allergens are extremely common and the general population is subject to continuous exposure on a daily basis. While the fragrance markers included in the current Spanish standard patch test series are good, there is room for improvement. New markers that have emerged in recent years have proven to be of value in standard series used in other countries. Diagnosing fragrance allergy has taken on even greater importance since the European Union added 26 fragrances to its list of mandatory ingredients to be specified on product labels. The aim of this review is to provide an update on allergic contact dermatitis to fragrances. We examine the main sources of exposure and clinical manifestations of this condition and propose a diagnostic and treatment protocol (AU)

Allergic contact dermatitis to fragrances. Part 1.

Fragrances are a large group of substances and the second most common cause of allergic contact dermatitis in Spain. These potential allergens are extremely common and the general population is subject to continuous exposure on a daily basis. While the fragrance markers included in the current Spanish standard patch test series are good, there is room for improvement. New markers that have emerged in recent years have proven to be of value in standard series used in other countries. Diagnosing fragrance allergy has taken on even greater importance since the European Union added 26 fragrances to its list of mandatory ingredients to be specified on product labels. The aim of this review is to provide an update on allergic contact dermatitis to fragrances. We examine the main sources of exposure and clinical manifestations of this condition and propose a diagnostic and treatment protocol.

Allergic Contact Dermatitis to Fragrances. Part 1. / Dermatitis de contacto alérgica por fragancias. Parte I.

Fragrances are a large group of substances and the second most common cause of allergic contact dermatitis in Spain. These potential allergens are extremely common and the general population is subject to continuous exposure on a daily basis. While the fragrance markers included in the current Spanish standard patch test series are good, there is room for improvement. New markers that have emerged in recent years have proven to be of value in standard series used in other countries. Diagnosing fragrance allergy has taken on even greater importance since the European Union added 26 fragrances to its list of mandatory ingredients to be specified on product labels. The aim of this review is to provide an update on allergic contact dermatitis to fragrances. We examine the main sources of exposure and clinical manifestations of this condition and propose a diagnostic and treatment protocol.

[Indications, techniques, complications and results of sleeve lobectomy]. / Indicazioni, tecniche, complicanze e risultati della sleeve lobectomy.

AIM: The authors analyse their personal series and compare it with reported data in order to assess the functional results sleeve lobectomy offers with respect to traditional techniques. METHODS: Sixty-six sleeve lobectomies were carried out from 1986 to 2000. In 49 cases the operation was carried out on the basis of criteria of choice and in 17 of functional necessity. Three vascular sleeves and 5 tangential vascular plastic operations were associated. The disparity of lumen was corrected with oblique sections on the intermediate bronchus according to Merendino. In the case of reimplantation of the intermediate on the left main bronchus high frequency jet ventilation was necessary. The anatomoses were covered with broad pedunculated pleural strips. In 3 cases extramucosal myectomy of the medio-thoracic esophagus was carried out associated in 1 case with mucous resection and subsequent direct suture. RESULTS: Morbility was 34.5% (21% atrial fibrillation, 7.5% parenchymal complications, 4.5% anastomotic complications and 1.5% mediastinitis). Mortality at 30 days was 6% (massive hemoptysis in 3 cases and respiratory failure in 1 case). The pTNM of the 57 survivors was IB in 35 cases, IIB in 6 and IIIA in 16. Follow-up showed 5-year survival of 62% for stage IB and 24% for stage IIIA. CONCLUSIONS: On the basis of their experience, with a postoperative mortality and a rate of complications comparable to literature data, the authors consider that sleeve lobectomy, although it presents postoperative problems requiring more prolonged clinical control, is preferable to traditional operations because of the functional advantages it offers patients with lung cancer.

Long-lived polyclonal B-cell lines derived from midgestation mouse embryo lymphohematopoietic progenitors reconstitute adult immunodeficient mice.

Lymphohematopoietic progenitors derived from midgestation mouse embryos were established in long-term cultures with stromal cell monolayers and interleukin 7 (IL-7), giving rise to B-lineage cell lines. The initial emergence and in vitro establishment of these early embryo cell lines were highly sensitive to IL-7-mediated signals, in comparison to cell lines similarly obtained using precursors from late fetal liver (> 13 days postcoitum) and adult bone marrow. The early embryo-derived progenitors spontaneously differentiated in vitro to CD19(+)IgM(+) immature B cells in the presence of optimal concentrations of IL-7, in contrast to those progenitors obtained from late gestation and adult mice, whose differentiation only occurred in the absence of IL-7. The newly in vitro-generated B cells of the early embryo cell lines repopulated adult immunodeficient severe combined immunodeficient mice on their adoptive transfer in vivo and generated specific humoral immune responses after immunization.

Differential involvement of the transcription factor Blimp-1 in T cell-independent and -dependent B cell differentiation to plasma cells.

Along humoral immune responses, different stimuli drive the differentiation of B lymphocytes to Ig-secreting plasma cells in discrete microenvironments. The Blimp-1 transcription factor is up-regulated early during the transition of mature B cells to IgM-secreting plasma cells. In the present study, we have examined the requirement of Blimp-1 in plasma cell formation after both T cell-independent (LPS) and -dependent (CD40 + IL-4, Th cell lines) stimulation of spleen B cells. B lymphocyte-induced maturation protein (Blimp-1) was expressed early after in vitro LPS stimulation, mainly in a population of IgM+Syndecan+CD43+ preplasma cells. In contrast, the BSAP transcription factor expressed in mature B cells was down-regulated during the differentiation to plasma cells. Treatment of these cultures with Blimp-1-specific antisense phosphorothioate oligonucleotides suppressed both Blimp-1 protein levels and the emergence of IgM+Syndecan+ cells and plasma cells. However, T-B cell cocultures of spleen B cells from C3H/HeJ (H-2k) mice and syngeneic autoreactive SR.10 Th2 cells submitted to the anti-Blimp-1 therapy did not show any significant reduction in IgM- and IgG1-secreting plasma cell formation. Spleen B cells treated with anti-CD40 mAb + IL-4 differentiated to IgG1-secreting cells without significant transcription of the Blimp-1 gene; anti-Blimp-1 treatment subsequently did not have any effect in the later cultures. Altogether, these results suggest that Blimp-1 transcription factor specifically promotes T cell-independent B cell differentiation to plasma cells, probably at preplasma cell stages. In contrast, T cell-dependent plasma cell formation likely evolves through Blimp-1-independent pathways.

[Laparoscopic versus laparotomic adrenalectomy: preliminary experiences]. / Surrenectomia laparoscopica versus laparotomica. Esperienze preliminari.

The authors report their experience about laparoscopic surgery in the treatment of adrenal tumours. Three laparoscopic right adrenalectomies were performed. From a comparison with five open adrenalectomies, microinvasive surgery is more advantageous than traditional management: recovery is earlier, incisions are smaller, post-operative discomfort is less, physiologic functions recover in a short time, return to full professional activity in one week.

[Surgical treatment of liver metastases of breast carcinoma. Our experience]. / Trattamento chirurgico delle metastasi epatiche da carcinoma mammario. Nostra esperienza.

The authors report their experience in the surgical treatment of breast cancer liver metastases. Although with a restricted number of cases (4 patients), the short-term results are satisfactory; this is in agreement with the literature. The survival of those patients treated with a loco-regional approach to metastases (chemotherapy and surgery), is longer than one obtained using systemic chemotherapy. This is still an open question requiring further experience.

[Hemoperitoneum caused by lesions to the appendix epiploica. An unusual complication of colonoscopy]. / Emoperitoneo da lacerazione di appendice epiploica. Una rara complicanza della colonscopia.

A rare case of hemoperitoneum in a young man who performed a diagnostic colonoscopy is reported. The rupture of an epiploic appendix among rectum and colon sigma caused massive bleeding into the peritoneum cavity followed by haemorrhagic shock. Diagnostic and therapeutic colonoscopy has a low rate of morbility; perforation and bleeding are the most common events; hemoperitoneum following colonscopy is usually due to spleen rupture. Among other complications, ileal and cecal volvolus, incarceration of hernias and subcutaneous emphysema are reported.

[Ultrasonography-guided percutaneous needle biopsy with large needle versus surgical biopsy in the diagnosis of breast lesions]. / Agobiopsia percutanea ecoguidata con ago grosso vs biopsia chirurgica nella diagnosi delle lesioni mammarie.

The authors report their experience on percutaneous large core biopsy with standard needle in the diagnosis of breast lesions. This method, that has the same advantages of open biopsy, allows a better cytological examination, prevent sequelae of surgery and lower costs.

[Vascularization of the gastric stump tubule in esophagogastroplasty (EGP)]. / La vascolarizzazione del tubulo gastrico nell'esofagogastroplastica (EGP).

The authors present the results of the vascular supply of tubulized gastric stump in patients who had sub-total oesophagectomy and cervical oesophago-gastroplasty (OGP) for oesophageal carcinoma, evaluating the importance of altered tubulized gastric stump's vascular supply on oesophago-gastric anastomosis efficiency. From April 1989 up today 51 patients who had OGP entered this study. Among these 2 had intestinal reconstruction by whole stomach and 49 by tubulized gastric stump. These 49 patients had celiac and upper mesenteric arterial angiography 30 days after surgery. As regards vascular patency angiography allowed us to divide the tubulized gastric stump into three parts; giving useful information above all on the distal part of the stump, considered "at risk" as concerning vascular supply. The authors thus demonstrate that the anastomosis high rate dehiscence is preferably due to the oesophageal stump vascular supply (strongly affected by cervical dissection) rather than to the poor vascular supply of the distal third of the transposed tubulized gastric stump.

[Arterio-portal fistula. Report of a case and review of the literature]. / Fistole artero-portali. Segnalazione di un caso e revisione della letteratura.

Mesenteric arteriovenous fistulas or arterioportal fistulas (APF) are rare and mostly secondary to penetrating abdominal wounds. A rare case of APF presenting 2 years later a blunt abdominal trauma has been reported. On the basis of a review of the literature (65 cases) the etiology, clinical findings, diagnostical aspects and the results of conservative and surgical treatment have been analyzed.

[Medullary carcinoma of the breast. A review of the literature and a report of the authors' own cases]. / Carcinoma midollare della mammella. Revisione della letteratura e presentazione della casistica personale.

Experience with 5 cases of medullary carcinoma of the breast is reported. Reviewing the literature, medullary carcinoma appears to have a better prognosis than infiltrating ductal carcinoma so the proper surgical approach is represented by conservative procedures for lesions < 3 cm with no more than 3 nodes involved. Chemotherapy and radiotherapy don't seem to improve the survival rate.

[Crossectomy combined with sclerosis in the ambulatory treatment of varicose veins]. / Crossectomia associata a sclerosi nel trattamento ambulatoriale delle varici.

This paper focuses on the advantages of an outpatient technique in the treatment of the 1st various syndrome based on crossectomy and complementary sclerotherapy to eliminate the proximal reflux. In addition to the speed, low costs and total absence of discomfort for the patient, this method results in a low percentage of easily correctable failures provided the patients to be treated are carefully chosen. Selection involves a preoperative screening phase based on anamnesis, semeiological tests, Doppler and evaluation of tibial venous pressure, as well as careful topographical mapping of proximal refluxes which allow a correct postoperative follow-up in the event of possible recidivation (14.3% based on the authors' experience). The surgical technique used entails an accurate crossectomy with full exposure of the SF crosse (??) and its affluent branches, and subsequent sclerotherapy with atoxysclerol in a variable quantity and % as required. Of a total of 91 cases treated with a 3-year follow-up, 5 cases of recidivation were observed during the first year and 8 during the third. In both cases postoperative pressure values in the tibial veins were considerably higher than in other patients and recidivation occurred through perforating sclerosed recanalised vessels.

Physostigmine and metoclopramide in oesophageal peristaltic spread in man.

Simultaneous recordings of electrical and mechanical activities at different levels of the oesophagus were performed in normal men before and after physostigmine and metoclopramide injections. Various parameters of the basal oesophageal peristalsis were significantly modified following drug treatment. In particular, physostigmine injections induced a shortening of electromechanical coupling time and a reduction of the propagation velocities of the electrical and mechanical oesophageal events. Metoclopramide shortened the electromechanical coupling time but increased the electrical and mechanical propagation velocities along the oesophagus.

Motor responses of the esophagus and lower esophageal sphincter (LES) to vestibular stimulation in man.

Pressure recordings in the esophageal body, LES and stomach were performed in 10 healthy subjects before and after caloric stimulation of the labyrinth. While esophageal and stomach responses varied or were absent, all subjects showed variations at the LES level. Duration of LES relaxation was increased and both time and amplitude of LES augmentation were significantly reduced. The physiological mechanism of labyrinthine-digestive connections and the possibility of clinical applications are discussed.

[Thyroid metastasis of carcinoma of the breast. Considerations on 2 cases]. / Metastasi tiroidee da carcinoma della mammella. Considerazioni su due casi.

Two cases of thyroid metastasis from breast cancer are reported, both occurring in patients previously given radical mastectomies. It is emphasised that postoperative follow-up should also monitor rarely affected sites of metastasis from breast cancer.