Granuloma anular perforante: patologia inusual / Perforating Granuloma Annulare: unusual pathology

Resumen El Granuloma Anular (GA) es una dermatosis inflamatoria crónica, benigna, auto limitada, de etiología desconocida. Existen numerosas variantes clínicas dentro de las cuales se encuentra la perforante, de presentación inusual. La histopatología más característica de GA, cuenta con la presencia de histiocitos epitelioides en empalizada alrededor de áreas de degeneración focal de fibras de colágeno con depósitos de mucina. La variedad perforante evidencia eliminación transepidérmica de fibras de colágeno. Se presenta un paciente de 72 años de edad, diabético, dislipémico, con lesiones pruriginosas en dorso de ambas manos, con el diagnóstico de granuloma anular perforante. Realizó tratamiento con clobetasol tópico, más antihistamínicos por vía oral, quedando una cicatriz atrófica.

Abstract Granuloma annulare is a chronic, benign, self-limiting, inflammatory dermatosis of unknown etiology. There are numerous clinical variants within which is the perforating, unusual presentation. The most histopathology characteristic of GA is the presence of palisading epithelioid histiocytes around areas of focal degeneration of collagen with mucin deposits. The perforating variety evidences transepidermal elimination of collagen tissue. A 72 years-old, diabetes, dyslipidemic patient is presented with pruritic lessions on the dorsum of both hands, with the diagnosis of perforating granuloma annulare. I perform medical treatment with topical clobetasol, leaving an atrophic scar.

[Assessment of an educational intervention regarding blood cultures as process indicators in an emergency department in Argentina]. / Evaluación del impacto de una intervención educativa en indicadores de gestión de un servicio médico de urgencias de Argentina.

OBJECTIVE: The aim of this study was to describe 2 process indicators related to taking blood cultures (BC) in an Adult Emergency Department of a tertiary university hospital in Buenos Aires,and to describe the changes after a series of educational activities for health professionals was implemented during May 2016 as regards the appropriate indication of BC and the proper collection technique. MATERIALS AND METHODS: A retrospective cohort study was designed to assess its effectiveness, which consecutively included all patients admitted during 2015-2016. The BC request rate was used as a process indicator, and the percentage of contaminated BCs and the true positives rate were used as quality indicators. Both were measured monthly and prospectively during the period of study. RESULTS: The annual adjusted rate of BC requests was 4.9% (95% CI 4.8-5) in 2015 and 2.9% (95% CI 2.8-2.9) in 2016. The rate of false positive (contaminated) BCs was 4.5% in 2015 and 4.3% after the educational intervention. The true positive BCs were 8.3% in 2015 and 12% post-intervention. CONCLUSIONS: These findings prove how important and effective the educational interventions are.

Pathogenesis of Vesicular Stomatitis New Jersey Virus Infection in Deer Mice ( Peromyscus maniculatus) Transmitted by Black Flies ( Simulium vittatum).

The natural transmission of vesicular stomatitis New Jersey virus (VSNJV), an arthropod-borne virus, is not completely understood. Rodents may have a role as reservoir or amplifying hosts. In this study, juvenile and nestling deer mice ( Peromyscus maniculatus) were exposed to VSNJV-infected black fly ( Simulium vittatum) bites followed by a second exposure to naive black flies on the nestling mice. Severe neurological signs were observed in some juvenile mice by 6 to 8 days postinoculation (DPI); viremia was not detected in 25 juvenile deer mice following exposure to VSNJV-infected fly bites. Both juvenile and nestling mice had lesions and viral antigen in the central nervous system (CNS); in juveniles, their distribution suggested that the sensory pathway was the most likely route to the CNS. In contrast, a hematogenous route was probably involved in nestling mice, since all of these mice developed viremia and had widespread antigen distribution in the CNS and other tissues on 2 DPI. VSNJV was recovered from naive flies that fed on viremic nestling mice. This is the first report of viremia in a potential natural host following infection with VSNJV via insect bite and conversely of an insect becoming infected with VSNJV by feeding on a viremic host. These results, along with histopathology and immunohistochemistry, show that nestling mice have widespread dissemination of VSNJV following VSNJV-infected black fly bite and are a potential reservoir or amplifying host for VSNJV.

Surgical management of infected Thomas shunts.

Infected Thomas shunts pose a problem for the surgeon treating end-stage renal failure patients. Complete removal of the prosthesis with ligation of the femoral vessels may jeopardize the limb. Removal of the shunt without the Dacron patch usually will not eradicate the infection. The present article describes a two-stage approach in six patients with arterial bypass of the infected area and complete removal of the prosthesis. There were no postoperative complications. Arterial circulation was maintained, and all operative sites healed completely.

In vivo study of a new radioisotope-powered cardiac pacer.

A new radioisotopic pulse generator has been developed. It is 6 cm. long, 4.7 cm. high, 1.92 cm. wide, and weighs 61 Gm. (2 oz.). It is the smallest pulse generator made and has a life expectancy of over 20 years. The circuit is a conventional ventricular-inhibited (V.V.I.) type. In vitro testing has passed all Atomic Energy Commission requirements. The present study is concerned with in vivo testing of the complete pacemaker system, by means of both myocardial and endocranial electrodes, in 20 dogs with and without induced heart block. Extensive testing for electromagnetic compatability was carried out on 1 animal with induced heart block and a special, fast-rate pulse generator. Based on studies to date, the Atomic Energy Commission has issued a license for limited clinical trial which has already begun at the collaborating institutions.