Guía para la valoración médico-forense de la rodilla / Guideline for evaluation of the knee in forensic medicine

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Carcinoma basoescamoso mutilante en región facial / Facial mutilant basosquamous carcinoma

El carcinoma basoescamoso constituye una neoplasia epithelial maligna poco frecuente, que comparte características clínicas y biológicas con el carcinoma basocelular y espinocelular. Esta neoplasia ha sido considerada durante años una variedad de carcinoma basocelular, aunque en la actualidad se acepta plenamente su entidad propia. Presentamos el caso de un varón de 59 años de edad, indigente, que presentaba lesión tumoral ulcerada, de cuatro años de evolución, localizada en región malar izquierda, orbitaria y pirámide nasal, con importante destrucción de estas estructuras y extensión a la base del cráneo a través del nervio óptico. La importancia del carcinoma basoescamoso radica en su gran agresividad local, tendencia a la recidiva y capacidad de producir metástasis a distancia, por lo que el tratamiento más efectivo es la detección precoz y extirpación completa del mismo; hecho, que como ocurre en el caso que presentamos, no es siempre posible

Basosquamous carcinoma is a rare epithelial malignant neoplasm with clinical and biological features of both basal and squamous cell carcinoma. This neoplasm has been characterized for years as a variant of basal cell carcinoma, although now it is widely accepted as a clinical entity. We report a 59-year-old male patient, homeless, who presented an ulcerated tumoral lesion from four years ago, located in left malar region, orbit and nasal pyramid. It caused an important destruction of these anatomic structures and spred out the skull base through optic nerve. The most important features of basosquamous carcinoma are its great local aggressiveness, high frequency of recurrences and its metastatic potential. Because of that, the most effective therapeutic measure is the early detection and complete removement of these tumours; although, as the case we report, it is not always possible

[Allergic contact dermatitis to temporary henna tattoos]. / Dermatitis de contacto alérgica a tatuajes temporales de henna.

INTRODUCTION: In the last years there have been increasing reports of adverse cutaneous reactions to temporary black henna tattoos. Black henna does not exist naturally, it is obtained from original henna after the addition of other compounds, among them paraphenylenediamine (PPD), that darken it and facilitate the process of tattoing. Paraphenylenediamine is an aromatic compound that presents cross reactions with other components that have a benzene ring in their molecular structure. Many of these products may be present in the daily life of any person. MATERIAL AND METHODS: We reviewed patients that have shown erythema, inflammation and/or vesiculation in a previously tattooed area. The patients have undergone a temporary tattoo in street stalls during the summer period (2004-2005). A total of five patients were included, there were four men and one woman with a mean age of 13 years (3-34) and a mean latency period of 9.4 days (5-14). Black ink and plastic stencils were used to perform the tattoo. None of the patients has had previous contact with hair dyes or tattoos and none of them referred a personal history of atopic dermatitis. Patch testing was carried out using the standard set of the Spanish Group for Research in Contact Dermatitis [GEIDC] (TRUE TEST, Pharmacia. Hillerod. Denmark), with readings at 48 and 96 hours. RESULTS: Sensitization to PPD is confirmed in three patients, one of them was also sensitized to formaldehyde. Hypopigmented scars persist in three patients. CONCLUSIONS: Black henna pseudotattoos are a source of sensitization to PPD with potential severe consequences in a medium to long term. Currently there is no specific legislation with respect to the practice of this type of tattoos in our country.

Dermatitis de contacto alérgica a tatuajes temporales de henna / Allergic contact dermatitis to temporary henna tattoos

Introducción. Las comunicaciones de reacciones cutáneas adversas a tatuajes temporales por henna negra son cada vez más frecuentes en los últimos años. La henna negra no existe de forma natural; se obtiene a partir de la henna original añadiéndole otros compuestos que la oscurecen y facilitan el proceso de tatuaje, entre ellos la parafenilendiamina (PPD). La PPD es un compuesto aromático que presenta reacciones cruzadas con otros componentes con anillo bencénico en su estructura molecular. Muchos de estos productos pueden estar presentes en la vida cotidiana de cualquier persona. Material y métodos. Realizamos una revisión de pacientes que presentaran un cuadro de eritema, inflamación y/o vesiculación en la zona tatuada previamente. Los pacientes se habían realizado un tatuaje temporal en puestos callejeros durante el periodo estival (2004-2005). Se incluyeron un total de 5 pacientes, 4 varones/1 mujer, con una edad media de 13 años (3-34 años) y un periodo de latencia medio de 9,4 días (5-14 días). Para el tatuado usaron tinta de color negro y plantillas de material plástico. Ninguno de los pacientes había tenido contacto previo con tintes capilares ni tatuajes y tampoco refirieron antecedentes personales de dermatitis atópica. Se realizaron pruebas epicutáneas con la batería estándar del GEIDC (TRUE TEST® Pharmacia. Hillerod. Denmark), con lectura a las 48 y 96 horas. Resultados. Se confirma una sensibilización a la PPD en 3 pacientes, en uno de ellos también a formaldehído. En 3 pacientes persisten las cicatrices hipopigmentadas. Conclusiones. Los pseudotatuajes con henna negra son una fuente de sensibilización a PPD con consecuencias graves potenciales a medio-largo plazo. En la actualidad no existe ninguna ley que regule la práctica de este tipo de tatuajes en nuestro país (AU)

Introduction. In the last years there have been increasing reports of adverse cutaneous reactions to temporary black henna tattoos. Black henna does not exist naturally, it is obtained from original henna after the addition of other compounds, among them paraphenilendiamine (PPD), that darken it and facilitate the process of tattoing. Paraphenilendiamine is an aromatic compound that presents cross reactions with other components that have a benzene ring in their molecular structure. Many of these products may be present in the daily life of any person. Material and methods. We reviewed patients that have shown erythema, inflammation and/or vesiculation in a previously tattooed area. The patients have undergone a temporary tattoo in street stalls during the summer period (2004-2005). A total of five patients were included, there were four men and one woman with a mean age of 13 years (3-34) and a mean latency period of 9.4 days (5-14). Black ink and plastic stencils were used to perform the tattoo. None of the patients has had previous contact with hair dyes or tattoos and none of them referred a personal history of atopic dermatitis. Patch testing was carried out using the standard set of the Spanish Group for Research in Contact Dermatitis [GEIDC] (TRUE TEST ®, Pharmacia. Hillerod. Denmark), with readings at 48 and 96 hours. Results. Sensitization to PPD is confirmed in three patients, one of them was also sensitized to formaldehyde. Hypopigmented scars persist in three patients. Conclusions. Black henna pseudotattoos are a source of sensitization to PPD with potential severe consequences in a medium to long term. Currently there is no specific legislation with respect to the practice of this type of tattoos in our country (AU)

[Facial mutilant basosquamous carcinoma]. / Carcinoma basoescamoso mutilante en región facial.

Basosquamous carcinoma is a rare epithelial malignant neoplasm with clinical and biological features of both basal and squamous cell carcinoma. This neoplasm has been characterized for years as a variant of basal cell carcinoma, although now it is widely accepted as a clinical entity. We report a 59-year-old male patient, homeless, who presented an ulcerated tumoral lesion from four years ago, located in left malar region, orbit and nasal pyramid. It caused an important destruction of these anatomic structures and spred out the skull base through optic nerve. The most important features of basosquamous carcinoma are its great local aggressiveness, high frequency of recurrences and its metastatic potential. Because of that, the most effective therapeutic measure is the early detection and complete removement of these tumours; although, as the case we report, it is not always possible.

Responsabilidad por malpraxis médica: la via extrajudicial / Medical responsibillity for malpraxis: the extrajuclicial channel

En este trabajo se hace un estudio crítico de la respuesta a la responsabilidad por malpraxis médica por vía extrajudicial. Se consideran en principio algunos de los problemas que tiene la vía judicial ordinaria, que pueden aconsejar otros métodos, que en ningún caso la excluyen, y el estado de la cuestión en diversos países, que han sido pioneros en la implantación de estos sistemas extrajudiciales, prestando atención especial a los de la Unión Europea y Estados Unidos.Se examinan después estos procedimientos en nuestro país, con especial atención a la mediación, conciliación y arbitraje, haciendo un estudio conceptual y valoración de las ventajas e inconvenientes de su aplicación en la práctica, y finalmente una crítica de los mismos (AU)

Infantile cutaneous rhabdomyosarcoma (Li-Fraumeni syndrome): cytological presentation of fine-needle aspirate biopsy, report of a case.

We describe the cytopathological picture of a cutaneous rhabdomyosarcoma located in the left nasal furrow of a 4-mo-old girl, some of whose close relatives have died or suffered from different types of neoplasias (Li-Fraumeni syndrome). We believe that the cytological picture is highly characteristic and rules out other round cell tumours of childhood. We underline the usefulness of FNAC in dermatology and strongly advocate the introduction of this technique into the diagnostic armoury of every dermatologist.

[Oropharyngeal pemphigus vulgaris]. / Penfigo vulgar orofaringeo.

Etiologic and pathogenic as well the Pemphigus vulgaris is an autoimmune disease, being its symptomatology polysystemic. Accordingly, under the diagnostic viewpoint, must be considered as a multidisciplinary illness. Either the evolutive course, the differential diagnosis or the treatment emphasizes the importance of the attendance of these patients ambulatory or hospitalized. An exclusively ENT case of pemphigus vulgaris seen by the AA. compelled them to a perusal of the bibliography of the subject, in order to update the problems of diagnosis and treatment of the disease.

Fine needle aspiration cytology of cutaneous vascular tumours.

We have studied 12 cutaneous vascular tumours by means of fine-needle aspiration cytology (FNAC): six capillary haemangiomas, one cavernous haemangioma, one Masson's pseudo-angiosarcoma, two angiosarcomas, one benign haemangioendothelioma and one glomus tumour. We describe the main cytopathological findings and we discuss the differential diagnosis in each case. We consider that the cytopathological findings of the above lesions, evaluated in the context of the clinical findings, are sufficiently characteristic for us to be able to make a definitive diagnosis. We believe that FNAC can play an important part in the diagnosis and therapeutic planning of these tumours.

Diagnosis of cutaneous leishmaniasis by fine needle aspiration cytology. Report of a case.

A case of cutaneous leishmaniasis diagnosed by means of fine needle aspiration (FNA) cytology is presented. The pathognomonic cytopathologic picture consisted of lymphocytes, plasma cells and epithelioid granulomas intermingled with histiocytes. Numerous Leishmania organisms were observed within the histiocytes and extracellularly. This case emphasizes the utility of FNA cytology in diagnosing lesions of the skin.

Melanocytic carcinogenesis in albino guinea pigs.

We describe an experimental model for the induction of cutaneous melanomas in albino guinea pigs by means of repeated topical application of 7,12-dimethyl-benzanthracene over 13 consecutive months. At the end of the experiment 87.5% of the animals presented multiple lesions of a melanocytic nature. The most frequent and the earliest detected was melanocytic hyperplasia, followed by dysplasia. These lesions occurred in 75% of animals and were observed from the 4th month onward. Nevus-type lesions appeared from the 12th month and affected 70% of animals, whilst melanomas occurred in 65%. Metastases were observed in 45% of animals, in lungs, lymph nodes, kidney, and adrenal gland.

[Molluscum contagiosum. Clinicopathologic and ultrastructural study]. / Molluscum contagiosum. Estudio clinicopatológico y ultraestructural.

26 usually multiple Molluscum contagiosum (MC) lesions corresponding to 14 patients (x age, 12 years old) mainly located in face and body, and unfrequently in genital area, were studied. Under light microscopy, we emphasize the presence of molluscum bodies corresponding ultrastructurally to large bodies of viral particles within a protein matrix. Intranuclear inclusions of suspected viral origin were noted too. Lesions previously embedded in paraffin showed a perfect preservation of their viral particles.

[Dermatophytoses in the Murcia region. Changes in the frequency of isolations in the last 22 years]. / Estudio de las dermatofitosis en la región de Murcia. Cambios en la frecuencia de los aislamientos en los últimos veintidós años.

Different clinical forms of dermatophyte infections were studied in 136 patients, T. mentagrophytes being the most frequently isolated species. Our results are similar to those of other authors of South-Eastern Spain, though differing from those in more distant, parts of the country. In our area, the rabbit is considered the most important dermatophytic animal reservoir.