Adolescence Pseudolymphoma / Pseudolinfoma na adolescência

Objective: report an uncommon case of cutaneous pseudolymphoma in teenage years, undiagnosed for approximately 8 years old. Methodology: data were taken from medical records, patient interviews, photographic records of the injuries, diagnostic methods, and literature review. The paper was subjected and approved by the Research Ethics Committee (REC), under the number 4.952.193, authorized by the patient and their legal sponsor. Final Conclusions: the related case shows the importance of reliable and differential diagnoses since the patient carried the injury through approximately eight years without getting any diagnosis and/or treatment. Furthermore, the unusual age and the location of the injuries make the information presented here fundamental to helping other professionals and contributing to the Public Health System (AU).

Objetivo: Relatar um caso incomum de Pseudolinfoma Cutâneo na adolescência, não diagnosticado por aproximadamente oito anos. Método: As informações foram obtidas pela revisão do prontuário, entrevista com o paciente, registro fotográfico das lesões e dos métodos diagnósticos e revisão de literatura. O trabalho foi submetido e aprovado pelo Comitê de Ética em Pesquisa (CEP), número de aprovação 4.952.193, com autorização do paciente e seus responsáveis legais. Considerações Finais: o caso relatado evidencia a importância de um diagnóstico fidedigno e dos diagnósticos diferenciais, uma vez que a paciente apresentou a lesão por aproximadamente oito anos, sem receber nenhum diagnóstico e/ou tratamento. Além disso, não só a faixa etária é incomum, mas também a localização da lesão e por esta razão, as informações são fundamentais para auxiliar outros profissionais, com benefício deste estudo para o Sistema de Saúde (AU).

Low-fluence and low-density CO2 laser: histological analysis of collagen fiber changes in skin and its clinical repercussions in photorejuvenation.

This study refers to clinical and histologic analysis of effects on photorejuvenation after one single treatment of fractional CO2 laser with low fluence and low density. To analyze histologically the quantitative variation of collagen fibers type I and III, elastic fibers, and epidermal thickness on D84, besides clinical evaluation of amount, length, thickness, and depth of periocular wrinkles during the same period. This is an open, prospective, interventional study. There were 40 healthy female with age between 35 and 65 years. Twenty-six participants were randomly selected for D0 and D84 biopsy. A single session of fractional CO2 laser was done in the hole face, using a 800-µm tip, 5% density, and 10 mJ fluence with a single pass. On D0, D42, and D84, a clinical comparative analysis of amount, length, depth, and thickness of periocular wrinkles has been done. On histological analysis, a comparative quantitative evaluation of collagen fibers type I and III, elastic fibers, and epidermal thickness has been done on D0 and D84. The results of this study denoted a significant clinical improvement of amount (- 32.17%; p < 0.0001), thickness (- 33%; p < 0.0001), lenght (- 35.84%; p < 0.0001), and depth of periocular wrinkles (- 32.46%; p < 0.0001). A significant increase in the amount of collagen fibers type III was observed on D84 (+ 60.67%; p = 0.0013). Collagen fibers type I and elastic fibers did not have the same result, with a nonsignificant increase (+ 8.31%; p = 0.3820) and a decrease (- 12.4%; p = 0.0585) respectively. Epidermal thickness has a tendency to significant variation (p = 0.05553). The results demonstrate that fractional CO2 laser with low fluence and low density is a safe and efficient option for photorejuvenation of the face.

Tratamento de necrobiose lipoídica no antebraço esquerdo com associação entre luz intensa pulsada e laser Erbium-YAG 2940nm / Treatment of Necrobiosis Lipoidica in the left forearm with association of Intense Pulsed Light and Erbium-Yag Laser 2940nm

A necrobiose lipoídica (NL) é uma dermatose granulomatosa, que acomete principalmente diabéticos devido à degeneração do colágeno. Embora existam diferentes tratamentos, todos apresentam pouca resposta. Dentre as opções, a luz intensa pulsada (LIP) e o laser Erbium-YAG permitem aumentar a produção e remodelamento do colágeno tratando a atrofia, além de diminuir o eritema pela coagulação de vasos sanguíneos. Relata-se caso de mulher, 24 anos, com diabetes mellitus tipo I, submetida a tratamento de NL no antebraço esquerdo em sete sessões com a associação entre LIP e laser Erbium-YAG 2940nm. Observou-se melhora da atrofia central e do eritema.

Necrobiosis Lipoidica (NL) is a granulomatous dermatosis, mainly affecting people with diabetes due to collagen degeneration. Although there are different treatments, all have little response. Among the options, the Intense Pulsed Light (IPL) and the Laser Erbium-YAG enhance the production and remodeling of the collagen treating the atrophy, besides reducing the erythema by the coagulation of blood vessels. We report a case of a 24-year-old woman with type I Diabetes Mellitus who underwent NL treatment on her left forearm in seven sessions with the association of IPL and 2940 nm Erbium-YAG laser. We observed improvement in central atrophy and erythema

Associação de luz intensa pulsada e laser Erbium: Yag 2940nm para tratamento de lentigo na face / Association of intense pulsed light and Erbium: Yag 2940 nm laser for treatment of lentigo on the face

O lentigo solar está presente em 90% da população com mais de 50 anos de idade, apresentando-se como manchas hipercrômicas em regiões fotoexpostas, que aumentam com o envelhecimento e são mais frequentes em peles claras. Há diversas modalidades terapêuticas com melhores resultados quando associadas. Descrevemos o caso de um homem de 62 anos, fototipo II de Fitzpatrick, com queixa de máculas acastanhadas em dorso nasal há oito anos. Foi submetido à biópsia de pele, e o estudo histológico confirmou ser lentigo solar. O paciente foi tratado com seis sessões de luz intensa pulsada associada a laser de Erbium: YAG 2940nm, com bom resultado clínico

Solar lentigo is present in 90% of the population over 50 years of age andcharacterizes as hyperchromic spots in photoexposed regions. It increases with aging and is more frequent in light skin. There are several therapeutic modalities, which achieve better results whenassociated. We describe the case of a 62-year-old man with Fitzpatrick skinphototype II, complaining of brownish macules in nasal dorsum for eight years. The patient underwent a skin biopsy, and the histological study confirmed solar lentigo. The patient was treated with six sessions of Intense Pulsed Light associated with Erbium-Yag2940 nm Laser with a good clinical result

O papel do uso de tecnologias combinadas na abordagem de uma paciente com microstomia / The role of the use of combined technologies in the approach to a patient with microstomia

A microstomia ocorre em 70% dos pacientes com esclerose sistêmica e há poucas opções terapêuticas. Descrevemos caso de mulher de 39 anos com diagnóstico de esclerose sistêmica em 2010, em uso de micofenolato de mofetil e rituximabe, apresentando microstomia. Foram realizadas duas sessões de luz intensa pulsada e sete sessões de laser fracionado ablativo Erbium:YAG de 2940nm, com resposta clínica importante. A formação e reorganização de fibras colágenas e elásticas foram responsáveis pela melhora da microstomia. Há poucos estudos com o uso de tecnologias para a abordagem da microstomia. Este é o primeiro com Er:YAG 2940nm para esta finalidade

Facial surgeries are often challenging for surgeons due to their complex anatomy, aesthetic and functional importance. Interventions in the cosmetic subunit that comprises the eyebrows can be particularly difficult. This case report aims to demonstrate the use of island flap in this region. We performed the excision of melanocytic nevus, with a good outcome and absence of postoperative complications. This technique is commonly used for facial reconstruction; however, the literature describes only a few cases using this method for eyebrow reconstruction.

Estudo comparativo do laser fracionado não ablativo 1340nm para rejuvenescimento facial: alta energia com passagem única versus energia média e passagem tripla / Comparative study of 1340nm non-ablative fractional laser for facial rejuvenation: single pass at high energy versus three passes at medium energy

Introdução: Atualmente há crescente procura de tratamentos não invasivos para o envelhecimento facial. Os lasers fracionados não ablativos promovem excelentes resultados, com efeitos colaterais reduzidos. Objetivos: Avaliar o rejuvenescimento facial, utilizando-se o lasers fracionados não ablativos 1340nm em alta energia com passagem única e em média energia com passagem tripla, mediante estudo prospectivo e comparativo. Métodos: 20 pacientes com envelhecimento facial foram tratadas com duas ou três sessões do laser a cada quatro semanas: a hemiface direita com lasers fracionados não ablativos 1340nm com fluência 90mJ, duração de pulso 5', 100mtz/cm2, três passadas; a esquerda com fluência 120mJ, duração de pulso 5', 100mtz/cm2 e passada única. As variáveis avaliadas foram manchas, rugas, porfirinas e aparência global. Resultados: As pacientes (n = 20) foram avaliadas a intervalos de seis a 24 meses. As análises fotográficas demonstraram melhora significativa das manchas no lado direito e das rugas de ambos os lados. Das 20 pacientes 18 apresentaram satisfação com o tratamento. Conclusão: O lasers fracionados não ablativos 1340nm demostrou-se alternativa atual, segura e eficaz para o rejuvenescimento facial. Para as manchas, o protocolo de energia média e passagem tripla demonstrou resposta superior. Nas rugas, entretanto, não houve diferença entre energia alta com passagem única e média com passagem tripla.

Introduction: Currently there is a growing demand for non-invasive therapies aimed at treating facial aging. Non-ablative fractional lasers lead to excellent outcomes, with reduced side effects. Objective: To evaluate the facial rejuvenation achieved by 1,340nm non-ablative fractional laser using a single pass at high energy versus three passes at medium energy, through a prospective comparative study. Methods: Twenty patients with facial aging were treated with 2 or 3 laser sessions with 4-week intervals. The right hemiface was treated with three passes of 1,340nm non-ablative fractional laser at a fluence of 90 mJ, pulse duration of 5ms and 100 mtz/ cm2. The left hemiface was treated with a single pass of the same laser at a fluence of 120 mJ, pulse duration of 5ms and 100 mtz/cm2. The evaluated variables were spots, wrinkles, porphyrins and overall appearance. Results: The patients (n = 20) were evaluated during 6 to 24 months. The photographic evaluations demonstrated a significant improvement of the spots on the right hand side and wrinkles on the right and left hand sides. Eighteen of the 20 patients reported satisfaction with the treatment. Conclusion: 1,340nm non-ablative fractional laser was proven as a modern, safe and effective alternative for facial rejuvenation. For spots, the triple passes at medium energy protocol led to a superior response. However, regarding wrinkles there was no difference between the single pass at high energy and triple pass at medium energy protocols.

Protective Effects of Ellagic Acid on Cardiovascular Injuries Caused by Hypertension in Rats.

Ellagic acid is described as having antioxidant and antiproliferative properties. Hence, it was hypothesized that ellagic acid could improve cardiovascular damage caused by hypertension. In this work, hypertension was induced in rats with Nω-Nitro-L-arginine methyl ester hydrochloride (60 mg/kg/day in drinking water) for 6 weeks. Ellagic acid was coadministered (10 or 30 mg/kg/day by gavage) between the second and sixth week. Blood pressure was recorded every week by tail-cuff plethysmography. After 6 weeks, the rats were sacrificed, the hearts and kidneys were weighed, and blood was collected. Aortas were isolated and set up to isometric recordings in an organ bath for histological assay and measuring of calcium content. Hypertension (233.6 ± 9.5 mmHg) was reduced (p < 0.01) by treatment with ellagic acid 10 or 30 mg/kg. The blood levels of nitrate/nitrite were reduced in hypertensive rats and the ellagic acid restored these levels. While the vascular relaxations to acetylcholine and sodium nitoprusside and the contraction to phenylephrine were impaired in the hypertensive group, they were improved after ellagic acid treatment. The alkaline phosphatase activity was increased by hypertension and returned to control levels after ellagic acid treatment. In the aorta, the administration of ellagic acid resulted in less aortic wall thickening and less calcification. In conclusion, ellagic acid attenuates hypertension, possibly improving nitric oxide bioavailability. The vascular response to acetylcholine, sodium nitroprusside, and phenylephrine was impaired by hypertension and improved after treatment with ellagic acid. Moreover, plasmatic alkaline phosphatase activity, calcium content, and hypertrophy in vascular tissues during hypertension were attenuated by treatment with ellagic acid.

Radical Scavenger Capacity of Jabuticaba Fruit (Myrciaria cauliflora) and Its Biological Effects in Hypertensive Rats.

Jabuticaba is an exotic fruit native to Brazil that has been arousing medicinal interest. Using chemical (HPLC-PDA, resonance mass spectra, and NMR), electroanalytical (differential pulse voltammetry, radical scavenging assay), and pharmacological (in vivo and in vitro) approaches, we have identified its bioactive compounds and hypotensive effects on hypertensive rats. The hydroalcoholic extract of jabuticaba (HEJ) presents a great quantity of phenolic compounds, and several molecules with hydroxyl groups present high efficiency as an antioxidant. The treatment with HEJ (100 and 300 mg/kg/day, for four weeks) presented hypotensive effects on L-NAME-induced hypertensive rats, possibly improving the nitric oxide bioavailability because of its high antioxidant potential. Furthermore, renal and cardiac hypertrophies were also attenuated after the HEJ treatment. Moreover, the vascular responses to contractile and dilating agonists were improved with the HEJ treatment, which is also able to induce nitric oxide production in endothelial cells.

Mixed-stock analysis in green turtles Chelonia mydas: mtDNA decipher current connections among west Atlantic populations.

The green turtle Chelonia mydas undertakes wide-ranging migrations between feeding and nesting sites, resulting in mixing and isolation of genetic stocks. We used mtDNA control region to characterize the genetic composition, population structure, and natal origins of C. mydas in the West Atlantic Ocean, at one feeding ground (State of Rio de Janeiro, Brazil), and three Caribbean nesting grounds (French Guiana, Guadeloupe, and Suriname). The feeding ground presented considerable frequency of common haplotypes from the South Atlantic, whereas the nesting sites presented a major contribution of the most common haplotype from the Caribbean. MSA revealed multiple origins of individuals at the feeding ground, notably from Ascension Island, Guinea Bissau, and French Guiana. This study enables a better understanding of the dispersion patterns and highlights the importance of connecting both nesting and feeding areas. Effective conservation initiatives need to encompass these ecologically and geographically distinct sites as well as those corridors connecting them.

Green turtle (Chelonia mydas) genetic diversity at Paranaguá Estuarine Complex feeding grounds in Brazil.

Sea turtles are marine reptiles that undertake long migrations through their life, with limited information regarding juvenile stages. Feeding grounds (FGs), where they spend most of their lives, are composed by individuals from different natal origins, known as mixed stock populations. The aim of this study was to assess genetic composition, natal origins and demographic history of juvenile green turtles (Chelonia mydas) at the Paranaguá Estuarine Complex (PEC), Brazil, considered a Natural World Heritage site. Tissue samples of stranded animals were collected (n = 60), and 700 bp mitochondrial DNA sequences were generated and compared to shorter sequences from previously published studies. Global exact tests of differentiation revealed significant differences among PEC and the other FGs, except those at the South Atlantic Ocean. Green turtles at PEC present genetic signatures similar to those of nesting females from Ascension Island, Guinea Bissau and Aves Island/Surinam. Population expansion was evidenced to have occurred 20-25 kYA, reinforcing the hypothesis of recovery from Southern Atlantic refugia after the last Glacial Maximum. These results contribute to a better understanding of the dynamics of green turtle populations at a protected area by providing knowledge on the dispersion patterns and reinforcing the importance of the interconnectivity between nesting and foraging populations.

Photodynamic therapy in actinic cheilitis: clinical and anatomopathological evaluation of 19 patients.

BACKGROUND: Actinic cheilitis, a common disease caused by chronic solar exposure and tobacco use, is considered a premalignant lesion with potential to develop into squamous cell carcinoma. Some of the available treatments are invasive, have unaesthetic results and require multiple sessions. OBJECTIVE: To assess the efficacy of a therapy and its cosmetic results. METHODS: In this uncontrolled clinical trial a single photodynamic therapy (PDT) session using 16% methyl-aminolevulinate was performed on actinic cheilitis of the lower lip. A standardized questionnaire was applied in order to assess the clinical improvement from the patients' point of view and the satisfaction with the treatment. Anatomopathological evaluation was performed before the treatment and two months afterwards. RESULTS: The sample was composed of 19 patients (10 males and 9 females), phototypes I to III, with average age of 62 years. Main adverse effects were: sudden pain, scabs, herpes flare-up, and edema. The average score of pain during the procedure was 5,8+2,9. At the final assessment the patients reported improvement of 80% and satisfaction of 85% (p<0.01). Anatomopathological analysis showed a significant decrease of dysplasia (p=0.03) in spite of its presence in 84% of cases. There was no significant correlation between the level of dysplasia with either the subjective impression of clinical improvement (p=0.82) or with the patients' final satisfaction (p=0.96). CONCLUSION: PDT is effective in the treatment of actinic cheilitis, but it is associated with a significant level of pain. Due to the persistence of dysplasia, more research needs to be done in order to define the ideal number of sessions for the effective treatment of these lesions.

Photodynamic therapy in actinic cheilitis: clinical and anatomopathological evaluation of 19 patients / Tratamento de queilite actínica com terapia fotodinâmica: avaliação clínica e anatomopatológica de 19 pacientes

BACKGROUND: Actinic cheilitis, a common disease caused by chronic solar exposure and tobacco use, is considered a premalignant lesion with potential to develop into squamous cell carcinoma. Some of the available treatments are invasive, have unaesthetic results and require multiple sessions. OBJECTIVE: To assess the efficacy of a therapy and its cosmetic results. METHODS: In this uncontrolled clinical trial a single photodynamic therapy (PDT) session using 16% methyl-aminolevulinate was performed on actinic cheilitis of the lower lip. A standardized questionnaire was applied in order to assess the clinical improvement from the patients' point of view and the satisfaction with the treatment. Anatomopathological evaluation was performed before the treatment and two months afterwards. RESULTS: The sample was composed of 19 patients (10 males and 9 females), phototypes I to III, with average age of 62 years. Main adverse effects were: sudden pain, scabs, herpes flare-up, and edema. The average score of pain during the procedure was 5,8+2,9. At the final assessment the patients reported improvement of 80% and satisfaction of 85% (p<0.01). Anatomopathological analysis showed a significant decrease of dysplasia (p=0.03) in spite of its presence in 84% of cases. There was no significant correlation between the level of dysplasia with either the subjective impression of clinical improvement (p=0.82) or with the patients' final satisfaction (p=0.96). CONCLUSION: PDT is effective in the treatment of actinic cheilitis, but it is associated with a significant level of pain. Due to the persistence of dysplasia, more research needs to be done in order to define the ideal number of sessions for the effective treatment of these lesions.

FUNDAMENTOS: Queilite actínica, afecção causada por exposição solar crônica e tabagismo, é considerada lesão pré-maligna com possibilidade de transformação para carcinoma espinocelular. Alguns tratamentos descritos são invasivos, têm resultados inestéticos e requerem múltiplas aplicações. OBJETIVO: Verificar o uso de tratamento efetivo com resultado esteticamente aceitável. MÉTODOS: Ensaio clínico não controlado, utilizando terapia fotodinâmica com cloridrato de aminolevulinato de metila creme 16%, única aplicação, na queilite actínica de lábio inferior. Aplicação de questionário padronizado para avaliar melhora clínica da lesão subjetiva do paciente e satisfação com tratamento. Avaliação anatomopatológica antes da aplicação e dois meses após. RESULTADOS: Amostra compreendeu 19 pacientes (10 homens e 9 mulheres), fototipos I a IH, idade média 62 anos. Principais efeitos adversos: dor imediata, crostas, herpes labial e edema. Escore médio de dor referida durante o procedimento foi 5,8±2,9. Na avaliação final, os pacientes referiram melhora de 80% das lesões e apresentaram mediana de 85% de satisfação (p<0,01). Análise anatomopatológica mostrou diminuição significativa de displasia (p=0,03), apesar da persistência em 84% dos casos. Não houve correlação significativa da redução no grau de displasia com impressão subjetiva de melhora clínica (p=0,82) ou com satisfação final do paciente (p=0,96). CONCLUSÃO: TFD é efetiva no tratamento da queilite actínica, porém associada a grau significativo de dor. Devido à persistência de displasia, mais estudos são necessários para definir o número ideal de aplicações para tratamento efetivo destas lesões.

Porphyria cutanea tarda and systemic lupus erythematosus.

The co-existence of systemic lupus erythematosus and porphyria although rare has been known for a long time. This association forces the physician to make a careful differential diagnosis of the bullous lesions that might appear in such patients and to be careful when prescribing certain drugs such as chloroquine. This drug, when used in the regular doses for treating lupus, may cause hepatotoxicity in patients.suffering from porphyria. It is described here the case of a patient with lupus who developed bullous lesions compatible with porphyria cutanea tarda.

Porfiria cutânea tarda e lúpus eritematoso sistêmico / Porphyria cutanea tarda and systemic lupus erythematosus

A associação de lúpus eritematoso sistêmico e porfiria, embora rara, é conhecida de longa data. Ela obriga o médico a realizar um cuidadoso diagnóstico diferencial das lesões bolhosas nesses pacientes e tomar cuidados com a prescrição de certas drogas, como a cloroquina. Esta, nas doses habituais para tratamento do lúpus, pode causar hepatotoxicidade em pacientes com porfiria. Descreve-se o caso de uma paciente com lúpus que desenvolveu lesões bolhosas compatíveis com porfiria cutânea tardia.

The co-existence of systemic lupus erythematosus and porphyria although rare has been known for a long time. This association forces the physician to make a careful differential diagnosis of the bullous lesions that might appear in such patients and to be careful when prescribing certain drugs such as chloroquine. This drug, when used in the regular doses for treating lupus, may cause hepatotoxicity in patients.suffering from porphyria. It is described here the case of a patient with lupus who developed bullous lesions compatible with porphyria cutanea tarda.

Antimalarial cutaneous side effects: a study in 209 users.

BACKGROUND: Antimalarial agents are commonly used drugs that may have skin side effects. OBJECTIVE: To study the prevalence of cutaneous side effects in antimalarial users. METHODS: We studied the prevalence of cutaneous manifestations in 209 antimalarial users, 127 with systemic lupus erythematosus (SLE) and 82 with rheumatoid arthritis (RA). As control we included 200 patients from the gynecologic and ophthalmologic departments who did not have antimalarial use. Patients were submitted to a structured questionnaire for demographic data, type of antimalarial drug used, and treatment time as well as skin complaints. Physical examination was performed by a dermatologist. RESULTS: In 159 of 209 (76%) of the antimalarial users, there were cutaneous findings. The most frequent was xerosis, followed by skin hyperpigmentation and pruritus. In 4.8% of the antimalarial users, allergic reactions led to drug withdrawal. When comparing them with the control group, skin hyperpigmentation and xerosis were more prevalent (p < .0001 for both), but pruritus was not (p = .39). No relationship could be found between the skin side effects and ethnic background, gender, antimalarial type, or treatment duration. Hair depigmentation was more common in SLE patients than in RA patients. CONCLUSION: Cutaneous side effects in antimalarial users are frequent. Xerosis and hyperpigmentation are the most common findings.

Telangiectasia nevoide unilateral adquirida em homem hígido / Acquired unilateral nevoid telangiectasia in a healthy men

A Telangiectasia Nevoide Unilateral é uma dermatose vascular rara, caracterizada por áreas de telangiectasia superficial, em uma distribuição linear unilateral, descrita, em 1899, por Zeisler e Blaschko. Diversas teorias foram desenvolvidas para explicar sua etiopatogenia, sendo a provável (e a mais fundamentada) a relação com elevação dos níveis de estrogênio. Há duas formas: a congênita e a adquirida. Esta, geralmente, se relaciona a hepatopatias, em pacientes do sexo masculino. Em homens hígidos, a ocorrência da forma adquirida é rara, com poucos relatos na literatura, sendo sua causa desconhecida. Este trabalho tem como objetivo relatar um caso de telangiectasia nevoide unilateral adquirida em homem jovem, sem comorbidades, alterações clínicas e/ou laboratoriais sugestivas de hiperestrogenismo.

Unilateral nevoid telangiectasia is a rare vascular dermatosis, characterized by areas of superficial telangiectases distributed in a linear unilateral pattern. It was described in 1899 by Zeisler and Blascko. Several theories where developed in order to explain its etiopathogenesis. The most widely accepted is the one which establishes its probable association with an increase in the estrogen levels. There are two types: congenital and acquired. The latter is associated with hepatopathies in male patients. The acquired form is rarely observed in healthy men, with a few cases reported in the medical literature, and its etiology is unknown. This study reports the case of a healthy young man with acquired unilateral nevoid telangiectasia, without any comorbidities, clinical and /or laboratory findings indicative of hyperestrogenism.

Acquired unilateral nevoid telangiectasia in a healthy men.

Unilateral nevoid telangiectasia is a rare vascular dermatosis, characterized by areas of superficial telangiectases distributed in a linear unilateral pattern. It was described in 1899 by Zeisler and Blascko. Several theories where developed in order to explain its etiopathogenesis. The most widely accepted is the one which establishes its probable association with an increase in the estrogen levels. There are two types: congenital and acquired. The latter is associated with hepatopathies in male patients. The acquired form is rarely observed in healthy men, with a few cases reported in the medical literature, and its etiology is unknown. This study reports the case of a healthy young man with acquired unilateral nevoid telangiectasia, without any comorbidities, clinical and /or laboratory findings indicative of hyperestrogenism.

Reação hansênica: estudo clínico, epidemiológico e terap~eutico de 27 casos / Hansenic reaction: clinical, epidemiological and therapeutic study of 27 cases

Introdução: reações hansênicas são reações do sistema imunológico do portador de hanseníase ao Mycobacterium leprae. Apresentam-se através de episódios inflamatórios agudos e subagudos que podem ocorrer antes, durante ou após tratamento específico tanto em paucibacilares quanto multibacilares. Sendo a principal causa de morbidade, seu diagnóstico e tratamento precoces assumem grande importância. Objetivo: análise clínica, epidemiológica e terapêutica de 27 casos de reação hansênica. Material e métodos: foram avaliados 78 pacientes com hanseníase no período de 1991-2004. Foram classificados quanto à forma clínica e, na presença de reação, em tipos Ie II. Todos os pacientes foram tratados com a poliquimioterapia segundo a Organização Mundial de Saúde. Resultados: cinte e sete pacientes desenvolveram reações na maioria tipo II e nos primeiros seis meses de tratamento. Os multibacilares foram mais acometidos. Conclusão: apesar da poliquimioterapia atual, a prevalência de reações hansênicas mantém-se elevada, levando-nos a questionar a eficácia dessa terapia na prevenção dessas complicações.

Correlação entre a velocidade de hemossedimentação e o índice de massa corporal / Relationship between erythrocyte sedimentation rate and body mass index

A velocidade de hemossedimentação (VHS) é solicitada com muita freqüência pelos clínicos. Um problema comum na prática é o achado de um resultado alterado em pacientes com queixas inespecíficas. Objetivo: Demonstrar a correlação da VHS com as subclasses de índice de massa corporal (IMC), sexo e idade. Métodos: Foram coletadas 335 amostras de sangue de pessoas saudáveis entre janeiro e abril de 2004. Foram anotados idade, peso e altura, sendo excluídos portadores de doenças inflamatórias, neoplasias, entre outras. As amostras foram processadas pela técnica de Westergreen. Os pacientes foram classifi cados de acordo com IMC em quatro grupos: magros (IMC ≤ 20), eutrófi cos (21 ≤ IMC ≤25), sobrepeso (26 ≤IMC ≤30) e obesos (IMC ≥ 31). Os resultados foram analisados estatisticamente pelos coeficientes de Spearman, tabelas de freqüência e contingência e análise multivariada, sendo o nível de significância de 5%. Resultados: A média da idade foi de 40,5 anos. Nesta amostra, 53,57% eram do sexo feminino. Dos pacientes avaliados, 6,85% eram magros, 42,26% eutrófi cos, 31,25% com sobrepeso e 19,64% obesos. Correlacionando-se a VHS com IMC, em todas as classes prevaleceu VHS normal, porém nos obesos, 43,94% tiveram sua VHS aumentada (p = 0,00497). Ao se estudar a variabilidade da VHS, de acordo com a idade, sexo e IMC por regressão multivariada, encontrou-se que as variáveis atuam independentemente, sendo a correlação entre IMC e VHS de 0,0119. Conclusão: Pode-se estabelecer correlação positiva entre a VHS e o IMC, além de sexo e idade

Associação entre vitiligo e doenças auto-imunes: prevalência no Serviço de Dermatologia do Hospital Universitário Evangélico de Curitiba / Association between vitiligo and auto-immune illnesses: prevalency in the Dermatology Service of the Hospital Universitário Evangélico de Curitiba

Objetivo: Analisar os portadores de vitiligo acompanhados no Serviço de Dermatologia do Hospital Universitário Evangélico de Curitiba quanto à prevalência de doenças auto-imunes. Materiais e Métodos: Realizou-se estudo retrospectivo no qual foram analisados os prontuários de 93 pacientes com diagnóstico de vitiligo. A partir dos dados obtidos, foi preenchido protocolo no qual constava: dados pessoais, história de doença auto-imune associada e a idade de seu diagnóstico, testes laboratoriais (TSH, T4 livre, FAN e glicemia de jejum), história familiar de vitiligo e de doenças auto-imunes. Os resultados foram analisados, estatisticamente, por estudo de freqüência. Resultados: Entre os 93 prontuários analisados encontraram-se 65,59% mulheres, sendo a média de idade ao diagnóstico de vitiligo de 23,1±18,05.Cerca de 7,52% dos pacientes apresentavam história familiar de vitiligo. 12,90% dos indivíduos apresentavam alguma patologia auto-imune. A mais prevalente foi a tireoidite de Hashimoto (n=5), seguida do lúpus eritematoso sistêmico (n=3). Entre os pacientes com patologia autoimune apenas 3 apresentavam história familiar de doençaauto-imune. Relacionando-se a idade de aparecimento do vitiligo com a idade do diagnóstico da doença auto-imune, observou-se o seguinte resultado: em 25%, a auto-imunidade precedeu o vitiligo; em 8,33% foi simultâneo;em 50% foi posterior. Em 2 prontuários não existia o dado disponível.Conclusão: Devido a pequena amostra de pacientes acometidos por doença auto-imune, recomendamos que seja realizado um estudo prospectivo em que exames laboratoriais sejam coletados de forma sistemática, para obtenção de diagnóstico precoce e avaliação da real associação entre o vitiligo e essas patologias...