THORACOLOMBAR BURST FRACTURES: SHORT FIXATION, WITHOUT ARTHRODESIS AND WITHOUT REMOVAL OF THE IMPLANT.

Objectives: To present the functional outcomes, through the first case series in our country, of patients with thoracolumbar burst fractures (A3,A4), submitted to short posterior fixation, without arthrodesis and without removal of the implants, until the end of the minimum follow-up of one year. Methods: Fifty five patients consecutively treated between January/2010 and January/2019 were evaluated through medical records and imaging exams. Radiographic analysis was performed by mea suring local and segmental kyphosis using the Cobb method. Functional assessment was analyzed using the non-specific SF-36 questionnaire and the 1983 Denis pain and work-specific questionnaire, applied after 12 months of follow-up. Results: With a loss of five patients (9%), 22 (44%) patients reported having minimal and occasional pain and 8 (16%) patients reported having no pain. Three (6%) patients responded that they were completely incapacitated. Patients had a mean score of 73.16 points in the SF-36 domains. There was a significant reduction in kyphosis in 12 months (9.1±5.2 [min-max 0-22]) compared to the preoperative period (14.9±7.8 [min-max 0-32]) ( p≤0.01). One patient required implant removal due to the symptomatic prominence of the implant. Conclusion: This case series suggests that the technique leads to satisfactory functional results, without implant failure or significant kyphosis after a minimum follow-up of 12 months of treatment. Evidence Level IV; Case series.

Objetivo: Apresentar os desfechos funcionais, mediante primeira série de casos no nosso meio, de pacientes com fratura toracolombar do tipo explosão (A3, A4), submetidos a fixação posterior curta, sem artrodese e sem retirada dos implantes, até o final do acompanhamento mínimo de um ano. Métodos: Foram avaliados, por meio de prontuários e exames de imagem, 55 pacientes consecutivamente tratados entre Janeiro/2010 e Janeiro/2019. A análise radiográfica foi realizada medindo a cifose local e segmentar, pelo método de Cobb. A avaliação funcional analisada por meio do questionário inespecífico SF-36 e questionário específico de dor e trabalho de Denis de 1983, aplicados após os 12 meses de seguimento. Resultados: Com perda de cinco pacientes (9%), 22 (44%) pacientes relataram ter dor mínima e ocasional e 8 (16%) pacientes responderam não ter dor. Três (6%) pacientes responderam que estavam completamente incapacitados. Os pacientes tiveram uma pontuação média de 73,16 pontos nos domínios do SF-36. Houve redução significativa da cifose em 12 meses (9,1±5,2 [min-máx 0-22]) na comparação com o pré-operatório (14,9±7,8 [min-máx 0-32]) (p≤0,01). Um paciente necessitou de retirada do implante em razão da proeminência sintomática do implante. Conclusão: Esta série de casos sugere que a técnica leva a resultados funcionais satisfatórios, sem falha do implante ou cifose pós-traumática após acompanhamento mínimo de 12 meses de tratamento. Nível de Evidência IV; Série de casos.

[Why is andrology part of dermatology]. / Warum Andrologie in der Dermatologie.

Andrology evolved more than 100 years ago in order to create an equivalent to gynecology for specific male problems in reproductive medicine. The first stimuli for the clinical and scientific development of this specialty in Germany arose from dermatologists. Andrology thus appears as a moiety of dermatology. In 2003 the visibility of andrology among the medical disciplines was accentuated by the introduction of an additional specialty specification for dermatologists, endocrinologists and urologists, since the other two disciplines also worked on andrological problems. Today, the majority of the members of the Society of Andrology are urologists and also urologists form the majority of medical practioners with this additional specialty. Besides reproductive medicine, there are several other topics which underline the conjunction of dermatology and andrology. Hence andrology should be observed as a part of dermatology not only for historical reasons. Andrology is a living subspecialty of dermatology and young dermatologists should be motivated to become engaged in it.

Association of skin hyperpigmentation and drug use: a systematic review.

INTRODUCTION: Part of the acquired hyperpigmentations of the skin are interpreted as adverse effect of drugs. However, systematic studies are rare in the literature, as case reports have predominantly been published. The present systematic review attempts to provide a contribution to the body of evidence for a causal relation. EVIDENCE ACQUISITION: The reports on an association of hyperpigmentation and drugs from 1970 until April 2016 found in Medline and EMBASE were rated according to the SIGN grading system for clinical studies. EVIDENCE SYNTHESIS: A total of 352 evaluated publications were found, which mainly consist of reports of single cases, only a small number of larger case series were available. Case-control-studies and randomized controlled studies have rarely been found. The level of evidence for a causal relation to hyperpigmentation is low for the major part of drugs as quoted in order to the Anatomical Therapeutic Chemical Classification System with Defined Daily Doses. A causal relation is likely only for prostaglandins, minocyclin, phenothiazine, nicotine, and anti-malaria drugs. CONCLUSIONS: There is paucity of evidence for an induction of hyperpigmentation by drugs. A causal relationship is likely only in a small number of drugs.

Drug-induced hperpigemntation: a systematic review.

BACKGROUND: Acquired hyperpigmentation of the skin is sometimes interpreted as an adverse effect of drugs. Systematic studies are rare in the literature; predominantly case reports have been published. The present review provides evaluates the evidence for a causal relation. METHODS: The reports on a relationship between hyperpigmentation and drugs from 1970 until June 2012 found in MEDLINE and EMBASE were rated according to the SIGN grading system for clinical studies. In this system, the grade of evidence of each report is rated. The highest grade of evidence for each drug is cited. RESULTS: 306 publications were included. They were predominantly case reports; only a small number of case series was available. Only very few case-control-studies and randomized controlled trials (RCT) were found. For the majority of drugs, there was a low level of evidence for a causal relationship in drug-induced hyperpigmentation. A causal relationship is likely only for prostaglandins, minocycline, phenothiazine, nicotine, and antimalarial drugs. CONCLUSIONS: There is little evidence for drug-induced hyperpigmentation. A causal relationship appears liklely only for a limited number of drugs.

Diseases of the male nipple and areola.

The male nipple-areola-complex (NAC) is a residual organ without physiologic functions in the male. It possesses similar hormone sensitivity and sexual sensitivity as the female organ. The location of the NAC on the chest wall with respect to other surface features is relevant for the male appearance. All known disseminated skin diseases may involve the nipple and areola. A number of specific localized diseases have been described in the literature, such as mammillary eczema, demodicidosis, lymphadenosis cutis benigna, nevoid hyperkeratosis, and thelalgia. Special attention is required if nipple discharge is observed. Areolar sebaceous hyperplasia and nearly all kinds of benign cutaneous tumors occur on the nipple and areola. Malignant tumors such as basal cell carcinoma, melanoma, Paget disease and other forms of breast cancer may also be found. In addition, aberrant mammary tissue may occur with a broad clinical spectrum, while absence of the nipple is an unusual observation and occurs in rare syndromes. The association of aberrant mammary tissue with urinary tract malformations has not been confirmed.

Skin diseases in consequence of endocrine alterations.

The skin is a target organ of several hormones. Specific diseases appear in consequence of hypo- or hypersecretion of endocrine organs, particularly in the elderly patient. There, knowledge of skin alterations is important not only for dermatologists, but also for endocrinologists and other physicians, because a clinical diagnosis of the underlying disease is often possible. In this review, a number of representative skin diseases having an endocrinological basis are described. These include acanthosis nigricans, diseases due to alterations of androgen metabolism, carcinoid syndrome, diseases due to alterations of corticosteroid metabolism, diseases in association with diabetes mellitus, diseases due to alterations of estrogen metabolism, genetic syndromes including dermatological and endocrine symptoms, the glucagonoma syndrome, diseases due to dysfunctions of growth hormone secretion, diseases in association with Merkel cells of the skin, diseases due to dysfunctions of the thyroid gland, diseases to alteration of vitamin D metabolism, and vitiligo and disorders of pigmentation.

Identification of evolutionary conserved mouse sperm surface antigens by human antisperm antibodies (ASA) from infertile patients.

PROBLEM: The presence of antisperm antibodies (ASA) in semen may impair sperm function leading to immunological infertility. The aim of the study was to identify the evolutionary conserved antigens on mouse sperm surface that react with human ASA in order to study the mechanism of autoimmune infertility. METHODS OF STUDY: The binding of human ASA to mouse sperm was investigated by means of indirect immunofluorescence. 2D-electrophoresis was applied to separate the biotin-labelled mouse membrane proteins using isoelectric focusing followed by polyacrylamide gel electrophoresis. Cognate antigens of ASA from seminal plasma of infertile patients were analysed by Western blotting. Performing avidin-blots it was detected which of the proteins recognized were sperm surface proteins. The spots of interest were analysed by means of mass spectrometry. RESULTS: ASA bound most frequently (36%) to the post-acrosomal region and to the midpiece of mouse spermatozoa. About 30% of ASA recognized apo lactate dehydrogenase (LDHC4) as a cognate antigen, 30% voltage-dependent anion channel (VDAC2). ASA of 20% bound to outer dense fibre protein and 20% of samples recognized glutathione S-transferase mu5. CONCLUSIONS: Human ASA bound to specific cognate antigens of mouse spermatozoa, offering the possibility to study their functional relevance in the mouse model.

Genital Paget's disease in a man.

Pagetoid cells are large intraepidermal cells which spread intraepidermally. We report a 67-year old Caucasian male, who presented for the first time in 1993 with a long-standing pruritic lesion at the scrotum. He was treated for several years by antiinflammatory ointments. Only in July 2003 was a biopsy taken for the first time. The histopathological evaluation revealed the diagnosis of an extramammary Paget's disease (EMPD). Pagetoid cells are large intraepidermal cells with a large nucleus and ample cytoplasm. EMPD consists of primary malignant cells of epidermal origin, but in rare cases, pagetoid cells may also originate from carcinomas with epidermotropic growth. EMPD is a slowly progressing disease, but invading and metastasing tumors may also develop. Considering the good prognosis with long-term survival, nonsurgical modalities should be considered as primary treatment for noninvasive EMPD.

Androgens in the demography of male life course--a review.

While the basics of testosterone production, effects and metabolism have been known for decades, there has been a flow of novel insights in the genomics of testosterone action on a molecular and cellular level, as well as in the clinical effects from modern clinical trials, improving the understanding of the role of testosterone in male life course. Androgens are produced under the control of an endocrine cascade from GnRH via gonadotropins to the testicular Leydig cells. In some organs, testosterone is reduced to 5alpha-dihydrotestosterone prior to the receptor binding by the 5alpha reductase. The androgen receptor gene is located on the X chromosome in the q11-12 region, each mutation in the gene will induce phenotypic manisfestations. In the first stage of the male life course, testosterone moderates the male embryonic development under the control of a complex molecular genetic network. The next important phase of male maturation is the puberty, in which testosterone levels increase and induce the development of somatic and psychological characteristics of male sexuality. In the adult male, testosterone maintains sexual functions and fertility. In aging men, testosterone levels decrease slowly. Testosterone supplementation in the aging male is able to restore the function of androgen target organs only in part.