Photodynamic therapy with delta-aminolevulinic acid and light-emitting diodes in actinic keratosis.

BACKGROUND: Photodynamic therapy is a form of treatment in which a photosensitizing substance is applied to tissue and activated by a light source at a specific wavelength, thus selectively destroying cells. New light sources are being evaluated for use in the treatment of actinic keratoses. OBJECTIVES: To evaluate the efficacy of photodynamic therapy with delta-aminolevulinic acid using a light emitting diode device as a light source in the treatment of actinic keratoses of the face and upper limbs. METHODS: Eighteen patients with actinic keratoses of the face or upper limbs received an application of a 20% delta-aminolevulinic acid cream and were submitted to diode light irradiation at a wavelength of 630 nm. RESULTS: A total of 328 actinic keratoses were treated, obtaining complete cure in 210 (64.0%) after 24 weeks. Lesions situated on the back of the hands were clinically cured in 49.2% of cases compared to 81.4% in the cases of lesions in other areas. There was no record of any severe adverse effects and patient satisfaction with the results was high. CONCLUSION: Photodynamic therapy with a diode light emitting source proved effective and well-tolerated for the treatment of actinic keratoses, with results similar to those reported in the literature with other light sources.

Terapêutica fotodinâmica com ácido delta-aminolevulínico e luz de diodos em ceratoses actínicas / Photodynamic therapy with delta-aminolevulinic acid and light-emitting diodes in actinic keratosis

FUNDAMENTOS: A terapêutica fotodinâmica é técnica de tratamento em que se aplica uma substância fotossensibilizante nos tecidos ativada por uma fonte de luz de comprimento de onda específico, gerando destruição celular seletiva. Estudam-se novas fontes de luz que possam ser usadas no tratamento de ceratoses actínicas. OBJETIVOS: Avaliar a efetividade da terapêutica fotodinâmica com ácido delta-aminolevulínico utilizando como fonte de luz um aparelho emissor de luz de diodos no tratamento de ceratoses actínicas de face e membros superiores. MÉTODOS: Dezoito pacientes com ceratoses actínicas na face ou membros superiores realizaram uma aplicação de creme de ácido delta-aminolevulínico a 20 por cento e foram submetidos à exposição de luz de diodos, comprimento de onda de 630 nm. RESULTADOS: Foram tratadas 328 ceratoses actínicas, obtendo-se cura clínica completa em 210 (64,0 por cento) após 24 semanas. Lesões do dorso das mãos apresentaram cura clínica completa em 49,2 por cento; nas demais áreas esse valor foi de 81,4 por cento. Não houve registro de efeitos adversos graves, e obteve-se bom grau de satisfação dos pacientes com os resultados. CONCLUSÃO: A terapêutica fotodinâmica com fonte de emissão de luz de diodos mostrou-se eficaz e bem tolerada para tratamento de ceratoses actínicas, com resultados semelhantes aos encontrados na literatura utilizando outras fontes luminosas.

BACKGROUND: Photodynamic therapy is a form of treatment in which a photosensitizing substance is applied to tissue and activated by a light source at a specific wavelength, thus selectively destroying cells. New light sources are being evaluated for use in the treatment of actinic keratoses. OBJECTIVES: To evaluate the efficacy of photodynamic therapy with delta-aminolevulinic acid using a light emitting diode device as a light source in the treatment of actinic keratoses of the face and upper limbs. METHODS: Eighteen patients with actinic keratoses of the face or upper limbs received an application of a 20 percent delta-aminolevulinic acid cream and were submitted to diode light irradiation at a wavelength of 630 nm. RESULTS: A total of 328 actinic keratoses were treated, obtaining complete cure in 210 (64.0 percent) after 24 weeks. Lesions situated on the back of the hands were clinically cured in 49.2 percent of cases compared to 81.4 percent in the cases of lesions in other areas. There was no record of any severe adverse effects and patient satisfaction with the results was high. CONCLUSION: Photodynamic therapy with a diode light emitting source proved effective and well-tolerated for the treatment of actinic keratoses, with results similar to those reported in the literature with other light sources.

Doença de Wilson com sinal da face do panda gigante na ressonância magnética de encéfalo / WilsonÆs disease with the face of giant panda sign on magnetic resonance imaging

A Doença de Wilson (DW), é uma desordem hereditária de transmissão genética autossômica recessiva, que altera o metabolismo hepático do cobre e ocasiona seu acúmulo em órgãos e tecidos. Embora alterações na Ressonância Magnética de Encéfalo (RM) não façam parte dos critérios diagnósticos as mesmas podem ser sensíveis para detectar alterações em pacientes com a doença. Os autores descrevem o caso de uma paciente de 22 anos com manifestações neurológicas progressivas cujo diagnóstico de DW foi suspeitado pelas manifestações clínicas associadas as anormalidades na RM. Paciente apresentava alterações no putamen, caudato e tálamo além do chamado sinal do face do panda gigante no mesencéfalo. Um sinal considerado característico da DW

Anthropometric and endocrine features in girls with isolated premature pubarche or non-classical congenital adrenal hyperplasia.

UNLABELLED: Clinical and hormonal changes in girls with precocious pubarche, a multifactorial entity, have not been thoroughly investigated. OBJECTIVES: To describe anthropometric features and bone age in Brazilian girls with precocious pubarche, and to compare clinical and hormonal findings for patients with isolated precocious pubarche (IPP) or non-classical congenital adrenal hyperplasia (NC-CAH). PATIENTS AND METHODS: Twenty-eight girls with precocious pubarche were consecutively seen at the Child and Pubertal Gynecologic Clinic and the Gynecological Endocrinology Unit of Hospital de Clinicas de Porto Alegre. Patients with central precocious puberty and pseudopuberty were excluded from the study. Diagnostic criteria: NC-CAH: 17-hydroxyprogesterone (17OHP) >12 ng/ml 60 min after 0.25 mg i.m. ACTH; IPP: hormonal levels compatible with adrenarche and normal adrenal function confirmed by ACTH testing. Anthropometric and hormonal features and bone age were assessed. RESULTS: Six patients had NC-CAH, and 22 IPP. NC-CAH frequency was 21.42%. Weight and BMI were above 50th percentile except for patients <4 years; 46% of the girls were either overweight or obese. Clinical and hormonal features, except for response to ACTH testing, were similar in both groups; all patients were in or above the 50th percentile for height. Bone age was advanced in 43% of the patients. There was no statistical difference between the groups. CONCLUSION: Slight acceleration of height and bone age, one of the clinical manifestations of precocious pubarche, is unlikely to be progressively severe.