Biópsia cutânea: onde, quando e como? / Skin biopsy: where, when and how?

A biópsia cutânea é um método de diagnóstico essencial em Dermatologia e é utilizado frequentemente na prática clínica. É um procedimento simplese rápido que permite, através do exame histopatológico, obter informações importantes para o diagnóstico.Existem diversas técnicas de biópsia, tais como biópsia por “shaving”/tesoura, curetagem, punção, incisional ou excisional.Os factores que determinam que tipo de biópsia a considerar incluem a localização da lesão, morfologia, tamanho, profundidade e, por último, a consideraçãocosmética.Na realização de uma biópsia cutânea, deve considerar-se para além do acto mecânico a selecção cuidadosa da lesão, o método cirúrgico mais apropriado,a manipulação e a fixação correcta da peça obtida.É muito importante a escolha da lesão ou lesões a biopsiar condicionando esta selecção, muitas vezes, o diagnóstico definitivo (AU)

A skin biopsy is an essential method of diagnosis in dermatology and is often used in clinical practice. It is a simple and rapid procedure that givesimportant information for the diagnosis through the histopathological examination. Some of the biopsy techniques are: “shaving”/scissors, curettage,punch, incisional or excisional biopsy.Factors that determine the type of biopsy include location, morphology, size, and depth of the lesion and, lastly the final cosmetic outcome.When performing a skin biopsy it should be taken into consideration the basic mechanics of the procedure itself, as well as the careful selection of thelesion, the most appropriate surgical method, proper handling and setting (fixation) of the sample. Selection of the lesion or lesions is a very importantissue since adequacy of the sample will lead to a definitive diagnosis (AU)

Idiopathic hypereosinophilic syndrome presenting as cholestatic liver disease.

We report the case of a 34-year-old white man with recurrent episodes of abdominal pain, cholestasis and eosinophilia. The diagnosis of idiopathic hypereosinophilic syndrome (IHS) was made after exclusion of all known causes of eosinophilia. Liver biopsy revealed an eosinophilic infiltrate with biliary damage. The patient recovered after prednisolone treatment. We review the literature on the association between IHS and liver disease.

Contact allergy to gold sodium thiosulfate. A comparative study.

During 1995, we added gold sodium thiosulfate and potassium dicyanoaurate to the patch test standard series. Our purpose was to compare the reactivity of the gold salts, to determine the frequency of contact allergy to gold in our country, to compare our results with those of the Malmö group and, finally to try to clarify the clinical relevance 2853 patients were routinely tested and 168 patients answered a questionnaire similar to that used by the Malmö group. Contact allergy to gold was found in 23 patients, all women: 22 to gold sodium thiosulfate (0.78%), only 1 to potassium dicyanoaurate and 2 to both salts. All reactors had their ears pierced and were exposed to gold jewelery (mainly earrings). Simultaneous allergies to nickel and cobalt were statistically significant in patients with positive patch tests to gold sodium thiosulfate. Atopy was no more common among these patients.

Patch testing with allergens from modified rosin (colophony) discloses additional cases of contact allergy.

Most rosin (colophony) used today is chemically modified. Will contact allergy to modified rosin be overlooked when testing is performed with only unmodified rosin in the standard series? 2 components from modified rosins, maleopimaric acid (MPA) and glyceryl I-monoabietate (GMA), earlier identified as contact allergens, were added to the patch test standard series. Some commonly-used modified rosin products were also tested. Positive reactions were observed to the modified components MPA and GMA. Of the patients with positive reactions to MPA and GMA, several did not react to unmodified rosin in the standard series. No reaction was observed to the modified rosin products without a concomitant reaction to unmodified rosin. The positive reactions observed to the modified rosins may be due to residual unmodified material in the product, but a possible contribution from allergenic modified rosin components cannot be disregarded. When a patient's history indicates a rosin allergy, but a negative response to unmodified rosin in the standard series is observed, additional testing with GMA and MPA or, second best, with glycerol-esterified rosin and maleic-anhydride-modified rosin is recommended. Some modified rosin products, which could be used for additional testing, are suggested.

Streptococcus bovis spontaneous bacterial peritonitis in patients with alcoholic cirrhosis.

Spontaneous bacterial peritonitis (SBP) is a frequent cause of decompensated alcoholic cirrhosis. The authors describe the first two cases caused by infection with Streptococcus bovis. They suggest that this microorganism may be present in the intestinal flora of these patients more frequently than assumed. Furthermore, the course of SBP due to S. bovis may be particularly severe.

Contact dermatitis to Disperse Blue 106.

9 patients with typical textile dermatitis were found to be allergic to dark polyester blouses. Thin-layer chromatography of the dyes extracted from the fabrics identified the presence of several dyes, from which Disperse Blue 106 was positive in all patients.

Sequential changes from minimal pancreatic inflammation to advanced alcoholic pancreatitis.

A correlation of several clinical parameters and pancreatitis morphological alterations observed in chronic alcoholics with and without pancreatic is presented. Three groups of patients were studied: asymptomatic chronic alcoholics (24); non-alcoholic controls (10); and cases with advanced chronic pancreatitis (6). Clinical, biochemical and functional studies were performed. Morphological studies were made on surgical biopsy specimens in light and electron microscopy. The results of this study showed: 1) fat accumulates within pancreatic acinar cells in alcoholics drinking more than 80 g of ethanol per day; 2) ultrastructural changes found in acinar cells of the alcoholics are similar to those described for liver cells; 3) the alterations found in alcoholics without pancreatitis are also observed in those with advanced chronic pancreatitis. An attempt to correlate the sequential changes in the histopathology of alcoholic pancreatic disease with the clinical picture and secretory patterns was made. According to these observations, admitting the ultrastructural similarities between the liver and the pancreas and the recently demonstrated abnormalities of lipid metabolism in pancreatic cells in experimental animal research, the authors postulate a toxic-metabolic mechanism as a likely hypothesis for the pathogenesis of chronic alcoholic inflammation of the pancreas.

Alcohol and the pancreas. I. Clinical associations and histopathology of minimal pancreatic inflammation.

Fat accumulation within pancreatic acinar cells was observed by examination in patients consuming more than 30 gm./day of ethanol. Ultrastructural changes within the cell are described in these alcoholics without clinical pancreatitis, changes which are similar to those seen in the hepatocytes of alcoholics. The mechanisms which induce these ultrastructural changes and accumulation of fat in the pancreatic acinar cell are not apparent at present. A toxic metabolic mechanism is an attractive hypothesis for these effects.

Alcohol and the pancreas. II. Pancreatic morphology of advanced alcoholic pancreatitis.

The histopathology of advanced chronic alcoholic pancreatitis is dominated by cellular degeneration, atrophy and fibrosis. Sequential changes in the histopathology of alcoholic pancreatic disease has been defined and traced from initial injury to end-stage disease. These sequential histopathologies have been correlated with clinical syndrome and secretory patterns. The data are more consistent with a toxic-metabolic pathogenesis of alcoholic pancreatitis than the previous Big Duct and Small Duct hypotheses.

[The secretin test with the standard dose and high dose in chronic pancreatitis]. / Il test della secretina a dose abituale o a dose elevata nelle pancreatiti croniche

Sequential standard (1.0 U/kg) and augmented (4.0-5.0 U/kg) secretin response of the pancreas has been briefly compared in normal subjects and in pathologic series. The results of sequential testing led to the conclusion that, for clinical purposes, the standard test is sufficient for the diagnosis of well established pancreatic pathologies causing gross destruction of the parenchyma, while the augmented test is of particular value when the response to 1 U/kg produces equivocal results, since a higher stimulation enhances the masked secretory deficiency. The application of the augmented stimulus in alcoholic patients suggested the hypothesis that the post-secretin response pattern of minimal pancreatic inflammatory pathology is hypersecretion. Repeated observations in alcoholic hypersecretors will provide physiologic data elucidating the evolution of pancreatic pathology towards the end stages of chronic pancreatitis.