Castleman disease. Interaction with dermatopathy: Case report.

INTRODUCTION: Castleman disease (CD) is a lymphoproliferative disorder with lymph node hypertrophy. In the unicentric form (UCD), it affects one lymph node or chain of lymph nodes. In the multicentric form (DCM), there is hypertrophy of several lymph node chains with the formation of tumor masses, causing compressive symptoms. This case report showed a case of CD in a different location(inguinal region) associated to a multiple skin lesions. PRESENTATION OF THE CASE: We reported a UCD in a 43-year-old female patient with no previous comorbidities. Since January 2016, this patient developed erysipelas lesions of the left leg (LL) from the thigh root to the foot. Concomitantly, a tumor mass appeared in the inguinal region. In 2019 we performed a biopsy that revealed changes characteristic of CD. Due to extremely poor trophic conditions, the skin area with erysipelas was resected, and the raw surface was grafted. DISCUSSION: As an inference, the erysipelas may have been responsible for the subsequent lymphangitis, lymphedema and lymph node hypertrophy. CONCLUSION: Resection of the diseased skin and lymph node excision constitute the treatment of UCD and result in improvement of the clinical picture. Nevertheless, further study of the inflammatory reaction and of markers such as interleukin-6 and the presence of skin disorders in DC is needed.

Study of the Effect of Hyperbaric Oxygen Therapy on the Viability of Dorsal Cutaneous Flaps in Tobacco-Exposed Rats.

BACKGROUND: Smoking causes a threefold increase in the risk of surgical complications in flaps. Hyperbaric oxygen therapy (HBOT) increases the viability of chronic wounds. However, there are few studies concerning the effects of HBOT on surgical flaps in patients who smoke. This study aimed to analyze the effect of HBOT on the viability of cutaneous flaps in tobacco-exposed rats. METHODS: Twenty Wistar rats were exposed to tobacco smoke for two months. Following this period, all animals underwent a dorsal cutaneous flap (3 × 10 cm) surgery and were divided into two groups: control (n = 10) and HBOT (n = 10). HBOT was performed in seven daily sessions (2 ATA, 90 min). After seven days, the animals were euthanized. The outcomes were total area, viable area, viable area/total area rate, analysis of dermal appendages and angiogenesis (hematoxylin-eosin), and gene expression analysis of iNOS and VEGF-a biomarkers. RESULTS: The HBOT group showed an increase in viable area compared with the control group (84% versus 47%, p = 0.009, respectively). The HBOT group also showed an increase in appendage units (1.69 ± 0.54 versus 1.87 ± 0.58, p = 0.04) and angiogenesis density (1.29 ± 0.45 versus 1.82 ± 0.64, p < 0.001) compared to the control group. There was a difference between the control and HBOT groups in iNOS levels (0.926 ± 1.4 versus 0.04 ± 0.1 p = 0.002, respectively). However, this study did not show a difference between the groups concerning the gene expression of VEGF-a. CONCLUSION: The use of hyperbaric oxygen therapy increased the viability of cutaneous flaps in tobacco-exposed rats and decreased iNOS mRNA levels; however, it did not change VEGF-a levels. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Evaluation of the poly-L-lactic acid implant for treatment of the nasolabial fold: 3-year follow-up evaluation.

The search for an ideal filler for soft tissue augmentation still continues. Because aging changes are continuous, temporary fillers should be preferred against permanent ones. Since 1999, the poly-L-lactic acid filler (PLA) has been marketed in Europe as Newfill. As a synthetic biocompatible polymer, PLA originally was used in suture materials and screws. In 2004, the U.S. Food and Drug Administration approved PLA under the name of Sculptra for the treatment of human immunodeficiency virus-related facial lipoatrophy. This study aimed to evaluate a 3-year follow-up investigation into the effect of PLA implant injection for the treatment of sunken nasolabial folds. Between October 2003 and February 2004, 10 women with a median age of 54 years (range, 43-60 years) were injected with polylactic acid hydrogel (Newfill) in the nasolabial fold area for aesthetic reasons. All the patients underwent three injections: one injection per month for 3 months. Evaluation of the results based on clinical examination and photography was performed at each session, at 6 months, and then 36 months after the third session. Injectable PLA was able to correct nasolabial folds successfully with a more lasting result than absorbable fillers commonly used in clinical practice, such as hyaluronic acid and collagen. Careful and standardized photographic documentation is indispensable.

Impact of recombinant human growth hormone (RH-GH) treatment on psychiatric, neuropsychological and clinical profiles of GH deficient adults. A placebo-controlled trial.

BACKGROUND: Untreated GH-deficient adults have a diversity of dysfunctions (e.g. reduced muscle strength, emotional instability during stress, depressive symptoms) that may cause deleterious effects on quality of life, and may be positively influenced by recombinant human growth hormone (rh-GH) therapy. AIM: To evaluate the impact of a clinical intervention with rh-GH therapy on GH- deficient adults. METHOD: The physical, psychiatric and neuropsychological status of 9 GH-deficient adults was determined before and after the administration of rh-GH (0.250 IU/Kg/week) in a double blind placebo-controlled trial for six months. Patients then received rh-GH for a further period of 6 months and their status was re-evaluated. RESULTS: Rh-GH was significant better than placebo at 6th month (p < 0.05), producing increased serum Insulin like growth factor-I (IGF-I) levels, reduced body mass index (BMI) and body fat, increased lean body mass and water, reduced waist/hip ratio and increased energy expenditure. The rh-GH therapy was also significantly better than placebo on depressive features as measured by the Hamilton Depression Scale (17-items) (p = 0.0431) and the Beck Depression Inventory (p = 0.0431). Neuropsychological evaluations showed significant improvements in measures of Attention: Digit Backward (p = 0.035), Verbal Fluency (FAS) (p = 0.02) and Cognitive Efficiency (WAIS-R tests): Vocabulary (p = 0.027), Picture Arrangements (p = 0.017), and Comprehension (p = 0.01) following rh-GH therapy. CONCLUSION: The clinical, psychiatric, and neuropsychological impairments of untreated GH-deficient adults can be decreased by rh-GH therapy.

[Microsurgical reimplantation of scalp: case report]. / Reimplante microcirúrgico de couro cabeludo: relato de caso.

With the introduction of modern techniques in plastic surgery, severe injuries concerning the extremities and scalp are now amenable to surgical treatment. Successful reimplantation of the scalp either total or partial have been rarely reported in the literature. We treated a patient with avulsion affecting 2/3 of the scalp, the right ear and a cutaneous flap on right side of the face. We report here the initial care and operative procedure. The avulsed scalp was revascularized through microanastomoses of the temporal artery and vein. The reimplantation was well succeed and cosmetic results were satisfactory.

Tratamento dos angiomas do labio / Treatment of lip angiomas

Foram estudados 25 pacientes portadores de angiomas de labio, sendo 17 maduros (15 venosos, 2 complexos) e oito imaturos (7 tuberosos, 1 strawberry). Existem varios tipos de tratamento propostos pela literatura. Dentre os varios metodos, os autores, apos dez anos de experiencia, optaram preferencialmente por cirurgia, cirurgia mais embolizacao e corticoide sistemico. O uso de corticoide local e de agentes esclerosantes foram utilizados apenas como coadjuvantes da cirurgia. A cirurgia, realizada em uma ou mais etapas, se mostrou alternativa segura e eficiente para angiomas maduros, com excecao dos complexos, imaturos com complicacoes e imaturos que nao incluiram ate os cinco anos de idade.

Emprego do retalho da arteria interossea posterior na reparacao do antebraco e mao / Use of posterior interosseus artery flap in the forearm and hand

A arteria interossea posterior irriga a pele da face dorsal do antebraco atraves de arterias septo-cutaneas. O retalho fascio-cutaneo com pediculo distal pode ser usado para reparacoes do antebraco e mao, pois promove cobertura cutanea de boa qualidade e baixa morbidade da area doadora. O emprego da expansao previa do retalho permitiu a ampliacao de suas indicacoes e o fechamento borda a borda da area doadora sem uso de enxerto de pele.

[Use of posterior interosseus artery flap in the repair of forearm and hand]. / Emprego do retalho da artéria interóssea posterior na reparação do antebraço e mão.

The posterior interosseous vessels give a significant contribution to the fascial plexus which supplies the skin of the forearm. This vascular arrangement forms the basis for an island fasciocutaneous flap which can be based either proximally or distally. Its principal advantage is that it is a thin flap with excellent circulation and that the donor area can be closed primarily. The design and usage of an island fasciocutaneous flap with possibility of expansion is also described.

[Treatment of lip angiomas]. / Tratamento dos angiomas do lábio.

The experience with the treatment of 25 patients with angiomas of the lips is presented. Among the several methods of treatment indicated in the literature, the authors have experimented with surgery, surgery and embolization, and systemic corticotherapy. Local application of corticosteroids and sclerosing agents were used just as a complementary therapy to the surgery. Surgery performed in one or more stages when necessary, were considered a safe and reliable method for treatment of mature venous angiomas, as well as for immature ones with no involution after a period of five years.

[Combined surgical treatment of endocarditis of the right atrium by Aspergillus sp and pulmonary fungus ball. Report of a case]. / Tratamento cirúrgico combinado de endocardite do átrio direito por Aspergillus sp e de bola fúngica pulmonar. Relato de caso.

Endocarditis due to Aspergillus is rare and associated with a high mortality. The authors report the case of a 23 year-old patient with Klippel-Trenaunay syndrome who was admitted with dyspnea and loss of weight. The physical examination showed split second sound and presystolic accentuation. In the chest x ray there were cavities in the upper lobe of the right lung and pleural thickening. The echocardiogram and the hemodynamic evaluation demonstrated an image suggesting a right atrial tumor. The patient was operated on under cardiopulmonary bypass, a vegetation in the valve of the inferior vena cava was resected and a lesion of the right lung was also resected. The histologic study showed that the lesions was caused by Aspergillus. The patient had had an uneventful recovery, was discharged on the 13th postoperative day and is well 65 months after the operation.