Influence of bisphenol A occurrence in wastewaters on biomass characteristics and activated sludge process performance.

In this work, the influence of bisphenol A (BPA) on biological wastewater treatment was studied. For it, two sequencing batch reactors (SBRs) were operated for three months. Both SBRs were fed with synthetic wastewater (SW), adding 1 mg·L-1 of BPA into the feed of reactor SBR-BPA, while the other one operated without BPA as a control reactor (SBR-B). In addition, batch experiments were performed with adapted and non-adapted activated sludge, simulating the reaction step of SBR-BPA, to determine the pathways for BPA removal. Results of batch experiments showed that adsorption and biodegradation were the only significant BPA removal routes. BPA removal by biodegradation was more efficient when adapted biomass was used in the tests (32.2% and 8.2% with adapted and non-adapted biomass, respectively), while BPA adsorption removal route was similar in both types of activated sludge (around 40%). Regarding the SBRs experiments, after 16 days no BPA concentration was detected in SBR-BPA effluent. In the adaptation process, SBR-BPA biomass was more sensitive to low temperatures resulting in higher effluent turbidity, COD and soluble microbial products concentrations than in SBR-B. However, once temperature increased, adapted biomass from SBR-BPA presented higher activity than SBR-B biomass, showing higher values of sludge production, microbial hydrolytic enzymatic activities and specific dynamic respiration rate. The bacterial community study revealed the increase of abundance of Proteobacteria (especially Thiothrix species) and Actinobacteria (especially Nocardioides species) phyla at the expense of Bacteroidetes and Chloroflexi phyla in SBR-BPA during its operation.

Reacción granulomatosa a cuerpo extraño a sílice, silicona y ácido hialurónico, en paciente con sarcoidosis inducida por interferón / Foreign Body Granulomatous Reaction to Silica, Silicone, and Hyaluronic Acid in a Patient With Interferon-Induced Sarcoidosis

Se describe el caso de una paciente que desarrolló granulomas sarcoideos 11 meses después de haber iniciado interferón α pegilado y ribavirina, como tratamiento de la hepatitis crónica C. Las lesiones se localizaban en relación a 3 cuerpos extraños diferentes: sílice en cicatrices cutáneas antiguas, ácido hialurónico que se había inyectado previamente en la cara, y silicona que se detectó en una adenopatía axilar donde había drenado de un implante mamario previo. La paciente también aquejaba tos seca, fiebre y en la analítica se detectó un incremento de la enzima convertidora de angiotensina y de las enzimas hepáticas. A partir de estos hallazgos se diagnosticó de sarcoidosis sistémica y se suspendió el tratamiento antiviral con posterior normalización de las pruebas hepáticas, desaparición de las lesiones cutáneas y de las adenopatías. Los dermatólogos y cosmetólogos deben ser conscientes del riesgo de aparición de manifestaciones sarcoideas en las áreas donde se han realizado implantes estéticos, en los sujetos que en un futuro requieran tratamiento con interferón (AU)

We report the case of a patient who developed sarcoid granulomas 11 months after starting treatment with pegylated interferon alfa and ribavirin for chronic hepatitis C. The sites of the lesions were related to 3 different foreign bodies: silica in old scars on the skin, hyaluronic acid that had been injected into facial tissues, and silicone in an axillary lymph node draining the area of a breast implant. Systemic sarcoidosis was diagnosed on the basis of a history of dry cough and fever and blood tests that revealed elevated angiotensin converting enzyme and liver enzymes. Interruption of the antiviral therapy led to normalization of liver function tests and disappearance of the skin lesions and lymphadenopathies. Dermatologists and cosmetic surgeons should be aware of the risk of sarcoid lesions related to cosmetic implants in patients who may require treatment with interferon in the future (AU)

Foreign body granulomatous reaction to silica, silicone, and hyaluronic acid in a patient with interferon-induced sarcoidosis.

We report the case of a patient who developed sarcoid granulomas 11 months after starting treatment with pegylated interferon alfa and ribavirin for chronic hepatitis C. The sites of the lesions were related to 3 different foreign bodies: silica in old scars on the skin, hyaluronic acid that had been injected into facial tissues, and silicone in an axillary lymph node draining the area of a breast implant. Systemic sarcoidosis was diagnosed on the basis of a history of dry cough and fever and blood tests that revealed elevated angiotensin converting enzyme and liver enzymes. Interruption of the antiviral therapy led to normalization of liver function tests and disappearance of the skin lesions and lymphadenopathies. Dermatologists and cosmetic surgeons should be aware of the risk of sarcoid lesions related to cosmetic implants in patients who may require treatment with interferon in the future.

Hematopoyesis extramedular cutánea en mielofibrosis idiopática: a propósito de un caso / A case of cutaneous extramedullary hematopoiesis associated with idiopathic myelofibrosis

La hematopoyesis extramedular cutánea es una manifestación infrecuente de los procesos mieloproliferativos crónicos, principalmente de la mielofibrosis crónica idiopática. En el adulto se manifiesta como máculas, pápulas, nódulos y úlceras en el tronco. La aparición suele darse poco después del diagnóstico y todavía es una cuestión debatida la posible relación entre la esplenectomía y la aparición de los focos de hematopoyesis extramedular. El diagnóstico se realiza mediante estudio histopatológico y la visualización de un infiltrado compuesto por diferentes combinaciones de precursores mieloides, eritroides y células megacariocíticas. El tratamiento es sintomático y el propio de la enfermedad de base. Aportamos un nuevo caso asociado a mielofibrosis crónica idiopática que a los 9 años del diagnóstico presentó focos de hematopoyesis extramedular cutánea. Dichas lesiones siguieron un curso progresivo, desarrollando posteriormente una leucemia mieloide aguda (AU)

Cutaneous extramedullary hematopoiesis is a rare manifestation of chronic myeloproliferative processes, mainly chronic idiopathic myelofibrosis. In adults, it manifests as macules, papules, nodules, and ulcers on the trunk. The lesions usually appear soon after diagnosis and the possibility of a relationship between splenectomy and the appearance of extramedullary foci of hematopoiesis is still debated. Diagnosis is based on histopathology showing an infiltrate with different combinations of myeloid and erythroid cell precursors and megakaryocytes. Symptomatic treatment is provided alongside treatment of the underlying disease. We report a new case associated with chronic idiopathic myelofibrosis in which foci of cutaneous extramedullary hematopoiesis were observed 9 years after initial diagnosis. The lesions were progressive and the patient went on to develop acute myeloid leukemia (AU)

[A case of cutaneous extramedullary hematopoiesis associated with idiopathic myelofibrosis]. / Hematopoyesis extramedular cutánea en mielofibrosis idiopática: a propósito de un caso.

Cutaneous extramedullary hematopoiesis is a rare manifestation of chronic myeloproliferative processes, mainly chronic idiopathic myelofibrosis. In adults, it manifests as macules, papules, nodules, and ulcers on the trunk. The lesions usually appear soon after diagnosis and the possibility of a relationship between splenectomy and the appearance of extramedullary foci of hematopoiesis is still debated. Diagnosis is based on histopathology showing an infiltrate with different combinations of myeloid and erythroid cell precursors and megakaryocytes. Symptomatic treatment is provided alongside treatment of the underlying disease. We report a new case associated with chronic idiopathic myelofibrosis in which foci of cutaneous extramedullary hematopoiesis were observed 9 years after initial diagnosis. The lesions were progressive and the patient went on to develop acute myeloid leukemia.

[Elastosis perforans serpiginosa in a patient with pseudoxanthoma elasticum]. / Elastosis perforans serpiginosa en una enferma afecta de pseudoxantoma elástico.

A 34-year-old female previously diagnosed of pseudoxanthoma elasticum developed an annular plaque with serpiginous borders of 42 by 30 mm in diameter on the inner left arm. A similar lesion later appeared on the inner right arm. Histopathological examination of a papule showed short, fragmented, granular, basophilic and calcified elastic fibers in the mid-reticular dermis. The epidermis showed hyperplasia surrounding degenerated and normal elastic fibers. Transepidermal elimination channels of these elastic fibers were also observed. These findings were consistent with the diagnosis of elastosis perforans serpiginosa. Abundant multinucleated giant cells were observed surrounding the area of epidermal hyperplasia and in the reticular dermis. The patient was treated with tazarotene, and the plaques disappeared in 9 months.

Elastosis perforans serpiginosa en una enferma afecta de pseudoxantoma elástico / Elastosis perforans serpiginosa in a patient with pseudoxanthoma elasticum

Mujer de 34 años de edad diagnosticada de pseudoxantoma elástico (PXE) consultó por presentar una placa anular de márgenes serpiginosos, que alcanzó 42 × 30 mm de diámetro en la cara interna del brazo izquierdo. Posteriormente le apareció otra lesión similar de menor tamaño en la cara interna del brazo derecho. El examen histopatológico de una pápula evidenció una alteración de las fibras elásticas, junto a otras de aspecto normal, en la dermis reticular alta y media. Eran cortas, deshilachadas, onduladas, agrupadas unas con otras. La epidermis mostraba una hiperplasia epitelial, que englobaba cúmulos de fibras elásticas degeneradas y otras de aspecto normal. También se apreciaban canales con eliminación transepidérmica de dichas fibras elásticas. Estos hallazgos eran compatibles con el diagnóstico elastosis perforans serpiginosa (EPS). Destacaba la presencia de abundantes células gigantes multinucleadas alrededor de la zona de hiperplasia epitelial y en la dermis reticular. Se trató con tazaroteno y las placas desaparecieron en 9 meses

A 34-year-old female previously diagnosed of pseudoxanthoma elasticum developed an annular plaque with serpiginous borders of 42 by 30 mm in diameter on the inner left arm. A similar lesion later appeared on the inner right arm. Histopathological examination of a papule showed short, fragmented, granular, basophilic and calcified elastic fibers in the mid-reticular dermis. The epidermis showed hyperplasia surrounding degenerated and normal elastic fibers. Transepidermal elimination channels of these elastic fibers were also observed. These findings were consistent with the diagnosis of elastosis perforans serpiginosa. Abundant multinucleated giant cells were observed surrounding the area of epidermal hyperplasia and in the reticular dermis. The patient was treated with tazarotene, and the plaques disappeared in 9 months

Direct immunofluorescence in granuloma faciale: a case report and review of literature.

A 49-year-old male presented at our department with erythematous brownish plaques in the malar areas and left cheek of 9 years' evolution. Histopathological study revealed a dense, predominantly perivascular, inflammatory infiltrate in the reticular dermis. The infiltrate was composed of abundant neutrophils, lymphocytes, histiocytes, and eosinophils. Leukocytoclasia and fibrin in some vessel walls were also observed. The patient was diagnosed with granuloma faciale (GF). Direct immunofluorescence (DIF) study showed heavy immunoglobulin G (IgG) and less intense deposits of IgA, IgM, C(3) and C(1q) surrounding superficial and deep vessels of the reticular dermis. Perivascular and diffuse fibrinogen deposits were also present. No deposits were detected at the dermoepidermal junction. Our findings lend support to the hypothesis that classical pathway activation of complement may be involved in the development of vasculitis in GF.

Clinical, histopathologic, and therapeutic aspects of subepidermal autoimmune bullous diseases with IgG on the floor of salt-split skin.

BACKGROUND: About 12% of patients with subepidermal autoimmune bullous disease and immunoglobulin G (IgG) at the dermal-epidermal junction present diseases other than bullous pemphigoid. MATERIALS AND METHODS: We report the clinical, histopathologic, and therapeutic aspects of eight cases of subepidermal bullous disorder with IgG on the floor of salt-split skin. RESULTS: A predominant neutrophilic infiltrate was detected in six of the eight patients. In one patient, the inflammatory infiltrate was neutrophilic and eosinophilic in the same proportion. A good response to dapsone alone or combined with prednisone was observed in six patients. CONCLUSIONS: The salt-split skin direct immunofluorescence test is useful for its diagnostic and therapeutic implications.

Generalized pruritic eruption with suprabasal acantholysis preceeding the development of bullous pemphigoid.

We report a patient who presented with a papular pruritic eruption of a 3-month duration that histologically showed suprabasal acantholysis accompanied of an eosinophilic inflammatory infiltrate that was consistent with the diagnosis of Grover's disease. Later, erythematous plaques and vesicles appeared which showed a histopathological pattern of eosinophilic spongiosis. The direct immunofluorescence (DIF) study showed lineal IgG and C'3 at the dermal epidermal junction which was consistent with the diagnosis of bullous pemphigoid. No anti-intercellular deposits of immunoglobulin G (IgG) or C'3 were observed. We consider that suprabasal acantholysis may represent the early phase of bullous pemphigoid.

Exuberant granulation tissue associated with chronic graft-versus-host disease after transplantation of peripheral blood progenitor cells.

Angiomatous lesions appearing in chronic graft versus host disease (cGVHD) has been reported previously. We report a case of a patient in whom cutaneous exuberant granulation tissue developed in the course of a cGVHD after allo-peripheral blood progenitor cells transplantation.

Repeat direct immunofluorescence (DIF) test, using, 1 M NaCl treated skin, in the subepidermal autoimmune bullous diseases that contain IgG at the dermal epidermal junction.

Knowledge of autoimmune bullous diseases has greatly increased with the recognition of new entities, and the use of the direct immunofluorescence (DIF) using 1 molar per liter of sodium chloride (1 M NaCl) treated skin has been proposed. To estimate the frequency with which the different DIF patterns are present, we performed a systematic study of the skin or oral mucosa samples in which linear deposits of IgG at the basement membrane zone were detected by routine DIF in the last 6 years. The DIF tests were done on 56 samples before and after splitting the epidermis from the dermis with 1M NaCl. In 40 biopsies (72%) IgG was found on either the epidermal side or on both sides after 1M NaCl split. These cases corresponded to bullous pemphigoid (n=33), herpes gestationis (n=5) and cicatricial pemphigoid (n=2). In 6 cases (10.7%), IgG deposits were observed only on the floor, five corresponding to bullous pemphigoid and one to bullous pemphigoid-like eruption induced by amoxicillin. Repeat direct immunofluorescence using 1M NaCl split skin indicates that at least 12% of patients who were initially diagnosed as bullous pemphigoid, may in fact suffer a different entity, requiring other techniques to achieve the right diagnosis. This test can be a useful routine screening for autoimmune bullous diseases.

Kaposi's sarcoma in a patient with erythroblastopenia and thymoma: reactivation after topical corticosteroids.

We report a 69-year-old female with erythroblastopenia and thymoma who developed lesions of Kaposi's sarcoma (KS) after thymectomy, 2 months after the initiation of therapy with methylprednisolone. Control of mucocutaneous KS lesions was obtained with radiotherapy, interferon alfa-2b and withdrawal of systemic immunosuppressive therapy. Erosive oral lichen planus appeared later, and after therapy with topical corticosteroids a new lesion of KS developed that regressed after withdrawal of topical corticosteroids. The detection of HHV-8 only in lesional skin supports the hypothesis that this virus can trigger the development of KS lesions.

Histopathological changes of primary HIV infection. Description of three cases and review of the literature.

The histopathological changes observed in the cutaneous rash of three patients who suffered the acute phase of HIV infection are described. In all three patients a perivascular and interstitial inflammatory infiltrate was present in the upper and mid-reticular dermis. In one biopsy isolated areas of epidermal necrosis were observed and in the two other biopsies a perifollicular inflammatory infiltrate was detected with perforation in one case. Furthermore, a periductal infiltrate was observed in one of these biopsies.

Expression of the p53 protein in sun-damaged skin.

The expression of the p53 protein in photodamaged skin from the face, forearm and neck of 18 subjects was compared to non-exposed skin taken at autopsy from the abdomens of 9 subjects of the same age. Paraffin sections and the polyclonal antibody CM1 were used with the ABC technique. The p53 protein was expressed in the nuclei of keratinocytes in 7 of the 18 samples obtained from sun-exposed skin and in 1 of 9 samples from non-exposed skin. The expression in sun-exposed skin can be due either to its overexpression due to DNA damage or to the appearance of mutant forms.

Persistent subcutaneous nodules in patients hyposensitized with aluminum-containing allergen extracts.

BACKGROUND: The development of persistent nodules that cause pain and itching at a vaccination or hyposensitization injection site is a rare event. These lesions have been mainly attributed to a hypersensitivity reaction to aluminum hydroxide, which is used as an absorbing agent in many vaccines and hyposensitization preparations. Patch tests with standard antigens and aluminum compounds and histopathologic and ultrastructural studies were performed on 10 patients with persistent subcutaneous nodules on the upper part of their arms after injection of aluminum-adsorbed dust and/or pollen extracts. OBSERVATIONS: The nodules appeared 1 month to 6.5 years after injections. The results of patch tests with 2% aluminum chloride were positive in five patients. Histopathologic examination revealed two different patterns: some biopsy specimens (from lesions of less than 9 months' duration) showed a pure foreign body histiocytic reaction characterized by extracellular amorphous dermal basophilic deposits with a histiocytic-macrophagic reaction; others showed a delayed hypersensitivity granulomatous reaction in association with an histiocytic foreign body response. The lesions were characterized by a unifocal or multifocal unencapsulated granulomatous reaction in the deep dermis and/or subcutaneous tissue. Eosinophilic necrotic areas surrounded by dense fibrous bands and a massive inflammatory infiltrate (lymphoid follicles, large histiocytic cells, abundant eosinophils, and some plasma cells) were observed. A granular basophilic material in extracellular spaces and within the cytoplasm of some histiocytes was also noted. Electron microscopic studies revealed intracytoplasmic and extracellular deposits of a fibrillar electron-dense material. CONCLUSIONS: Persistent subcutaneous nodules that develop after the administration of aluminum-containing preparations may show two characteristic histopathologic patterns. A pure histiocytic foreign body reaction was observed in early lesions, and a delayed hypersensitivity granulomatous reaction was seen in older lesions. No relationship between histopathologic pattern and patch test results was observed. Aluminum-free preparations should be used in patients in whom these nodules develop.

Effect of topical tretinoin on epidermal Langerhans' cells in photodamaged skin.

BACKGROUND: Topical tretinoin has been successfully applied to treat photoaging; however, a decrease in the number of Langerhans' cells (LC) has been reported after its topical application in Macaque skin. A study was performed to evaluate the possible effect of topical tretinoin on the number of LC in human beings. METHODS: Eight patients were studied. Topical tretinoin was applied in progressively increasing concentrations: 0.025% for 1 month, 0.05% for one month and 0.1% for 4 months. A skin biopsy from the malar area was taken before this therapy and 6 months later. To study LC, 4 mu frozen sectionswere stained with the anti-CD1 antibody. RESULTS: The number of CD1+ cells did not change when they were counted per unit of epidermal length, but they decreased when they were counted per unit of epidermal surface. CONCLUSIONS: These results indicate that topical tretinoin might damage epidermal Langerhans' cells, when it is applied for long periods of time; future studies are necessary to clarify this point.

Median raphe cyst of the penis with ciliated cells.

Cystic lesions occurring on the ventral surface of the penis have been classified as median raphe cysts of the penis. They are lined by pseudostratified, columnar or stratified squamous cell epithelium, mimicking the epithelial lining of the male urethra. Ciliated cysts of the human skin are unusual. Cystic lesions containing ciliated cells have been noted to occur in the chest, neck, or head, and bronchogenic origin has been the most accepted explanation for its origin. Other reports show the presence of ciliated cysts on the lower extremities, and the mechanism of formation is still a debated question. A case of median raphe cyst of the penis containing ciliated epithelium is presented. The existing literature about these cutaneous lesions is reviewed, including the possible mechanisms believed to be involved in its origin.