Risk factors for facial melasma in women: a case-control study.

BACKGROUND: Melasma is a localized chronic acquired hypermelanosis, common in adult women and which has an important impact on their life quality. Its pathology is unknown, despite some recognized triggering factors. OBJECTIVE: To evaluate risk factors for developing facial melasma in women. METHODS: This was a case-control study involving adult women with or without facial melasma, paired by age. Variables were grouped into hierarchical levels: personal characteristic data, exposure variables, links to hormonal stimuli and the State-Trait Anxiety Inventory questionnaire, Brazilian version. The data were analysed using conditional multiple logistic regression. RESULTS: We evaluated 207 patients and 207 controls. The mean age was 38 years. Cases differed from controls for phototype, Amerindian ancestry [odds ratio (OR) 2·59], years of beach or rural residence (OR 1·06), time exposed to sun at work (OR 1·65), time exposed to sun in leisure activities (OR 1·04), antidepressant/anxiolytic use (OR 4·96), menstrual irregularity (OR 3·83), pregnancy history (OR 3·59), years of oral contraceptive use (OR 1·23) and anxiety scores (OR 1·08). A family history of melasma was reported in 61% of cases and 13% of controls (OR 10·40). CONCLUSIONS: Facial melasma is independently associated with elements linked to pigmentation capacity, family ancestry, chronic sun exposure, sexual hormone stimuli, psychotropics and anxiety traits.

Heat stroke complicated by liver failure and hyperbilirubinaemia--a case report.

Heat stroke may appear as a result of exposure to high environmental temperature or strenuous exercise. It represents a medical emergency characterized by an elevated core body temperature and multi-organ failure. We have described a case of a 41 year-old female after sun exposure, who was admitted to the hospital with the temperature of 42 degrees C. Because of high plasma bilirubin level the Molecular Adsorbent Recirculating System (MARS) was started. Three sessions of MARS, which lasted for eight hours each, were conducted on 15h, 18th, and 23rd day of hospitalization. The procedure was well tolerated by the patient and resulted in a sustained decline of plasma bilirubin from 33.5 to 14.7 mg/dl. The female was discharged from the hospital in good general condition. The two months follow up showed that the patient felt very well, and the plasma bilirubin was reduced to 2.2 mg/dl.

Cáncer basocelular en área costera y valles interiores: IV Región / Basal cell cancer in coast area and interior valleys: IV region

Se presentan 277 pacientes portadores de cáncer basocelular primarios tratados entre 1989 y 1998. Se analiza retrospectivamente su comportamiento epidemiológico comparando la incidencia y tasa de morbilidad en la planicie costera y las zonas altas de los valles interiores. Además se describe y compara la incidencia de radiación UVB en las dos áreas. La insolación UVB media acumulada mensual de los valles interiores casi duplica la del área costera siguiendo un ritmo estacional más alto en el verano y más bajo en el invierno. La comparación de dos zonas que se diferencian en altitud y humedad relativa ambiental muestra una diferencia de incidencia y de tasa de morbilidad de cáncer basocelular, siendo aquellas más elevadas en el área de mayor insolación ultravioleta, correspondiente a los valles interiores. En conclusión, la incidencia de CBC en la IV región de Chile duplica los valores medios de incidencia de grandes series internacionales, por otra parte, el riesgo relativo de desarrollar la enfermedad es hasta un 44 por ciento mayor para los habitantes de los valles interiores (RR=1,44 en 1998) y, por último, la tasa de morbilidad es uniformemente mayor en el área de mayor insolación UVB

Idiopathic acquired anhidrosis: reversible generalized anhidrosis after sunstroke.

Idiopathic acquired generalized anhidrosis is a very rare condition in which the pathogenesis is still unknown. Although varied findings have been reported, no consistent abnormal findings in sweat glands have been established by histological study or electronmicroscopic study. An 18-year-old Korean boy suffered from generalized anhidrosis after sunstroke. Physical and neurologic examination could not reveal any abnormal findings. There were no specific changes in the sweat glands, but amorphous vacuole-like structures were seen in the cytoplasm of secretary cells. We reviewed the previous reports about this rare condition and compared them with our patient.

Heat illness.

Heat stroke is reviewed in detail. Particular attention is paid to diagnosis and current emergency department treatment, and a brief overview of pathophysiology is included. Early complications, with recommendations for prevention and management, are described. Minor heat related syndromes are also mentioned.

Xanthopsia and van Gogh's yellow palette.

A survey of van Gogh's work from 1886 to 1890 indicated that paintings with a yellow dominance were numerous, episodic, and multi-regional. His underlying illness, by his own admission, affected his life and work; furthermore, episodes of malnutrition, substance abuse, environmental exposure, and drug experimentation (all evident from correspondence) exacerbated his condition. Accordingly, we reviewed plausible agents that might have modified the artist's colour perception. Xanthopsia due to overdosage of digitalis or santonin is well documented elsewhere, but evidence of useage of either drug by van Gogh cannot be substantiated. It is unlikely that ageing of the human lens was an influence because of the artist's youth. Sunstroke is too restrictive to fit the multiplicity of regions and motifs. Hallucinations induced by absinthe, the popular liqueur of the period, may explain particular canvases but not the majority of 'high yellow' paintings. Van Gogh's proclivity for exaggerated colours and his embrance of yellow in particular are clear from his letters and, in contradistinction to chemical or physical insults modifying perception, artistic preference is the best working hypothesis to explain the yellow dominance in his palette.

Adult respiratory distress syndrome and disseminated intravascular coagulation complicating heat stroke.

Fifty two consecutive patients with heat stroke were examined for evidence of adult respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). Twelve patients were found to have ARDS (incidence of 23 percent) of whom nine (75 percent) died. All of these 12 patients had DIC as compared to only one among the 40 patients without ARDS. Review of the evidence in literature linking ARDS and DIC and our own observations in this study lead to the conclusion that the coagulopathy may be an essential mediator of lung damage in heat stroke and is a reliable marker of its occurrence. This suggests the possibility that screening of heat stroke victims for DIC may identify patients at increased risk of developing overt ARDS and allow early institution of measures which may possibly improve survival.

Dehydrational crises from severe diarrhoea or heatstroke and risk of cataract.

The first of a series of epidemiological studies in progress in India has shown a strong association between risk of cataract and remembered episodes of dehydrational crises from severe cholera-like diarrhoeal disease. The findings suggest that severe diarrhoea is a major risk factor in early development of cataract and might account for about 36% of cases in the study area.

Disseminated intravascular coagulation in heat stroke. Response to heparin therapy.

A 14-year-old patient with heat stroke, disseminated intravascular coagulation, central nervous system dysfunction, and renal failure was treated, in addition to conventional therapy, with heparin sodium for seven days. Despite very poor prognostic signs on addmission, the patient survived the acute episode and ultimately progressed to a complete recovery.