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1.
Int J Dermatol ; 60(1): 60-69, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32989780

RESUMO

BACKGROUND: Prompt management of acute graft-versus-host disease (GVHD) may prevent its morbidity and mortality. Maculopapular (MP) eruption is a presenting sign of acute GVHD, but differentiation from other causes of MP rash is challenging. METHODS: A retrospective study was conducted among patients developing MP eruptions after allogeneic hematopoietic stem cell transplantation. We compared the clinical and histopathological differences between an acute cutaneous GVHD (group 1) and other MP eruptions (group 2). We also determined the clinical prognostic indicators linked to acute GVHD severity, morbidity, and mortality. RESULTS: Of 95 patients identified, 75 met the classification criteria for acute GVHD, and 25 had other MP eruptions. Palm and/or sole involvement was more frequently found (51.4% vs. 12%, odds ratio [OR] [95% confidence interval] = 7 [2.1, 23.7], P < 0.01 and 41.4% vs. 0%, OR 37.2 [2.2, 635], P < 0.01, respectively) in group 1 than in group 2. Comparing the histological features between the two groups, necrotic keratinocytes in basal and spinous layers (92.9% vs. 22.2%, OR 27 [3.5, 594.7], P < 0.01) and (85.7% vs. 33.3%, OR 9.3 [1.4, 60.8], P = 0.02, respectively), diffuse basal vacuolization (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04), lymphocyte satellitosis (71.4% vs. 0%, OR 44.3 [2.1, 936.8], P < 0.01), and subepidermal clefts (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04) were significantly more apparent in group 1. Among extracutaneous presentations, diarrhea alone and/or accompanied by hyperbilirubinemia (47.1% vs. 16%, OR 4.3 [1.4, 13.1], P = 0.03 and 27.1% vs. 0%, OR 19.3 [1.1, 332.8], P < 0.01, respectively) and newly developed transaminitis (37.1% vs. 12%, OR 3.3 [1.1, 12.6], P = 0.02) suggested the diagnosis of acute GVHD. Mucosal involvement and/or blister formation correlated with severe acute GVHD (OR 26.6 [5.4, 130.4], P < 0.01). Skin and systemic GVHD severity correlated with time to rash resolution (P = 0.03 and P = 0.04, respectively), length of hospital stays (P < 0.01 and P < 0.01, respectively), and mortality (OR 4.87 [1.4, 17.4], P = 0.02 and OR 4.6 [1.3, 16.5], P = 0.02, respectively). CONCLUSIONS: Our findings may be beneficial tools for establishing the diagnosis of acute GVHD.


Assuntos
Exantema/diagnóstico , Exantema/patologia , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/patologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Doença Aguda , Adolescente , Adulto , Vesícula/etiologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Diarreia/etiologia , Exantema/etiologia , Feminino , Dermatoses do Pé/etiologia , Doença Enxerto-Hospedeiro/etiologia , Dermatoses da Mão/etiologia , Humanos , Hiperbilirrubinemia/etiologia , Lactente , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Membrana Mucosa , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
4.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 38(10): 757-759, 2020 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-33142380

RESUMO

Objective: To explore the observation and nursing of patients with acute mass asphyxia poisoning with pulmonary bullae treated by nasal high-flow humidification and oxygen therapy. Methods: Review and summarize the data of 5 patients with acute mass asphyxial gas poisoning with pulmonary vesicles who were admitted to the department of toxicology of this hospital in June 2019 and received nasal high-flow humidification and oxygen therapy. The oxygenation index, airway humidification and prognosis were observed. Results: All the 5 patients were successfully transferred to nasal catheter for oxygen inhalation after nasal high-flow humidification and orygen therapy without intubation. When discharged from the hospital without oxygen, pH: 7.36-7.42, PO(2):82-106 mmHg, PCO(2):32-39 mmHg. All the white blood cells and myocardial enzymes were normal, and there was no brain injury, perinasal skin damage and abdominal distension. Conclusion: Nasal high-flow humidification and oxygen therapy can effectively improve the efficacy of oxygen therapy for patients with acute mass asphyxial gas poisoning with pulmonary vacuoles.


Assuntos
Asfixia , Oxigênio , Vesícula , Gasometria , Humanos , Oxigenoterapia
5.
Gan To Kagaku Ryoho ; 47(9): 1355-1357, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130699

RESUMO

A 54-year-old man with a history of smoking developed infectious bullae at the apex of his left lung and underwent long-term antimicrobial treatment. The bullae gradually reduced in size along with a slight left pleural thickening. Left back pain relapsed after a year, and CT revealed a rapid increase in pleural thickening. Left upper lobectomy led to the diagnosis of pulmonary polymorphic carcinoma. Chronic inflammation due to infection could contribute to carcinogenesis; therefore, post-inflammatory changes should be carefully followed-up.


Assuntos
Carcinoma , Pneumopatias , Neoplasias Pulmonares , Vesícula , Humanos , Pulmão , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade
6.
Afr Health Sci ; 20(2): 885-890, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33163055

RESUMO

Vesicobullous lesions of skin may occur in different forms of dermatosis, which include various inflammatory, infective, autoimmune, drug induced as well as genetic conditions. Autoimmune bullous lesions, may be fatal if not treated with appropriate agents. Bearing in mind, the morbidity of these diseases, it is important to establish a firm diagnosis. A diagnostic skin biopsy with immunofluorescence is frequently used to confirm a clinical diagnosis, especially where it is not apparent clinically. There are many centres in India where immunofluorescence is not available and the diagnosis in these lesions is based on clinical and histopathological features only. Here in this study, we studied 53 skin punch biopsies with clinical suspicion of vesicobullous lesions followed by histopathological examination was carried out over a period of 2 years in a Medical College in Gujarat. Lesions were categorised based on the location of the blister. 1) Suprabasal 2) subcorneal 3) and subepidermal. Further subtyping was done based on additional histopathological features and clinical correlation. All the patients responded appropriately to the treatment and the results correlated well with the immunofluorescence done in a few cases. This study lays emphasis upon the histopathology and clinical features keeping in consideration of the lack of ancillary techniques in many centres especially in the developing world.


Assuntos
Vesícula/diagnóstico , Pele/patologia , Adulto , Idoso , Biópsia , Vesícula/epidemiologia , Dermatite Herpetiforme/diagnóstico , Dermatite Herpetiforme/epidemiologia , Feminino , Imunofluorescência , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pênfigo/diagnóstico , Pênfigo/epidemiologia , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/epidemiologia
7.
Vestn Oftalmol ; 136(6): 93-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33084285

RESUMO

Currently, there is a need to assess the condition of structures at the surgery site after glaucoma intervention due to the necessity to decide further treatment tactics after performed operations, as well as the possibility of developing more advanced methods of surgical treatment of glaucoma. Despite the fact that there are several methods of examining the filtration bleb (FB), some of them have both clear advantages and significant disadvantages. This article reviews the possibilities of using optical coherence tomography (OCT), ultrasound biomicroscopy (UBM), thermography, confocal microscopy, and the Hyperemia-3 program for assessing the structural and functional state of the FB.


Assuntos
Vesícula , Glaucoma , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Glaucoma/diagnóstico , Glaucoma/cirurgia , Humanos , Microscopia Acústica , Procedimentos Cirúrgicos Oftalmológicos , Tomografia de Coerência Óptica
9.
Eur J Cardiothorac Surg ; 58(4): 858-860, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32951046

RESUMO

This report describes a patient with COVID-19 who developed spontaneous pneumothorax and subpleural bullae during the course of the infection. Consecutive chest computed tomography images indicated that COVID-19-associated pneumonia had damaged the subpleural alveoli and distal bronchus. Coughing might have induced a sudden increase in intra-alveolar pressure, leading to the rupture of the subpleural alveoli and distal bronchus and resulting in spontaneous pneumothorax and subpleural bullae. At the 92-day follow-up, the pneumothorax and subpleural bullae had completely resolved, which indicated that these complications had self-limiting features.


Assuntos
Betacoronavirus , Vesícula/virologia , Infecções por Coronavirus/diagnóstico , Doenças Pleurais/virologia , Pneumonia Viral/diagnóstico , Pneumotórax/virologia , Adulto , Betacoronavirus/isolamento & purificação , Vesícula/diagnóstico por imagem , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Humanos , Masculino , Pandemias , Doenças Pleurais/diagnóstico por imagem , Pneumonia Viral/complicações , Pneumotórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X
10.
Vet Radiol Ultrasound ; 61(6): 641-648, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32898319

RESUMO

Spontaneous pneumothorax presents a unique diagnostic and therapeutic challenge in veterinary medicine, specifically with regard to accurate identification of bullous lesions. Positioning of dogs with spontaneous pneumothorax during CT has not previously been evaluated. This retrospective, diagnostic accuracy study was performed to evaluate the sensitivity, positive predictive value (PPV), and interobserver variability for detection of pulmonary bullae with dogs positioned in multiple recumbencies. Dogs underwent CT in sternal and dorsal recumbency followed by thoracic exploration via median sternotomy. Three American College of Veterinary Radiology-certified veterinary radiologists blinded to surgical findings reviewed dorsal and sternal images simultaneously. Severity of pneumothorax, degree of atelectasis, lesion location and size, and view in which lesions were most confidently identified were compared to surgical and histologic findings. Sensitivities and PPVs for bulla detection ranged from 57.7% to 69.2% and 62.1% to 78.9%, respectively. For two of the 3 radiologists, the location of bullae in the thorax was significantly associated with the recumbency in which the lesion was best identified. Degree of atelectasis was found to be associated with the ability to identify lesions (P ≤ .02). The interobserver variability for identification was good (κ = 0.670). The sensitivity of CT when performed in both sternal and dorsal recumbency is similar to that previously reported. Because the distribution of bullae is unknown prior to advanced imaging and bulla location affects which recumbency is most useful for identification, acquisition of CT images in both sternal and dorsal recumbency may improve detection of bullous lesions and aid surgical planning.


Assuntos
Vesícula/veterinária , Doenças do Cão/diagnóstico por imagem , Pneumopatias/veterinária , Pneumotórax/veterinária , Animais , Vesícula/complicações , Vesícula/diagnóstico por imagem , Doenças do Cão/fisiopatologia , Cães , Feminino , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Variações Dependentes do Observador , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Decúbito Dorsal , Tomografia Computadorizada por Raios X/veterinária
11.
JAMA ; 324(12): 1180-1189, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32960242

RESUMO

Importance: Obesity increases the risk of both cesarean delivery and surgical-site infection. Despite widespread use, it is unclear whether prophylactic negative pressure wound therapy reduces surgical-site infection after cesarean delivery in obese women. Objective: To evaluate whether prophylactic negative pressure wound therapy, initiated immediately after cesarean delivery, lowers the risk of surgical-site infections compared with standard wound dressing in obese women. Design, Setting, and Participants: Multicenter randomized trial conducted from February 8, 2017, through November 13, 2019, at 4 academic and 2 community hospitals across the United States. Obese women undergoing planned or unplanned cesarean delivery were eligible. The study was terminated after 1624 of 2850 participants were recruited when a planned interim analysis showed increased adverse events in the negative pressure group and futility for the primary outcome. Final follow-up was December 18, 2019. Interventions: Participants were randomly assigned to either undergo prophylactic negative pressure wound therapy, with application of the negative pressure device immediately after repair of the surgical incision (n = 816), or receive standard wound dressing (n = 808). Main Outcomes and Measures: The primary outcome was superficial or deep surgical-site infection according to the Centers for Disease Control and Prevention definitions. Secondary outcomes included other wound complications, composite of surgical-site infections and other wound complications, and adverse skin reactions. Results: Of the 1624 women randomized (mean age, 30.4 years, mean body mass index, 39.5), 1608 (99%) completed the study: 806 in the negative pressure group (median duration of negative pressure, 4 days) and 802 in the standard dressing group. Superficial or deep surgical-site infection was diagnosed in 29 participants (3.6%) in the negative pressure group and 27 (3.4%) in the standard dressing group (difference, 0.36%; 95% CI, -1.46% to 2.19%, P = .70). Of 30 prespecified secondary end points, 25 showed no significant differences, including other wound complications (2.6% vs 3.1%; difference, -0.53%; 95% CI, -1.93% to 0.88%; P = .46) and composite of surgical-site infections and other wound complications (6.5% vs 6.7%; difference, -0.27%; 95% CI, -2.71% to 2.25%; P = .83). Adverse skin reactions were significantly more frequent in the negative pressure group (7.0% vs 0.6%; difference, 6.95%; 95% CI, 1.86% to 12.03%; P < .001). Conclusions and Relevance: Among obese women undergoing cesarean delivery, prophylactic negative pressure wound therapy, compared with standard wound dressing, did not significantly reduce the risk of surgical-site infection. These findings do not support routine use of prophylactic negative pressure wound therapy in obese women after cesarean delivery. Trial Registration: ClinicalTrials.gov Identifier: NCT03009110.


Assuntos
Bandagens , Cesárea/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa , Obesidade , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Antibacterianos/uso terapêutico , Bandagens/efeitos adversos , Vesícula/etiologia , Índice de Massa Corporal , Cesárea/métodos , Feminino , Humanos , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Gravidez , Complicações na Gravidez
12.
Hautarzt ; 71(10): 809-826, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32926199

RESUMO

Vesicles, pustules and vesiculopustules are frequent in newborns and infants and mostly self-limiting. In order to differentiate the rare life-threatening diseases and to therefore initiate the treatment in a timely manner, knowledge of vesicular, pustular and vesiculopustular dermatoses in early childhood is necessary.


Assuntos
Vesícula , Exantema , Dermatopatias Vesiculobolhosas , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido
13.
An Bras Dermatol ; 95(5): 551-569, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32732072

RESUMO

Inherited epidermolysis bullosa is a group of genetic diseases characterized by skin fragility and blistering on the skin and mucous membranes in response to minimal trauma. Epidermolysis bullosa is clinically and genetically very heterogeneous, being classified into four main types according to the layer of skin in which blistering occurs: epidermolysis bullosa simplex (intraepidermal), junctional epidermolysis bullosa (within the lamina lucida of the basement membrane), dystrophic epidermolysis bullosa (below the basement membrane), and Kindler epidermolysis bullosa (mixed skin cleavage pattern). Furthermore, epidermolysis bullosa is stratified into several subtypes, which consider the clinical characteristics, the distribution of the blisters, and the severity of cutaneous and extracutaneous signs. Pathogenic variants in at least 16 genes that encode proteins essential for the integrity and adhesion of skin layers have already been associated with different subtypes of epidermolysis bullosa. The marked heterogeneity of the disease, which includes phenotypes with a broad spectrum of severity and many causal genes, hinders its classification and diagnosis. For this reason, dermatologists and geneticists regularly review and update the classification criteria. This review aimed to update the state of the art on inherited epidermolysis bullosa, with a special focus on the associated clinical and genetic aspects, presenting data from the most recent reclassification consensus, published in 2020.


Assuntos
Epidermólise Bolhosa Distrófica , Epidermólise Bolhosa Juncional , Epidermólise Bolhosa , Vesícula , Epidermólise Bolhosa/genética , Epidermólise Bolhosa Distrófica/genética , Epidermólise Bolhosa Juncional/genética , Humanos , Pele
18.
Stomatologiia (Mosk) ; 99(3): 18-21, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32608943

RESUMO

The article is devoted to the study of immunohistochemical parameters in patients with bullous lesions of the oral mucosa. The biopsy samples of the oral mucosa were studied in 57 patients, including patients with pemphigoid bullosa (38 people) and pemphigus vulgaris (19 people). The results of immunohistochemical studies indicate the cellular mechanisms of damage to the epithelium, in which IL-1, IL-6 and HPV16 are involved.


Assuntos
Penfigoide Bolhoso , Pênfigo , Vesícula , Humanos , Mucosa Bucal
20.
An Bras Dermatol ; 95(4): 514-517, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32522451

RESUMO

Dissecting cellulitis is a chronic, progressive, and relapsing inflammatory disease that predominantly affects the vertex and occiput of young Afro-descendent men. It starts with papules and pustules that evolve to nodules, abscesses, and cicatricial alopecia. This article illustrates the evolutive trichoscopy of dissecting cellulitis, from its early phase, through the abscess phase, to the fibrotic cicatricial phase. Trichoscopy complements clinical-pathological classification, representing a complementary tool useful in early diagnosis and monitoring of the patient during treatment.


Assuntos
Celulite (Flegmão) , Dermoscopia , Alopecia , Vesícula , Humanos , Masculino , Recidiva
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