CHLORACNE IN THE 1990s

Background. Chloracne is a disease associated with toxicity of halogenated compounds used in some industrial processes. A patient affected by chloracne led us to study a total of nine cases from a single factory. Methods. We studied the clinical features of nine patients exposed chronically to chlorobenzenes. On all of them blood samples were drawn and biopsies of affected skin and liver were taken. Their work environment was visited and studied. Results. All nine patients were men and had polymorphic skin lesions, characterized mainly by comedones and cysts. They had chronic conjunctivitis and seven had cysts in the Meibomian glands. All of them had polyneuropathy and liver damage and seven had hypertriglyceridemia. Compounds known to cause chloracne were found in exceedingly high concentrations in the water used in the workplace. Conclusions. Every patient exposed to halogenated compounds with the cutaneous manifestations of chloracne should be carefully investigated for systemic complications (such as ophthalmic, neuropathic, hepatic, and lipoprotein abnormalities).     

A Randomized, Double-Blind Comparison of Two Topical Anesthesic Formulations Prior to Electrodesiccation of Dermatosis Papulosa Nigra

BACKGROUND: Liposomal lidocaine 4% (L.M.X.4 cream, Ferndale Laboratories Inc., Ferndale, MI, USA) has been proposed as a more rapidly acting topical anesthetic than the eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream, AstraZeneca LP, Wilmington, DE, USA) for venipuncture and laser procedures. However, their anesthetic efficacy has not been previously compared for electrosurgical destruction of superficial skin lesions. OBJECTIVE: To test the hypothesis that L.M.X.4 and EMLA differ in anesthetic efficacy when applied under occlusion for 30 minutes prior to electrodesiccation of papules of dermatosis papulosa nigra. METHODS: Forty adults were randomly assigned to treatment with either agent for 30 minutes under Tegaderm. The study drug was administered for an additional 30 minutes if the electrodesiccation of the first few papules was too painful. RESULTS: One subject treated with EMLA versus none treated with L.M.X.4 experienced complete anesthesia after a single 30-minute application. Nineteen of 20 (95%) subjects treated with EMLA versus 18 of 20 (90%) subjects treated with L.M.X.4 required only a single application (p = .49). Pain scores after the initial 30-minute application (scale: 0 = none to 10 = very severe) were EMLA 3.3 +/- 2.2 (mean +/- SD) versus L.M.X. 4 2.9 +/- 2.0 (p = .46). CONCLUSION: EMLA and L.M.X.4 provide comparable levels of anesthesia after a single 30-minute application under occlusion prior to electrodesiccation of superficial skin lesions.     

Incidence of Atrial Fibrillation in Patients with Different Mode of Pacing. Long-term Follow-up

We evaluated the incidence of atrial fibrillation in 189 patients (92males, 97females, mean age 75 ± 12yrs, range 41–100yrs) with pacemaker, during a mean follow-up of 5.5yrs (range 1–24yrs). The indications for implant were: complete AV block (115pts), second degree Möbilz 2 AV block (51pts). bifascicular block (5pts). sick sinus syndrome (14pts), symptomatic bradycardia (4pts). The mode of stimulation considered were VVI (105pt), VVI rate responsive (21pts), single lead VDD (43pts), DDD (20pts). The occurrence of retrograde VA conduction in patients with VVI or VVI rate responsive pacing was also evaluated. Atrial fibrillation occurred in 40 pts (21%). The highest incidence was evidenced in patients with sick sinus syndrome (9pts, 64%), and in patients with VVI stimulation (28pts, 27%). On the contrary, the lowest incidence was found in single lead VDD stimulation (4pts, 9%). The patients with dual chamber pacing showed a relatively high incidence of the arrhythmia (5pts, 25%). Atrial fibrillation occurred in 9 out of 32 patients with retrograde VA conduction, and in 22 out of 94 patients without retrograde conduction (28% versus 23%, p=NS). In conclusion, it is confirmed that patients with sick sinus syndrome are at high risk for atrial fibrillation. Single lead VDD stimulation seems to be the better mode of pacing in preventing atrial fibrillation, while dual chamber pacing showed minor efficacy. The presence of retrograde VA conduction could not predict the occurrence of the arrhythmia.     

A case of optic atrophy possibly induced by quinoline in acrodermatitis enteropathica

A 2-year-old girl with acrodermatitis enteropathica, developed optic atrophy during quinoline treatment (600 mg/day, later gradually increased to 1700 mg/day; a total dose of 280 g was given). The optic atrophy developed rapidly 9 months after the start of the quinoline treatment. The right eye was blinded and developed a convergent strabismus. Eight months after the quinoline had been stopped, the left eye began a slow and partial recovery of vision with an improvement in the appearance of the optic disc.     

Human β-endorphin

¹H spectra at 270MHz of the β_h-endorphin glycyl residues in aqueous solution are reported. The chemical shifts, coupling constants and temperature coefficients are compared with those of the glycyl residues in Met-enkephalin and in a random coil model peptide. The local conformation of Tyr-Gly-Gly-Phe-segment observed in Met-enkephalin is maintained in β_h-endorphin.     

AMERICAN CUTANEOUS LEISHMANIASIS: INTERMEDIATE FORM

A man of Portuguese nationality presented with increased volume of the forehead and multiple pustules, which subsequently ulcerated. The pustules appeared progressively on the rest of the face and in the right scapular region during a period of 2 years.
Physical examination revealed multiple rounded ulcers of different sizes with erythematous and infiltrated borders covered by serosanguineous scabs on the face and right scapular region (Figs. 1 and 2).
The otorhinolaryngologic examination showed an infiltrate of granulomatous aspect in the anterior third of the septum. Posterior rhinoscopy was normal.
When the patient was first seen, complete hematology and hepatic and renal tests were normal. Additional tests included: HIV, nonreactive; venereal disease reference laboratory test, nonreactive; chest x-ray, normal; Montenegro skin test, 14 mm; purified protein derivative, 0 mm.
The skin biopsy revealed a granulomatous infiltrate with a dense infiltrate composed principally of plasmocytes, with few lymphocytes (Fig. 3).
A skin smear stained with Giemsa and culture of biopsy material in blood agar were positive for the presence of Leishmania. Antibodies against Leishmania measured in an ELISA test were strongly positive, titer 1:6400. Typing of the isolate using absorbed polyclonal antisera revealed Leishmania braziiiensis .
During hospitalization, the patient received systemic immunotherapy with a combined vaccine containing heat-killed Leishmania mexicana promastigotes and bcg ,^1,2 as well as chemotherapy with meglumine antimoniate in a dose of 50 mg/kg/day IM, two cycles of 20 days with an in-terval of 7 days of rest.
The patient presented clinical healing of his lesions without relapse during a 2 year follow up after completion of therapy.