Pemphigus-like eruption as a complication of molluscum contagiosum treatment with imiquimod in a 5-year-old girl

Pemphigus and pemphigus-like reactions can be triggered by a variety of medications including topical therapies, such as imiquimod. While the association between imiquimod and pemphigus-like reactions has been reported in adults, this is the first report of a generalized reaction beyond the site of imiquimod application in a child. The mechanism by which this occurs may be through a unique pathway, separate from the classic antibody-mediated pathway. Our patient had a full recovery without recurrence after cessation of the inciting drug.     

Recurrent and severe epistaxis secondary to nasal trauma. Report of an atypical case in a 22-year-old male

We report the case of a 22-year-old male who presented a diferred, recurrent and severe epistaxis after nasal trauma which required several admissions in our hospital and different treatments. Concretely by chronological order it has been practiced anterior tamponades, endoscopic ligature-cauterization of the sphenopalatine artery, classic posterior packing and finally a new FENS with cauterization of anterior ethmoidal artery. Besides it was necessary a transfusion to go up the anemia suffered by the patient whose global stay was 16 days. Recurrent postraumatic epistaxis are very rare but can be represent a difficult problem to solve.     

Management of N0 neck in laryngeal carcinoma. Impact on patient's survival

Management of patients with carcinoma of the larynx should systematically include an appropriate treatment of lymph nodes according to the TNM stage. One of the most controversial points of the treatment in these patients is the management of the clinically negative neck (N(0)). A retrospective study of 295 patients with laryngeal carcinoma and N(0) neck undergoing treatment in our centre between 1983 and 1993 is presented. We observed a significant decrease in the survival of clinically N(0) patients with histologically affected lymph nodes. Lymphadenopathy was more frequently detected in patients with supraglottic tumours (38 per cent) when compared to glottic tumours (16 per cent). In our experience, routine bilateral and unilateral dissection of N(0) necks in all supraglottic tumours and in T3-T4 glottic tumours, respectively, is the most beneficial approach for patients in terms of survival.     

Familial isolated unilateral large vestibular aqueduct syndrome

Large vestibular aqueduct syndrome (LVAS) is one of the most frequent inner ear malformations. It is associated with varying degrees of hearing loss, that may be progressive, sudden or fluctuant; nevertheless normal hearing in cases with LVAS has been described. Although unilateral LVAS has been described, all patients show clinical and radiological findings in both ears, in contrast to the family presented here, where 2 siblings are affected by unilateral sensorineural hearing loss associated with ipsilateral LVAS, with an autosomal recessive pattern. In order to search for the origin of this inner ear malformation, mutations in genes GJB2 (connexin-26 gene), PDS (Pendred's syndrome gene) and mitochondrial 12sRNA were studied, without positive results. In this paper we hypothesize the probable embryological origin for this malformation.     

Melatonin concentration in the umbilical artery and vein in human preterm and term neonates and neonates with acute fetal distress

In order to assess the existence of a rhythmic secretion of melatonin (aMT) in newborns and whether this rhythm is affected by neonatal stress, we studied 112 newborns classified in three groups: normal babies delivered at term, preterm infants born before the 38th week, and babies with fetal distress. Melatonin was measured by RIA in the umbilical artery and vein at the time of birth. Melatonin levels in umbilical arterial and venous blood showed a diurnal rhythm in all groups. Melatonin levels in umbilical cord artery and vein were closely related. Nocturnal melatonin levels were increased in newborns with acute fetal distress in comparison with normal term and preterm neonates. These results suggest that (1) a rhythm of aMT secretion exists in newborns, although it cannot be determined whether this rhythm is of maternal or fetal origin and (2) neonatal stress (acute fetal distress) increases aMT production during the night in comparison with normal term and preterm neonates.     

Lipoprotein profile in elderly persons from northwestern Spain consuming the Atlantic diet, a variant of the Mediterranean diet

To screen some cardiovascular risk factors in institutionalized elderly persons of the Spanish Northwest who consume the Atlantic variant of the Mediterranean diet, rich in vegetables, fruit, meat, fish, olive oil and dairy products, anthropometric and dietary measurements were carried out and serum glucose and lipoprotein values were determined in 94 subjects. Men consumed significantly more legumes, fruit, meat, alcohol and precooked foods but fewer vegetables than women. Significant positive correlations were found between total fat and MUFA consumption and HDL-cholesterol. Fish intake correlated negatively with total cholesterol (TC) and LDL-cholesterol. The prevalence of high TC, LDL-cholesterol, triglyceride and TC/HDL-cholesterol levels was 29%, 37%, 21%, 25% respectively, and that of low HDL-cholesterol was 15%. Women displayed a higher prevalence of dyslipemia, with significantly higher TC and higher LDL-cholesterol levels than men. Fifty percent of the women aged 75-80 presented concurrent hyperglycemia, excess weight and hypertriglyceridemia, predisposing them to the metabolic syndrome. Nonetheless, as regards the lipoprotein profile, the Atlantic diet appears appropriate for most institutionalized elderly persons.     

Effect of a low-tryptophan diet as an adjuvant to conventional neuroleptic therapy in schizophrenia.

Eleven patients with DSM-III-R schizophrenia were entered into a 4-day tryptophan (TRP)-deficient diet. The diet lowered total plasma TRP levels in all patients; during the diet phase, there was a greater than 50% reduction in mean total plasma TRP levels from the pre-diet phase. The low-TRP diet improved performance on the Stroop Color and Word Test. These data are especially intriguing in view of the suggestion that a deficit in color-word naming is related to frontal lobe dysfunction and the possible occurrence of frontal lobe abnormalities in patients with schizophrenia. Interestingly, depressive symptomatology did not emerge on the TRP-deficient diet, despite the lowering of total plasma TRP levels. There were statistically significant improvements noted on objective ratings of the severity of psychotic symptomatology; however, these statistical improvements were without obvious clinical significance, as the magnitude of the changes on the behavioral ratings were minimal. The results of this study suggest that there might be some adjuvant potential for a low-TRP diet in the treatment of schizophrenia, and that schizophrenia or antipsychotic medications might offer some protection against the depressive effects of a TRP-deficient diet.