Multi-injection plate for intralesional corticosteroid treatment of patchy alopecia areata.
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Alopecia Areata↗
Biomedical subjects
J Ferrando
Publications and source records attributed to J Ferrando.
Corrective photoepilation for improper hairline placement after hair transplantation.
BACKGROUND: Noncoherent filtered flashlamp pulsed light has not been used for correction of surgical problems after hair transplantation. OBJECTIVE: To evaluate the clinical results of photoepilation in a patient with improper hairline placement after hair transplantation. METHODS: A noncoherent filtered flashlamp pulsed light source was used to photoepilate the misplaced frontal hairline in a 37-year-old Caucasian man, skin phototype IV (Fitzpatrick scale), who suffered from common baldness grade IV (Ebling scale) and had undergone a hair transplant 6 years before. The frontal hairline received three treatment sessions at 2-month intervals with the following treatment parameters: 695 nm cutoff filter, fluence 38 J/cm2, 3.5-msec pulse duration, triple-pulse mode, and 30-msec delay. The gulfs received two treatment sessions with the same protocol. RESULTS: Final clinical aspect was good and no hair regrowth in the frontal hairline has been observed after 1.5 years of follow-up. CONCLUSION: Noncoherent filtered flashlamp pulsed light is a novel therapeutic choice that offers a nonsurgical solution to unnatural hairline after hair transplantation.
Adult↗
Impact of a helmet law on two wheel motor vehicle crash mortality in a southern European urban area.
BACKGROUND: In Spain, a federal road safety law went into effect in the fall of 1992 extending to urban areas the unrestricted use of safety helmets by all two wheel motor vehicle occupants. OBJECTIVES: To assess the effect of the law in reducing fatal motorcycle crash injuries; to estimate the number of lives saved; and to determine changes in the distribution of severity and anatomical location of injuries. METHODS: Pre-test/post-test design of all deaths of two wheel motor vehicle occupants from 1990-92 (pre-law period) and from 1993-95 (post-law period) detected by the Barcelona Forensic Institute and the city police department. Injuries were coded using the 1990 version of the abbreviated injury scale. Poisson regression methods were used to model trends in mortality ratios and to provide estimates of the number of lives saved. RESULTS: Between 1993 and 1995, 35 lives of two wheel motor vehicle occupants were spared, representing a decrease of 25% in the observed motorcycle crash mortality in the post-law period when compared with what would be expected if no such law had gone into effect. The proportion of deaths with severe head injuries was also reduced from 76% to 67% in the post-law period. CONCLUSIONS: This study offers the first evaluation of a helmet law using combined forensic and police data in a large south European urban area where there is widespread use of motorcycles. Our results confirm the effectiveness of the helmet law, as measured by the reduction in the number of deaths and mortality ratios after the law implementation. The findings reinforce the public health benefits of mandatory non-restricted motorcycle and moped helmet use, even in urban areas with lower traffic speeds.
Accidents, Traffic↗
Social inequalities in health related behaviours in Barcelona.
OBJECTIVE: This study describes social class inequalities in health related behaviours (tobacco and alcohol consumption, physical activity) among a sample of general population over 14 years old in Barcelona. DESIGN: Cross sectional study (Barcelona Health Interview Survey). SETTING: Barcelona city (Spain). PARTICIPANTS: A representative stratified sample of the non-institutionalised population resident in Barcelona was obtained. This study refers to the 4171 respondents aged over 14. DATA: Social class was obtained from a Spanish adaptation of the British Registrar General classification. In addition, sociodemographic variables such as family structure and employment status were used. As health related behaviours tobacco consumption, alcohol consumption, usual physical activity and leisure time physical activity were analysed. Age adjusted percentages were compared by social class. Multivariate analysis was performed using logistic regression models. MAIN RESULTS: Women in the upper social classes were more likely to smoke, the adjusted odds ratio (OR) for social class V in reference to social class I was 0.36 (95% confidence intervals (95%CI): 0.19, 0.67), while the opposite occurred among men although it was not statistically significant in multivariate analysis. Smoking cessation was more likely among men in the higher classes (OR for class V 0.41, 95%CI: 0.18, 0.90). Excessive alcohol consumption among men showed no differences between classes, while among women it was greater in the upper classes. Engaging in usual physical activity classified as "light or none" in men decreased with lowering social class (OR class IVa: 0.55 and OR class IVb: 0.47). Women of social classes IV and V were less likely to have two or more health risk behaviours (OR for class V 0.33, 95% CI: 0.18, 0.62). CONCLUSION: Health damaging behaviours are differentially distributed among social classes in Barcelona. Health policies should take into account these inequalities.
Adolescent↗
[The effects of enalapril on exercise capacity and right ventricular function in patients with chronic cor pulmonale].
BACKGROUND: Chronic cor pulmonale (CPC) in patients with chronic obstructive pulmonary disease (COPD) is a predictor of mortality. ACE inhibitors (ACEIs) improve the symptoms and reduce mortality of left ventricular or congestive failure, however their long term use in patients with CPC has not been tested. The aim of this study is to assess the effect on exercise tolerance and cardiorespiratory function of long term administration of enalapril in patients with CPC. METHODS: Placebo-controlled, double blind, randomized study. 28 patients (24 men and 4 women, mean age of 68.11 +/- 7.78, range 51-79) with CPC and without exacerbation of their respiratory symptoms at baseline were double blind randomised to receive enalapril or placebo for 6 months, added to their previous therapy. Respiratory function test, exercise tolerance ("six minutes walking test") and isotopic ventriculography were performed at baseline and at the end of the study. RESULTS: At baseline there were no differences in FEV1, FVC, FEV1/FVC and exercise tolerance. Both placebo and enalapril were well tolerated. At the end of the study, patients taking enalapril increased their exercise tolerance an 8.9% (19 m) vs 4.7% (33 m) in the placebo group (p 0.44; 95 percent confidence interval, -41.10 to 91.99). RVEF improved a 6.4% with enalapril but worsened a 7.09% in placebo group (p 0.15; 95 percent confidence interval, -12.87 to 2.10). CONCLUSIONS: Long term administration of enalapril do not improve neither exercise tolerance, nor right ventricular (RV) function, although given in increasingly doses is well tolerated and might prevent further worsening in RV systolic function.
Aged↗
Motor-vehicle injury patterns in emergency-department patients in a south-European urban setting.
The objectives are to identify the main injury patterns in the various types of user (of cars, motorcycles/mopeds, bicycles and pedestrians) injured in traffic crashes and treated in hospital emergency services, along with their main demographic characteristics. One-year cumulative survey all of patients attended to emergency departments in Barcelona, Spain, over a 12-month period (1998) for injuries due to motor vehicle crashes. Bivariate descriptive analyses were conducted to identify the different profiles of motor-vehicle injury patients by age, sex, user type, injured body region and type of injuries. ISS scoring was used to determine injury severity. Of the nearly 17,000 injured traffic victims during 1998, 62% were men. Young people between 15 and 39 (71.6%) were most affected. 42% were users of two-wheeled motor vehicles, followed by car occupants (32%) and pedestrians (24%). Neck sprain (33%) was the most common injury among car occupants, multiple contusion and contusion of lower limbs among two-wheeled motor vehicles (23.5% and 14% respectively) and pedestrians (17.3% and 14.4% respectively) and upper limb fractures (20%) among cyclists. Motorcycle and moped users, mainly young males, have the highest probability of suffering injuries, with lower limbs being the most affected anatomical region. Elderly pedestrians sustaining injuries to the lower limbs and the head contribute substantially to the overall injury situation.
Accidents, Traffic↗
Comparison of the hypolipidemic effect of gemfibrozil versus simvastatin in patients with type III hyperlipoproteinemia.
BACKGROUND: Type III hyperlipoproteinemia is characterized by the accumulation of chylomicron and very low density lipoprotein (VLDL) remnants. Individuals with this disorder have a high risk of premature atherosclerosis, and hypolipidemic drugs are useful in their management. METHODS: We compared, in a double-blind, placebo-controlled, randomized crossed study, the effects of gemfibrozil (1200 mg/day) and simvastatin (20 mg/day) on lipids, apolipoprotein AI, apolipoprotein B, and apolipoprotein E and on lipids and apolipoprotein B content in VLDL, intermediate-density lipoprotein (IDL), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) in 10 patients with type III hyperlipoproteinemia. RESULTS: Levels of total cholesterol, VLDL cholesterol, IDL cholesterol, and apolipoprotein B decreased with both drugs. Larger reductions in triglycerides (109 +/- 28.2 mg/dL, P =.005), VLDL cholesterol (24.7 +/- 10.9 mg/dL, P =.05), and VLDL triglycerides (86.3 +/- 20.2 mg/dL, P =.003) were obtained with gemfibrozil compared with simvastatin. LDL cholesterol reduction was more effective with simvastatin than with gemfibrozil (44.3 +/- 17.1 mg/dL, P =.03). HDL cholesterol after gemfibrozil was 5.71 +/- 2.37 mg/dL higher than after simvastatin. CONCLUSIONS: In patients with type III hyperlipoproteinemia gemfibrozil is more effective in reducing total triglyceride and VLDL lipid levels than simvastatin, and simvastatin is better in reducing LDL cholesterol than gemfibrozil is. IDL and apolipoprotein E levels were reduced similarly with both drugs.
Adult↗
Paraneoplastic pemphigus: a case of long-term survival associated with systemic lupus erythematosus and polymyositis.
A 35-year-old man presented with a generalized bullous eruption and oral ulceration. He had been diagnosed as having systemic lupus erythematosus and pelvic Castleman disease (hyaline-vascular type) in the past. Histologic, direct and indirect immunofluorescence and immunoprecipitation studies confirmed a diagnosis of paraneoplastic pemphigus (PNP). Initially several medical treatments were tried unsuccessfully. The pelvic tumor was surgically removed and the mucocutaneous lesions slowly regressed. Four years after presentation, he developed polymyositis which was completely controlled with short courses of corticosteroids. There was no evidence of relapse of PNP or lupus erythematosus at that time. At the 6-year follow-up he showed no clinical evidence of PNP, lupus erythematosus or polymyositis without requiring immunosuppressive therapy. This case emphasizes the fact that patients with benign-neoplasm-associated PNP may undergo complete remission of the autoimmune disease upon complete excision of the tumor. This case also stresses the possible association of PNP with other autoimmune diseases such as lupus erythematosus and polymyositis.
Adult↗
Partial response of severe alopecia areata to cyclosporine A.
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Adolescent↗
Social inequalities in perceived health and the use of health services in a southern European urban area.
People of lower social class have worse health and less access to health services and preventive care. This article describes social class inequalities in health status and use of services, both curative and preventive, in Barcelona, in a country with a national health service. The cross-sectional study uses information from the 1992 Barcelona Health Interview Survey. Social class was designated using an adaptation of the British Registrar General classification. The study variables measured health status, health services utilization, and preventive practices. Bivariate and multivariate analyses were used. Some 88 percent of men in social class I and 81 percent in class V had very good or good perceived health status. For women these figures were 85.2 and 57.6 percent, respectively. Chronic illness increased with lower social class. There were no social class differences in the frequency of physician visits during the two weeks prior to the interview among people with poor perceived health. Some 60.7 percent of women aged over 29 in social class I had periodic cervical smears, but only 32 percent of those in class V; the corresponding figures for mammography were 37.8 and 11.3 percent. The national health service has advantages in terms of access to health services, but more knowledge about the quality of these services is required. The study findings are sufficient to defend the undertaking of equitable health policies, especially in providing access to preventive care for the entire population.
Adolescent↗
Guess what? Macronodular iatrogenic acne due to amineptine.
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Acne Vulgaris↗
[Atypical primary biliary cirrhosis or autoimmune cholangitis?].
The term autoimmune cholangitis is used for a disease with clinical and pathological features of primary biliary cirrhosis (PBC), lack of anti-mitochondrial antibodies (AMA), presence of anti-nuclear antibodies (ANA), and good response to immunosuppresive therapy. The current knowledge of this condition is limited and it is not established whether or not it is a different syndrome from the CBP. We report a 51-year-old woman with chronic cholestasis, histological features of PBC, negative AMA and positive peripheral fluorescent ANA pattern, without response to prednisone.
Antibodies, Antinuclear↗
[Achilles tendon size by high resolution sonography in healthy population. Relationship with lipid levels].
BACKGROUND: Sonography is a useful technique for the study of the Achilles tendon, and specially in the detection of tendon xantomas. Normal sonographic size is not well established, and is essential in the clinical diagnosis of monogenic familial hypercholesterolemia (FH). Possible relationship between Achilles tendon size and plasma lipid concentrations in normolipidemic population is not known. SUBJECTS AND METHODS: The antero-posterior Achilles tendon diameter (ATD) was measured with high resolution sonography in 100 healthy subjects, 50 males and 50 females, 20-70 years old, 10 subjects for each decade of age and sex. ATD was correlated with age, gender, body mass index, physical activity and lipid and apolipoprotein B plasma concentrations. RESULTS: The ATD was significantly higher in males than in females, 5.32 (standard desviation [SD] 0.48) mm versus 4.91 (SD 0.47) mm (p < 0.01). In the multivariate analysis, ATD of males was positively associated with total plasma cholesterol (TC) level (p < 0.01). The ATD in females was positively associated with weight (p < 0.01). CONCLUSIONS: Normal ATD has been defined. Its range is relatively narrow and different in both sexes. Similarities in the histology between vascular and tendinous intersticium probably explain the relationship found between Achilles tendon and TC. Achilles tendon size could be a simple marker of lipid deposition in tissues.
Achilles Tendon↗
Disabilities resulting from traffic injuries in Barcelona, Spain: 1-year incidence by age, gender and type of user.
The purpose of this study was to examine the 1-year incidence of disabilities resulting from traffic injuries among the population of Barcelona (Spain), as well as its distribution by age, gender and type of motor-vehicle user, taking into account different exposure criteria. This is a population-based cross-sectional study; subjects were all cases (n = 4080) having undergone a medical examination for a traffic injury having occurred in 1993 resulting in a disability among residents in the area of Barcelona. Subjects were considered to have suffered a disability as a result of an injury if they were prevented from carrying out their normal activities for a period of 2 days or more. In 1993, the cumulative incidence rate of disability was 237.9 cases per 100,000 inhabitants, higher for men (287.1) than for women (193.9). The 20-24 year age group showed the highest incidence of disability (607.5). The rate of incidence of disability was 95.5 per 100,000 inhabitants among occupants of two wheeled vehicles, 87.7 among car occupants and 39.9 in pedestrians. When length of exposure to traffic was taken into account, the incidence rate of disability for residents aged > 14 years was 1.09 per 100,000 hours per person per year, similar for both sexes. This study represents a first attempt to use population-based health data to evaluate the incidence of disabilities due to traffic injuries. The results allow the identification of the groups with the greatest risk and who contribute the most to disabilities resulting from injuries, especially young users of two-wheeled motor vehicles.
Accidents, Traffic↗
Systemic xanthohistiocytoma: a variant of xanthoma disseminatum?
We present a 66-year-old man who had maculopapular pigmented lesions on the skin of the head, neck and trunk suggesting generalized eruptive histiocytoma (GEH). These lesions had a yellowish centre in a target-like pattern that has not been previously described. The patient suffered from diplopia and had a severe sensorimotor polyneuropathy causing progressive paresis of the limbs. The explorations performed disclosed the presence of specific xanthomatous infiltrates in the skin, lungs, respiratory tract, peripheral nerves and meninges, suggesting xanthoma disseminatum (XD) or juvenile xanthogranuloma. Multiple osteolytic lesions of large bones were also found. The infiltrate was CD68, MAC 387 and factor XIIIa positive and S-100 and CD1 negative. Some cells contained worm-like bodies visible by electron microscopy. Our patient presented clinical and immunohistochemical findings suggestive of GEH, juvenile xanthogranuloma or XD, supporting the idea of a wide spectrum of non-Langerhans cell histiocytosis. These specific target-like xanthomatous lesions seem to be unique for this new variant of XD.
Aged↗
Effective dose to the patient undergoing superior vena cava stent.
Metallic stents have been recently introduced for treating superior vena cava (SVC) obstruction. Dose data, in terms of dose-area product (DAP), from 44 patients referred for SVC stent placement on a digital unit have been retrospectively analysed in terms of their fluoroscopic and radiographic components. The mean DAP for the 44 examinations was 42 Gy cm2 and the effective dose was estimated to be 5.8 mSv. The fluoroscopic component was approximately 80%, with a mean screening time for these examinations of 17 min. The mean number of digital exposures was 86.
Aged↗
Barrett's esophagus, markers to distinguish risk groups.
BACKGROUND: As compared to the general population, patients with Barrett's esophagus (BE) present a 30 to 40 times higher risk of developing cancer. Their prognosis is poor and it will only be changed trying to recognize and detect preneoplastic changes early in order to provide these patients with an effective surgical therapy. Although epithelial dysplasia is still the "gold standard" as a marker of increased risk for malignancy, in view of the inter and intraobserver differences for interpreting it, both as regards its existence and grade, we have investigated other markers which can show this increased cancer risk. OBJECTIVE: Our aim has been to analyze which parameters, in addition to dysplasia, can distinguish groups with a higher or lower risk of progression to malignancy for a differentiated follow-up, so that the cost-benefit ratio is adequate and a sufficiently early diagnosis can be achieved which allows for a healing surgical therapy in most patients. PATIENTS AND METHODS: Twenty-seven patients have been studied, 9 with BE without dysplasia (control group), 9 with Barrett's esophagus with dysplasia, and 9 adenocarcinomas over BE, in all of which the presence of p53, c-erb-2, PCNA and CEA was established by histochemistry and the existence of aneuploidy by static cytometry. RESULTS: PCNA was positive in the three groups, though it was not at the surface epithelium in 55.5% of the control cases. C-erb-2 was negative in all control cases and positive in 5 cases with dysplasia, and 2 with adenocarcinoma. Protein p53 was positive in one control case, in 2 with dysplasia, and 4 with adenocarcinoma. CEA was positive in 7 control cases and in all cases with dysplasia and adenocarcinoma. Finally, aneuploidy was found by static cytometry in 5 of 9 control cases, in 4 of 9 with dysplasia, and in all adenocarcinomas. From the analysis of the results obtained, it can be concluded that a positive marker, even in the absence of dysplasia, suggests the presence of a "genomic instability" which may lead to progression to malignancy. CONCLUSIONS: This study allows us to establish three risk groups (high, low and intermediate) for a differentiated follow-up which allows an early diagnosis, with an adequate cost-benefit ratio.
Barrett Esophagus↗