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[Giant sebaceous gland hyperplasia of the vulva].

BACKGROUND: Sebaceous gland hyperplasia is an epithelial tumour with sebaceous differentiation. Genital involvement is rare. In this paper, we report a new case of sebaceous gland hyperplasia of the vulva. CASE REPORT: A 27 year-old woman presented multiple polypoid lesions of the lower third of left labium majus. The lesions were soft to the touch, measured 5 cm in length and were painless. The cutaneous biopsy confirmed the diagnosis of sebaceous gland hyperplasia of the vulva. Surgical excision was performed in two separate procedures and was successful. DISCUSSION: This case was unusual in terms of the site, the clinical appearance and the weeping seen due to the high concentration of hyperplasic sebaceous glands.

Adult↗

Tritium and 36Cl as constraints on fast fracture flow and percolation flux in the unsaturated zone at Yucca Mountain.

An analysis of tritium and 36Cl data collected at Yucca Mountain, Nevada suggests that fracture flow may occur at high velocities through the thick unsaturated zone. The mechanisms and extent of this "fast flow" in fractures at Yucca Mountain are investigated with data analysis, mixing models and several one-dimensional modeling scenarios. The model results and data analysis provide evidence substantiating the weeps model [Gauthier, J.H., Wilson, M.L., Lauffer, F.C., 1992. Proceedings of the Third Annual International High-level Radioactive Waste Management Conference, vol. 1, Las Vegas, NV. American Nuclear Society, La Grange Park, IL, pp. 891-989] and suggest that fast flow in fractures with minimal fracture-matrix interaction may comprise a substantial proportion of the total infiltration through Yucca Mountain. Mixing calculations suggest that bomb-pulse tritium measurements, in general, represent the tail end of travel times for thermonuclear-test-era (bomb-pulse) infiltration. The data analysis shows that bomb-pulse tritium and 36Cl measurements are correlated with discrete features such as horizontal fractures and areas where lateral flow may occur. The results presented here imply that fast flow in fractures may be ubiquitous at Yucca Mountain, occurring when transient infiltration (storms) generates flow in the connected fracture network.

Chlorine↗

[Urofacial Ochoa's syndrome: a clinical case].

An 11 year-old girl had an urinary diversion because of a complex uropathy with vesical sphincter dyssinergism. Her inexpressive face with lost eyes and forced gestures, especially when smiling--her smile looking rather like weeping--was the clue to the diagnosis of Ochoa's syndrome. She underwent psoic bladder fixation, right ureteral reimplantation, bladder neck loosening and cystostomy undiversion. At follow-up, renal function deteriorated. She has recently received a kidney transplantation in another institution, and is now symptom-free.

Child↗

[Comparation of reactogenicity of vaccine combinations with an injection volume of 0,5 and 1 ml in infants].

OBJECTIVE: To compare the local and systemic reactogenicity of two vaccine associations in infants, in order to ascertain if a greater volume of injection is associated with a greater adverse effects rate. DESIGN: Intervention study, without random distribution. Site. A unit of vaccinations with free access and public dependency. PARTICIPANTS: 228 infants (138 male, 90 female) aged 2, 4 and 6 months that were attending to compliment their vaccine schedule. INTERVENTIONS: To those aged 2 and 6 months (group 1: 108 children) it was administered the association DTPw + Hepatitis B + Hib (Tritanrix-HB + Hiberix) with a volume of injection of 0,5 ml, and to those aged 4 months (group 2: 120 children) the association DTPw + Hib (Anatoxal Diteper + Hibtiter) with a volume of 1 ml. The injection was applied in the thigh and paracetamol was indicated in the following 24 hours. Adverse reactions were registered through telephonic interview, and nursing visit of those which might have presented some one. RESULTS: There were not meaningful differences between both associations in signs or symptoms analyzed (pain, inflammation, aseptic cyst, fever, behavior alterations, diarrhea, encephalopathy, hypotonic-hyporesponsive episode or inconsolable weeping). With both associations the local reactions rate (0% of inflammation or aseptic cyst) and fever (10%) were very inferior to the previous published data. CONCLUSION: The vaccine association with a volume of injection of 1 ml did not produce more adverse effects than the association of 0,5 ml. Both produced a number of local reactions and fever much less than previously published, what is attributed to the prophylactic use of paracetamol and other preventive measures. Therefore, the association elected for the vaccination at 4 months (DTPw + Hib with a volume of 1 ml) is useful and practical to improve vaccine coverage and for the welfare of vaccinated infants, upon avoiding them an injection and without provoking more adverse reactions.

Female↗

Paget's disease of the vulva with underlying apocrine adenocarcinoma and local lymph node invasion.

A case of Paget's disease of the vulva with an underlying apocrine adenocarcinoma and local lymph node invasion is reported in a female aged 70. Subjective symptoms of pruritus, burning and pain were associated with typical, but unspecific clinical findings of an erythematous, indistinctly limited, weeping lesion of palm-size with small superficial erosions. Near the right labium majus a solid measuring 2.5 X 1.5 cm in diameter was palpable. The diagnosis was established by microscopic examination of biopsy material, showing intraepidermally the typical Paget's disease with a subjacent, highly differentiated apocrine adenocarcinoma of the sweat glands combined with inguinal lymph node invasion. Other epidermal malignancies were excluded by histochemical reactions. For therapy, telecobalt irradiation combined with high energy electron was applied.

Adenocarcinoma↗

Asthma caused by Ficus benjamina latex: evidence of cross-reactivity with fig fruit and papain.

BACKGROUND: Ficus benjamina or weeping fig is a plant used increasingly for indoor decoration that can cause allergic rhinitis and asthma. OBJECTIVE: We report a clinical and immunologic study in a patient with perennial asthma caused by F. benjamina latex in whom several episodes of angioedema of the oropharyngeal tract and tongue followed ingestion of figs and kiwi. METHODS: Hypersensitivity to latex from F. benjamina and from Hevea brasiliensis, fig fruit, kiwi, papain, and bromelain was investigated by means of skin prick test, specific IgE determination by CAP, histamine release test, and bronchial provocation test to F. benjamina latex. CAP-inhibition assays were carried out to study possible cross-reactivity among these antigens. RESULTS: Hypersensitivity to F. benjamina latex, fig, kiwi, and proteases was demonstrated by means of skin prick test, determination of specific IgE and histamine release test. Bronchial provocation test with F. benjamina latex resulted in a dual asthmatic reaction, confirming the etiologic role of this plant. A rise of eosinophil cationic protein in patient's serum was observed 21 hours after bronchial challenge, suggesting activation of eosinophils. Inhibition assays showed that F. benjamina latex as liquid-phase inhibited up to 95% the CAP to fig and up to 57% the CAP to papain. Neither sensitization nor cross-allergenicity with H. brasiliensis latex was found. CONCLUSIONS: Hypersensitivity to F. benjamina latex may cause IgE-mediated respiratory allergy. The association with allergy to fig and papain is likely due to the existence of cross-reactive allergen structures.

Adult↗

The pragmatics of "madness": performance analysis of a Bangladeshi woman's "aberrant" lament.

A fine-grained analysis of the transcript of a Bangladeshi woman's lament is used to argue for an anthropology of "madness" that attends closely to performance and performativity. The emergent, interactive production of wept speech, together with the conflicting use to which it is put by the performer and her relatives, is linked problematically to performance genres and to ethnopsychiatric indexes of madness. Tuneful weeping is taken by relatives to be performative of madness, in a sense something like Austin's. Yet, exploration of the divergent linguistic ideologies which are brought to bear on the lament not only enables more nuanced ethnographic treatment but also has reflexive ramifications for medical and psychological anthropology. This leads to a critique of the referentialism in our own treatment of language. The role played by transparent reference is overshadowed by indexicality and by dialogical processes of proposing and resisting labels for speech genres attributed to the "mad."

Acting Out↗

Efficacy of clonidine and of methadone in the rapid detoxification of patients dependent on heroin.

The efficacy of a rapid detoxification schedule (8 to 10 days) with clonidine or methadone was evaluated in 30 patients addicted to heroin. The dose of study drug was preestablished according to the subject's weight and the amount of opioid consumption, and the total daily dose was reduced by approximately 15% during the study. All subjects completed the detoxification program and stayed in the hospital for at least 12 days. Clonidine and methadone therapies proved to be highly effective. There was a marked reduction in anxiety during opioid detoxification, although subjects' experiences differed according to the drug used. On the day of discharge, subjects who had received methadone still had attenuated withdrawal symptoms, whereas there were no such symptoms in the clonidine group. Muscular aching, flatulence, and daily drowsiness were more common among subjects in the methadone group, while subjects in the clonidine group had more sleep disturbances and weeping. Syncopal episodes and bradycardia occurred more frequently in the clonidine group.

Adolescent↗

Imiquimod for actinic keratosis: systematic review and meta-analysis.

Benefit and harm associated with treating actinic keratosis (AK) with the immune response modifier imiquimod was assessed using published randomized-controlled trials. Five randomized double-blind trials lasted 12-16 weeks and treated 1,293 patients. Complete clearance occurred in 50% of patients treated with imiquimod, compared to 5% treated with vehicle, and the number needed to treat (NNT) for one patient to have their keratosis completely cleared after 12-16 weeks was 2.2 (95% confidence interval 2.0-2.5). For partial (>/=75%) clearance the NNT was 1.8 (1.7-2.0). The proportion of patients with any adverse event, any local adverse event, or any treatment-related adverse event was substantially higher with imiquimod than with vehicle, and numbers needed to harm for one additional adverse event with imiquimod over 12-16 weeks ranged from 3.2 to 5.9. Particular local adverse events with imiquimod included erythema (27%), scabbing or crusting (21%), flaking (9%), erosion (6%), edema (4%), and weeping (3%). Imiquimod 5% cream was effective in the treatment of AK, preventing potential development of squamous cell carcinoma. Future investigation might be aimed at elucidating optimal dosing to minimize adverse events without detriment to efficacy, and evaluating long-term recurrence.

Aminoquinolines↗

Staphylococcus aureus colonization in atopic dermatitis and its therapeutic implications.

Skin colonization with Staphylococcus aureus is a characteristic feature of atopic dermatitis with more than 90% of patients being colonized. Extracellular matrix proteins are important for the adherence of S. aureus to human keratinocytes. The bacterium interferes in the inflammatory process of atopic dermatitis in various ways, among which the ability to release superantigens in a high percentage of clinical isolates is of great importance. As the colonization correlates significantly with the severity of eczema, anti-staphylococcal treatment measurements are widely used. In cases of atopic dermatitis exacerbation with wide-spread weeping lesions, a systemic antibiotic treatment is warranted, with erythromycin no longer being recommended due to an increased resistance rate. In localized superinfected lesions the topical application of an antibiotic-glucocorticoid preparation may offer advantages to the mere steroid application. Based on efficacy and resistance data, fusidic acid is the antibiotic of choice. There is evidence that phototherapy in atopic dermatitis may be even more effective when combined with anti-staphylococcal measurements. In the future new therapeutical options may be available.

Anti-Bacterial Agents↗

Oral tramadol: analgesic efficacy in children following multiple dental extractions.

In a randomized double-blind study, 60 children, aged 4-7 years, undergoing dental extractions of six or more teeth under day-case general anaesthesia, were assigned to receive either tramadol drops 1.5 mg kg-1 (n = 31), or placebo (normal saline) (n = 29), 30 min before surgery. In addition, all received anxiolytic pre-medication of oral midazolam 0.5 mg kg-1 (max 7.5 mg) at the same time. No differences were seen in behaviour, respiratory or cardiovascular assessments. In both groups, 93% were drowsy pre-anaesthetic, 3% were asleep but rousable and less than 4% exhibited minor distress. At induction, mild weeping occurred in 9.7% of the tramadol group and 6.9% of the placebo group (P > 0.05). Active awake recovery took 48.8 min, SD 32.6 in the tramadol group and 36.4 min, SD 29.6 in the placebo group (P > 0.05). Post-operative analgesia (paracetamol 120 mg) was given to 19.4% of the tramadol group compared with 82.8% of the placebo group (P < 0.05), after which the Hannalah objective pain scale scores were comparable. Analysis of the Oucher six faces pain scale showed significantly better analgesia in the tramadol group at all time points, the pain score being half that of the placebo group at 60 min and one third from 60 to 120 min (P < 0.05). No adverse respiratory or cardiovascular effects were seen. For children undergoing multiple extractions, 10.7, SD 3.0, effective postextraction analgesia was provided.

Acetaminophen↗

[Crocodile tears and retraction syndrome].

BACKGROUND: An association between crocodile tears and Duane's syndrome has been described in more than 50 cases. PATIENT: A 29-year-old man had tearing of his right eye whenever he ate something sour. At psychic weeping his right eye remained dry. In addition, he had Duane's retraction syndrome, also in the right eye. CONCLUSION: In this case of congenital crocodile tears with an ipsilateral Duane's syndrome the normal function of the facial muscles suggests that the abnormal coupling between the gustatory nucleus and the lacrimal gland is not located in the facial nerve proximal to the Ganglion geniculi, as in most acquired cases. Rather, the abnormal coupling may be located in the brainstem. The association with Duane's syndrome indicates that abnormal innervational coupling is present also in the ocular motor domaine.

Abducens Nerve↗

Double-blind, randomized trial of scheduled use of a novel barrier cream and an oil-containing lotion for protecting the hands of health care workers.

CONTEXT: Many health care workers suffer severe hand irritation, with cracking and bleeding, as a consequence of frequent handwashing and glove use. Integumentary breakdown has major implications for nosocomial infection control and promotes the spread of bloodborne viruses. The potential benefits of scheduled use of hand-care agents-lotions or creams-in health care workers has not been established by controlled trial. OBJECTIVE: To compare the value of an oil-containing lotion with a novel barrier skin cream in health care workers with severe hand irritation. DESIGN: Prospective, randomized, double-blind trial. SETTING: University medical center. PARTICIPANTS: Fifty-four health care workers from multiple departments with severe hand irritation, 74% with one or more full-thickness cracks or other integumentary breaks. MAIN OUTCOME MEASURES: Objective and subjective parameters for scaling, cracking, weeping, bleeding, and pain were scored by two blinded investigators weekly for 4 weeks, and the hands of subjects were cultured quantitatively at the onset and after 2 weeks and 4 weeks. RESULTS: Subjects in both groups experienced marked improvement in overall hand condition (each, P <.02), particularly in scaling, cracking, and pain. Persons randomized to use of the oil-containing lotion showed greater improvement (mean score, from 6.5 to 2.7 vs 6.8 to 4. 7, P =.006). In 18 (69%) of 26 persons who used the control lotion, all full-thickness integumentary breaks were healed and pain was totally resolved, compared with 14 (52%) of 27 persons who used the barrier cream (P =.26). Use of the two agents in a scheduled fashion had no effect on the levels or profile of the transient hand flora. However, by the fourth week of use, handwashing frequency was 50% higher in subjects randomized to use the control lotion than it was in subjects randomized to use the barrier cream (17.8 vs 11.7 times per day, P =.04). CONCLUSION: Use of an oil-containing lotion or a barrier cream on a scheduled basis can substantially protect the hands of vulnerable health care workers against drying and chemical irritation, preventing skin breakdown and promoting more frequent handwashing.

Academic Medical Centers↗

Corroboration of in vivo cartilage pressures with implications for synovial joint tribology and osteoarthritis causation.

Pressures on normal human acetabular cartilage have been collected from two implanted instrumented femoral head hemiprostheses. Despite significant differences in subjects' gender, morphology, mobility, and coordination, in vivo pressure measurements from both subjects covered similar ranges, with maximums of 5-6 MPa in gait, and as high as 18 MPa in other movements. Normalized for subject weight and height (nMPa), for free-speed walking the maximum pressure values were 25.2 for the female subject and 24.5 for the male subject. The overall maximum nMPa values were 76.2 for the female subject during rising from a chair at 11 months postoperative and 82.3 for the male subject while descending steps at 9 months postoperative. These unique in vivo data are consistent with corresponding cadaver experiments and model analyses. The collective results, in vitro data, model studies, and now corroborating in vivo data support the self-pressurizing "weeping" theory of synovial joint lubrication and provide unique information to evaluate the influence of in vivo pressure regimes on osteoarthritis causation and the efficacy of augmentations to, and substitutions for, natural cartilage.

Aged↗

Delayed hypersensitivity test with paracoccidioidin in captive Latin American wild mammals.

The aim of this investigation was to study epidemiological aspects of paracoccidioidomycosis, the main endemic systemic mycosis in Brazil. This study was carried out using the paracoccidioidin delayed hypersensitivity test in 96 Latin American wild mammals, including 49 arboreal animals (primates): 33 Cebus apella (weeping-capuchin), 16 Callithrix jacchus (marmoset); and 47 terrestrial animals (carnivora): 37 Nasua nasua (coatimundi), and 10 Felidae [Panthera onca (jaguar), Felis paradalis (ocelot), Felis wiedii (margay), Felis tigrina (wild cat) and Felis geoffroyi (wild cat)], taking their behaviour and habitat into consideration. When the levels of paracoccidiodin positive reactions were examined, terrestrial animals showed significantly higher rates (82.98%) while arboreal animals showed lower reactivity (22.45%) (P < 0.01). The data are relevant because there are quite a few papers regarding domestic and wild animals and this study may help the understanding of some aspects of the parasite ecology. These results point to the soil as the most probable reservoir of Paracoccidioides brasiliensis, and this is possibly the ecological niche of the saprophytic phase in nature.

Animals↗

Emotional coping, age, and physical disorder.

Traditional ideas suggest that emotional expression is healthy, but empirical support for this position is mixed. Adult subjects participated in a telephone interview to examine the relationships among age, emotional coping (ie, laughter and crying), physical disorder, sex, and income level. Results indicated that cry-coping in women and in low-income participants was associated with increased disorder as age increased. Humor-coping had no relationship to physical disorder across the adult lifespan. These results indicate that emotional weeping does play a role in the prediction of physical disorder, especially in certain groups. In the future, researchers need to concentrate on more subtle physiological effects as well as on the psychological and social consequences of emotional expression.

Adaptation, Psychological↗

Effects of applying Safe2O poultry wash to broiler wings on shelf life, Listeria monocytogenes, Pseudomonads, Staphylococcus species, and psychrotrophic bacteria levels after three, seven, and ten days of storage.

Bacterial contamination of raw processed poultry continues to be of concern to consumers as well as regulatory and health officials. For many years wings were considered a low-value product; therefore, shelf life of wings was not a major concern. Due to changes in consumer attitudes and increases in the fast-food market, wings are now a valuable commodity. Because wings have a shorter shelf life than most other raw poultry products, acceptable intervention to decrease the population of associated spoilage organisms and human enteropathogens are needed. Safe2O Poultry Wash was evaluated as a postchill treatment to reduce microbial contamination and increase shelf life. Ninety-six carcasses were obtained from a local processor prior to final wash. On arrival at the research facility all carcasses were inoculated with 1 mL of a culture with 10(3) cfu/mL Listeria monocytogenes. After a 30-min attachment time, carcasses were subjected to a 4-s in-out final wash, hung for 3 min, and chilled in ice-water for 45 min. After the chilling, wings were removed by hand with a knife, pooled together, and subjected to a hand spray (4 mL/wing) with deionized water or Safe2O Poultry Wash. Two wings were then placed in each of 96 ziplock type storage bags, and wings were held at 5 +/- 1 degrees C for 3, 7, 10, and 14 d. On the day of sample, weep was decanted, and 100 mL of Butterfield's phosphate buffer was added to each bag. Three sets of wings were shaken by hand for 1 min, and total aerobes, Pseudomonads, Staphylococcus sp., psychrotrophic bacteria, and L. monocytogenes in the rinsates were enumerated. By using 7 log10 recovery of total aerobes from rinsates as a spoilage baseline, all wings were spoiled by d 10, but the wings treated with water were approaching spoilage counts on d 7, (log10 6.8), whereas only log10 5.5 bacteria were recovered from the wings sprayed with Safe2O Poultry Wash. Fewer Pseudomonads, Staphylcoccus sp., L. monocytogenes, and psychrotrophic bacteria were recovered from wings treated with Safe2O Poultry Wash and stored for 10 d. Log10 counts for the organisms were Pseudomonas sp., 8.2 and 6.9; Staphylcoccus sp., 5.5 and 4.9; L. monocytogenes, 5.2 and 4.6; and psychrotrophs, 8.2 and 6.9 for the water and Safe2O Poultry Wash treatments, respectively. Use of the Safe2O Poultry Wash as a postchill treatment on wings could increase the shelf life of wings by up to 3 d.

Animals↗

Magnaporthe grisea pathogenicity genes obtained through insertional mutagenesis.

We have initiated a mutational analysis of pathogenicity in the rice blast fungus, Magnaporthe grisea, in which hygromycin-resistant transformants, most generated by restriction enzyme-mediated integration (REMI), were screened for the ability to infect plants. A rapid primary infection assay facilitated screening of 5,538 transformants. Twenty-seven mutants were obtained that showed a reproducible pathogenicity defect, and 18 of these contained mutations that cosegregated with the hygromycin resistance marker. Analysis of eight mutants has resulted in the cloning of seven PTH genes that play a role in pathogenicity on barley, weeping lovegrass, and rice. Two independent mutants identified the same gene, PTH2, suggesting nonrandom insertion of the transforming DNA. These first 7 cloned PTH genes are described.

Amino Acid Sequence↗