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This work shows the influence of parameters such as temperature, throughput (TR), the gasifying agent and the use of catalysts (olivine, alumina and dolomite) on the products resulting from the gasification of sewage sludge on a fluidised bed. An increase in temperature of between 750 and 850 °C rises the production of combustible gas and reduces the production of gravimetric tar (by 65%, at TR = 110 kg/h m 2 , and 49% at TR = 322 kg/h m 2 ), while the increase in TR at a given temperature produces the contrary effects. An analysis of the composition of the tar detected by gas chromatography (GC), shows that higher temperatures increase the concentration of polycyclic aromatic hydrocarbons (PAH). In spite of all the catalysts being active in tar removal, dolomite showed the most marked results in the air tests, with a reduction in the production of gravimetric tar of 40–50% and a conversion of the heavy PAHs (4–7 aromatic rings) of up to 90%. The combined use of a catalyst and air + steam increases the H 2 and CO 2 content in the synthesis gas and reduces the CO, CH 4 and C n H m production, in addition to improving by 20% the catalysts performance in gravimetric tar removal compared to the tests with catalyst and air. Under the evaluated gasification conditions, the dew point of the gas was never below 108 °C, which means that technical problems could be expected due to tar condensation if the synthesis gas were to be used in combustion engines without applying additional tar removal measures.

Resumen Introduccion Los tumores sebaceos son un grupo infrecuente de neoplasias. En algunos casos se han relacionado con neoplasias viscerales en pacientes con el sindrome de Muir-Torre; una variante clinica del sindrome de cancer de colon hereditario no poliposico. El objetivo de este trabajo es revisar el diagnostico y el seguimiento de una serie de pacientes con tumores sebaceos para comprobar cuantos de ellos cumplian criterios de sindrome de Muir-Torre. Pacientes y metodos Se realizo una busqueda en la base de datos del Servicio de Dermatologia del Consorcio Hospital General Universitario de Valencia entre 1990 y 2005, buscando pacientes con tumores sebaceos. Se revisaron las biopsias para confirmar el diagnostico. Tambien buscamos datos en las historias clinicas que sugiriesen un diagnostico de sindrome de Muir-Torre, cuando las historias estaban incompletas nos pusimos en contacto por telefono con los pacientes. Resultados Encontramos 20 pacientes diagnosticados de tumores sebaceos, pero despues de revisar la biopsia solo confirmamos este diagnostico en 12 pacientes. Dos pacientes pertenecian a una familia con antecedents de neoplasias viscerales, que cumplia los criterios clinicos de sindrome de cancer de colon hereditario no poliposico. No hubo un seguimiento uniforme de los pacientes ni se realizaron las mismas pruebas en todos ellos. Conclusiones Es fundamental descartar la presencia de un sindrome de Muir-Torre en pacientes con tumors sebaceos. El uso de nuevas tecnicas como la deteccion de la inestabilidad de microsatelites o la inmunohistoquimica pueden ayudar a detectar a las familias que tienen un mayor riesgo de padecer el sindrome de Muir-Torre.

Background. Sebaceous gland tumors are a rare type of neoplasm. In some cases they have been associated with visceral tumors in patients with Muir-Torre syndrome, a hereditary form of nonpolyposis colorectal cancer. The aim of this study was to review the diagnosis and follow-up of a series of patients with sebaceous gland tumors to assess how many met the criteria for Muir-Torre syndrome. Patients and methods. A search was performed of records from 1990 to 2005 in the database of the Department of Dermatology of the Consorcio Hospital General Universitario de Valencia in Valencia, Spain, to identify patients with sebaceous gland tumors. The biopsy material was reviewed to confirm the diagnosis. We also searched the patient histories for information suggestive of a diagnosis of Muir-Torre syndrome; when the histories were incomplete, we contacted the patients by telephone. Results. We identified 20 patients diagnosed with sebaceous gland tumors, but after reviewing the biopsy material diagnosis was only confirmed in 12. Two patients belonged to a family with a history of visceral tumors that met the clinical criteria for hereditary nonpolyposis colorectal cancer syndrome. Follow-up was not uniform in all patients and not all underwent the same tests. Conclusions. It is essential to rule out the presence of Muir-Torre syndrome in patients with sebaceous gland tumors. The use of new techniques such as immunohistochemistry or detection of microsatellite instability may help to identify families at increased risk of Muir-Torre syndrome.

We present the cases of 2 regular cocaine users aged 30 and 37 years who developed a cutaneous condition with an identical presentation and a similar clinical course. The lesions first appeared as eruptions on the back and then spread to other parts of the body. They consisted of painful inflammatory nodules that developed into abscesses and ulcers that grew outwards. They had a granulomatous base and irregular violaceous edges. The results of histopathologic studies were compatible with the clinical diagnosis of pyoderma gangrenosum, and additional tests ruled out underlying diseases. After several therapeutic failures with usual treatments, the patients responded quickly to infliximab after interrupting their cocaine consumption. The association between pyoderma gangrenosum and cocaine use was clear as both suffered clinical relapses at the same time as they started using the drug again.

Pemphigus vulgaris is a potentially fatal autoimmune bullous disease. High doses of immunosuppressive drugs are used in managing severe cases of pemphigus. Rituximab, an anti-CD20 monoclonal antibody, has proven to be effective in patients with refractory pemphigus vulgaris and pemphigus foliaceus. We review cases of pemphigus vulgaris and pemphigus foliaceus not associated with lymphoma that were treated with rituximab, and we report a new case of severe refractory pemphigus vulgaris successfully treated with rituximab.

El eberconazol es un compuesto imidazolico de aplicacion topica con actividad fungistatica y fungicida a altas dosis, de amplio espectro de accion, caracterizado por poseer una estructura molecular de tipo hidrofilo-lipofilo que favorece la penetrabilidad y la permanencia en la piel. Los componentes galenicos de este azol topico favorecen y optimizan la accion del farmaco en la piel. Los esteres de acidos grasos facilitan la penetracion en la piel y la extensibilidad de la crema, mientras que las poliacrilamidas producen un efecto filmogeno y facilitan la permanencia del principio activo en la piel. Estudios preclinicos han mostrado una alto grado de actividad in vitro frente a especies de Candida , incluyendo C. tropicalis , dermatofitos y Malassezia furfur . En un estudio reciente, el eberconazol mostro una actividad in vitro superior al clotrimazol, el ketoconazol y el miconazol frente a 200 cepas de dermatofitos. El eberconazol ha mostrado actividad en pruebas in vivo : dermatofitosis, candidiasis y pitiriasis experimentales del cobayo. No presenta hipersensibilidad retardada, y no produce fotosensibilidad, efecto fototoxico ni absorcion sistemica. Ha demostrado una eficacia superior que el clotrimazol en crema al 1% y equivalencia terapeutica con miconazol al 2% en el tratamiento de las micosis cutaneas producidas por dermatofitos, con una eficacia similar en el tratamiento de la candidiasis y la pitiriasis versicolor. Por todo ello, puede considerarse su uso en la practica clinica habitual.

Cutaneous fistulas and sinuses in the maxillofacial region secondary to osteomyelitis rarely appear in clinical practice. The most frequent cause of mandibular osteomyelitis is a dental infection, but it may also be hematogenic in origin. The diagnostic criteria for bacterial osteomyelitis are suppuration and osteolytic changes in the radiological study. The differential diagnosis of an ulcerative lesion in the mandibular area includes several pathologies, such as a fistula of dental origin, a reaction to a foreign body, a deep mycotic infection, a pyogenic granuloma or a congenital malformation.

Papillary dermal elastolysis similar to pseudoxanthoma elasticum is an elastolytic disorder characterized by cutaneous lesions on the neck and in the supraclavicular region that are clinically similar to pseudoxanthoma elasticum, with no systemic complications. The histological examination shows a loss of elastic fibers in the papillary dermis. We report a case in a 76-year-old woman with typical lesions on the neck.

We present the case of a 26-year-old Ecuadorian woman who presented with multiple hypertrophic scars along the lower left limb, secondary to a cutaneous process that she had had for 11 years, previously diagnosed and treated in her country as cutaneous leishmaniasis. It had been clinically worsening for 9 months with suppuration through the scars in the groin and thigh, associated with local pain and systemic symptoms. As we suspected cutaneous tuberculosis, we performed a number of complementary examinations to confirm the diagnosis and rule out bone involvement. Finally, a lymph node culture confirmed that it was scrofuloderma.

A 42-year-old woman presented with a 12-year history of extensive yellow and erythematous plaques, round and oblong with irregular configuration and glossy atrophic central areas on the pretibial aspects of both legs. Her 45-year-old sister presented with a 7-year history of a single plaque with erythematous margins, abundant telangiectases, and an atrophic center in the lower portion of the left leg. There was no family history of type-1 or type-2 diabetes mellitus. Both patients had normal fasting glucose concentration, oral glucose tolerance test, and glucose overload test. Different treatment options including topical corticosteroids were unsuccessful. Treatment with oral fumaric acid esters was attempted but the medication was discontinued because of intolerable side effects (flushing and gastrointestinal discomfort). At present, after a follow-up of 2 years, the plaques remain unchanged. These two cases should be added to the few cases of familial nondiabetic necrobiosis lipoidica previously reported.

Cutaneous fistulas and sinuses in the maxillofacial region secondary to osteomyelitis rarely appear in clinical practice. The most frequent cause of mandibular osteomyelitis is a dental infection, but it may also be hematogenic in origin. The diagnostic criteria for bacterial osteomyelitis are suppuration and osteolytic changes in the radiological study. The differential diagnosis of an ulcerative lesion in the mandibular area includes several pathologies, such as a fistula of dental origin, a reaction to a foreign body, a deep mycotic infection, a pyogenic granuloma or a congenital malformation.

Papillary dermal elastolysis similar to pseudoxanthoma elasticum is an elastolytic disorder characterized by cutaneous lesions on the neck and in the supraclavicular region that are clinically similar to pseudoxanthoma elasticum, with no systemic complications. The histological examination shows a loss of elastic fibers in the papillary dermis. We report a case in a 76-year-old woman with typical lesions on the neck.

Pemphigus vulgaris is a potentially fatal autoimmune bullous disease. High doses of immunosuppressive drugs are used in managing severe cases of pemphigus. Rituximab, an anti-CD20 monoclonal antibody, has proven to be effective in patients with refractory pemphigus vulgaris and pemphigus foliaceus. We review cases of pemphigus vulgaris and pemphigus foliaceus not associated with lymphoma that were treated with rituximab, and we report a new case of severe refractory pemphigus vulgaris successfully treated with rituximab.

We present the case of a 26-year-old Ecuadorian woman who presented with multiple hypertrophic scars along the lower left limb, secondary to a cutaneous process that she had had for 11 years, previously diagnosed and treated in her country as cutaneous leishmaniasis. It had been clinically worsening for 9 months with suppuration through the scars in the groin and thigh, associated with local pain and systemic symptoms. As we suspected cutaneous tuberculosis, we performed a number of complementary examinations to confirm the diagnosis and rule out bone involvement. Finally, a lymph node culture confirmed that it was scrofuloderma.

Exploracion fisica Esta lesion lineal se habia originado en la region suprapubica y se habia extendido hacia el abdomen, ocupando la fosa iliaca izquierda y ocasionando una asimetria mas notoria en la imagen de perfil (fig. 1). La piel suprayacente no mostraba signos inflamatorios, hiperpigmentacion ni induracion local. Su unico antecedente medico era que a los 9 anos de edad le habia aparecido una banda anular, de identico curso evolutivo y similares caracteristicas clinicas, localizada en la cara interna del pie izquierdo, que desde la planta del pie se extendia por detras del maleolo interno hasta el tercio distal de la pierna. Desde su aparicion hasta la fecha, la lesion del tobillo se mantenia estable, sin ocasionarle ningun deficit funcional, tan solo una disfuncion estetica poco marcada (fig. 2). Exploraciones complementarias Se le realizo una resonancia magnetica de la pelvis, que mostro una zona de morfologia en banda donde la piel practicamente contactaba con el plano muscular de la pared anterior del abdomen; la grasa tenia un grosor menor de 1 mm, frente a los 10 mm del lado opuesto. Se le realizo ademas una analitica sanguinea con hemograma y bioquimica basicas, que incluia serologia infecciosa para borreliosis y autoanticuerpos (ANA, ENA), que estaba dentro de la normalidad. Las mismas exploraciones analiticas le fueron realizadas a los 9 anos, cuando se desarrollo la lesion del tobillo, y tambien entonces resultaron normales. En ambas ocasiones se le realizo una biopsia de las lesiones que confirmo el diagnostico de sospecha (figs. 3 y 4).

Varon de 6 anos llevado a urgencias en el mes de marzo porque en las ultimas 72 h habia desarrollado un exantema pruriginoso distribuido en el hemicuerpo derecho. Las lesiones se habian iniciado en la axila derecha y se habian extendido al brazo derecho, afectando incluso a la palma de la mano, y posteriormente al torax y el abdomen, con escasos elementos que sobrepasaban la linea media del tronco (figs. 1 y 2). Estaba compuesto por lesiones maculopapulosas, eritematosas y edematosas, que confluian formando placas de mayor tamano en los pliegues de flexion. Como unico antecedente los padres destacaban que, en los dias previos al inicio del exantema, habia cursado un proceso infeccioso leve de vias respiratorias superiores que habian tratado sintomaticamente con paracetamol. No referian antecedentes infecciosos recientes o clinica cutanea similar entre los familiares.

A la exploracion fisica se apreciaba, en el tercio medio de la porcion anterolateral de los muslos, 2 depresiones semicirculares a modo de bandas horizontales, de 2 cm de anchura y 0,5 cm de profundidad (figs. 1 y 2). La piel suprayacente era normal y no presentaba induraciones al tacto. Debido a la clinica caracteristica y la naturaleza benigna del proceso, no se preciso de exploraciones complementarias para establecer el diagnostico. 445 CASOS PARA EL DIAGNOSTICO

A 62-year-old woman developed pruritus, oedema, erythema and vesiculation, well demarcated at the application sites of nitroglycerin TTS on the trunk and upper arms (Fig. 1). Lesions healed with post-inflammatory hyperpigmentation. Two weeks before, the patient had started treatment for coronary insufficiency with daily nitroglycerin transdermal patches (Dermatrans 5®, Recordati group, Madrid, Spain), and 6 days later she noted pruritus. The symptoms started 12 h after rechallenge. Although the patches were substituted with another brand, the pruritus and eczema did not decrease. Nitroglycerin TTS was withdrawn and the patient was treated with topical corticosteroids and oral antihistamines for a week. Later, patch tests were carried out with adhesives and nitroglycerin 1%, 0.5% and 0.1% in petrolatum (Fig. 2). All the nitroglycerin patch tests were positive at 48 h (stronger) and at 72 h, but the adhesive proved negative. The woman subsequently received sublingual nitroglycerin without adverse effects. Furthermore, the patient had been on isosorbide mononitrate orally for the last year because she had high blood pressure, but no cross-sensitivity allergic reaction occurred.