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Objective: During its first year, the AWARE study assessed disease activity, patient quality of life (QOL), and treatment patterns in chronic urticaria (CU) refractory to H1-antihistamines (H1-AH) in clinical practice. Methods: We performed an observational, prospective (24 months), international, multicenter study. The inclusion criteria were age ≥18 years and H1-AH–refractory CU (>2 months). At each visit, patients completed questionnaires to assess disease burden (Urticaria Control Test [UCT]), disease activity (7 day-Urticaria Activity Score [UAS7]), and QOL (Dermatology Life Quality index [DLQI], Chronic Urticaria Quality of Life Questionnaire [CU-Q2oL], and Angioedema Quality of Life Questionnaire [AE-QoL]). We present data for Spain. Results: The study population comprised 270 evaluable patients (73.3% female, mean [SD] age, 48.9 [14.7] years). At baseline, 89.3% were prescribed a CU treatment. After 1 year, first- and second-line treatments became less frequent and third-line treatments became more frequent. At baseline, 47.0% of patients experienced angioedema; at 1 year, this percentage had fallen to 11.8%. The mean (SD) AE-QoL score decreased from 45.2 (28.7) to 24.0 (25.8). The mean (SD) UCT score decreased from 7.0 (4.5) to 12.1 (4.1). According to UAS7, 38.2% of patients reported absence of wheals and itch in the previous 7 days at 1 year compared with 8.3% at baseline. The mean (SD) DLQI score decreased from 8.0 (7.4) to 2.8 (4.6). At the 1-year visit, the percentage of patients reporting a high or very high impact on QOL fell from 29.9% to 9.6%. Conclusions: H1-AH–refractory CU in Spain is characterized by absence of symptoms and a considerable impact on QOL. Continuous follow-up of CU patients and third-line therapies reduce disease burden and improve patients’ QOL.

Resumen Concepto El exantema es una erupcion cutanea asociada a una enfermedad sistemica o general, habitualmente de causa infecciosa. En el nino son numerosas las enfermedades que cursan con exantema; algunas de ellas de causa todavia desconocida y sin un tratamiento efectivo. Clasificacion Siguiendo una clasificacion morfologica o de predominio de las lesiones, podemos dividir los exantemas en: maculopapulosos, escarlatiniformes, papulovesiculosos, petequiales o purpuricos (objeto de nuestro protocolo), urticariales y tipo eritema exudativo multiforme. Tratamiento Cualquier exantema petequial o purpurico es un signo de alerta que requiere una atencion urgente y una evaluacion analitica para descartar una infeccion meningococica. Solamente cuando las petequias son puntiformes y estan por encima de la linea intermamilar y el nino esta afebril puede prescindirse de las pruebas de laboratorio.

espanolResumen Introduccion Las enfermedades cutaneas que cursan con pustulas en la piel son multiples y de muy diversas etiologias, por lo que no es posible encuadrarlas en un unico grupo. Clasificacion Podemos dividir las enfermedades pustulosas de la piel en localizadas y generalizadas. Estos dos grupos los subdividiremos a su vez en enfermedades inflamatorias o infecciosas. Existiria otro gran grupo de enfermedades dermatologicas que no vamos a tratar, y que estaria formado por la patologia tumoral. Este tipo de patologia no suele cursar con lesiones pustulosas. Diagnostico Dada su amplia diversidad, no existen criterios definidos de actuacion. Lo principal, como ocurre de forma habitual en dermatologia, es realizar el diagnostico del cuadro con los medios disponibles a nuestro alcance y, en funcion del mismo, realizar las pruebas complementarias precisas y el tratamiento adecuado. EnglishIntroduction There are many skin diseases that present with pustules. Because they have very diverse aetiologies, it is not possible to place them all in one group. Classification We can divide pustular skin diseases into localised and generalised, and in turn subdivide these two groups into inflammatory and infectious diseases. Tumoural diseases are another large group of dermatological diseases that we are not going to cover here. These diseases do not generally present with pustular lesions. Diagnosis Given their great diversity, there are no defined criteria for action. The most important thing, as is routine in dermatology, is to diagnose the symptoms with the means that are available to us and then undertake precise complementary tests and give appropriate treatment.

espanolResumen Patogenia La alopecia androgenica o patron de caida del pelo masculino es una caida del pelo mediada por dihidrotestosterona, la forma activa de la testosterona. Tratamientos aprobados Actualmente solo existen dos tratamientos aprobados por la FDA para su uso en la alopecia androgenica, minoxidil y finasteride, unidos a un tercer tratamiento reconocido por la FDA, el laser de baja frecuencia. Otros tratamientos Existen otros tratamientos que tambien se utilizan para la alopecia androgenica, pero que no presentan los mismos datos de eficacia que los tratamientos comentados previamente. Entre ellos se encuentra el uso del plasma rico en plaquetas y, en el caso de la alopecia androgenica femenina, anticonceptivos orales y antiandrogenos. Se utilizan tambien en la practica clinica complejos vitaminicos y con aminoacidos que, si bien no han demostrado eficacia en ensayos, podrian aumentar en algunos casos el grosor del pelo. EnglishPathogenesis Androgenic alopecia or the pattern of masculine hair loss is an loss mediated by dihydrotestosterone, the active form of testosterone. Approved treatments There are currently only two FDA-approved treatments for androgenic alopecia, minoxidil and finasteride, together with a third FDA-recognised treatment, low frequency laser. Other treatments Although there are other treatments which are also used to treat androgenic alopecia, they are not associated with the same level of efficacy as the above-mentioned treatments. They include the use of platelet-rich plasma and, in the case of female androgenic alopecia, oral contraceptives and anti-androgens. Vitamin complexes with amino acids are also used in clinical practice which, although they have not been proven to be effective in trials, may in some cases increase the thickness of the hair.

espanolResumen Introduccion Las neoplasias epiteliales cutaneas (cancer cutaneo no melanoma) son el tipo de cancer mas simple de diagnosticar y tratar. Se originan principalmente de los queratinocitos de la capa epidermica germinativa o en los anejos cutaneos (glandulas sudoriparas, foliculos pilosos). Tipos de cancer cutaneo Los dos tipos principales de cancer cutaneo no melanoma son el carcinoma basocelular y el carcinoma espinocelular. El carcinoma basocelular se considera el cancer mas frecuente en el ser humano y puede presentar diferentes presentaciones clinicas: nodular, ulcerativo, pigmentado, esclerosante y superficial. El carcinoma espinocelular suele originarse a partir de una lesion identificable con displasia in situ que puede tratarse antes de que se convierta en una lesion francamente invasiva. El melanoma cutaneo requiere una mencion especial, tanto por su frecuencia de aparicion como por su potencial de metastatizacion en diferentes organos. Tratamiento del cancer cutaneo Como norma general, la cirugia constituye el pilar basico de tratamiento de las lesiones malignas cutaneas, aunque conviene individualizar el tratamiento en funcion del tipo de lesion y la extension de la misma. EnglishIntroduction Cutaneous epithelial neoplasms (nonmelanoma skin cancer) are the simplest type of cancer to diagnose and treat. They originate mainly from the keratinocytes of the epidermal germ layer or in the skin attachments (sweat glands, hair follicles). Types of skin cancer The two main types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma. Basal cell carcinoma is considered the most frequent cancer in humans and may present different clinical presentations: nodular, ulcerative, pigmented, sclerosing and superficial. Squamous cell carcinoma usually originates from an identifiable lesion with in situ dysplasia that can be treated before it becomes a frankly invasive lesion. Cutaneous melanoma requires special mention, both for its frequency of appearance and for its potential for metastasis in different organs. Treatment of skin cancer As a general rule, surgery is the basic pillar for the treatment of cutaneous malignant lesions although it is convenient to individualize the treatment depending on the type of lesion and the extent of the lesion.

Resumen Tipos Las infecciones cutaneas son una patologia de frecuencia y severidad crecientes, que pueden clasificarse en 3 grandes grupos: bacterianas, fungicas y viricas. Tratamiento En la mayoria de las infecciones bacterianas, si la presentacion clinica es tipica, podemos iniciar tratamiento empirico, si hay dudas diagnosticas realizaremos tincion de Gram y cultivo bacteriano de la lesion. La fascitis necrotizante es una excepcion, ya que ante la sospecha es obligatorio realizar fasciotomia exploratoria y cultivo del exudado. Diagnostico El diagnostico de infeccion por el virus herpes simple suele ser clinico, pero ante la duda realizaremos cultivo o PCR. Las infecciones por virus del papiloma humano tambien suelen diagnosticarse clinicamente, pudiendose realizar biopsia y analisis histologico en casos dudosos. En las infecciones cutaneas por hongos es recomendable realizar un examen directo para confirmar la visualizacion rapida de estructuras fungicas, y efectuar el posterior cultivo para confirmar la especie.

Summary Urticarial vasculitis (UV) is a mainly leucocytoclastic vasculitis with urticarial plaques. Treating these patients is challenging as the available treatments have poor efficacy. Oral corticosteroids are considered the first-line treatment, but H1 antihistamines, dapsone, colchicine, antimalarials, ciclosporin and antileucotrienes have all been tried also. However, because of their adverse effects and/or lack of efficacy, new agents are still needed. Omalizumab, an anti-IgE antibody, shows efficacy in chronic spontaneous urticaria, and might also be a good treatment for angio-oedema and urticarial vasculitis. To our knowledge, there have been only seven relevant case reports published in the English literature. We add a new case of severe chronic recurrent urticarial vasculitis refractory to all of the drugs mentioned above. We started the patient on subcutaneous omalizumab 300 mg every 4 weeks, which produced clinical improvement within the first month and total remission in the fifth month. The patient has remained stable for 23 months, and follow-up is ongoing.

Psoriatic arthritis (PA) is a chronic inflammatory condition whose symptoms generally appear after the skin symptoms. Making an early diagnosis and treatment of the disease is of vital importance because of the potential development of mutilating and deforming arthritis. Classical treatments of PA include the use of non-steroid anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARD) such as methotrexate, sulfasalazine, or gold, and finally, leflunomide. Research on the pathophysiology of psoriasis and of the PA has led to the incorporation of biological treatments, specifically anti-TNF drugs. The three treatments used most in PA are etanercept, infliximab and adalimumab. Of all these, we are going to make a systematic review of the principal studies available on etanercept for the treatment of PA.

Skin lesions associated with Candida septicaemia occur only in a minority of patients, who are usually immunocompromised, but they can help to establish a diagnosis rapidly. The lesions form a characteristic maculopapular or nodular rash at the onset of the infection. We report three cases of systemic candidiasis (SC) with cutaneous manifestations in immunocompromised patients. In these patients, the lesions started as asymptomatic or slightly pruriginous macules, papules or nodules localized on the trunk and extremities. The patients' general condition was very poor and they presented a high fever at the onset of the illness. Candida spp. were isolated from blood in all cases, and histology showed yeasts in two of them. Most of the lesions resolved with antifungal treatment. The diagnosis of SC is often delayed or missed because of the absence of useful diagnostic tools, the varying clinical manifestations and the frequent negativity (50-75%) of blood cultures for Candida. Fluconazole is the treatment of choice for Candida albicans, but treatment response is unknown for other Candida spp., which may require treatment with amphotericin B.

Hidradenitis suppurativa is a chronic inflammatory disease that usually affects areas of the skin with a high density of apocrine glands (axillae, groin, perianal and perineal regions, submammary area, etc). It usually appears in women during puberty. The etiology of the disease is unknown, although it is thought to be a primary defect of the hair follicle. When diagnosing hidradenitis suppurativa, a number of genetic and hormonal predisposing factors should be considered alongside other putative triggers, such as obesity, smoking, and tight clothing. Diagnosis is essentially clinical and it is important to bear in mind the possible complications associated with the disease, such as the development of tumors. Management of the disease includes general measures (antiseptic soaps, warm baths, etc), pharmacological therapy (topical, intralesional, and systemic), surgery (direct closure, second-intention healing, grafts, flaps, etc), and other measures (carbon dioxide laser, radiation therapy, etc). It is important that the disease be diagnosed and treated as soon as possible given the potential physical and psychological problems that it can generate.

Hidradenitis suppurativa is a chronic inflammatory disease that usually affects areas of the skin with a high density of apocrine glands (axillae, groin, perianal and perineal regions, submammary area, etc). It usually appears in women during puberty. The etiology of the disease is unknown, although it is thought to be a primary defect of the hair follicle. When diagnosing hidradenitis suppurativa, a number of genetic and hormonal predisposing factors should be considered alongside other putative triggers, such as obesity, smoking, and tight clothing. Diagnosis is essentially clinical and it is important to bear in mind the possible complications associated with the disease, such as the development of tumors. Management of the disease includes general measures (antiseptic soaps, warm baths, etc), pharmacological therapy (topical, intralesional, and systemic), surgery (direct closure, second-intention healing, grafts, flaps, etc), and other measures (carbon dioxide laser, radiation therapy, etc). It is important that the disease be diagnosed and treated as soon as possible given the potential physical and psychological problems that it can generate.

Resumen Introduccion La hidrosadenitis supurativa es una enfermedad inflamatoria cronica, que cursa en brotes, con lesiones dolorosas, fistulas y cicatrices en axilas, ingles, gluteos, region perianal e inframamaria. Entre los multiples tratamientos farmacologicos disponibles, en los ultimos cinco anos se ha demostrado la eficacia del infliximab, un tratamiento habitualmente utilizado en dermatologia para el control de la psoriasis. Pacientes y metodo Estudio prospectivo, observacional, realizado con el objetivo de determinar la eficacia y seguridad del infliximab en el tratamiento de la hidrosadenitis supurativa. Tres pacientes mujeres con hidrosadenitis supurativa de mas de 10 anos de evolucion, con afectacion de al menos dos localizaciones anatomicas y resistente a terapias convencionales. Se realiza tratamiento con infliximab a cada una de las pacientes en dosis de 5 mg/kg/infusion en las semanas 0, 2, 6 y posteriormente cada 8 semanas. Resultados Dos de las tres pacientes presentaron una mejoria leve-moderada de su enfermedad, mientras que la tercera paciente no obtuvo mejoria. Podemos destacar la variabilidad de los resultados observada entre las tres pacientes. Los efectos secundarios fueron en general leves y bien tolerados por las tres pacientes. Pese a ello, dos de las pacientes tuvieron que suspender el tratamiento debido a la falta de eficacia del mismo en uno de los casos y a un cuadro de artralgias generalizadas en otro. Conclusiones El tratamiento de la hidrosadenitis supurativa con infliximab constituye una alternativa moderadamente util en algunos casos.

Resumen El deficit de C1 inhibidor es un raro sindrome caracterizado clinicamente por episodios recurrentes de tumefaccion en el tejido celular subcutaneo o angioedema. Puede afectar a la piel, las vias respiratorias superiores y el abdomen. Se describen principalmente dos tipos: hereditario y adquirido. El angioedema puede afectar a practicamente cualquier parte de la superficie cutanea, puede causar edema laringeo mortal y cursar con caracteristicas clinicas identicas a una obstruccion del tracto gastrointestinal. Los ataques pueden ser desencadenados, de forma general por traumatismos, farmacos o infecciones. El diagnostico se confirma mediante la presencia de C4 disminuido en suero y la ausencia o gran reduccion del nivel o la funcion de C1 inhibidor. Los androgenos atenuados, los agentes antifibrinoliticos y la infusion de concentrado de C1 inhibidor son los farmacos habitualmente utilizados en el manejo profilactico y terapeutico de estos pacientes. El plasma fresco congelado es una opcion a considerar en caso de profilaxis a corto plazo o ataque agudo. Es conveniente conocer este sindrome, ya que se trata de una enfermedad potencialmente mortal. El diagnostico de este raro sindrome se basa en el reconocimiento de las caracteristicas clinicas y en las alteraciones caracteristicas de las pruebas de laboratorio. El tratamiento del ataque agudo se debe realizar lo mas rapidamente posible. El tratamiento profilactico esta indicado en determinadas situaciones (manejo dental y cirugia oral).

C1 inhibitor deficiency is a rare syndrome clinically characterized by recurrent episodes of swelling of subcutaneous tissue or angioedema. It can involve the skin, upper respiratory airways and abdomen. There are two main types: hereditary and acquired. Angioedema can involve practically any part of the cutaneous surface, it can cause lethal laryngeal edema and can present as gastrointestinal obstruction. The attacks can be triggered, in general, by trauma, drugs or infections. Diagnosis is confirmed by decreased serum levels of C4 and absence or marked decrease of the level or function of C1 inhibitor. Commonly employed drugs for prophylaxis and treatment of these patients include anabolic steroids, antifibrinolytic agents, and infusion of C1 inhibitor concentrate. Fresh frozen plasma is an option to be considered for short term prophylaxis or treatment of the acute attack. It is convenient to know this syndrome as it is a potentially life-threatening disease. Diagnosis of this rare syndrome is based on clinical features and characteristic alterations of laboratory tests. The acute attack should be treated as quickly as possible. Prophylactic therapy is indicated in certain circumstances (dental procedures, oral surgery).

The management of angio-oedema is quite complicated because of the frequent poor response to usual treatments, including H1 antihistamines, systemic corticosteroids, immunosuppressant drugs, antileucotriene drugs or tranexamic acid. Omalizumab, an anti-immunoglobulin (Ig)-E antibody, has shown good resuts in chronic spontaneous urticaria, and might also be a good option for angio-oedema. To our knowledge, there have been eight relevant case reports published in the English literature. We report two further cases (a 55-year-old man and a 36-year-old woman) with severe chronic recurrent angio-oedema affecting the face, pharynx, hands, feet and hips. Both patients were refractory to H1 antihistamines, systemic corticosteroids and tranexamic acid. We decided to start with subcutaneous omalizumab 375 mg every other week and tapering doses up to 375 mg every 4 weeks. Both patients showed a very good response to the therapy, with clinical improvement in the first week. This response remained stable more than 3 years later.

Large B-cell lymphoma of the leg (LBCLL) accounts for 2 % of primary cutaneous lymphomas, and the EORTC considers it to be of intermediate prognosis. It usually presents in elderly patients, and manifests clinically as erythematous nodules or tumors, often unilateral, on the lower third of the legs. On rare occasions, it presents with extracutaneous dissemination. We present the case of a 77-year-old male who consulted his physician because of an asymptomatic indurated erythematous papule which had appeared one month earlier on his left leg and had quickly and progressively increased in size. Concurrently, other similar lesions had been appearing on the thigh and back of the same leg. Histological analysis detected a large cell lymphoid infiltrate positive for CD20 and bcl-2 throughout the dermis. The extension study was normal. The patient was treated with an intravenous infusion of rituximab for four consecutive weeks, with full remission of the lesions.

A54-year-oldwomanpresentedwithanapproximately2-year history of lesions in the vulvar area, which had increased in numberandhadbecomepruriticoverthepastseveralmonths. Shehadahistoryofhuman immunodeficiencyvirus (HIV) with a normal CD4 count while receiving triple antiretroviral therapy, as well as a history of cervical dysplasia previously treated and followed by her gynecologist. Her familyhistorywasnegative forsimilar lesions.Onexamination, she had numerous discrete monomorphous white to skincolored keratotic papules involving her labia majora, proximal medial thighs, perineum, and gluteal cleft (Figure 1). The rest of the findings from her skin examinationwerenormal.Abiopsyspecimenwastaken(Figure2 and Figure 3). What is your diagnosis?

Psoriatic arthritis (PA) is a chronic inflammatory condition whose symptoms generally appear after the skin symptoms. Making an early diagnosis and treatment of the disease is of vital importance because of the potential development of mutilating and deforming arthritis. Classical treatments of PA include the use of non-steroid anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARD) such as methotrexate, sulfasalazine, or gold, and finally, leflunomide. Research on the pathophysiology of psoriasis and of the PA has led to the incorporation of biological treatments, specifically anti-TNF drugs. The three treatments used most in PA are etanercept, infliximab and adalimumab. Of all these, we are going to make a systematic review of the principal studies available on etanercept for the treatment of PA.

A study was made of semen quality and serum hormonal profiles (FSH, LH, prolactin, testosterone) of patients with type I diabetes mellitus. Semen parameters and levels of prolactin and testosterone were significantly altered in the diabetic state. The concentration of insulin in serum and seminal plasma and the serum levels of FSH, LH, and testosterone were measured in 80 men classified in the following groups: fertile subjects, infertile normoglycemic subjects, subjects with carbohydrate intolerance, and excretory and secretory azoospermic subjects. In all groups, seminal insulin concentrations were higher than those obtained in serum. The hormone appears to freely cross the blood-testis barrier, there to be concentrated in the semen. The levels of insulin in serum and seminal plasma did not correlate with semen parameters and are not suitable markers of seminal quality. For unknown reasons, the concentrations of insulin in seminal plasma were lower in the subjects suffering from carbohydrate intolerance.

Hidradenitis suppurativa is a chronic inflammatory disease that usually affects areas of the skin with a high density of apocrine glands (axillae, groin, perianal and perineal regions, submammary area, etc). It usually appears in women during puberty. The etiology of the disease is unknown, although it is thought to be a primary defect of the hair follicle. When diagnosing hidradenitis suppurativa, a number of genetic and hormonal predisposing factors should be considered alongside other putative triggers, such as obesity, smoking, and tight clothing. Diagnosis is essentially clinical and it is important to bear in mind the possible complications associated with the disease, such as the development of tumors. Management of the disease includes general measures (antiseptic soaps, warm baths, etc), pharmacological therapy (topical, intralesional, and systemic), surgery (direct closure, second-intention healing, grafts, flaps, etc), and other measures (carbon dioxide laser, radiation therapy, etc). It is important that the disease be diagnosed and treated as soon as possible given the potential physical and psychological problems that it can generate.

Hidradenitis suppurativa is a chronic inflammatory disease that runs in outbreaks with painful lesions, fistulas and scars in axillae, groins, buttocks, and perianal and submammary regions. Among multiple drug therapies available, infliximab, usually employed in dermatology to control psoriasis, has shown its efficacy in the past five years.It is a prospective, observational study to determine the efficacy and safety of infliximab in the treatment of hidradenitis suppurativa. We selected three women with a history of hidradenitis suppurativa of more than 10 years, with involvement of at least two anatomic locations that was recalcitrant to conventional therapies. Each patient received infliximab at a dose of 5mg/kg/infusion on weeks 0, 2, 6 and every 8 weeks thereafter.Two of the three patients showed mild to moderate improvement of their disease while the third patient did not improve. We can highlight the variability of the results observed in these three patients. Adverse effects were generally mild and well tolerated by the three patients. Despite this, two patients withdrew the therapy due to loss of efficacy in one case and the development of generalized arthalgias in the other case.Treatment of hidradenitis supurativa with infliximab constitutes a moderately useful alternative in some cases.

Background There are numerous studies that individually evaluate the efficacy/effectiveness and toxicity of drugs in the systemic treatment of psoriasis. On the contrary, we can hardly find studies that compare each other. Objective To evaluate and compare the effectiveness and toxicity of mycophenolate mofetil and cyclosporin in chronic plaque psoriasis through a prospective, sequential, cross-over, non-randomized, two-phase, open-label study. Patients/methods Eight patients (five women and three men; mean age 57, range 35-78) with moderate-to-severe chronic plaque psoriasis were included in the study. They were treated with oral mycophenolate mofetil (30 mg/kg/day) over a period of 16 weeks. Following a variable washout period and after a new outbreak of the disease, oral cyclosporin was introduced at a dose of 4 mg/kg/day. During both treatment regimens, follow-up visits were performed at 3, 8 and 16 weeks. Results In both groups, the PASI started to decrease once treatment was begun. Cyclosporin was faster and statistically a lot more effective than mycophenolate mofetil, reaching a higher number of complete remissions and better percentages of PASI improvement from baseline (45.7%, 60.2% and 60.5% at 3, 8 and 16 weeks respectively for mycophenolate mofetil, and 89.7%, 95.3% and 95.3% respectively at the same intervals for cyclosporin). Cyclosporin was also more predictable in its action as the percentage of improvement along the follow-up visits had a much wider range for mycophenolate mofetil. Overall, the tolerability of both drugs was good. None of the patients had to discontinue treatment because of an adverse event. Two patients treated with cyclosporin showed increased plasma levels of creatinine. Conclusions Cyclosporin is more effective, fast, and predictable in its effect than mycophenolate mofetil to control moderate-to-severe chronic plaque psoriasis. Both drugs are well tolerated in short courses of treatment.

Mycophenolate mofetil (MMF) has been shown to be effective in the treatment of psoriasis. MMF is the morpholinoethyl ester of mycophenolic acid (MPA), the active compound. Our objective was to characterize the pharmacokinetic profile of MPA in patients with psoriasis treated with MMF and to examine its correlation with effectiveness and toxicity. Eleven patients with moderate-to-severe chronic plaque psoriasis were treated with oral MMF 30 mg kg-1 daily over a period of 16 weeks. Patients were reviewed at 3, 8 and 16 weeks, checking the Psoriasis Area and Severity Index (PASI) and possible adverse events, and performing MPA C0 (trough) and C1 (1-hour post-dose) plasma levels. The reduction in PASI was statistically significant in all our patients. The drug was well tolerated. There was no significant correlation between C0 and C1 MPA levels and the reduction of PASI, improvement rates of PASI from baseline, weight of the patients and total dosage of MMF. Nevertheless, the highest detected mean levels of MPA C1 were observed in two of the patients with the highest improvement rate of PASI at the end of the study. Although C1 levels do not seem to strongly correlate with the effectiveness of the drug, the finding that the highest detected mean levels of MPA C1 were observed in two of the patients with the highest improvement rate of PASI suggests that the monitoring of C1 could be useful in some individual cases.

Auteur(s) : Esteban Dauden1, Javier Pedraz2, Silvia Perez-Gala1, Cecilia Munoz3, Manuel Viton3, Maria-Jesus Onate4, Amaro Garcia-Diez1 1Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain 2Department of Dermatology, Hospital Clinico Universitario San Carlos Profesor Martin Lagos, s/n, 28040. Madrid, Spain 3Dept of Immunology, Hospital Universitario de la Princesa, Madrid, Spain 4Centro de Especialidades de Fuencarral, Madrid, Spain Mycophenolate [...]

In pancreatic ductal adenocarcinoma induced in the Syrian hamster by N-nitrosobis (2-oxopropyl) amine (Bop) B cells persisted with focal dispersion in the tumor zone. The localization of these varied depending on whether the animals had initial or long standing tumors. In the animals with initial tumors, immunohistochemical techniques indicated the B cells formed part of the tumoral glands and/or were intimately related to the cells of the walls of the tumor glands or present in the stroma. Insulin values were high in these animals. In the longer-developed tumors, insulin levels tended to be lower and although B cells were seen forming part of the tumor glands, those in the tumoral stroma were predominant.

Experimental pancreatic carcinoma induced in Golden Syrian Hamsters by subcutaneous injections of N-nitrosobis-(2-oxopropyl) amine (BOP) was studied during the different phases of its development by determination of serum CA 19-9 levels and tissue labeling with CA 19-9 TM. Significant differences were observed in the CA 19-9 values between the controls and animals with carcinoma (p < 0.01) and between the latter and animals with cystic or cystic papillary lesions (p < 0.01). Distribution of the deposits of CA 19-9 TM was different in the initial tumoral lesions and in the longer-developed tumors. An important correlation was observed between tissue deposits and serum levels of this tumor marker.

Monocytes derived from peripheral blood of patients with rheumatoid arthritis (RA) had a marked defect in their chemotactic and phagocytic activity. The chemotactic defect resides at a cellular level, while the phagocytic defect is serum-dependent. Both defects could be of importance in the pathogenicity of RA and the susceptibility to infection such patients show. Finally, monocytes were found to have a negative influence over spontaneous cytotoxicity mediated by T lymphocytes.

The mononuclear phagocytic system (Mo) possesses a series of well defined functions regarding both its circulatory components--monocytes--and histiocytic macrophages. These functions--antimicrobial defense, elimination of cellular particles or detritus, immunological interaction with lymphocytes cells, antitumoral defense and control of granulopoiesis--require chemotaxis and phagocytosis or preceding steps. Although knowledge of these functional aspects is continually becoming better--always assured by advances obtained in the study of the function and pathology of polymorphonuclear cells--, an authentic pathology of monocyte chemotaxis as an independent clinical entity doesn't exist. This is attributed to of these cells. The techniques currently in use differ not only in their methodology but also in their bases and thus the results obtained by various authors are not generally comparable. All this led us to do a comparative study, in control subjects, between two techniques which explore the chemotactic capacity of monocytes from peripheral blood. The chemotactic capacity of monocytes from peripheral blood in control subjects, measured by two distinct quantification methods, were studied: Radioanalytic Method (monocytes tagged with 99 mTc) and a morphological method (counting the number of monocytes per field in immersion). The results obtained from both techniques were very similar, the existence of significant differences in cell behavior with exposure to the different chemotactic substances used could not be demonstrated. These results are commented on.

Development of human C. system was studied by quantification of total serum hemolytical activity (CH50) and individual levels of C3, C4 and C5 in full term newborns. Comparison of results in newborn infants and their mothers sera is made. The ratios of neonatal-maternal sera concentrations were CH50, 0.29; C3, 0.61; C4, 0.51, and C5, 0.63. Serum concentrations of C3 and C4 reached maternal concentrations at twelve months of age. Serum concentrations of C4 and CH50 reached maternal levels at six months of age.

Serum opsonic capacity for "Staph. aureus" was studied in 58 full term infants at birth and through their 1st year of life. The comparison between serum opsonic activity from the infants and their mothers disclosed that infants had a significant decrease of the opsonic activity during the first three months of life. The study of serum levels of C3, C4, IgG and IgM, showed a significant correlation between opsonizationa and low levels of the complement components C3 and C4.

Chemotactic activity in 58 full term newborn and in infants during the first year of life was studied. Samples were taken from cord blood and blood drawn at three and 15 days after birth and at one, three, six and 12 month of age. Chemotactic activity was assessed by Boyden's technique. It was found that samples obtained before the first month of life had a decrease of function as compared with those of the mothers. Chemotactic indexes were parallel to those of mothers by the end of the first year of life. These findings suggest that impairment of the function observed in infants may be due to a deficit in synthesis of complement factors.