Botryomycosis mimicking acute abdome: a case report

Botryomycosis is a rare chronic granulomatous bacterial infection involving mostly the skin and subcutaneous tissues. The nomenclature is a misnomer as it is caused by true bacteria and not by fungus. This uncommon infection sometimes simulates neoplasia and actinomycosis. Staphylococcus aureus is the agent isolated in most cases, followed by Pseudomonas sp. cepas. The authors present an uncommon case of invasive umbilical Botriomycosis simulating an acute abdome. A combination of surgery and antibiotic therapy treatment was applied with complete resolution of the infection. More often seen in the skin, this is the first report of Botryomycosis affecting this site

Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups : a cross-sectional study

Background: Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. Methods: Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. Results: Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). Conclusion: Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails

Botryomycosis mimicking acute abdome: a case report

Botryomycosis is a rare chronic granulomatous bacterial infection involving mostly the skin and subcutaneous tissues. The nomenclature is a misnomer as it is caused by true bacteria and not by fungus. This uncommon infection sometimes simulates neoplasia and actinomycosis. Staphylococcus aureus is the agent isolated in most cases, followed by Pseudomonas sp. cepas. The authors present an uncommon case of invasive umbilical Botriomycosis simulating an acute abdome. A combination of surgery and antibiotic therapy treatment was applied with complete resolution of the infection. More often seen in the skin, this is the first report of Botryomycosis affecting this site

Oxidative stress evaluation of ischemia and reperfusion in kidneys under various degrees of hypothermia in rats

PURPOSE: To design an animal model of ischemia-reperfusion (I/R) in kidneys and evaluate the role that predetermined ranges of local hypothermia plays on markers of stress-oxydative as well as on histologic sections. METHODS: Twenty eight male rats Wistar, under general anesthesia, undergone right nephrectomy (G0, control group) followed by left kidney ischemia during 40 min. Four temperatures groups were designed, with seven animals randomized for each group: normothermic (G1, ±37oC), mild hypothermia (G2, 26oC), moderate hypothermia (G3, 15oC) and deep hypothermia (G4, 4oC). Left kidney temperature was assessed with an intraparenchymal probe. Left nephrectomy was performed after 240 min of reperfusion. After I/R a blood sample was obtained for f2-IP. Half of each kidney was sent to pathological evaluation and half to analyze CAT, SOD, TBARS, NO3, NO2. RESULTS: Histopathology showed that all kidneys under I/R were significantly more injured than the G0 (p<0.001). TBARS had increased levels in all I/R groups compared with the G0 (p<0.001). CAT had a significant difference (p<0.03) between G1 and G4. Finally, no difference was found on SOD, NO3, NO2 nor on f2-IP. CONCLUSION: This model of I/R was efficient to produce oxidative-stress in the kidney, showing that 4ºC offered significant decrease in free radicals production, although tissue protection was not observed

Índice de resistência na matriz ungueal avaliado através de ultrassonografia espectral : comparação entre pacientes com psoríase, pacientes com artrite psoriásica e grupo controle

Base Teórica: O Doppler é um método ultrassonográfico utilizado para identificar presença de inflamação em estruturas musculoesqueléticas. O Doppler Espectral (DE) fornece informações sobre características quantitativas do fluxo sanguíneo, entre elas, o Índice de Resistência (IR). Este índice é estudado como possível marcador quantitativo de inflamação na sinóvia, podendo assumir valores entre 0 a 1. Níveis mais baixos de IR indicariam inflamação devido à vasodilatação e neoangiogênese. A microcirculação ungueal dos pacientes com psoríase (Pso) e com artrite psoriásica (APs) pode ser avaliada através do Power Doppler (PD) e do DE, porém, não há consenso sobre os parâmetros a serem avaliados e nem sobre a técnica a ser utilizada. Os resultados de estudos que avaliam o IR na matriz ungueal de pacientes com Pso comparados com controles e de pacientes com APs comparados com controles são divergentes. A escala de cinza é outro modo ultrassonográfico de avaliação que possibilita avaliar alterações morfoestruturais, assim como espessura da lâmina, do leito e da matriz ungueais. Essas alterações e medidas são estudadas como possíveis diferenciadores entre pacientes com doença psoriásica e controles. Objetivo: Verificar se há diferença do IR na microcirculação da matriz ungueal na comparação entre pacientes com APs, Pso e controles sem doença psoriásica. Métodos: Estudo transversal, unicêntrico. Foi realizada Ultrassonografia (US) no segundo e terceiro quirodáctilos bilateralmente de 35 pacientes com Pso, 31 com APs e 35 controles, nos modos escala de cinza, PD e DE. O mesmo médico realizou todas as US com aparelho Esaote (Italy) MyLab 50, com transdutor linear de 18MHz na escala de cinza e de 8,0 MHz no PD. Posteriormente, o mesmo médico, cegado, avaliou a Estrutura Trilaminar ungueal (ET) e mensurou a espessura da lâmina, do leito e da matriz ungueais, além de avaliar o grau de PD e o IR na matriz e leito ungueais nas imagens armazenadas. A análise estatística foi feita através do SPSS 21.0. Resultados: Não foi encontrada diferença entre as médias de IR entre os grupos, nem no leito e nem na matriz ungueal. Na análise com regressão linear, não houve relação entre o diagnóstico de Pso ou de APs com as medidas de IR, nem na lâmina e nem no leito ungueais. Não houve diferenças no grau de PD ungueal entre os grupos. Os pacientes do grupo Pso apresentaram maior frequência de alterações na ET dos tipos I e IV; enquanto os pacientes do grupo APs apresentaram maior frequência de alterações do tipo II e III (p<0.001). A espessura da lâmina ungueal foi maior nos pacientes dos grupos APs e Pso em comparação com o grupo controle (média ± DP) (mm) APs 0,73 ± 0,14, Pso 0,72 ± 0,15, controles 0,67 ± 0,10 (p=0.001). Conclusão: O IR e o PD não foram capazes de diferenciar os grupos. Foram encontradas diferenças entre os grupos na frequência e tipos de alterações da estrutura trilaminar ungueal. A espessura da lâmina ungueal também foi maior nos grupos casos em relação aos controles, porém, sem diferença entre o grupo com psoríase ou artrite psoriásica.Background: Ultrasound Doppler detects inflammation in musculoskeletal structures. The Spectral Doppler (SDp) identifies blood flow quantitative characteristics, like the Resistance Index (RI). In musculoskeletal structures, this index can have values between 0 and 1, being the values close to 0 indicative of inflammation, due to vasodilation and neoangiogenesis. The psoriasis (PsO) and psoriatic arthritis (PsA) nail microcirculation can be evaluated through Power Doppler (PD) and SDp, however, there is no consensus on what parameters to evaluate nor about its technical aspects. Studies that have compared RI in nail matrix between Pso patients and controls and others that compared between PsA and controls have divergent results. The Gray Scale (GS) is a form of ultrasound evaluation that allows identify morphostructural changes and measure the nail plate thickness (NPT), the nail bed thickness (NBT) and the nail matrix thickness (NMT). These changes and measures are being studied as possible forms of differentiation between psoriatic disease patients and controls. Objective: Evaluate if there is difference of RI measures in the nail matrix and nail bed between PsA patients, PsO patients and controls. Methods: Single-center, cross-sectional study. Ultrasonography (US) images of bilateral second and third fingernails was collected through GS, PD and SDp, and stored. Thirty five patients with PsO, 31 with PsA and 35 controls were evaluated. The same physician did all the US evaluations with a Esaote (Italy) MyLab 50, equipped with a linear probe with GS frequency of 18MHz and PD frequency of 8,0MHz. Posteriorly, the same physician evaluated the presence and degree of PD and measured the RI in the nail matrix and nail bed in the saved images. The NBT, NPT, NMT and morphostructural nail changes were also evaluated in the same moment. The statistical analysis was made through SPSS 21.0. Results: There is no difference of nail bed RI and nail matrix RI means between groups. In a linear regression analysis, PsO and PsA did not have relation nor with nail bed RI neither with nail matrix RI. There is no difference in nail PD grade between groups. PsO patients presents higher frequency of trilaminar structure alterations type I and IV; PsA have higher frequency of trilaminar structure alterations types II and III (p<0.001). NPT was higher in PsA and PsO groups in comparision with control group (mean ± Standard Deviation) (mm) PsA 0.73±0.14, PsO 0.72±0.15, Controls 0.67±0.10 (p=0.001). Conclusion: Neither PD grade, nor RI could differentiate the groups. Differences in trilaminar structure alterations type and nail plate thickness were found among psoriatic arthritis, psoriasis and controls

Índice de resistência na matriz ungueal avaliado através de ultrassonografia espectral : comparação entre pacientes com psoríase, pacientes com artrite psoriásica e grupo controle

Base Teórica: O Doppler é um método ultrassonográfico utilizado para identificar presença de inflamação em estruturas musculoesqueléticas. O Doppler Espectral (DE) fornece informações sobre características quantitativas do fluxo sanguíneo, entre elas, o Índice de Resistência (IR). Este índice é estudado como possível marcador quantitativo de inflamação na sinóvia, podendo assumir valores entre 0 a 1. Níveis mais baixos de IR indicariam inflamação devido à vasodilatação e neoangiogênese. A microcirculação ungueal dos pacientes com psoríase (Pso) e com artrite psoriásica (APs) pode ser avaliada através do Power Doppler (PD) e do DE, porém, não há consenso sobre os parâmetros a serem avaliados e nem sobre a técnica a ser utilizada. Os resultados de estudos que avaliam o IR na matriz ungueal de pacientes com Pso comparados com controles e de pacientes com APs comparados com controles são divergentes. A escala de cinza é outro modo ultrassonográfico de avaliação que possibilita avaliar alterações morfoestruturais, assim como espessura da lâmina, do leito e da matriz ungueais. Essas alterações e medidas são estudadas como possíveis diferenciadores entre pacientes com doença psoriásica e controles. Objetivo: Verificar se há diferença do IR na microcirculação da matriz ungueal na comparação entre pacientes com APs, Pso e controles sem doença psoriásica. Métodos: Estudo transversal, unicêntrico. Foi realizada Ultrassonografia (US) no segundo e terceiro quirodáctilos bilateralmente de 35 pacientes com Pso, 31 com APs e 35 controles, nos modos escala de cinza, PD e DE. O mesmo médico realizou todas as US com aparelho Esaote (Italy) MyLab 50, com transdutor linear de 18MHz na escala de cinza e de 8,0 MHz no PD. Posteriormente, o mesmo médico, cegado, avaliou a Estrutura Trilaminar ungueal (ET) e mensurou a espessura da lâmina, do leito e da matriz ungueais, além de avaliar o grau de PD e o IR na matriz e leito ungueais nas imagens armazenadas. A análise estatística foi feita através do SPSS 21.0. Resultados: Não foi encontrada diferença entre as médias de IR entre os grupos, nem no leito e nem na matriz ungueal. Na análise com regressão linear, não houve relação entre o diagnóstico de Pso ou de APs com as medidas de IR, nem na lâmina e nem no leito ungueais. Não houve diferenças no grau de PD ungueal entre os grupos. Os pacientes do grupo Pso apresentaram maior frequência de alterações na ET dos tipos I e IV; enquanto os pacientes do grupo APs apresentaram maior frequência de alterações do tipo II e III (p<0.001). A espessura da lâmina ungueal foi maior nos pacientes dos grupos APs e Pso em comparação com o grupo controle (média ± DP) (mm) APs 0,73 ± 0,14, Pso 0,72 ± 0,15, controles 0,67 ± 0,10 (p=0.001). Conclusão: O IR e o PD não foram capazes de diferenciar os grupos. Foram encontradas diferenças entre os grupos na frequência e tipos de alterações da estrutura trilaminar ungueal. A espessura da lâmina ungueal também foi maior nos grupos casos em relação aos controles, porém, sem diferença entre o grupo com psoríase ou artrite psoriásica.Background: Ultrasound Doppler detects inflammation in musculoskeletal structures. The Spectral Doppler (SDp) identifies blood flow quantitative characteristics, like the Resistance Index (RI). In musculoskeletal structures, this index can have values between 0 and 1, being the values close to 0 indicative of inflammation, due to vasodilation and neoangiogenesis. The psoriasis (PsO) and psoriatic arthritis (PsA) nail microcirculation can be evaluated through Power Doppler (PD) and SDp, however, there is no consensus on what parameters to evaluate nor about its technical aspects. Studies that have compared RI in nail matrix between Pso patients and controls and others that compared between PsA and controls have divergent results. The Gray Scale (GS) is a form of ultrasound evaluation that allows identify morphostructural changes and measure the nail plate thickness (NPT), the nail bed thickness (NBT) and the nail matrix thickness (NMT). These changes and measures are being studied as possible forms of differentiation between psoriatic disease patients and controls. Objective: Evaluate if there is difference of RI measures in the nail matrix and nail bed between PsA patients, PsO patients and controls. Methods: Single-center, cross-sectional study. Ultrasonography (US) images of bilateral second and third fingernails was collected through GS, PD and SDp, and stored. Thirty five patients with PsO, 31 with PsA and 35 controls were evaluated. The same physician did all the US evaluations with a Esaote (Italy) MyLab 50, equipped with a linear probe with GS frequency of 18MHz and PD frequency of 8,0MHz. Posteriorly, the same physician evaluated the presence and degree of PD and measured the RI in the nail matrix and nail bed in the saved images. The NBT, NPT, NMT and morphostructural nail changes were also evaluated in the same moment. The statistical analysis was made through SPSS 21.0. Results: There is no difference of nail bed RI and nail matrix RI means between groups. In a linear regression analysis, PsO and PsA did not have relation nor with nail bed RI neither with nail matrix RI. There is no difference in nail PD grade between groups. PsO patients presents higher frequency of trilaminar structure alterations type I and IV; PsA have higher frequency of trilaminar structure alterations types II and III (p<0.001). NPT was higher in PsA and PsO groups in comparision with control group (mean ± Standard Deviation) (mm) PsA 0.73±0.14, PsO 0.72±0.15, Controls 0.67±0.10 (p=0.001). Conclusion: Neither PD grade, nor RI could differentiate the groups. Differences in trilaminar structure alterations type and nail plate thickness were found among psoriatic arthritis, psoriasis and controls