El deterioro del Baluarte de San Pedro, un estudio de caso

RESUMENEl centro histórico de la ciudad de San Francisco de Campeche, México, cuenta con edificios civiles y militares de la época colonial, los cuales se encuentran sometidos a la acción de agentes ambientales como humedad, radiación solar, temperatura, erosión eólica, acción biológica y productos de origen antropogénico que inducen su deterioro. El objetivo del presente estudio fue diagnosticar el daño y posible origen de costras negras en el Baluarte de San Pedro, edificio representativo del sistema defensivo de la ciudad. Las patologías de deterioro y el análisis mediante difracción de Rayos X realizado en muestras representativas del edificio indican la presencia de yeso en los muros sur y suroeste del Baluarte. Lo anterior es indicio de la acción de emisiones de vehículos automotores que circulan diariamente sobre las avenidas circundantes. Por otra parte, existe abundante colonización microbiana cuya actividad se relaciona con la presencia de oxalatos de calcio, compuestos característicos de procesos de biodeterioro.Palabras Clave: Deterioro; edificios históricos; San Francisco de Campeche; Baluarte de San Pedro; biodeterioro.ABSTRACTThe downtown of San Francisco de Campeche, México, has several civilian and militarian ancient buildings dating from the Hispanic colonization. These buildings are exposed to environmental agents such as high relative humidity and temperature, sun radiation, wind erosion, biologic action and anthropogenic products, which produce their deterioration. The objective of this paper is to present and discuss the diagnosis of deterioration of the San Pedro bastion as well as the possible origin of black crusts observed over the walls. Visual inspection and X Ray Diffraction analysis detected gypsum at south and southwest walls, which is indicative of the action of combustion products of vehicles circulation over neighboring avenues. Moreover, it was observed abundant microbial colonization, which activity is related to the presence of calcium oxalates that are evidence of a bio-deterioration process.Keywords: Deterioration; historic buildings; San Francisco de Campeche; Bastion of San Pedro; biodeterioration.

[Bilateral pseudo-Kaposi sarcoma in upper limbs]

Acroangiodermatitis or pseudo-Kaposi sarcoma is an angioproliferative, self-limited entity that includes a group of diseases, congenital or acquired, with cutaneous lesions similar to Kaposi sarcoma (KS). This term can lead to confusion because it comprises several entities that are completely different, nonetheless, it has an important clinical value as it guides the diagnosis and management of these patients. We report the case of a 67-year-old patient with lesions of acroangiodermatitis in both forearms secondary to arteriovenous shunts from hemodialysis. Doppler ultrasound showed a former arteriovenous fistula in addition to the one already known. Immunohistochemical study showed CD34+ staining in endotelial cells and absence of HHV-8 expression.

[Fatal Sweet syndrome associated to chronic idiopathic systemic inflammatory response syndrome]

Sweet syndrome is one of the cutaneous processes more frequently associated to systemic diseases. Its association to the systemic inflammatory response syndrome has rarely been described. We report a case of chronic and relapsing Sweet syndrome associated to a chronic and idiopathic systemic inflammatory response syndrome that lasted seven years and proved fatal to the patient. Among the rare cases of Sweet syndrome associated to a systemic inflammatory response syndrome that have been described there have not been any fatal cases as occurred with our patient.

Necrobiotic xanthogranuloma associated with lymphoplasmacytic lymphoma. Palliative treatment with carbon dioxide laser

Necrobiotic xanthogranuloma (NXG) with paraproteinemia is a rare non-x histiocytosis with conspicuous lesions mainly located on the periorbital skin. A 68-year-old woman, with a previous history of lymphoplasmacytic lymphoma associated with IgG monoclonal gammopathy over a period of almost 4 years, presented typical lesions of NXG on the periorbital regions and left buttock. Treatment with dioxide carbon laser resulted in great improvement of cutaneous lesions, and no evidence of relapse after a 12-month follow-up. The association of NXG with lymphoplasmacytic lymphoma has not been previously described to our knowledge. The treatment of these lesions represents a true challenge for the clinician and palliative treatment of cutaneous lesions of NXG with CO(2) laser may constitute an alternative treatment in selected cases.

Fixed drug eruption from piroxicam

The pathogenetic mechanism of fixed drug eruption (FDE) is still unknown. One of the most common causes of FDE is the use of nonsteroidal antiinflammatory drugs (NSAIDs). Oxicams are in the NSAID group and piroxicam is one of the most used of these drugs. FDE caused by piroxicam is rare but a few cases have been reported. Patch tests are useful for diagnosing some cases of FDE; they give variable results on previously affected skin while no reaction appears on unaffected skin. Some cases of cross-sensitivity among piroxicam and other substances have been reported. We report two new cases of FDE due to piroxicam with negative patch test on normal skin and positive results on affected skin.

Cutaneous ulceration as a sign of methotrexate toxicity

Methotrexate (MTX) inhibits DNA synthesis by competition with dihydrofolate reductase. Adverse cutaneous reactions to MTX are usually dose-related and have been mainly reported in patients receiving extremely large doses of chemotherapy. Painful erosion of psoriatic plaques has been often reported as an early sign of MTX toxicity, but cutaneous ulceration as a sign of MTX toxicity in patients without psoriasis has only been described in one case. We report a patient with rheumatoid arthritis and without psoriasis who developed cutaneous ulceration on the knuckles as a sign of MTX toxicity. Cutaneous ulceration by MTX toxicity is an exclusion diagnosis and its pathogenic mechanism may be multifactorial, including direct toxicity of the drug in addition to local factors.

Linear immunoglobulin A bullous dermatosis induced by gemcitabine

OBJECTIVE

To report a case of linear immunoglobulin (Ig) A bullous dermatosis (LABD) induced by gemcitabine.

CASE SUMMARY

A 59-year-old man was diagnosed with squamous-cell carcinoma of the lung in T4N2M0 stage and treated with cisplatin, vinorelbine, and gemcitabine. Twenty-four hours after the administration of gemcitabine, a symmetric, bullous, herpetiform eruption appeared on his trunk and upper limbs. Histopathologic examination and direct immunofluorescence test were consistent with IgA bullous dermatosis. Cutaneous lesions resolved two weeks after the drug was withdrawn and topical steroid treatment was instituted.

DISCUSSION

Drug-induced LABD is a variant of classic or idiopathic LABD. Vancomycin is the most frequently implicated drug, but other agents have been reported to cause LABD. According to the Naranjo probability scale, the relationship of gemcitabine treatment with cutaneous eruption in our patient is possible.

CONCLUSIONS

We report the first case of gemcitabine-induced LABD. Clinicians should monitor patients receiving this drug for signs of LABD.

Dermatomyositis and mucinosis

BACKGROUND

Mucin deposition is a common feature in autoimmune collagen diseases including dermatomyositis. Nevertheless, clinical manifestations of mucinosis are uncommon in patients with dermatomyositis. Two cases of mucinosis associated with dermatomyositis are reported.

PATIENTS

A 53-year-old woman presented with symmetrical plaques on the upper limbs formed by the coalescence of small, violaceous papules. In addition, she showed the typical cutaneous and muscle features of dermatomyositis. A 44-year-old woman with dermatomyositis of 5 years' evolution developed linear, flesh-colored papules across the flexural creases of her palms and fingers.

RESULTS

Skin biopsy of the upper limb lesions in the first patient showed epidermal changes compatible with dermatomyositis and dermal mucin deposition. Histopathologic examination of the palmar lesions of the second patient showed less intense epidermal changes of dermatomyositis and dermal mucin deposition.

CONCLUSIONS

Mucin deposition in patients with dermatomyositis may have an unusual clinical presentation, and it should be considered in the differential diagnosis of atypical cutaneous lesions in these patients.

Systemic lupus erythematosus presenting with a reticular erythematous mucinosis-like condition

We report the case of a woman with clinical and histopathological features of reticular erythematous mucinosis syndrome (REM) who six years later developed diagnostic criteria for systemic lupus erythematosus (SLE). Two biopsies performed at the same area initially showed mucin dermal deposits and further development of characteristic dermo-epidermal changes of lupus erythematosus. Our findings suggest that SLE may present with an REM-like condition.

Ecthyma gangrenosum-like eruption associated with Morganella morganii infection

Ecthyma gangrenosum is considered as a pathognomonic sign of Pseudomonas aeruginosa sepsis. Lesions similar to ecthyma gangrenosum may be caused by other organisms. We report a case of an ecthyma gangrenosum-like eruption caused by Morganella morganii, a Gram-negative bacillus.

Reticular erythematous mucinosis syndrome. Report of a case with positive immunofluorescence

We report a case with the clinical and histological features of the reticular erythematous mucinosis syndrome (REM), in which there was moderate, continuous, fine, granular, IgM deposition along the basal layer. Similar direct immunofluorescence results have been reported in only two previous cases.

Rubinstein-Taybi syndrome with piebaldism

A young girl is reported suffering from multiple congenital anomalies typical of Rubinstein-Taybi syndrome, in association with cutaneous lesions of piebaldism and occipital poliosis. Clinical characteristics of both entities are described and cutaneous manifestations of Rubinstein-Taybi syndrome are reviewed. To the best of our knowledge, this is the first case reporting such an association.

[Hydralazine and oxygen transport in interstitial and chronic obstructive pneumopathies]

We studied the effect of hydralazine (HDL) on peripheral oxygen transport (TO2) in 8 patients with chronic obstructive lung disease (EPOC, group I) and 11 patients with chronic interstitial lung disease (NI, group II) and pulmonary arterial hypertension (HAP). Mean pulmonary artery pressure (Pp) at basal conditions were 31 +/- 3 mmHg for the EPOC group and 26 +/- 9 mmHg for NI patients. After HDL, pulmonary vascular resistance (Rp) decreased significantly only in NI patients (Rp basal = 7.1 +/- 4, Rp post HDL = 5.9 +/- 3u m2). In EPOC patients Pp increased after HDL (Pp basal = 31 +/- 3, Pp post HDL = 36 +/- 4 mmHg, p less than 0.05). This was not the case for NI patients in whom Pp did not change. Both groups showed reduction in systemic vascular resistance after HDL. PaO2, PvO2, SaO2, CvO2 and TO2 were significantly increased in both groups after HDL. TO2 change was correlated with the increasing cardiac index in both diseases and with arterial oxygen content in group II only. Our study suggest that TO2 improves in EPOC and NI patients after HDL, however only in NI was associated with a reduction in pulmonary vascular resistance.

[Effect of chronic altitude hypoxia on the behavior of the respiratory center. Study on normal subjects living at the altitude of Mexico City (2,240 meters)]

Respiratory center (RC) output has been shown to be increased in hypoxemic Chronic Obstructive patients at sea level. In order to asses the separate role of chronic hypoxia on the RC output we studied 30 normal subjects all of them native and residents of Mexico City (altitude: 2,240 m, PaO2: 65-70 torr.). The parameters studied were: occlussion pressure (P0.1), mean inspiratory flow (Vi), and the ratio inspiratory time to total duration of the respiratory cycle (Ti/Ttot). The inspiratory impedance of the respiratory system as well as the minute ventilation (VE) and lastly to ensure isocapnic conditions, the end-tidal CO2 (PECO2), were also measured. These parameters were determined: 1) While breathing room air (RA), 2) after 30 min of breathing an inspired oxygen fraction (FiO2) of 30% and again 3) after 30 min of breathing and FiO2 of 100%. Fifteen of the subjects were studied on supine and the other 15 in the seated position. In most of the subjects the baseline (RA) values of P0.1 were found to be higher than those reported for normals at sea level. In every case, independent of body position, the P0.1 decreased (less than 0.01) to normal sea level values after 30 min of breathing O2 30%. Likewise, Vi and mechanical impedance also decreased (p less than 0.01) and no changes in Ti/Ttot were noted at this FiO2. No further changes occurred after breathing 100%. The above results show that: 1) The RC output in normal people at altitude (i.e. without mechanical abnormalities but with chronic hypoxia) is increased as compared to sea level.(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of blood oxygen partial pressure in the right atrium in the calculation of intrapulmonary shunt]

In order to assess the usefulness of blood samples taken from the right atrium (RA) in the calculation of intrapulmonary shunt (Qs/Qt), we correlated the values of Qs/Qt obtained through RA sampling with those obtained form a simultaneous sample of blood from the pulmonary artery (PA). The study was done in six mongrel dogs (15 to 23 Kg) who were anesthetized and artificially ventilated. The Qs/Qt measurements were repeated at different levels of cardiac output (CO). Changes in CO were elicited by both mechanical (A-V fistula) and pharmacological (Hydralazine) means. Besides the Qs/Qt correlation we also correlated the oxygen-hemoglobin saturation (Sat %) and oxygen tension (PvO2) values between the two sites of mixed venous sampling. The correlations of the different parameters between RA and PA samples we obtained were as follows: Qs/Qt r = 0.93 (p less than 0.001); Sat % r = 0.87 (p less than 0.001); and for PvO2 r = 0.91 (p less than 0.001). The significant correlations of these parameters were maintained independent of the CO level. We conclude that in our model a sample of blood obtained from the RA is useful for the calculation of Qs/Qt.