Abstract: Background: Basal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking. Objectives: To evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts. Methods: A retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence. Results: Of the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types. Study limitations: Retrospective nature of the study. Conclusion: The present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.

Abstract Proliferating pilomatricoma is proliferative, rare tumor variant of pilomatricoma. It is a benign neoplasm of hair matrix that can have potentially involve local recurrence. We report the case of a 60-year-old man who presented an asymptomatic nodule on the scalp. Histological exam demonstrated a basaloid epithelium at the periphery, filled with eosinophilic cornified material containing shadow cells. The tumor was excised and there was no evidence of recurrence one year later.

Subcutaneous phaeohyphomycosis is an infection caused by dematiaceous fungi which mainly affects immunosuppressed patients. We report a case of subcutaneous phaeohyphomycosis on the back of the left hand in a kidney transplant patient who had been taking prednisone, tacrolimus, and azathioprine daily for 3 years.

A acne medicamentosa é uma dermatose comum, que pode apresentar no seu quadro clássico semelhanças à pérola rosa, como no caso apresentado de um paciente do sexo masculino cujo quadro surgiu após uso intempestivo de creme contendo corticoesteróide.

Drug-induced acne is a common skin condition whose classic symptoms can be similar to a rose pearl, as in the case of a male patient presenting with this condition after excessive use of a cream containing corticosteroids.

FUNDAMENTOS: Leishmaniose tegumentar americana é uma dermatozoonose de notificação compulsória com morbidade relevante, considerada endêmica no norte do Paraná. OBJETIVOS: Avaliar os aspectos clinicos, laboratoriais e epidemiológicos de pacientes com leishmaniose tegumentar americana atendidos no Hospital das Clinicas da Universidade Estadual de Londrina, Brasil (Paraná). MÉTODOS: Estudo observacional, transversal, retrospectivo com caráter descritivo. Realizada a avaliação dos prontuários médicos dos pacientes com leishmaniose tegumentar americana atendidos no Hospital Universitário de Londrina - Paraná, no período compreendido entre 1998 e 2009. RESULTADOS: Incluídos no estudo um total de 470 pacientes com uma prevalência de 8,72 casos/ 100.000 habitantes. A maior parte dos pacientes eram do sexo masculino, na faixa etária de 21 a 40 anos, com lesão única ulcerada como apresentação clínica mais comum, com localização principal em área descoberta. Dentre os testes imunológicos, a intradermoreação de Montenegro apresentou positividade em 84,4% dos casos. O tratamento com antimonial pentavalente foi bem tolerado, e o seguimento dos pacientes por um ano ocorreu em 59% dos casos. CONCLUSÃO: Leishmaniose tegumentar americana ainda é uma doença com caráter endêmico na região, com potencial mórbido elevado, porém com percentual de cura com o tratamento usual em torno de 95%. O uso de técnicas imunológicas facilita o diagnóstico de casos clinicamente duvidosos.

BACKGROUND: American cutaneous leishmaniasis is a dermatozoonosis of compulsory notification with relevant morbidity. The disease is considered endemic in northern Paraná. OBJECTIVES: To evaluate the clinical, laboratory and epidemiological aspects of patients with American cutaneous leishmaniasis treated at Clinics Hospital, State University of Londrina, Brazil (Paraná). METHODS: This was an observational, cross-sectional, retrospective and descriptive study. The medical records of patients with American cutaneous leishmaniasis treated at the University Hospital of Londrina - Paraná, from 1998 to 2009 were evaluated. RESULTS: A total of 470 patients, with prevalence of 8.72 cases / 100,000 inhabitants, participated in the study. Most patients were male, aged 21-40 years, with a single ulcerated lesion as the most common clinical presentation, located mainly in an exposed area of the body. With regard to immunological tests, the Montenegro intradermal reaction was positive in 84.4% of cases. Treatment with pentavalent antimony was well tolerated, and patient follow-up for a year occurred in 59% of cases. CONCLUSION: American cutaneous leishmaniasis is still an endemic disease in the region, with a high potential for morbidity, but with a cure rate of around 95% after treatment. The use of immunological techniques facilitates the diagnosis of clinically suspicious cases.

FUNDAMENTO: Dermatite esfoliativa é síndrome cutânea caracterizada por eritema e descamação generalizados, que pode ser conseqüente ou estar associada a várias doenças dermatológicas prévias, doenças sistêmicas ou reações medicamentosas. OBJETIVOS: Relatar a freqüência das diferentes causas e características clínicas associadas à dermatite esfoliativa nos pacientes atendidos no Setor de Dermatologia do Hospital Universitário Regional do Norte do Paraná, da Universidade Estadual de Londrina. MÉTODOS: Foram revisados os registros de pacientes com diagnóstico de dermatite esfoliativa diagnosticados no Hospital Universitário Regional do Norte do Paraná no período de 10 anos. RESULTADOS: Foi encontrado o total de 58 pacientes com diagnóstico de dermatite esfoliativa, com idade média de 56,89 anos. Em 33 pacientes, foi definida uma dermatose como causa (psoríase, 11 casos; dermatite de contato, nove casos; eritrodermia ictiosiforme congênita, três casos; dermatite seborréica, cinco casos; dermatite atópica, três casos; pitiríase rubra pilar, dois casos). Reações a drogas foram observadas em 11 pacientes. Em 14 casos (24%) não foi possível determinar a causa básica. CONCLUSÕES: Numa amostra de pacientes atendidos num serviço de referência em dermatologia, a dermatite esfoliativa foi ocorrência pouco comum, e a maior parte dos casos estava relacionada a doenças dermatológicas.

BACKGROUND - Exfoliative dermatitis is a cutaneous syndrome characterized by generalized exfoliation and erythema, which may be result from or be associated with pre-existing skin conditions, systemic diseases or drug reactions. OBJECTIVE - To report the frequency of clinical features and causes associated with exfoliative dermatitis in patients seen at the Dermatology Section of the Hospital Universitário Regional do Norte do Paraná, Universidade Estadual de Londrina. METHODS - Medical records from patients with diagnosis of exfoliative dermatitis seen at the Hospital Universitário Regional do Norte do Paraná were reviewed over a ten-year period. RESULTS - A total of 58 patients with diagnosis of exfoliative dermatitis was assessed. Mean age was 56.89 years. The underlying disorder in 33 patients was a skin disease (psoriasis, 11 cases; contact dermatitis, 9 cases; congenital ichthyosiform erythroderma, 3 cases; seborrheic dermatitis, 5 cases; atopic dermatitis, 3 cases; pityriasis rubra pilaris, 2 cases). Drug reactions were observed in 11 patients. Etiology could not be determined in 14 cases (24%). CONCLUSIONS - In a sample of patients attending a reference dermatology center, exfoliative dermatitis was a rare condition, and in most cases it was related to skin diseases.

A total of 250 dentists (53.6% men and 46.4% women), with a mean age of 35.1 ± 9.8 years, were submitted to serological tests for the diagnosis of hepatitis B (HB) - HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe - using a radioimmunoassay. One or more of these markers were detected in 78 individuals (31.2%) who were excluded from the group to be vaccinated. Of the 172 HB-susceptible individuals, 135 (78.5%) responded to the call and were intradermally injected with three 2 µg doses of the Belgian HB recombinant vaccine, applied at an interval of one month between the 1st and 2nd dose and of five months between the 2nd and 3rd dose. A new determination of HB markers carried out 50 days after the 3rd dose showed that 110 (81.5%) individuals had become anti-HBs positive (65.5% good responders and 34.5% poor responders). Mean serum anti-HBs titer of these 110 dentists was 42.4 U S/N, similar in both sexes. The adverse effects analyzed in 106 dentists were: (a) local: pain (12.3%), burning sensation (14.1%), pruritus (25.5%), erythema (28.3%), local heat (18.9%), and a hypochromic spot (32.1%); (b) systemic (4.7%): discomfort in two patients, and fever, anorexia, and asthenia in one patient each. Intradermal administration of a fourth 2 µg vaccine dose to 39 dentists (poor or non-responders) increased the total number of anti-HBs-positive individuals from 110 (81.5%) to 114 (84.4%), with the number of good responders increasing from 72 (65.5%) to 85 (74.6%). We conclude that the Belgian recombinant vaccine applied in the scheme used here induces a high rate of seroconversion and causes only mild and transitory adverse effects.

Of the 110 dentists who had presented seroconversion 50 days after the intradermal application of three 2 µg doses of the Belgian recombinant vaccine against hepatitis B (HB), administered eight years before at an interval of one month between the 1st and 2nd doses and of five months between the 2nd and 3rd doses, 51 were included for the assessment of the persistence of immunity. None of the dentists had hepatitis or had received HB vaccine during this period. All subjects were submitted to serological tests for the detection of the following markers of hepatitis B virus (HBV) infection: HBsAg, anti-HBc, HBeAg, anti-HBe, and anti-HBs, with no HBsAg, anti-HBc, HBeAg or anti-HBe being detected. A microparticle enzyme immunoassay (MEIA) revealed the presence of anti-HBs at protective titers (> 10 mIU/ml) in 42 dentists (82.4%), with the anti-HBs titer being higher than 100 mIU/ml in 36 of them (70.6%) (good responders), between 10 and 100 mIU/ml in 6 (11.8%) (poor responders), and lower than 10 mIU/ml in 9 (17.6%) (non-responders). According to clinical data and serological tests, none of the dentists had presented disease or latent HBV infection during the eight years following the first vaccination. A 2 µg booster dose was administered intradermally to eight dentists with anti-HBs titers lower than 10 mIU/ml (non-responders) and to six dentists with titers ranging from 10 to 100 mIU/ml (poor responders); the determination of anti-HBs one month later demonstrated the occurrence of seroconversion in the eight non-responders and an increase in anti-HBs titer in the six poor responders. In summary, the present results demonstrated the prolonged persistence of protection against HBV infection and the development of immunologic memory provided by vaccination against HB - with intra-dermal application of three 2 µg doses of the Belgian recombinant vaccine at 0, 1, and 6 months - carried out eight years before in 51 dentists.

A forma de aquisição mais freqüente da Doença de Chagas em áreas endêmicas foi a transmissão clássica, através das fezes de triatomíneos contaminados. Entretanto, atualmente deve-se dar especial atenção nos centros urbanos para a transmissão por transfusão de sangue, justificando a necessidade de rigorosa triagem sorológica dos doadores. As primeiras investigações em bancos de sangue de Londrina mostraram uma soroprevalência de anticorpos anti-T. cruzi de aproximadamente 7,0% nos anos 50(9,34). Estudos posteriores praticamente registraram a manutenção desta soroprevalência até a década de 80(4,32,41). Com o objetivo de obter subsídios quanto a dimensão atual da soropositividade de anticorpos anti-T. cruzi em nossa região, foi feito um levantamento dos resultados das reações sorológicas para doença de Chagas em 45.770 amostras de soro de doadores de sangue do Hemocentro do HURNP. realizadas no período de maio de 1990 a dezembro de 1994. As amostras foram analisadas empregando-se a técnica de hemaglutinação indireta (HAI, comercialmente obtida da EBRAM) e imunofluorescência indireta (IFI, obtidos da LIO SERUM) usando-se conjugados anti-IgG humano (fornecidos pela LABORCLIN). Destas, 643 (1,4%) amostras apresentaram resultado reagente para ambas as técnicas. Pode-se observar uma alteração significativa nos índices de positividade de anticorpos anti-T. cruzi em doadores de sangue de Londrina. Dados correlacionando sexo e idade dos doadores soropositivos são apresentados, bem como os possíveis fatores que contribuíram para os resultados observados.

The most frequent form of acquisition of Chagas' disease in endemic areas was the transmission through the feces of contaminated triatominae. However, special attention should be paid in urban areas to transmission by blood transfusion, justifying the compulsory screening of blood donors. Early investigations at blood banks in the town of Londrina, Brazil, demonstrated that the seroprevalence of anti-Trypanosoma cruzi antibodies among blood donors was approximately 7.0% in the fifties9,34. Further studies demonstrated pratically the same seroprevalence until the eighties4,32,41. In an attempt to obtain data about the real dimension of the seropositivity for anti-Trypasonoma cruzi antibodies in the region, the authors carried out a large-scale study on 45,774 serum samples from blood donors of the Hemocentro of Hospital Universitário Regional do Norte do Paraná (HURNP), Universidade Estadual de Londrina. The immunological tests were done at the Division of Clinical Immunology of HURNP from May 1990 to December 1994. The serum samples were studied by the indirect hemagglutination assay (IHA, using kits commercially obtained from EBRAM) and by indirect immunofluorescence (IFI, using kits from LIO SERUM) with anti-human IgG conjugate (LABORCLIN). The results demonstrated that 643 serum samples were positive in both assay corresponding to a seroprevalence of 1.4%, i.e., a significant decrease in anti-Trypanosoma cruzi antibodies in the region in comparison with the previously mentioned rates. Data correlating sex and age of seropositive blood donors are presented, as well as the possible factors that may have contributed to the results observed.