Abstract Introduction Clinical and pathological staging plays an important role on the prognosis of head and neck cancer (HNC) patients. Objective The present study aims to compare clinical and pathological T, N and overall staging in patients with HNC, to identify factors associated with these discrepancies, and to analyze and compare survival or disease-free survival in staging disagreements. Methods Retrospective cohort including every patient submitted to neck dissection from January 2010 to December 2020 in the department of Otorhinolaryngology of a tertiary hospital center. Results A total of 79 patients were analyzed; their mean age was 58.52 ± 13.15 years old and 88.9% were male. Assessing overall staging, discrepancies were noted in 53% (36.4% upstaging and 16.6% downstaging) and were significantly associated with clinical overall staging (p = 0.006). Regarding T staging, differences were noted in 45.5% (30.3% upstaging and 15.2% downstaging) and were significantly associated with imaging modality (p = 0.016), clinical T staging (p = 0.049), and histology (p = 0.017). Discrepancies in N staging were noted in 38% (25.3% upstaging and 12.7% downstaging) and were significantly associated with age (p = 0.013), clinical N staging (p < 0.001), and presence of extranodal invasion (p < 0.001). Both in Overall, T, and N staging, the aforementioned disagreements were not associated with either higher mortality or higher disease relapse. Conclusion Overall, T, and N staging disagree in an important number of cases, and the overall stage can disagree in up to 53% of the cases. These disagreements do not seem to influence overall and disease-free survival.

SUMMARY We present the unique case of an adult Brazilian woman with severe short stature due to growth hormone deficiency with a heterozygous G to T substitution in the donor splice site of intron 3 of the growth hormone 1 (GH1) gene (c.291+1G>T). In this autosomal dominant form of growth hormone deficiency (type II), exon 3 skipping results in expression of the 17.5 kDa isoform of growth hormone, which has a dominant negative effect over the bioactive isoform, is retained in the endoplasmic reticulum, disrupts the Golgi apparatus, and impairs the secretion of other pituitary hormones in addition to growth hormone deficiency. This mechanism led to the progression of central hypothyroidism in the same patient. After 5 years of growth and thyroid hormone replacement, at the age of 33, laboratory evaluation for increased weight gain revealed high serum and urine cortisol concentrations, which could not be suppressed with dexamethasone. Magnetic resonance imaging of the sella turcica detected a pituitary macroadenoma, which was surgically removed. Histological examination confirmed an adrenocorticotropic hormone (ACTH)-secreting pituitary macroadenoma. A ubiquitin-specific peptidase 8 (USP8) somatic pathogenic variant (c.2159C>G/p.Pro720Arg) was found in the tumor. In conclusion, we report progression of isolated growth hormone deficiency due to a germline GH1 variant to combined pituitary hormone deficiency followed by hypercortisolism due to an ACTH-secreting macroadenoma with a somatic variant in USP8 in the same patient. Genetic studies allowed etiologic diagnosis and prognosis of this unique case.

Abstract Background Skin lesions of patients affected by non-ulcerated cutaneous leishmaniasis (NUCL) caused by L. (L.) infantum chagasi are characterized by lymphohistiocytic inflammatory infiltrate associated with epithelioid granuloma and scarce parasitism. However, the in situ cellular immune response of these patients is unclear. Therefore, the aim of the present study was to characterize the cellular immune response in the skin lesions of patients affected by NUCL. Methods Twenty biopsies were processed by immunohistochemistry using primary antibodies to T lymphocytes (CD4, CD8), NK cells, B lymphocytes, macrophages, nitric oxide synthase and interferon-gamma. Results Immunohistochemistry revealed higher expression of all cellular types and molecules (IFN-γ, iNOS) in the dermis of diseased skin compared to the skin of healthy individuals (p < 0.05). Morphometric analysis performed in the skin lesions sections showed the predominance of CD8+ T lymphocytes in the mononuclear infiltrate, followed by macrophages, mostly iNOS+, a response that could be mediated by IFN-γ. Conclusion Our study improves knowledge of the cellular immune response in non-ulcerated or atypical cutaneous leishmaniasis caused by L. (L.) infantum chagasi in Central America and pointed to the pivotal participation of CD8+ T lymphocytes in the host defense mechanisms against the parasite in patients with NUCL.

Abstract The papaya cultivar UC14, recommended for the Southeast and Northeast regions of Brazil, was developed by UENF/CALIMAN breeding program. ‘UC14’ produces smaller fruit than those of Formosa hybrid, with a mean weight of 0.8 kg and a mean fruit yield of 199.45 t ha-1.

RESUMO Objetivo: A via de acesso mais utilizada na osteossíntese das fraturas de úmero proximal é a deltopeitoral. A via anterolateral sofre resistência, pois muitos temem suas complicações, principalmente lesão do nervo axilar. Objetivo é avaliar a função do ombro e as complicações nas fraturas de úmero proximal, tratados pela via anterolateral com observação direta do nervo axilar. Métodos: Estudo retrospectivo com avaliação radiológica e funcional (Constant e DASH scores) pós-operatórios e complicações. A associação entre a classificação da fratura e a diferença dos escores entre os membros, bem como o ângulo final de consolidação, foram analisados pelo Teste de Fisher ou Anova. A comparação dos escores Constant entre os membros foi conduzida pelo teste t pareado. Resultados: foram avaliados 35 pacientes. Houve diminuição da função do ombro em relação ao contralateral (p<0,005). O único fator relacionado à piora funcional foi fratura Neer IV. A principal complicação foi consolidação viciosa. Não se observou alterações clínicas relacionadas ao nervo axilar. Conclusão: A osteossíntese das fraturas do úmero proximal realizada pela via de acesso anterolateral estendida, apesar da diminuição da função do ombro (fraturas Neer IV), evoluiu com bom resultado funcional e mostrou-se segura na proteção do nervo axilar. Nível de evidência III, Estudo Retrospectivo.

ABSTRACT Objective: The main surgical approach in proximal humeral fractures is the deltopectoral approach. Many surgeons avoid the anterolateral approach, fearing its complications, especially axillary nerve injury. The objective of this study is to evaluate shoulder function and complications in patients with proximal humeral fractures treated using an anterolateral approach with direct observation of the axillary nerve. Methods: Retrospective study with postoperative radiological and functional evaluations (Constant and DASH scores) and review of the complications. The associations between fracture classification and the difference in Constant scores among the subjects and the final angle of consolidation were analyzed using Fisher's test or analysis of variance (ANOVA). The Constant scores were compared among the shoulders using the paired t-test. Results: The study evaluated 35 patients. Shoulder function was decreased, compared with the contralateral side (p<0.005). The only factor related to functional worsening was the Neer IV fracture. The main complication was malunion. There were no clinical changes related to the axillary nerve. Conclusion: The treatment using the extended anterolateral approach produced good functional results, although the function was decreased (Neer IV fractures). The main complication was malunion. There were no side effects due to exposure of the axillary nerve. Level of evidence III, Retrospective Study.

Abstract UC10 is a new papaya cultivar, recommended to the southeast and northern regions of Brazil. It has a very good agronomic performance in and adaptation to these regions, with Formosa fruits of approximately 1.9 kg and yield of 260 t ha-1. The cultivar has early fruit production, and fruits have excellent flavor.

RESUMO: Atualmente, os fabricantes de tratores agrícolas disponibilizam aos agricultores uma diversidade de marcas, modelos e configurações para as mais diversas operações agrícolas. Nesse sentido, a relação massa/potência do trator influencia de forma direta no desempenho dessas operações. Objetivou-se estudar os tratores agrícolas de rodas comercializados no mercado brasileiro, no que se refere a sua massa, visando obter dados atuais que auxiliem sua seleção e uso adequado. A pesquisa envolveu 145 modelos de tratores agrícolas de oito marcas diferentes, contemplando as versões 4x2, TDA e 4x4. Foram analisadas separadamente as variáveis massa sem lastro e relação massa/potência para as diferentes marcas, tipo de tração e potência do trator, sendo esta última classificada em: Classe I (menores que 50kW), Classe II (entre 50 e 150kW) e Classe III (maiores que 150kW), de acordo com a potência nominal do motor, declarada pelo fabricante. As análises estatísticas foram realizadas por meio dos testes t de Student e Tukey. O maior número de tratores pertence à Classe II, sendo considerados versáteis, devido à sua relação massa/potência, podendo ser usados nas mais diversas operações agrícolas. Há uma tendência de os tratores agrícolas comercializados no mercado brasileiro diminuírem sua relação massa/potência, conforme aumenta a potência nominal do motor.

ABSTRACT: Currently, manufacturers of agricultural tractors offer to farmers a diversity of brands, models, and settings for the most diverse agricultural operations. In this sense, the relation mass/power of tractor influences directly in the performance of these operations. The objective of this research was to study the agricultural wheel tractors marketed in Brazil in relation to their mass, in order to obtain current data to help their selection and proper use. The research involved 145 agricultural tractors models of eight different brands, including 2WD, MFWD and 4WD versions. The variables mass without ballast, relation mass/power for the different brands, type of traction and tractor power were analyzed separately. Tractor power was classified in: Class I (<50kW), Class II (50 to 150kW) and Class III (>150kW), according to the rated engine power declared by the manufacturer. Statistical analyses used were the t-Student and Tukey tests. The most number of tractors belongs to Class II and are considered versatile due to their mass/power relation, and can be used in the most diverse agricultural operations. From these analyses it was detected the mass/power relation decreases when the rated engine power increases.

RESUMO: Os ensaios oficiais de motores agrícolas visam à determinação do torque e potência, que são informações importantes para a tomada de decisão no momento da compra de uma máquina agrícola. Neste trabalho, foram comparados os valores de torque e potência máxima do motor, fornecidas pelos fabricantes com os dados obtidos a partir de testes dinamométricos. Para tanto, utilizaram-se 40 tratores agrícolas novos comercializados no mercado brasileiro. Os tratores foram classificados quanto à faixa de potência em: Classe I (menor ou igual a 22,1kW); Classe II (entre 22,1 e 51,5kW); Classe III (51,5 e 73,5kW); Classe IV (73,5 e 117,7kW); e Classe V (117,7 e 183,9 kW). As variáveis foram submetidas ao teste estatístico t de Student (P≥0,05). A potência dos motores dos tratores da Classe IV é maior em comparação aos especificados pelos fabricantes. Para os motores de tratores da Classe III, os valores observados de torque são maiores em relação aos especificados, enquanto que, para os da Classe V, esses valores foram menores. Como conclusão, no que diz respeito à potência máxima do motor, verificou-se que 67,5% dos tratores avaliados atendem às informações disponibilizadas pelos fabricantes.

ABSTRACT: Official agricultural engineering testing aims to determine torque and power, which are important information for decision making when buying an agricultural tractor. In this research the torque and maximum power values provided by manufacturers with the dynamometer tests values, were compared. Forty new agricultural tractors commercialized in the brazilian market were used. Tractors were classified according to the power range in: Class I (less than or equal 22.1kW); Class II (between 22.1 and 51.5kW); Class III (51.5 and 73.5kW); Class IV (73.5 and 117.7kW); and Class V (117.7 and 183.9kW). Variables were analyzed with the statistic t-Student test (P≥0.05). Class IV tractors engines power is bigger in comparison to the values specified by manufacturers. As for Class III tractors engines, torque values observed were bigger when compared to the specified, while for Class V was presented smaller values. As conclusion, with respect to the maximum engine power, it was verified that 67.5% of the evaluated tractors meet the information provided by manufactures.

INTRODUÇÃO: Obstrução nasal é um sintoma comum e atinge 25% da população. A hipertrofia de cornetos inferiores é a principal causa de obstrução nasal. Na falha do controle clínico um procedimento cirúrgico para redução do volume dos cornetos inferiores é indicado. OBJETIVO: Comparar a melhora da qualidade de vida no pós-operatório tardio de turbinectomia e turbinoplastia. MÉTODO: Estudo de Série de Casos retrospectivo. Foram avaliados 24 pacientes submetidos à cirurgia nasal de turbinectomia ou turbinoplastia em 2007. Os pacientes foram convocados para uma entrevista em agosto de 2008. Os pacientes foram avaliados quanto aos seguintes itens: escala NOSE pós-operatória, morbidade no PO, sangramentos e quantidade de crostas no PO. RESULTADOS: Compareceram para a avaliação 24 pacientes. A principal variável analisada foi à diferença entre a escala NOSE no pré e no pós-operatório tardio. Não houve significância estatística pelo teste t de student nas variáveis estudadas. DISCUSSÃO: Na avaliação dos diversos tipos de tratamento cirúrgico do corneto inferior a literatura mostra resultados semelhantes ao do nosso estudo encontrando resultados semelhantes entre as diversas técnicas cirúrgicas quanto à melhora da obstrução nasal e a atividade mucociliar. CONCLUSÃO: Não há evidencia na literatura e em nossa amostra da superioridade de uma técnica do tratamento cirúrgico do corneto inferior sobre os outros tratamentos.

INTRODUCTION: Nasal Obstruction is a common symptom and affects 25% of the population. The inferior turbinate hypertrophy is the main cause of nasal obstruction. In the failure of clinical control, a surgical procedure to reduce the size of the inferior turbinate is indicated. OBJECTIVE: Compare the improvement of life quality in late postoperative of Turbinectomy and turbinoplasty. METHOD: Study of a retrospective case series. 24 patients were submitted to a nasal surgery of turbinectomy or turbinoplasty in 2007. The patients were invited to an interview in august of 2008. The patients were evaluated in the following items: Postoperative NOSE scale, morbidity in postoperative, bleeding and quantity of crusts in postoperative. RESULTS: 24 patients attended for the evaluation. The main variable analyzed was the difference between NOSE scales in late pre and post operative. There was no statistically significant by the test in the variables studied. Discussion: In the evaluation of the various types of surgical treatment of the inferior turbinate, literature shows similar results to our study, finding similar results between many surgical techniques in the improvement of the nasal obstruction and in mucociliary activity. CONCLUSION: There are no evidence in the literature and in our sample of the superiority of a technique of surgical treatment in the inferior turbinate under other treatments.

O objetivo do presente estudo foi analisar o efeito de um treinamento de força no meio aquático (TFA) na força muscular de mulheres jovens saudaveis. O grupo treinamento de força (GTF, n=13) realizou o treinamento por onze semanas enquanto o grupo controle (GC, n=7) não realizou nenhum exercício físico regular durante esse período. O TFA consistiu em duas sessões semanais de 50 minutos, sendo a parte principal da sessão organizada em forma de circuito. A força máxima dinâmica (FM) foi mensurada através do teste de uma repetição máxima em sete exercícios de força. Utilizou-se o teste t pareado para a comparação entre as situações pré e pós-treinamento (p<0,05). O GTF demonstrou um aumento significativo (p<0,001) na FM em todos os exercícios avaliados sendo que esse aumentos variaram de 12,53 ± 9,28% a 25,90 ± 17,84%. Já o GC não apresentou alterações significativas da FM em nenhum exercício. Dessa forma, é possível recomendar treinamentos de força no meio aquático de onze semanas como um método alternativo e eficaz para a melhora da força muscular de mulheres jovens e saudáveis.

The aim of this study was to analyze the effects of an aquatic strength training (AST) upon muscle strength in young and healthy women. The aquatic training group (ATG, n=13) trained during eleven weeks and the control group (CG, n=7) did not practice any exercise throughout this period. The AST was performed twice a week for 50 minutes and the main part was performed in circuit form. The maximum dynamic strength (MS) was evaluated by the one repetition maximum test in seven strength exercises. The paired t test was used to compare the situations pre and post training (p<0.05). The AST showed a significant increase (p<0.001) in MS in all exercises and the increases ranged between 12.53 ± 9.28% to 25.90 ± 17.84%. No significant changes were observed in the CG. In general ways, we may recommend aquatic strength training of eleven weeks as an alternative and effective method to increase muscle strength in health and young women.

OBJETIVO: O objetivo deste trabalho foi estudar a TSC em estatura dos recrutas de Blumenau e correlacioná-la com o Índice de IDH. MÉTODOS: Estudo transversal em recrutas com idades entre 18 e 20 anos que foram incorporados ao 23º Batalhão de Infantaria de Blumenau por ocasião do alistamento militar no período de 1963 a 2007. A amostra consistiu em 600 inscritos de um total de 3000 recrutas incorporados no período. Os dados foram coletados a partir dos registros individuais dos recrutas armazenados em fichas que foram arquivadas por ano. De cada década, selecionou-se três anos (finais 3, 5, e 7) e destes anos foram selecionadas sistematicamente as primeiras 40 fichas do arquivo anual para análise. Na análise estatística utilizou-se a estatística descritiva, o teste T-Student e a regressão linear simples. RESULTADOS: Constatou-se que em Blumenau ocorreu um aumento da ordem de 7 cm na estatura dos recrutas nos últimos 47 anos (1,7 metros na década de 1960 e 1,77 metros na década de 2000), sendo este incremento mais evidente entre as décadas de 1970 e 1980. As estaturas médias de anos de diferentes décadas mostraram correlação forte e positiva com o IDH de Blumenau e do Brasil, que aumentou progressivamente no perÃodo estudado. CONCLUSÃO: A tendência secular de crescimento em estatura foi positiva em Blumenau com associação positiva com o IDH.

OBJECTIVE: This study aimed to characterize the secular trends of stature growth in Blumenau and to correlate it with the human development index (HDI). METHODS: A cross-sectional study was carried out with recruits aged 18 to 20 in the Brazilian Army from 1963 to 2007 in the city of Blumenau. Six hundred individuals obtained by systematic sampling among 3000 recruits were studied. Three years were selected out of each decade (final 3, 5 ,7) and from each year the first fourty records were analyzed RESULTS: A descritive statistics mean from different decades was compared by Student's t test, and linear regression analyses were used to correlete stature with years, decades and the HDI. Results: A stature increase of 7 cm was found in the last 47 years (1.7 meters in 1960 and 1.77 meters in 2000). Differences among decades have been significant, except between 1980 and 1990. From 1960 to 2000 Brazilian HDI increased significantly from 0.394 to 0.757. The greatest increment in stature occurred between 1970 and 1980, as well as the greatest increase in the HDI. CONCLUSION: The secular trend of growth was positive in Blumenau - SC in the last decades with an association to the HDI.

OBJETIVO: Estudo retrospectivo comparando resultados da IA e da IP em pacientes operados com o diagnóstico de EIA (tipo 1 de Lenke). MÉTODOS: Os resultados de 24 pacientes com idade de 11 a 18 anos com EIA tipo Lenke I e submetidos a tratamento cirúrgico por meio da abordagem anterior (12 pacientes) ou posterior (12 pacientes) foram comparados. Todos os pacientes foram operados pelo mesmo cirurgião e seguidos por um período mínimo de cinco anos. As variáveis de comparação incluíram: correção sagital e coronal, distância da vértebra apical a linha média, rotação da vértebra apical, número de vértebras instrumentadas e variáveis funcionais por meio do questionário SRS-22. Os dados obtidos foram analisados com a versão 9 do programa SAS. Os dois grupos foram comparados com o teste t de Student com um nível de significância de 5% (0,05). RESULTADOS: A correção da curva no plano frontal no pós-operatório imediato (p = 0,031), tardio (p = 0,043) e também a rotação da vértebra apical no pós-operatório imediato (p = 0,002) e tardio (p = 0,021) no grupo de pacientes submetidos à correção por meio da abordagem anterior. O número de vértebras instrumentadas foi 7,69 ± 1,38 no grupo de pacientes submetidos a IA e 11,38 ± 2,92 na IP (p = 0,021). A avaliação funcional (SRS-22) não demonstrou diferença significativa (p > 0,05) entre os grupos. CONCLUSÃO: O grupo de pacientes submetidos à correção da escoliose por instrumentação anterior apresentou maior correção no plano frontal, maior derrotação da vértebra apical e menor número de vértebras artrodesadas.

OBJECTIVE: To evaluate and compare the results of AI and PI in patients diagnosed with Lenke type I curves who were treated surgically. METHODS: The results of 24 patients aged 11 to 18 years with Lenke type I idiopathic scoliosis who underwent surgery with anterior (12 patients) or posterior (12 patients) instrumentation were compared. All patients were operated by the same surgeon and were followed up for a minimum period of five years. Variables for comparison include: coronal and sagittal correction, distance from apical vertebra to midline, apical vertebral rotation, number of instrumented vertebrae and functional variables by means of the SRS-22 questionnaire. The data obtained were analyzed with the SAS program, version 9. The two groups were compared with a 2-tailed Student's t-test with a level of significance set at 5% (0.05). RESULTS: The correction of the curve on the frontal plane was higher at immediate (p=0.031) and late postoperative (p=0.043) as well the apical vertebral rotation during immediate (p=0.002) and late (p=0.019) evaluation in the anterior spinal fusion group. The number of instrumented vertebrae was 7.69±1.38 in the anterior spinal fusion patients and 11.38±2.92 in the posterior spine fusion patients (p=0.021). Functional assessment (SRS-22) showed no significant difference (p>0.05) between groups. CONCLUSION: Anterior spine fusion patients presented greater scoliosis correction on frontal plane, greater derotation of apical vertebrae and smaller number of fused vertebrae.

Redescriptions are given of the mature oocysts of Eimeria aguti Carini 1935, E. cotiae Carini, 1935 and E. paraensis Carini, 1935, in the faeces of five specimens of the rodent Dasyprocta leporina (Rodentia: Dasyproctidae) from the state of Pará, North Brazil. New information is provided on the sporulation time of these parasites and the prepatent period in experimentally infected D. leporina. Some endogenous stages of E. cotiae are described in the epithelial cells of the ileum, and the absence of any oocysts in the gall-bladder contents of the infected animals indicates that the intestine is also the site of development of E. aguti and E. paraensis. Difficulties in separating E. cotiae and E. paraensis on morphology of the oocysts are discussed. The oocysts of both parasites share many structural features and have a wide size range. It is concluded that although it is at present best to maintain these names, the possibility exists that they were separately given to oocysts of smaller dimensions (E. cotiae) and larger dimensions (E. paraensis) of a single parasite. Location of an endogenous site of development for E. paraensis that is distinctly separate from that of E. cotiae might establish more definitely the separate specific status of the two parasites.

Sistemas agroflorestais são indicados como alternativa para o cultivo de cana-de-açúcar (Saccharum officinarum) em Piracicaba, SP, Brasil, porém, há falta de experimentos sobre o desempenho da cultura nestas condições. O objetivo deste trabalho foi avaliar a produção e partição da cultura em uma interface cana-de-açúcar/seringueira (Hevea brasiliensis) em condição de campo comercial. Simulou-se a disponibilidade de irradiância para a cultura ao longo da interface e testou-se seu efeito sobre a produção final de matéria seca da cana-de-açúcar. A produção da cultura foi afetada de forma negativa pela distância das árvores, mas o desenvolvimento e o teor de sacarose não foram afetados. A matéria seca acima do solo aumentou de 16,6 para 51,5 t ha-1, a partir das árvores. A partição não apresentou um padrão definido, pois o índice de colheita aumentou de 0,85 para 0,93, contudo a área foliar específica não apresentou alteração significativa, com variação de 13,48 a 15,73 m² kg-1. A luz é o principal fator de competição entre a árvore e a cultura, mas a importância relativa das interações abaixo do solo aumenta próximo das árvores. A viabilidade deste sistema depende da maturidade das árvores e de estratégias de manejo.

Agroforestry systems are indicated as an alternative for sugarcane (Saccharum officinarum) cultivation in Piracicaba, SP, Brazil, however there are not many field experiments on plant performance under these conditions in the world. The objective of this work was to assess crop yield and partitioning in a sugarcane-rubber (Hevea brasiliensis) interface in on-farm conditions. The availability of irradiance for the crop along the interface was simulated and its effe ct over sugarcane dry matter production was tested. Crop yield was negatively affected by distance of the trees, but development and sucrose were not affected. Above ground dry matter increased from 16.6 to 51.5 t ha-1 from trees. Partitioning did not have a defined standard, as harvest index increased from 0.85 to 0.93, but specific leaf area was not significant along the transect, ranging from 13.48 to 15.73 m² kg-1. Light is the main factor of competition between the trees and the crop, but the relative importance of below ground interactions increases closer to the trees. Feasibility of the system depends on maturity of the trees and management strategies.

Leishmania (Leishmania) amazonensis has for some time been considered as the causative agent of two distinct forms of American cutaneous leishmaniasis (ACL): localized cutaneous leishmaniasis (LCL), and anergic diffuse cutaneous leishmaniasis (ADCL). Recently, a new intermediate form of disease, borderline disseminated cutaneous leishmaniasis (BDCL), was introduced into the clinical spectrum of ACL caused by this parasite, and in this paper we record the clinical, histopathological, and immunological features of eight more BDCL patients from Brazilian Amazonia, who acquired the disease in the Pará state, North Brazil. Seven of them had infections of one to two years' evolution and presented with primary skin lesions and the occurrence of metastases at periods varying from six to 12 months following appearance of the first lesion. Primary skin lesions ranged from 1-3 in number, and all had the aspect of an erythematous, infiltrated plaque, variously located on the head, arms or legs. There was lymphatic dissemination of infection, with lymph node enlargement in seven of the cases, and the delayed hypersensitivity skin-test (DTH) was negative in all eight patients prior to their treatment. After that, there was a conversion of DTH to positive in five cases re-examined. The major histopathological feature was a dermal mononuclear infiltration, with a predominance of heavily parasitized and vacuolated macrophages, together with lymphocytes and plasma cells. In one case, with similar histopathology, the patient had acquired his infection seven years previously and he presented with the largest number of disseminated cutaneous lesions. BDCL shows clinical and histopathological features which are different from those of both LCL and ADCL, and there is a good prognosis of cure which is generally not so in the case of frank ADCL.