New molecular methods of research have greatly expanded the knowledge about the role of cytokines in several diseases, including psoriasis. The work orchestrated by these peptides is essential for the communication between resident inflammatory cells (keratinocytes and endothelial cells) and infiltrating cells (neutrophils, lymphocytes, Langerhans cells). This is a complex network due to redundancy, synergism and, sometimes, the antagonism of cytokines, which prevents full understanding of the pathogenesis of the disease. Currently, it seems premature to try to establish a main actor, but TNFalpha participates in all stages of psoriatic plaque development, as we shall see. Keywords: Cytokines; Psoriasis; Tumor necrosis factor-alpha Resumo: A introdução de novos métodos moleculares de investigação ampliou muito o conhecimento sobre o papel das citocinas em diversas doenças, entre elas a psoríase. O trabalho orquestrado desses polipeptídeos é fundamental na comunicação entre as células inflamatórias residentes (queratinó-citos e células endoteliais) e infiltrantes (neutrófilos, linfócitos, células de Langerhans). Trata-se de uma rede complexa devido à redundância, ao sinergismo e, por vezes, ao antagonismo das citocinas, o que dificulta a compreensão da fisiopatogenia da doença a partir de um mecanismo linear. No momento atual, parece precoce tentar estabelecer um regente, mas o TNF-alfa se destaca em todos os passos do desenvolvimento da placa psoriásica, como veremos a seguir. Palavras-chave: Citocinas; Fator de necrose tumoral alfa; Psoríase

Cyclosporine was effective and safe for psoriasis in low doses, with significant decrease of PASI and dermal dendrocytes number after 8 weeks of therapy. CK10 and 14 pattern changed and, less prominently, CK16 expression. These modifications occur later than the PASI and dermal dendrocytes variation.

Objectives:To determine the more frequently seen clinical and immunologic manifestations in the antiphospholipid syndrome (APS) in patients of 2 referral centers. Methods: We studied 50 patients with the diagnosis of primary or secondary APS, 49 females and 1 male, with ages ranging between 15 and 65-year-old, using a predetermined protocol in which we measured the immunologic and clinical spectrum, including the determination of anticardiolipin antibodies (ACA) and lupus anticoagulant (LA); in some cases we also measured anti-␤ 2-glycoprotein I. Results: The most frequent clinical manifestations were thromboses in several sites detected in 88% of cases; the most common location was the lower extremities (40%) and as pulmonary emboli was detected in 20%. Arthritis was found in 70% of the cases, livedo reticularis in 52%, Raynaud phenomena in 50%, migraine in 40%, hemolytic anemia in 30%, major depressive disorder in 22% and recurrent miscarriage in 18%. Immunologic studies showed antinuclear antibodies (ANA) in 80%, ACA of IgM and IgG isotypes were found in 56% and 44% respectively, LA in 34% and anti-DNA antibodies in 40%. Conclusions:The main clinical manifestations in patients with APS are: lower extremities thromboses, pulmonary emboli, cutaneous, articular and neurologic involvements, with the presence of ACA (isotype IgM). Introduction:The catastrophic antiphospholipid syndrome (CAPS) is characterized by a rapid-progressive thrombosis of small vessels, multiple organ failure in the presence of antiphospholipid antibodies, might be fatal in more than 50% of cases. The risk-factors identified in the develop of CAPS are, bacterial and/or viral infections, surgery, inadequate treatment of systemic lupus erythematosus (SLE), inadequate treatment of antiphospholipid syndrome (APS), or use of estrogens. Objectives: To identify methods to prevent the progression to CAPS in patients with primary and secondary antiphospholipid syndrome (APS). Patients: Patient 1: 28-year-old female with SLE without treatment, with a previous history of 2 fetal losses and 2 normal vaginal deliveries. During the 3rd trimester of her 5th pregnancy the patient presented with fever, hypertension, renal involvement, deep vein thrombosis, cerebral organic syndrome, convulsions and coma. Patient 2: 22-year-old female with SLE, lupus nephropathy classified as WHO class IV, secondary APS and cutaneous vasculitis. Exacerbation of the SLE was secondary to sun exposure and insufficient corticosteroids doses. Methods:The risk-factors were identified and the patients were treated with: 1. High corticosteroid doses. 2. Full anticoagulation with low molecular weight heparin. 3. Aggressive broad-spectrum antibiotic treatment. 4. Intravenous immunoglobulins infusions at the doses of 1g/kg/d for 2 subsequent days. 5. Control of the hematological disorder in the intensive care unit (ICU). Results: The outcomes of both patients were successful as demonstrated by controlling the events and not developing CAPS. Conclusions: Our experience suggests that ever...