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ABSTRACT Objective: to assess the effectiveness of 5% Brazilian green propolis (ointment) in individuals with chronic ulcers. Methods: a randomized clinical trial, developed with 40 patients randomized equally to control group (treated with essential fatty acid) and experimental group (treated with 5% green propolis) for 30 days. The outcomes of interest were sociodemographic, clinical and laboratory characteristics, lesion characteristics, such as type of tissue in the bed, presence of exudate, edge characteristics, microbial content and pain. Results: regarding sociodemographic, clinical and laboratory characteristics, the two groups did not show statistically significant differences. After assessment in 30 days, an effect was observed for both treated groups, but for the experimental group, greater effectiveness in terms of the type of tissue in the bed, type of exudate, edge characteristics, microbial content and pain. Conclusion: propolis-based ointment showed a healing effect, presenting itself as a potential tool in healing chronic ulcers.

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Erythema multiforme is a mucocutaneous disease characterized by the acute appearance of blisters and ulcers, with or without oral involvement. In this report, a 12-year-old female patient presented with extensive ulcerative lesions on the upper and lower lips, with painful symptoms and areas of bleeding and suppuration. Despite these lesions being restricted to the lips and skin around, the patient was diagnosed with erythema multiforme. Dexamethasone was then prescribed, in addition to the use of lip balm. At the first return evaluation, there was no regression of the clinical picture, and the medication was replaced by prednisone, associated with amoxicillin and 0.12% chlorhexidine mouthwash. In the second return visit, there was considerable regression of the lesion, and the process of gradual discontinuation of the corticosteroid was initiated. After 1 week, the lesions had healed, and the drug was discontinued. The oral cavity may be the only site affected by erythema multiforme, so knowledge of this disease is necessary for its correct diagnosis and treatment.

Objective: to analyze the healing process of venous ulcers treated with an Unna’s boot. Methods: longitudinal study, prospective, with 14 individuals with chronic venous ulcers, followed at four different moments of time. Data collection was based on clinical and sociodemographic profile and clinical evaluation of the lesions. Data were analyzed using the Friedman test. Wilcoxon’s signed ranks test was used to compare means, and for multiple comparisons Bonferroni’s correction was used (p

Objective: to analyze the demographic, clinical and therapeutic profiles of the patients treated in a Comprehensive Wound Care Unit. Method: a quantitative and retrospective study that analyzed management reports and medical records of patients with chronic wounds treated at a Comprehensive Wound Care Unit in Vitória da Conquista-Bahia, Brazil. The data, collected in February 2020, were submitted to descriptive and inferential analysis, and the Chi-square test with p value

Marjolin ulcer (epidermoid carcinoma) is a rare condition that arises from a chronic skin lesion. We present a patient who developed an epidermoid carcinoma in the scar tissue of a pressure ulcer. After eleven years of surgery to correct a pressure ulcer in the right gluteus, the patient developed an epidermoid carcinoma in a pressure ulcer in the left gluteus and neglected the condition. Wide resection of the lesion was performed with free margins in the final histopathological result. Marjolin ulcer is an expression that commonly refers to the malignant degeneration of chronic wounds that have not healed or healed by secondary intention. It is often described as various types of lesions, including the scars of pressure ulcers. The pathogenic mechanisms behind the malignant transformation of these lesions have not yet been completely elucidated. The diagnosis is initially made by clinical examination due to the lesion aspect and is confirmed by biopsy. Surgery is the choice treatment closing the defect with flaps or grafts, depending on each case.

Abstract Trichosporon asahii is the causal agent of trichosporonosis. Patients with immunosuppression or hematological malignancies are at higher risk of infection. Skin and mucosal involvement appear as fast-growing papulonodular lesions and necrotic ulcers. Internal organ dissemination is lethal. Therapeutic success depends on the underlying disease. Here, the authors present the first case of disseminated mucocutaneous trichosporonosis in a patient with a post-mortem diagnosis of histiocytic sarcoma, a rare and aggressive haematolymphoid neoplasm. Regretfully, death occurred despite treatment with liposomal amphotericin B and supportive measures, showcasing the fatality of both diseases.

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Abstract Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for L. braziliensis and the presence of amastigotes of Leishmania sp. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.

Vulvar ulcers are a frequent reason for doubt and difficulty of etiological diagnosis. Among the causes of genital ulcers, we can mention sexually transmitted infections such as herpes simplex virus infection, syphilis, chancroid, granuloma inguinale or Donovanosis, and lymphogranuloma venereum, as well as non-infectious etiologies including psoriasis, sexual trauma, Behçet’s syndrome, Wegener’s granulomatosis, and Zoon Vulvitis. In the present study, a case of a seven months evolution genital ulcer patient (who did not respond to the various proposed therapies) was referred to the Service of Vulvar Pathology of the Hospital Universitário Antônio Pedro (Universidade Federal Fluminense). A biopsy of the lesion was performed, and the histopathological report was compatible with Zoon Vulvitis. The treatment with corticosteroids was initiated. Patient presented a successful evolution. An extensive review of the literature on differential diagnoses of vulvar ulcers was carried out in order to guide a clinical reasoning and a therapeutic approach to the different etiologies.

Abstract Diabetes is a systemic disease that has achieved epidemic proportions in modern society. Ulcers and infections are common complications in the feet of patients with advanced stages of the disease, and are the main cause of amputation of the lower limb. Peripheral neuropathy is the primary cause of loss of the protective sensation of the feet and frequently leads to plantar pressure ulcers and osteoarticular disruption, which in turn develops into Charcot neuropathy (CN). Common co-factors that add to the morbidity of the disease and the risk of amputation in this population are obesity, peripheral arterial disease, immune and metabolic disorders. Orthopedic surgeons must be aware that the early detection and prevention of these comorbidities, through diligent medical care and patient education, can avoid these amputations.

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The treatment of ulcerated lesions of the oral cavity is usually carried out using topical analgesic drugs, anti-inflammatory corticosteroids, and alcohol-free oral antiseptics. The topical use of 0.05% Clobetasol Propionate in aqueous solution for ulcerated lesions in the oral cavity is little publicized nationally and little mentioned in scientific studies regarding its effectiveness, lesion regression time, and adverse effects. Therefore, the objective of this study was to retrospectively evaluate the medical records of patients who were treated for ulcerated or erosive lesions, using Clobetasol Propionate 0.05%, in the stomatology clinic of an institution to investigate its effectiveness. Medical records of patients who presented the fundamental ulcerated alteration and made topical use of 0.05% Clobetasol Propionate were selected. An examiner selected the sample following the inclusion and exclusion criteria and performed the retrospective analysis. The types of information collected were age, gender, diagnosis of the disorder, amount of injury, time of use, the evolution of the injury, exact time of regression, and presence of adverse reactions. A total of 17 medical records were included, of which five were from patients with erosive lichen planus lesions, three traumatic ulcers, three lichenoid lesions, two multiform erythema, one lactose allergy, one cold sore, and one scaly gingivitis. All cases had their symptoms solved, but, in six cases, the clinical changes remained, although milder and asymptomatic. No adverse reaction was noted in the medical record. The statistical analysis showed no association in relation to gender (Fisher's exact test; p = 0.49; p> 0.05). There was no statistically significant difference in the frequency of injuries (Fisher's exact test; p = 0.85; p> 0.05). The use of 0.05% Clobetasol Propionate, prescribed for up to five days, proved effective in treating ulcerated lesions of the oral mucosa, mainly for symptomatic relief. Furthermore, it revealed no adverse effects. [ABSTRACT FROM AUTHOR]

There is a high prevalence of skin conditions and metabolic disturbances in patients with schizophrenia. Skin ulcers, in particular those of the lower extremities, mostly arise from arterial and/or venous pathology. Diabetes is considered a prominent risk factor. Atypical antipsychotics carry an increased risk for cardiometabolic side effects, clozapine being among those with the highest risk. We explore the case of a 57-year-old female patient with refractory schizophrenia who received a combination of clozapine and haloperidol. She soon developed type 2 diabetes mellitus and persistent malleolar ulcerations shortly thereafter. We discontinued clozapine and the ulcerations resolved definitively. We discuss underlying ulcer pathophysiology and review the literature for metabolic and cutaneous side effects of antipsychotics. To our knowledge, this is the first report of a patient developing leg ulcers upon treatment with clozapine.

Abstract: Pyoderma gangrenosum is a rare neutrophilic dermatosis, which usually presents as ulcers with erythematous-violaceous undermined edges and a rough base with purulent or sanguinous exudate. It can be primary or associated with an underlying disease. However, rare cases of its association with autoimmune hepatitis have been described in the literature. Diagnosis is based on a characteristic clinical picture and ruling out other causes of ulcers. This paper aims to discuss the management of corticosteroid therapy and the importance of local treatment. We report a case with torpid evolution, presented with multiple and deep ulcers in a young patient with autoimmune hepatitis, causing pain and significant disability. We observed complete healing of lesions after two months of successful treatment.

Abstract Hemangioma is a benign neoplasm that may affect the vulva, and it can cause functional or emotional disability. This article reports the case of a 52-year-old female patient with a history of a genital ulcer for the past 3 years and who had undergone various treatments with creams and ointments. The patient was biopsied and diagnosed with vulvar hemangioma and was subsequently submitted to surgical excision of the lesion. We emphasize the importance of following the steps of the differential diagnosis and proceeding with a surgical approach only if necessary.

Objectives - To understand the relationship between plantar pressures and the ulcers' occurrence in individuals with neuropathic diabetic foot, using this factor as a possible method of risk assessment and identification. To investigate the association between the epidemiological data and the ulcer's occurrence. To identify an indicative value for its occurrence. Methods - A quantitative cross-sectional, correlational, and epidemiological study was carried out by collecting sociodemographic and clinical information from the participants and conducting sensitivity tests to identify neuropathy. The sample (N = 60) was divided into two groups: neuropathic diabetics and non-neuropathic diabetics. Podological evaluations were performed using a baropodometric platform, and later statistical analyses were made with the results obtained. Results - There is an association between age, gender, and increased BMI with the occurrence of neuropathy. More than half of the diabetic population in the study has associated peripheral neuropathy. The presence of deformities in the feet of the individuals in the sample was shown to have an influence on the occurrence of ulcer, as well as PPP and IPT values. It can be assumed that the value 88.06 kPa is a reference value for the development of an ulcer. Conclusions - There is a relationship between PP and the occurrence of ulcers. Podological analysis on a baropodometric platform allows us to understand whether or not the patient is at risk of developing an ulcer. This study shows a possible PPP value that serves as an indicator of the development of an ulcer on a diabetic foot. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a worldwide public health problem, it is estimated that the risk of microvascular complications in diabetics is about 10 to 20 times higher than in subjects without diabetes and the relative risk of macrovascular complications is greater than 2 to 4 times than individuals without the disease. Foot infection is related to the duration of the disease and the management of diabetic ulcers requires an understanding of the pathophysiology, together with a multimodal approach to infection control and care. With this it is important to define the treatment in the most appropriate nowadays. [ABSTRACT FROM AUTHOR]

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Cornea is one of the most highly innervated tissues in the organism. Opioid receptors have already been detected in cornea; so the topical use of opioids is presented as an analgesic alternative in treatment of ulcerated corneas, with no damage in cicatrization. This research aimed to evaluate the corneal sensitivity of the 1% morphine sulfate solution in the intact cornea of dogs. Ten dogs with no ocular lesions were treated with one drop of saline solution on right eye (GC), and one drop of 1% morphine sulfate solution with the pH corrected for 7.2 on left eye (GM). The parameters evaluated were: tonometry, esthesiometry, Schirmer lacrimation test, pupil diameter and the presence of conjunctival hyperemia and blepharospasm with and without light source. The evaluations happened before collyrium instillation and 10, 20, 30, 60 and 240 minutes after it. It was performed variance analysis (ANOVA) for the parametric tests, comparing the means by the Tukey-Kramer test. Hyperemia and blepharospasm were evaluated by the chi-square test. The conjunctival hyperemia observed in the GM group was significantly higher (7/10) than in the CG group, which did not present hyperemia (P<0.05). Two eyes from GM showed blepharospasm with light source at 10 minutes. There were no differences in corneal sensibility, pupil diameter and Schirmer lacrimation test. The intraocular pressure was lower in the GM group compared to the GC group at 240 minutes. Topical administration of 1% morphine sulfate solution does not cause analgesia in intact cornea and promote irritation in eye and annex after instillation. [ABSTRACT FROM AUTHOR]

This descriptive documental research aimed to characterize the socio-demographic and clinical profile of patients in a nursing outpatient center for the treatment of wounds in a teaching hospital. Data collection occurred in October 2013. The sample was 142 medical records of patients attended between January 2007 and December 2012. The study reveals the importance of the nursing outpatient center for treating chronic wounds. Among the characteristics, the following stand out: a predominantly female population 73 (51.40%), and mean age of 55 years old, and an age range of 0 to 90 years old, with the highest percentage between 61 and 70 years old; the most frequent wounds were venous, with 112 (44.45%). In relation to the number of wounds per person attended, 79 (55.64%) had one wound. The diseases associated with the development of the wounds were Systemic Arterial Hypertension 67 (47.18%) and Chronic Venous Insufficiency 58 (40.84%).

BACKGROUND:One of the most stigmatizing physical sequelaeof leprosy in cured patients is the development of chronic lower extremity ulcers. The bacterial diversity present in ulcers is considered one of the factors that can delay the healing process, as well as serve as a focus for severe secondary infections.OBJECTIVE:To identify the microbiota and antimicrobial resistance profile of bacteria isolated from skin ulcers in patients cured of leprosy.METHODS:After obtaining informed consent, material was collected from ulcers of 16 patients treated at the Outpatient Public Health Dermatology Clinic of Rio Grande do Sul and Hospital Colônia Itapuã. Sampleswere collected during dressing, and the material sent to the Microbiology Laboratory of the Federal University of Health Sciences of Porto Alegre for microbiological culture. Methicillin-resistant Staphylococcus aureus(MRSA) was characterized by two molecular methods, including detection of the mecA gene by PCR and SCCmecgene typing.RESULTS:Cultures revealed microorganisms in all ulcers: Gram-negative bacilli in 80%, Gram-positive cocci in 63%, and mixed microflora in 36%. Staphylococcus aureusand Pseudomonas aeruginosa were the most prevalent bacteria. Assessment of the antimicrobial resistance profile was notable for the presence of MRSA. Molecular analysis of this isolate revealed presence of the mecA gene contained in a type IV staphylococcal cassette chromosome mec (SCCmec).CONCLUSIONS:In patients with leprosy, laboratory culture of skin ulcers is essential for correct antibiotic selection and to control emerging pathogens, such as MRSA carrying SCCmec type IV.

Pyoderma gangrenosum is an uncommon and recurrent neutrophilic dermatosis of unknown cause. The lesions usually start as tender sterile papulopustules or erythematous nodules that undergo necrosis followed by ulceration. The lower limbs are most commonly affected and around half of the cases are associated with systemic disorders. Although rare, cases of pyoderma gangrenosum with extramucocutaneous sterile neutrophilic infiltrate have been reported, with the lungs being the most commonly affected organ. We report a case of pyoderma gangrenosum with splenic and renal impairment. Pyoderma gangrenosum should be considered a multisystemic disease with classic cutaneous manifestations and potential involvement of internal organs.

Sebaceous carcinoma is a rare and aggressive skin tumor. It can be located in any area of the body, the most commonly involved area being the periorbital region. It does not entail a typical clinical presentation, which explains the often late diagnosis. The aim of this report is to outline the rarity of the disease and its atypical clinical description, since to this day, inguinal ulcers with clinical manifestation have not been reported. We present and discuss a case of sebaceous carcinoma with an unusual clinical presentation, in an elderly male patient. The precise approach to genital ulcers, as shown in this case, is a diagnostic challenge that requires a great deal of effort on the part of the clinician.

AbstractEosinophilic ulcer of the oral mucosa is a rare, self-limiting, chronic and benign lesion of unknown pathogenesis that affects the oral mucosa. We present the case of a 65 year-old Caucasian female with a fivemonth history of a painful ulcer on the lateral side of her tongue. The ulcer was not adhered to the underlying structures and there was no evidence of regional lymph node involvement. Laboratory examinations and X-rays revealed no abnormalities. Topical treatments had been performed without any improvement. Histopathological examination showed an ulcerated surface and mixed inflammatory infiltrate with several eosinophils extending into the mucosa and submucosa. No cellular atypia was observed. Based on the patient-s history and mucosal biopsy, a final diagnosis of eosinophilic ulcer of the oral mucosa was made.

AbstractEverolimus, a mammalian target of rapamycin inhibitor, is an emerging drug, which is being increasingly applied in oncology and solid organ transplantation. Oral ulcers are a frequent side effect associated with this immunosupressor. We report the case of a renal transplant recipient who developed disfiguring oral and perianal ulcers secondary to everolimus's toxicity. This is probably the first report of perianal involvement. Dermatologists need to be aware of the potential mucocutaneous adverse effects related to these new drugs that are becoming evermore common in our clinical practice.

Objetivo: estructurar un protocolo de cuidados de enfermería para la persona adulta con herida de abdomen abierto, en una empresa social del Estado de la ciudad de Bogotá. Método: estudio descriptivo transversal, cuya muestra se constituye por cuatro personas con herida de abdomen abierto y el aporte de la experiencia del enfermero profesional de la institución. La información se recolecta a partir de una guía de observación, del registro fotográfico de la evolución de cuatro personas adultas con herida de abdomen abierto y de una entrevista semiestructurada realizada al profesional de enfermería de la Clínica de Heridas tomada como referencia, la cual sirve como guía y en la que se recomienda profundizar en investigaciones posteriores. Resultados: se estructura un protocolo de cuidados de enfermería, integrado por doce flujogramas agrupados y distribuidos en cuatro lineamientos básicos. Conclusiones: el protocolo es el resultado de la descripción y análisis de los procedimientos realizados por personal de enfermería que cuenta con una amplia experiencia en el manejo de personas con herida de abdomen abierto, confrontados a la luz de la literatura. Sin embargo, se requiere continuar la estructuración del mismo, teniendo en cuenta no solo la parte fisiológica del proceso de cicatrización, sino también las dimensiones psicosociales que intervienen en el cuidado de las personas adultas con herida abierta de abdomen.Objetivo: criar um protocolo de cuidados de enfermagem para adultos com feridas de abdômen abertas numa empresa social do Estado, na cidade de Bogotá. Método: estudo descritivo transversal, cuja amostra foi constituída por quatro (4) pessoas com feridas de abdômen abertas, e o aporte da experiência do enfermeiro profissional da instituição. A informação é arrecadada de um guia de observação, do registro fotográfico da evolução de quatro adultos com feridas de abdômen abertas e de uma entrevista semies-truturada feita ao profissional de enfermagem da Clínica de feridas que foi tomada como referência, servindo de guia na qual é recomendado aprofundar em pesquisas posteriores. Resultados: um protocolo de cuidados de enfermagem é estruturado e integrado por doze (12) diagramas de fluxo, agrupados e distribuídos em quatro lineamentos básicos. Conclusões: O protocolo é o resultado da descrição e análise, dos procedimentos realizados pelo pessoal de enfermagem, contando com uma ampla experiência no cuidado de pessoas com feridas de abdômen, à luz da literatura. No entanto, a continuação da estruturação deste protocolo é necessária, levando em conta tanto o processo de cicatrização quanto as dimensões psicossociais que intervém no cuidado dos adultos com feridas abertas no abdômen.Goal: the creation of a nursing protocol for adults with open abdomen wounds, in a State-owned social enterprise of the city of Bogota. Method: a descriptive and transversal study, whose sample was constituted by four (4) people with an open abdomen wound, and the contribution of the experience of the institution's professional nurse. The information gathered from an observation guide, from the photographic register of the evolution of four adults with an open abdomen wound and from a semi-structured interview made to a nursing professional form the Wound Clinics taken as reference, which serves as a guide and should be used further in future researches. Results: a nursing protocol is created, and is composed by twelve (12) flowcharts, grouped and divided in four basic guidelines. Conclusions: the protocol is the result of the description and analysis of the procedures performed by the nursing staff, who has a rich experience in the care of people with open abdomen wounds thanks to literature available to them. However, the construction of the protocol must be continued, taking into consideration not only the physiological aspect of the scarification process, but also the psychosocial dimension involved in the caring of adults with open abdomen wounds.

This descriptive study has a qualitative approach and aims to understand the meaning of the wound for patients with chronic ulcers. Data collection was carried out between January and May 2010, by means of individual interview with five patients and checking the medical records of patients attended during the period 2008 – 2010 in a clinic unit. Analysis of the data was via thematic content analysis, which permitted the identification of the categories of outstanding sensations, daily routine, the chronic wound and the emotional impact. The results demonstrate that having a chronic ulcer means living with pain, prejudice, dependency on others for the carrying out of activities of daily living, worries, fears, and anxiety over the prognosis. The study hopes to orientate health professionals as to the principle needs of this clientele in order to elaborate individualized strategies for patients and cares to manage the experiences they confront.

INTRODUÇÃO: A infusão controlada do CO2 recupera o tecido de granulação em úlceras crônicas por insuficiência venosa dos membros inferiores, facilitando a integração do enxerto autólogo de pele. MÉTODO: Foram avaliadas ulcerações com evolução média de 12,5 meses. A infusão controlada do CO2 foi aplicada a 0,5 cm da borda da ferida, com a agulha voltada para o tecido de granulação. As puncturas foram realizadas a cada 2,5 cm. As sessões foram repetidas com intervalos de 72 horas. Biopsias foram realizadas no tecido de granulação antes e após a infusão do CO2. RESULTADOS: Observou-se aumento numérico de capilares, macrófagos e fibroblastos no tecido de granulação após a infusão controlada do CO2. O aumento médio do diâmetro das arteríolas pré-capilares foi de 3,4 vezes. CONCLUSÃO: A infusão controlada do CO2 estimulou a fibrogênese e promoveu uma resposta vasomotora e celular na ferida, facilitando o fechamento espontâneo das úlceras de membros inferiores ou tornando-as aptas a receber o enxerto autólogo de pele.INTRODUCTION: CO2 infusion-controlled restores granulation tissue in chronic venous caused by venous insufficiency of the lower limbs, becoming ready to receive autologous skin grafting. METHODS: Mean time of ulceration was 12.5 months. CO2 infusion-controlled was applied 0.5 cm from the wound edge. Punctures were done 2.5 cm distant from each other along the border of the wound with the needle pointed toward the granulation tissue. Biopsies were taken from the granulation tissue before and after CO2 application. The sessions were performed at intervals of 72 hours. RESULTS: Noticeable increase of capillaries, macrophages and fibroblasts were founded into the granulation tissue after CO2 infusion-controlled. Diameter of pre-capillary arterioles increased 3.4 times after CO2 infusion-controlled. CONCLUSION: CO2 infusion-controlled restores the blood flow in chronic wound of the lower limbs, promoting its spontaneous closure or improving granulation tissue ready to receive autologous skin grafting.

FUNDAMENTOS: Leishmaniose Tegumentar Americana é zoonose de manifestações clínicas variadas, em expansão no Brasil, sendo o estado de Mato Grosso do Sul importante área endêmica. OBJETIVOS: Avaliar clínica, epidemiológica e laboratorialmente pacientes com Leishmaniose Tegumentar Americana , atendidos no Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Brasil (HU/UFMS). MÉTODOS: Trata-se de um estudo observacional do tipo transversal com abordagem descritiva e analítica. Foram avaliados, retrospectivamente, dados de pacientes suspeitos de Leishmaniose Tegumentar Americana , atendidos no HU/UFMS de 1998 a 2008, e encaminhados ao Laboratório de Parasitologia/UFMS para complementação diagnóstica. Para a inclusão neste estudo foram considerados critérios clínicos e laboratoriais. RESULTADOS: Quarenta e sete pacientes foram incluídos no estudo. Houve predominância de homens de 45 a 59 anos, com a forma cutânea, lesão única, ulcerada, em áreas expostas do corpo e com duração menor que seis meses. O comprometimento de mucosas foi crescente com o aumento da idade e maior em pacientes que procuraram atendimento tardiamente. Intradermorreação de Montenegro foi o exame de maior sensibilidade e o encontro do parasito mostrou-se mais difícil em lesões antigas. CONCLUSÃO: Suspeição diagnóstica precoce é de extrema importância para diagnóstico preciso. Associação de exame parasitológico e imunológico torna mais seguro o diagnóstico laboratorial.BACKGROUND: American cutaneous leishmaniasis is a disease with a wide variety of clinical manifestations that is expanding throughout Brazil, the state of Mato Grosso do Sul constituting a significant endemic area. OBJECTIVES: To evaluate the clinical, epidemiological and laboratory characteristics of patients with American cutaneous leishmaniasis. Patients were recruited among those attending the Maria Aparecida Pedrossian Teaching Hospital of the Federal University of Mato Grosso do Sul, Brazil. METHODS: This was a cross-sectional, observational study conducted using a descriptive and analytical approach. Data from patients suspected of having American cutaneous leishmaniasis who were receiving care at this institute between 1998 and 2008 and were referred to the institute's parasitology laboratory for confirmation of diagnosis were evaluated retrospectively. Clinical and laboratory criteria were taken into consideration for the inclusion of patients to the study. RESULTS: Forty-seven patients were included in the study, the majority of whom were male and between 45 and 59 years of age. Most had the cutaneous form of the disease with a single, ulcerated lesion on exposed areas of the body, which had generally been present for periods of less than six months. Mucosal involvement increased with age and was highest in patients who had sought medical care at a later stage. The Montenegro skin test showed the highest sensitivity. Finding the parasite was more difficult in older lesions. CONCLUSION: Suspicion of the disease at an early stage is of extreme importance for a precise diagnosis. A combination of parasitological and immunological tests renders laboratory diagnosis more reliable.

Abstract Ecthyma gangrenosum is an uncommon dermatological manifestation characterized by round, indurated ulcers with a central necrotic black eschar and surrounding erythema. This report describes the case of a 5-year-old girl, affected by acute lymphocytic leukemia, presenting with a black eschar on her right thigh. Such lesions should always be correctly identified to avoid potentially fatal bacteraemia. Furthermore, because of its similar clinical presentation, cutaneous anthrax must be ruled out.

INTRODUÇÃO: A úlcera de Marjolin é uma rara complicação de cicatrizes crônicas, mais comum após queimaduras, havendo predominância nos membros inferiores. OBJETIVO: Descrever uma série de pacientes com úlcera de Marjolin nos membros inferiores, atendidos no Hospital Sarah Brasília entre 2001-2008. RELATO DOS CASOS: Foram realizadas a excisão tumoral e a reconstrução com enxertia de pele; retalho sural reverso, amputação e programa de reabilitação. A amputação foi considerada nos casos em que não foi possível a reconstrução. Foi diagnosticado carcinoma epidermóide bem diferenciado por biopsia de congelação transoperatória e exame histopatológico. Não houve relato de recidiva após cinco anos. CONCLUSÃO: Os autores recomendam o seguimento e a avaliação de cicatrizes instáveis com biopsia em intervalos regulares. Nos casos diagnosticados de câncer realizar a excisão completa e atenção para as adaptações funcionais com órteses e próteses.INTRODUCTION: Marjolin's ulcer is a rare complication of chronic scars that is most often associated with burn wounds. There was predominance developing in the lower extremities. OBJECTIVE: To describe results in a serie of cases with Marjolin's ulcer in lower extremity admitted in the Hospital Sarah Brasilia, between 2001-2008. CASE REPORTS: We performed wide tumoral excision and reconstruction with grafts, sural reverse flap, amputation and rehabilitation program. Amputation was considered in cases where surgical excision is not possible. Differentiated squamous cell carcinoma was diagnosis by frozen section biopsy and histopathological analyze. There were no reports of disease recurrence after five years. CONCLUSION: The authors recommend the follow up and that unstable scars were evaluated with biopsy at regular intervals. If cancer is found wide excision is indicated and attention for functional adaptations with orthesis or prosthesis.

Contexto: O sistema linfático tem papel relevante em qualquer tipo de edema periférico. Atualmente, a linfocintilografia é considerada o principal exame para diagnóstico da doença linfática das extremidades. Embora haja associação entre edema linfático e úlcera de estase venosa crônica, a fisiopatologia dessas alterações permanece indefinida. Objetivo: Verificar as alterações linfocintilográficas qualitativas que ocorrem em pacientes portadores de úlceras de estase dos membros inferiores. Métodos: Quarenta pacientes portadores de úlcera de estase venosa crônica ou cicatriz unilateral foram submetidos a linfocintilografia de ambos os membros inferiores. Foram estudados 25 mulheres e 15 homens, com média de idade de 53,7 anos (28 a 79 anos) e tempo médio de úlcera de 71,5 meses (3 a 240 meses). Foram comparados qualitativamente os parâmetros linfocintilográficos dos membros inferiores, previamente classificados em três grupos de acordo com a classificação clínica, etiológica, anatômica e patológica (CEAP): I, membros sem sinais clínicos de doença venosa ou com telangiectasias e veias reticulares (classes 0 e 1); II, membros inferiores com veias varicosas, edema e/ou alterações de pele e subcutâneo (classes 2, 3 e 4); III, membros inferiores com úlcera e/ou cicatriz (classes 5 e 6). Resultados: Quando foi comparada a presença de alterações linfocintilográficas dos membros com úlcera ou cicatriz (grupo III - classes 5 e 6) com as dos membros sem úlcera (grupos I e II - classes 0, 1, 2, 3 e 4), houve diferença significativa (p < 0,001). Estratificando os membros inferiores de acordo com a classificação CEAP, também foi observada diferença estatisticamente significante (p < 0,001), sendo as alterações linfocintilográficas presentes em 72,5% no grupo III (classes 5 e 6), 30,8% no grupo II (classes 2, 3 e 4) e 7,1% no grupo III (classes 0 e 1). Em relação aos parâmetros analisados na linfocintilografia, ocorreu diferença significativa entre o grupo III e os outros grupos quanto à retenção de radiofármaco, adenomegalia inguinal e refluxo dérmico. Não houve significância nos parâmetros linfonodo poplíteo e circulação colateral. Conclusão: Considerando os resultados, conclui-se que quanto mais grave a estase venosa crônica, maiores serão as alterações linfocintilográficas observadas, corroborando a associação entre doença venosa e linfática e entre linfedema secundário e estase venosa crônica.Background: The lymphatic system plays a relevant role in any type of peripheral edema. Lymphoscintigraphy is currently considered the primary test in the diagnosis of lymphatic disease of the lower limbs. Although there is an association between lymphatic edema and chronic venous ulcers, the physiopathology of such changes remains uncertain. Objective: To assess qualitative lymphoscintigraphic findings in patients with chronic venous ulcers of the lower limbs. Methods: Forty patients with unilateral chronic venous ulcer or scar were submitted to bilateral lymphoscintigraphy of the lower limbs. The sample was comprised of 25 women and 15 men, with a mean age of 53.7 years (28 to 79) and mean ulcer duration of 71.5 months (3 to 240 months). Lymphoscintigraphic parameters were qualitatively compared among three groups of lower limbs previously classified according to the clinical, etiologic, anatomic and pathologic classification (CEAP): I, limbs without clinical signs of venous disease or with telangiectasias and/or reticular veins (classes 0 and 1); II, limbs with varicose veins, edema and/or skin and subcutaneous alterations (classes 2, 3 and 4); III, lower limbs with ulcer and/or ulcer scars (classes 5 and 6). Results: There was a significant difference (p < 0.001) in the comparison of lymphoscintigraphic findings of the lower limbs with (group III - classes 5 and 6) and without ulcers/scars (groups I and II - classes 0, 1, 2, 3 and 4). There was also a significant difference (p < 0.001) in the comparison of groups according to the clinical CEAP classification: lymphoscintigraphic abnormalities were present in 72.5% in group III (classes 5 and 6), in 30.8% in group II (classes 2, 3 and 4), and in 7.1% in group I (classes 0 and 1). There was a statistically significant difference between group III and the other groups with regard to radiotracer retention, inguinal adenomegaly and dermal reflux. There was no significance as to the parameters popliteal lymph node and collateral circulation. Conclusion: The more severe the venous chronic stasis, the more lymphoscintigraphic abnormalities were observed, corroborating the association between venous and lymphatic disease and between chronic venous stasis and secondary lymphedema.

O vírus herpes simplex é o principal responsável por ulcerações genitais de etiologia infecciosa. No contexto de imunodeficiência, manifesta-se frequentemente de forma atípica, com lesões mais floridas, sendo também frequente a resistência à terapêutica clássica, resultando numa evolução prolongada. Descreve-se o caso clinico de um homem de 25 anos, com antecedentes de imunodeficiência comum variável, que recorre à nossa consulta por ulcerações genitais extensas e exuberantes da região inguino-escrotal de etiologia herpética. Após terapêutica prolongada com valaciclovir, o doente mantinha-se sintomático, tendo-se optado pela associação de imiquimod 5% tópico, com resolução do quadro clínico e excelente tolerância. O imiquimod, funcionando como um imunomodulador local, estimula a resposta imunológica antiviral. Configura- -se assim como uma alternativa nos casos de infeções herpéticas de difícil controlo, especialmente em doentes imunodeprimidos.

Relato de 12 casos de úlcera de Marjolin observados de 1990 a 2003 no HUCFF-UFRJ. Cinco pacientes do sexo feminino e sete do masculino, com idade variando de 38 a 86 anos. Tempo de evolução de 10 a 50 anos, da cicatriz até surgimento do carcinoma espinocelular. Ressecção da lesão em dois casos e amputação terapêutica em oito. Em um caso realizada exérese paliativa da lesão por apresentar metástase para coluna sacrococcígea. Um caso de impossibilidade terapêutica. Concluiu-se que a biópsia é essencial em úlceras crônicas, para diferenciar carcinoma espinocelular de hiperplasia pseudoepiteliomatosa.The authors report twelve cases of Marjolin's ulcer that have been diagnosed between 1990 and 2003 at HUCFF-UFRJ. Five females and seven males, aged 38 to 86 years old, formed the group. Evolution time from scar to squamous cell carcinoma onset ranged from 10 to 50 years. Amputation was performed in eight cases and in one of them radiation therapy was associated. Two patients underwent local excision. One patient who already had spinal metastasis was submitted to palliative local excision. Finally, one case had no therapeutic possibilities. Early biopsy was concluded to be essential in chronic ulcers, to establish the difference between squamous cell carcinoma and pseudoepitheliomatous hyperplasia

OBJETIVO: Determinar os fatores predisponentes para a amputação de membros inferiores nos doentes internados com diabetes melito e úlceras nos pés. MÉTODOS: Foram acompanhados os pacientes diabéticos com úlceras nos pés internados no período de 6 meses e analisadas as amputações nesses doentes em relação à idade, sexo, amputação prévia, número de ulcerações, tempo de diagnóstico do diabete, tempo de ulceração, tempo médio de internação, gravidade das lesões, presença de pulso. RESULTADOS: Verificou-se que 55% (44/80) dos doentes evoluíram para algum tipo de amputação de membros inferiores; a mediana das idades foi de 61 anos, porém a ocorrência de amputação foi significativamente maior na faixa etária dos 60 aos 90 anos (P = 0,03). Não se observou uma variação significativa da mediana do tempo de diagnóstico do diabetes, do tempo de ulceração e do tempo médio de internação em relação ao grupo de pacientes que foram amputados. Entretanto, as lesões mais graves, quando avaliadas pela classificação de Wagner (P OBJECTIVE: To determine the predisposing factors for amputation of lower limbs in diabetic patients with foot ulceration. METHODS: The research was carried out in hospitals, and all diabetic patients with foot ulceration were included. Amputation was studied in relation to age, sex, previous amputation, number of ulcers, time of diagnosis of diabetes mellitus, time of ulceration, average number of days in hospital, Wagner's classification, and presence of foot pulse. RESULTS: We verified that 55% (44/80) of the patients progressed to some type of amputation of the lower limbs; mean age was 61 years, but the occurrence of amputation was significantly higher in the age group between 60 and 90 years (P = 0.03). We did not observe a significant variation in the following variables: time of diagnosis of diabetes, time of ulceration, and hospitalization time in relation to the group of patients who were amputated. Nevertheless, the most severe lesions, when evaluated by Wagner's classification (P

Background: Facial pressure ulcers are one of the most common complications associated with non-invasive ventilation (NIV ). Objectives: To determine the frequency of facial pressure ulcers in patients admitted to an intermediate care unit (ICU) and submitted to NIV, as well as to identify the associated factors. Methodology: A prospective study was conducted between September and December 2015. Inclusion criteria: age ≥ 18 years, admitted to ICU, submitted to NIV and without facial ulcers at time of admission. A sample of 30 participants was obtained. Data were collected through a questionnaire, the Braden Scale and the Glasgow Scale. Results: The frequency of facial pressure ulcers was 26.7%, 16.7% of stage II and with a mean onset of 3.3 days. Most participants were male (70.0%), and the mean age was 74.2 years. Patients undergoing more hours of VNI per day, more days of NIV and more days of hospitalization had a higher frequency of facial pressure ulcers. Conclusion: Given that the number of hours of NIV increased the frequency of Facial pressure ulcers, we suggest periods of interruption of NIV use. [ABSTRACT FROM AUTHOR]

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivo Brasileiro de Medicina Veterinaria e Zootecnia is the property of Universidade Federal de Minas Gerais, Escola de Veterinaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A córnea, devido a sua localização externa e exposta, está freqüentemente sujeita a traumas ou processos lesivos como lacerações, perfurações e ulcerações, havendo, em muitos casos a necessidade de correção cirúrgica. Os enxertos pediculados de conjuntiva têm seu uso indicado nestes casos e se prestam bem como medidas de proteção e suporte para as ulcerações, porém impedem a capacidade visual plena do olho afetado. Os transplantes lamelares são outra indicação de tratamento, principalmente quando se deseja prevenir a ocorrência da perda visual. Os adesivos de cianoacrilato foram descobertos no final da década de 40, mas somente foram utilizados em oftalmologia no início da década de 60. Devido a propriedades como boa aderência aos tecidos biológicos, rápida secagem e polimerização, têm sido indicados no tratamento de úlceras profundas ou refratárias, descemetoceles e ainda em pequenas perfurações corneanas. Com o objetivo de testar o adesivo de cianoacrilato na fixação e manutenção de botões córneo-lamelares autógenos e de enxertos pediculados de conjuntiva em úlceras corneanas experimentais, foram utilizados 10 cães, machos ou fêmeas, provenientes do Biotério Central da Universidade Federal de Santa Maria (UFSM). Após anestesia, blefarostase e fixação do globo ocular como de rotina, foram realizadas trepanações compreendendo 2/3 da espessura da córnea sendo de 5,5 mm de diâmetro no olho esquerdo (OE) e de 5 mm no olho direito (OD). O botão lamelar resultante do OE foi fixado no leito receptor do OD com o uso de adesivo ao longo das bordas do enxerto e da córnea receptora. No olho esquerdo, após sua confecção, o enxerto de conjuntiva pediculado foi fixado à área receptora também por meio da colocação de adesivo sobre suas bordas. Foi realizada avaliação oftalmológica diária durante 30 dias. Os botões lamelares permaneceram fixados e foram incorporados à córnea receptora. A técnica de fixação foi de fácil realização, sendo rápida e de baixo custo com opacidade leve em 20% dos casos e ausente em 80% e ausência de vascularização aos 30 dias. Porém, houve 100% de deiscência total nos enxertos pediculados. A técnica de ceratoplastia lamelar autógena com o uso de adesivo de n-butil cianoacrilato pode ser indicada como opção terapêutica nas úlceras profundas em cães.The cornea is frequently exposed to traumas, lacerations, perfurations and ulcers, needing in most cases surgical correction. The conjunctival pedicle grafts are indicated in these cases, giving protection and support for ulcers, but obstructing the visual capacity of the affected eye. The lamelar grafts are other indications for treatment, mainly when preventing the visual loss. The cianoacrylate adhesive was discovered at the end of the forthies, but started to be used in ophtalmology in the begigning of the sixties. Due to its properties, as good tissue adhesion, quick dried and polimerization, it has been indicated in the treatment of deep or refractive corneal ulcers, descemetoceles and in punctiform corneal perforations. With the objective to test the cianoacrylate adhesive in the fixation and maintenance of corneolamelar grafts and conjunctival pedicle grafts in corneal ulcer, 10 male and female mongrel dogs from the Central Bioterio of Santa Maria Federal University were used. After anesthesia protocol and routine eyeball fixation, a trephination was performed, involving 2/3 of the corneal stroma, being 5.5mm in diameter in the left eye and 5mm in the right eyes. The lamelar corneal grafts from the left eyes were fixed in the recipient cornea of the right eyes, using the adhesive in the margin of the graft. In the left eyes, a conjunctival pedicle flaps were fixed in the corneal deffects, using the same adhesive in the margins. Daily ophtalmologic control was made during 30 days. The corneal lamelar grafts were incorporated to the recipient cornea. The fixation technique was rapid and easily performed, with low cost. The eyes had 20% opacities with the use of the lamelar corneal graft, and 80% with no vascularization and opacities present in 30 days. When conjunctival flaps technique was used, it has 100% dehiscence of the cases.

Lipschütz Ulcer, or ulcus vulvae acutum, is a rare and probably underdiagnosed entity that usually presents as an acute painful vulvar ulcer in young women. The etiology is unknown, although recent reports have associated it with the Epstein-Barr virus. The diagnosis is made by exclusion after ruling out sexually transmitted diseases, autoimmune causes, trauma, and other etiologies of genital ulcerations. We report a case of a young woman who developed flu-like symptoms and painful vulvar ulcers. Complementary examinations ruled out sexually transmitted diseases and the other usual causes of genital ulcers; lesions healed with no sequelae or recurrences. This case represents a rare important differential diagnosis of genital ulceration.A Úlcera de Lipschütz, ou ulcus vulvae acutum, é uma entidade rara mas provavelmente subdiagnosticada, que se apresenta como úlcera vulvar aguda dolorosa numa mulher jovem. A etiologia é desconhecida embora relatos recentes a tenham associado à primo-infecção pelo vírus Epstein-Barr. O diagnóstico é estabelecido após exclusão de doenças sexualmente transmissíveis, causas autoimunes, traumáticas e outras etiologias de úlceras genitais. Relatamos o caso de uma jovem que desenvolveu quadro gripal e dolorosas úlceras genitais. Os exames complementares excluiram doenças sexualmente transmissíveis e as outras causas habituais de ulceração genital. As lesões cicatrizaram sem sequelas e sem recorrências. Este caso representa um diagnóstico diferencial importante e raro de ulceração genital.

N/A.

Corneal sequestration is a disease unique to domestic cats, clinically characterized by chronicity; signs of ocular pain with the development of a dark brown to black, opaque, oval, paracentral or central corneal plaque. The purpose of this review article was to approach and discuss about the etiology, clinical manifestations, diagnosis, and treatment of the corneal sequestrum.Seqüestro corneano é uma doença única dos gatos domésticos. Caracterizada clinicamente pela crônicidade, sinais de dor ocular, com desenvolvimento de placa marrom a enegrecida, opaca, de localização central ou paracentral. O propósito deste artigo de revisão é abordar e discutir questões sobre a etiologia, manifestações clínicas, diagnóstico e tratamento da enfermidade.

The cytomegalovirus infection is prevalent in developed countries. The natural history of disease includes three phases: primoinfection (majority is asymptomatic), latency and reactivation. In certain immunosuppressive states, as in the case of transplantation and HIV infection, the virus can reactivate, occurring cutaneous manifestations, of what stands out the occurrence of genital ulcers. In these, co-infection with other etiologic agents is common, particularly with the herpes simplex virus, leading to more severe manifestations and difficulty in the differential diagnosis. In this context, it is relevant to know the pathogenesis of this virus and the diagnostics means available in order to optimize its therapy. [ABSTRACT FROM AUTHOR]

The herpes simplex virus is a common cause of genital ulcers. In the immunocompromised, it may have an atypical presentation, with exuberant lesions, frequently resulting in resistance to the mainstream therapeutic options, and a consequent prolonged course. A 25-year-old male with a previous history of common variable immunodeficiency, presented with herpetic extensive genital ulcerations on the inguinoscrotal region. Despite a long period of valacyclovir therapy, the patient remained symptomatic. We decided to add topical 5% imiquimod as an adjunctive therapy, and observed a completed resolution of the ulcerations. Imiquimod, working as a local immunomodulator, stimulates the anti-viral immunologic response. Therefore, it is an alternative in recalcitrant herpetic lesions, especially in the setting of immunosuppression. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the frequency of lesions in different regions of stomach of asymptomatic horses. Stomachs were evaluated macroscopically, which identified the nature of lesions. Subsequently, fragments were obtained from five regions previously mapped for histological examination, as well as from other areas with lesions. From a total of 21 animals, only one had isolated macroscopic lesion in glandular region, six in nonglandular region and 13 showed lesions in both regions. One animal showed no macroscopic lesion. Histologically, the most frequent lesions were gastritis (19/21), ulcers (14/21) and erosion (8/21). Most cases were acute ulcer and erosion, and gastritis chronic. The results of this study show the high frequency of lesions in the stomach of apparently healthy slaughter horses. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers have been receiving increased attention due to the severity of the situations and the large number of diabetic patients, whose prevalence exceeds 10% of the Portuguese population. The lack of feet vigilance among diabetic patients is an actual problem which limits the identification of risk factors, prevention and early intervention. To overcome this problem, nurses need to be familiar with and perform procedures for regular vigilance and assessment of the risk for ulceration in diabetic patients. Therefore, this paper aims to update knowledge on diabetic foot and characterise the process of assessing the risk for foot ulceration in diabetic patients. Recent scientific papers, reports, monographs and guidelines published on this topic were analysed. Despite the different opinions and differences, we concluded that the theoretical frameworks found are a sufficiently sound basis for nursing intervention, and that the existing legal framework is relatively simple, objective and achievable. The assessment of the risk for diabetic foot ulceration is within the reach of family nurses, particularly regarding the competences of level 1 teams. [ABSTRACT FROM AUTHOR]

Treatment of an ulcerated diabetic foot was documented photographically. We adapted the ultrasonographic tissue characterization (USTC or CATUS) technique to develop a photographic image tissue characterization (p-IMTC or CATIM) method. Five photographs, taken during medical treatment of an ulcerated diabetic foot following digital amputation, were quantified using imaging software designed to determine brightness intensity in grey scale images. The grey scale median (GSM) changed from 127 to 98; 86; 76; and 83 (out of 255) during follow-up. The area of lesion was estimated by number of pixels and reduced from 17.85 cm² to 12.44; 3.68; 2.11; and 0.15 cm². The percentage of total number of pixels showing granulation tissue increased from 11% to 34%; 56%; 62%; and 75%. p-IMTC quantified treatment progress. GSM quantified generalized changes in tissues, while the area of lesion and granulation tissue were documented quantitatively. Lesions, ulcers, wounds or other tissues can be analyzed using p-IMTC, allowing quantification, characterization and control of the progression of a condition or treatment. [ABSTRACT FROM AUTHOR]