Localized cutaneous leishmaniasis of the plantar region: a 40-year outcome.

We report the case of a 78-year-old male Brazilian farmer, who presented with an extensive ulcer on the right foot that had an erythematous and raised border. This ulcer involved most of the right plantar region and had persisted for more than 40 years. Satellite erythematous papules and tumor-like growths were also seen on the right ankle. Extracutaneous involvement was not found. Light microscopy showed epithelial hyperplasia and diffuse histiocyte infiltration with intense plasmocytosis. Cultures for fungi and Leishmania were negative. The polymerase chain reaction with specific primers for Leishmania was performed using DNA extracted from the lesions; it showed an amplification of 120 pB. The patient had an excellent response after two 20-day cycles of intra-venous N-methylglucamine antimonate (15 mg/Kg/day). Leishmaniasis should be highly considered in the differential diagnosis of chronic ulcers in endemic areas.

Exuberant verrucous carcinoma arising from a burn scar.

Verrucous carcinoma (VC) is an unusual, well-differentiated, and low-grade type of squamous cell carcinoma, characterized by slow growth, low metastatic spread, local invasion, and little dysplasia. It occurs predominantly on the genitals, in the oropharynx, or in the palmoplantar region, being less frequent at other sites; however, it can occur on any part of the body. Many factors have been associated with its pathogenesis, including the presence of previous skin lesions, such as varicose, decubitus, traumatic, or neuropathic plantar ulcers. VC arising from a burn scar is rare. We report the case of a patient who developed exuberant VC on his knee many years after having burn injuries at that site.

A proteína p16 e o melanoma cutâneo / P16 protein and cutaneous malignant melanoma

Nas últimas décadas, é intensa a procura de uma explicação genética sobre a origem, o crescimento e a progressão do melanoma cutâneo. A tentativa de encontrar uma ligação direta entre as mutações gênicas e a origem da doença tem sido o objetivo dos pesquisadores dedicados ao estudo dessa neoplasia. Diversos métodos são utilizados na busca de uma avaliação prognóstica para a progressão do melanoma, citando-se, entre eles, a pesquisa do linfonodo sentinela, a imuno-histoquímica, as técnicas moleculares e a técnica de microarray. A necessidade de estabelecer um método, com excelente sensibilidade e especificidade, tem levado os pesquisadores a buscarem melhores evidências. É importante para esses estudos a obtenção de dados confiáveis sobre as técnicas, progressão e sobrevida livre de doença. Por meio da imuno-histoquímica, técnica relativamente simples e de baixo custo, a expressão da proteína p16 pode ser analisada e correlacionada com o prognóstico da doença. No melanoma cutâneo, a expressão da proteína diminui, à medida que aumenta sua agressividade, ou seja, é forte nos nevos e melanomas in situ e fraca ou ausente nos melanomas metastáticos. Em alguns estudos, a comparação com outros marcadores é analisada. A finalidade deste estudo é fazer uma revisão da literatura internacional sobre o uso da proteína p16 como fator prognóstico para o melanoma, bem como avaliar a importância das alterações do gene p16INK4a, corresponsáveis pela gênese e evolução do melanoma

In the last decades there has been an intense search for a genetic explanation of the origin, growth and progression of cutaneous melanoma. The attempt to find a direct link between gene mutations and the root of the disorder has been the aim of researchers devoted to the study of this neoplasia. Many are the methods used in the search of a prognostic evaluation for the progression of melanoma, e.g. research on the sentinel lymph node, immunohistochemistry, molecular techniques and the microarray technique. The need for a method with optimal sensitivity and specificity has led researchers to search for better evidence. For these studies it is important to obtain reliable data on the techniques, progression and survival free of disease. By means of immunohistochemistry, which is a relatively simple, low cost technique, the p16 protein expression can be assessed and correlated with disease prognosis. In cutaneous melanoma, p16 expression decreases as its aggressiveness increases, i.e. it is strong in the nevi and melanomas in situ and weak or absent in the metastatic melanomas. Other studies have analyzed how it compares with other markers. The purpose of this study is to make a review of the international literature on the use of p16 protein as a prognostic factor for melanoma, as well as to evaluate the importance of alterations in the p16INK4a gene, co-responsible for the genesis and progress of melanoma

Pneumonia hospitalar / Nosocomial pneumonia

Os autores apresentam uma revisão da literatura sobre a etiologia, quadro clínico, diagnóstico e tratamento das pneumonias hospitalares