Solitary nodule on the shoulder of an 11-year-old child.

Plexiform fibrohistiocytic tumor is an uncommon soft tissue neoplasm of intermediate malignancy, most frequently occurring as a painless, slow-growing nodule that shows a distinct predilection for children and young adults. We report a healthy 11-year-old boy presenting with a 1-year history of an asymptomatic cutaneous nodule on his left shoulder. Histopathological and immunohistochemical analysis confirmed a diagnosis of plexiform fibrohistiocytic tumor. Despite following a usually benign clinical course, this neoplasm is prone to frequent local recurrence and occasional metastatic ability. It should be considered in the differential diagnosis of an enlarging nodule in pediatric patients.

Nonuremic Calciphylaxis: Four Cases Associated with Autoimmune Diseases.

Calciphylaxis is a rare and severe syndrome of vascular calcification with unclear pathogenesis. This disease mainly affects patients with end-stage renal disease; however, it also has been described in nonuremic patients. We report four cases of nonuremic calciphylaxis (NUC) with ulcerated lesions associated with autoimmune disease. These cases support the literature suggesting that bisphosphonates and sodium thiosulfate are effective drugs in the treatment of calciphylaxis regardless of renal function.

Estimating common dolphin bycatch in the pole-and-line tuna fishery in the Azores.

Small-scale artisanal fisheries can have a significant negative impact in cetacean populations. Cetacean bycatch has been documented in the pole-and-line tuna fishery in the Azores with common dolphins being the species more frequently taken. Based on data collected by observers on ∼50% of vessels operating from 1998 to 2012, we investigate the influence of various environmental and fisheries-related factors in common dolphin bycatch and calculate fleet-wide estimates of total bycatch using design-based and model-based methods. Over the 15-year study dolphin bycatch occurred in less than 0.4% of the observed fishing events. Generalized additive modelling results suggest a significant relationship between common dolphin bycatch and duration of fishing events, sea surface temperature and location. Total bycatch calculated from the traditional stratified ratio estimation approach was 196 (95% CI: 186-205), while the negative binomial GAM estimated 262 (95% CI: 249-274) dolphins. Bycatch estimates of common dolphin were similar using statistical approaches suggesting that either of these methods may be used in future bycatch assessments for this fishery. Our work shows that rates of common dolphin bycatch in the pole-and-line tuna fishery in the Azores are low, despite considerable variations between years. Dolphins caught were released alive although the fate of these individuals is unknown. Continued monitoring will provide a better understanding of dolphin bycatch and more accurate estimates essential in the development of potential mitigation measures.

Topical timolol for the treatment of pyoderma gangrenosum.

Treatment of pyoderma gangrenosum (PG) remains a challenge, and there are currently no specific or uniformly effective therapies. Although widespread or rapidly progressive disease often requires systemic treatment, localised and mild lesions may be effectively controlled with topical agents. The most frequently applied topical drugs are corticosteroids and calcineurin inhibitors. Recently, a patient with idiopathic PG of the lower limb was successfully treated with topical timolol and collagenase. Here, we report a case of a patient with collagenous colitis, ankylosing spondylitis and periumbilical PG. Persistent ulcerated skin lesions were successfully treated with topical timolol, although a flare of the underlying bowel disease temporarily interrupted the improvement. The case presented enhances the previously reported therapeutic potential of topical timolol in the treatment of PG. Control of chronic underlying disorders is critical to prevent rebound flares and maintain the benefit.

Predicting Interactions between Common Dolphins and the Pole-and-Line Tuna Fishery in the Azores.

Common dolphins (Delphinus delphis) are responsible for the large majority of interactions with the pole-and-line tuna fishery in the Azores but the underlying drivers remain poorly understood. In this study we investigate the influence of various environmental and fisheries-related factors in promoting the interaction of common dolphins with this fishery and estimate the resultant catch losses. We analysed 15 years of fishery and cetacean interaction data (1998-2012) collected by observers placed aboard tuna fishing vessels. Dolphins interacted in less than 3% of the fishing events observed during the study period. The probability of dolphin interaction varied significantly between years with no evident trend over time. Generalized additive modeling results suggest that fishing duration, sea surface temperature and prey abundance in the region were the most important factors explaining common dolphin interaction. Dolphin interaction had no impact on the catches of albacore, skipjack and yellowfin tuna but resulted in significantly lower catches of bigeye tuna, with a predicted median annual loss of 13.5% in the number of fish captured. However, impact on bigeye catches varied considerably both by year and fishing area. Our work shows that rates of common dolphin interaction with the pole-and-line tuna fishery in the Azores are low and showed no signs of increase over the study period. Although overall economic impact was low, the interaction may lead to significant losses in some years. These findings emphasize the need for continued monitoring and for further research into the consequences and economic viability of potential mitigation measures.

Recurrent Wells' syndrome associated with allergic asthma exacerbation.

Wells syndrome is an inflammatory eosinophilic dermatosis of unknown pathogenesis characterized by clinical polymorphism, a suggestive but nonspecific histopathologic traits, usually with a recurrent course and inconstant response to therapy. It seems to be an unspecific hypersensitivity reaction in response to various exogenous and endogenous stimuli, such as insect bites, infections, drug eruption or underlying internal disorders. We present a patient with allergic asthma and atopic dermatitis in whom a skin eruption developed in the sequence of allergic asthma exacerbation, which was clinically and histologically consistent with the diagnosis of eosinophilic cellulitis. The authors discuss the probability of a common pathogenesis and the role of IL-5. To our best knowledge this is the first pediatric case where this association is reported.

Erythema multiforme-like lesions revealing allergic contact dermatitis to exotic woods.

We report a 45-year old man who developed maculopapular exanthema on the inferior cervical folder, axillae and umbilicus, as well as erythema multiforme-like lesions on the wrists after the introduction in his work of pao ferro (Machaerium scleroxylon). Patch tests were positive to pao ferro and ebony. This case highlights the importance of patch tests for the confirmation of the culprit agent in occupational dermatoses and also to identify other occupational allergens that the patient should avoid. Tropical woods contain quinones that could explain the possible cross-reactions between woods belonging to different families.

[Uncommon causes of leg ulcers: investigative approach and therapeutics]. / [In Process Citation]

Chronic wounds of the lower limbs are a major public healthcare problem affecting 1 percent of the adult population and 3 to 5 percent of people older than 65 years. These numbers are rising in the western population as a result of increased life expectancy and increased risk factors for atherosclerotic occlusion, such as smoking, obesity, and diabetes mellitus. This very debilitating condition, which reduces significantly the quality of life, causes social discomfort and generates considerable cost, not only to the patient but also to the society. Treating chronic leg ulcers is always a challenge. Over the last years, the treatment of this condition has been given more attention because of the frequent ineffectiveness of the methods used, the awareness of the psychological and social impact, and the recognition of the risks of malignancy in these wounds. Determining the etiology is an essential factor for directed and more effective wound care. Although 90 percent of ulcers are of vascular origin, the list of other possible causes responsible for the other 10 percent is extremely long. In this review, the authors focus on the differential diagnosis of chronic leg ulcers and the impact of directed treatment in the prognosis of this condition.

Severe onychodystrophy caused by allergic contact dermatitis to acrylates in artificial nails.

Acrylic resin monomers, especially acrylates and methacrylates, are well-known sensitizers responsible for allergic contact dermatitis mainly in the occupational setting. The most frequently affected professionals are dentists, orthopedic surgeons, manicurists, painting industry and fiberglass workers. The authors report the case of a 39-year-old healthy woman, a secretary, who developed severe onychodystrophy of all fingers, 1 week after the application of sculptured acrylic nails.