Ulcerating stasis dermatitis of the forearm associated with arteriovenous graft and central vein stenosis.

INTRODUCTION: Stasis dermatitis is a pathologic condition of the skin that most commonly occurs in the lower limb, where it is caused by chronic venous insufficiency. Stasis dermatitis of the upper limb is rare. CASE REPORT: A 45-year-old male, resident in Angola, presented to the emergency department with an ulcer encompassing the entire left forearm. Past medical history comprised arterial hypertension and end stage renal disease treated with hemodialysis. Dialysis access consisted of a left brachial-basilic AV graft obtained 4 years before. The patient also reported that a right internal jugular vein catheter was used previously during the maturation of the left brachial-basilic AV graft. Stenosis of the left brachiocephalic vein was documented at angiography. Angioplasty was performed, with complete resolution of the wound 2 months after admission. CONCLUSION: The differential diagnosis of extensive ulcer of the forearm must include neoplasms, cellulitis, and/or deep tissue infection with secondary ulceration, but it is also important to maintain suspicion for venous stasis syndrome as a rare but possible cause of these lesions.

Contribution of cereals and cows' milk consumption to the exposure to mycotoxins: a study with Portuguese children.

The ubiquitous occurrence of mycotoxins in the environment results in unavoidable and repeated human exposure to mixtures of mycotoxins, the main exposure being through the consumption of contaminated foods, such as cereals and milk. Considering the frequency of contamination of these foods with mycotoxins, this study aimed to evaluate the risk of exposure to aflatoxins, ochratoxin A, deoxynivalenol and zearalenone in a Portuguese population under 17 years old through the consumption of these foods. To assess mycotoxin exposure, food contamination data was provided by the Official National Plan to Control Food and the food consumption information from the National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population (2015-2016); risk assessment calculations were performed through the Monte Carlo probabilistic method. In view of the results obtained for aflatoxins, ochratoxin A, deoxynivalenol and zearalenone, and considering the legislation in force, the levels observed were below the maximum levels. However, there was a risk in deoxynivalenol exposure for children from 0 to 9 years old (average and high consumers), and for high consumers from 10 to 17 years old. Given the potential adverse effects of these mycotoxins, their co-existence in the same foods and being a priority issue defined by the European Food Safety Authority, tight control should be carried out, in addition to re-evaluation of the maximum levels of these mycotoxins.

Melanoma Marjolin's ulcer in the hand: A case report.

INTRODUCTION: Burn scars have the potential to malignant transformation, creating an identity named Marjolin's ulcer. This term refers to any scar in a traumatized skin that degenerates into a skin cancer. The majority of them are derived from burns that were not grafted, appearing several years later. The most frequent type is squamous cell carcinoma with few cases of melanoma described in the literature. This last one accounts for a poor prognosis. CASE PRESENTATION: Female, 74 years old, presents to our department with a malignant melanoma arising from a thermal burn scar in the right thenar eminence 14 years after the initial injury. The lesion was excised and the defect covered by a full thickness skin graft. At 6 months post-operatively there are no signs of locoregional recurrence or systemic dissemination. DISCUSSION: Malignant melanoma arising from a burn scar is extremely rare and the pathogenesis is unknown. Many theories try to explain this low incidence and the factors that contribute to degenerative changes of melanocytes in the affected skin. CONCLUSION: Health professionals must consider this pathology when evaluating a burn scar or a chronic wound, performing a biopsy when suspicion is high. An early diagnosis, a prompt surgical intervention and a greater vigilance are the keys to success and survival.

Reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap in a teenager: A case report and literature review.

There is evidence that nerve flaps are superior to nerve grafts for bridging long nerve defects. Moreover, arterialized neurovenous flaps (ANVFs) have multiple potential advantages over traditional nerve flaps in this context. This paper describes a case of reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap and presents a literature review on this subject. A 16-year-old boy sustained a stab wound injury to the medial aspect of the distal third of his right forearm. The patient was initially observed and treated at another institution where the patient was diagnosed with a flexor carpis ulnaris muscle and an ulnar artery section. The artery was ligated and the muscle was sutured. Four months later, the patient was referred to our institution with complaints of ulnar nerve damage, as well as hand pain and cold intolerance. Physical examination and ancillary tests supported the diagnosis of ulnar artery and nerve complete section. Surgery revealed an 8 cm hiatus of the ulnar artery and a 5 cm defect of the ulnar nerve. These gaps were bridged with a flow through ANVF containing the sural nerve and the lesser saphenous vein. The postoperative course was uneventful. Two years postoperatively, the patient had regained normal trophism and M5 strength in all previously paralyzed muscles according to the Medical Research Council Scale. Thermography revealed good perfusion in the right ulnar angiosome. The ANVF may be an expedite, safe and efficient option to reconstruct a long ulnar nerve and artery defect.

A 63-year-old woman presenting with a synovial sarcoma of the hand: a case report.

INTRODUCTION: Synovial sarcoma is a high-grade, soft-tissue sarcoma that most frequently is located in the vicinity of joints, tendons or bursae, although it can also be found in extra-articular locations. Most patients with synovial sarcoma of the hand are young and have a poor prognosis, as these tumors are locally aggressive and are associated with a relatively high metastasis rate. According to the literature, local recurrence and/or metastatic disease is found in nearly 80% of patients. Current therapy comprises surgery, systemic and limb perfusion chemotherapy, and radiotherapy. However, the 5-year survival rate is estimated to be only around 27% to 55%. Moreover, most authors agree that synovial sarcoma is one of the most commonly misdiagnosed malignancies of soft tissues because of their slow growing pattern, benign radiographic appearance, ability to change size, and the fact that they may elicit pain similar to that caused by common trauma. CASE PRESENTATION: We describe an unusual case of a large synovial sarcoma of the hand in a 63-year-old Caucasian woman followed for 12 years by a multidisciplinary team. In addition, a literature review of the most pertinent aspects of the epidemiology, diagnosis, treatment and prognosis of these patients is presented. CONCLUSION: Awareness of this rare tumor by anyone dealing with hand pathology can hasten diagnosis, and this, in turn, can potentially increase survival. Therefore, a high index of suspicion for this disease should be kept in mind, particularly when evaluating young people, as they are the most commonly affected group.

Hand involvement in Ollier Disease and Maffucci Syndrome: a case series.

Ollier Disease and Maffucci Syndrome are two rare diseases that can cause tumors in several organs, having a special predilection for the hand. However, there have been very few reports in the literature focusing on hand manifestations of these diseases. We report the cases of three female patients: one with Ollier Disease, and two other with Maffucci Syndrome. All patients had hand involvement as their initial primary complaint. The Ollier Disease patient developed chondrosarcomas of two digits and had to have these fingers amputated. One of the Maffucci patients died one year after presentation from a brain glioblastoma. These cases emphasize the importance of early diagnosis of Ollier Disease and Maffucci Syndrome, as these two conditions are associated not only to crippling hand deformity, but also to a significant risk of chondrosarcoma, and other malignant tumors.