Young man with painful black dots on left foot

A 30-year-old previously healthy man was admitted to the emergency room due painful black dots on the left foot. On physical examination, multiple erythematous macules with central black dots on left heel (A) were observed. After topical anaesthesia (lidocaine 40mg/g cream), several spines were removed. The patient was seen in a dermatology consultation complaining of local pain 22 days later. Dermatological examination revealed local erythema, and dermoscopy showed several punctiform wounds, some centered by dark brown pinpoint dots or dashes (B). The diagnosis of injuries caused by spicules of cactus in the heel was made. The removal of the fragments from the patient's foot and the follow-up visits to dermatologist led to a successful treatment that allowed the patient to return to work promptly. He was walking on an ecologic trail in Arraial do Cabo, Rio de Janeiro, when the pain started (C). Encounters with cactus spines, needles, prickles and glochids (barbed hairs) are rarely reported. Common signs of a retained cactus spine include: sharp pain as pressure is applied to the site, and discoloration of the skin. Smaller spines of the cactus plant break off easily on contact, and the fragments frequently get embedded in the skin and soft tissues. The lesion is predominantly aseptic. The most frequently affected area by cactus spine-related injuries are extremity and non-fluctuant tender skin papules which is the most frequently presented. Dermoscopy can be useful in helping to promptly detect and remove remaining embedded spines as seen in this cactus injury. Clinicians should consider injuries by cactus's spines in the differential diagnosis of retained foreign material

Liver abscess due to fish bone ingestion

A 50-year-old previously healthy male presented with epigastric pain for 10 days and fever in the last three days. Laboratory testing was remarkable for elevated white blood cells at 19,580/mm3 and C-reactive protein of 83.9 mg/dl. Abdomen computed tomography showed a small linear structure with calcium density, transfixing the wall of the gastric antrum and penetrating the left hepatic lobe; an oval massive hypodensity was observed in the surrounding liver parenchyma (A); pneumoperitoneum, free intra-abdominal fluid or vesicular changes were not observed. The hypothesis of gastric perforation due to ingestion of a foreign body with abscess formation was raised. In a new clinical interview, the patient reported a routine habit of fish consumption. Abdominal surgical approach was performed which confirmed the presence of a fish bone and the hepatic collection with purulent fluid (B). After seven days of surgery and treatment with intravenous ceftriaxone and metronidazole, the patient evolved with clinical and laboratory improvement and was discharged. Gastrointestinal perforation by an ingested fish bone resulting in hepatic abscess is very rare. In these cases, the site of perforation is usually in the stomach or duodenum with the abscess most commonly developing in the left hepatic lobe. The classic indicators of hepatic abscess, such as fever with chills, abdominal pain and jaundice are present in only a small number of patients. Among several causative objects that can perforate the gastrointestinal tract are included toothpicks, sewing needles, hairpins, wire, fish bones, chicken bones and dental plates

MONOPAQUIDERMODACTILIA - RELATO DE CASO

Pachydermodactyly is a rare benign superficial fibromatosis, painless and asymptomatic, characterized by diffuse increase of connective tissue in the skin of the proximal interphalangeal joints of the second, third and fourth fingers, with symmetrical character, usually associated with trauma. The histopathology is non-specific, showing epidermal hyperplasia, increased collagen in the dermis and slight increase in the number of fibroblasts. The authors present the case of a 27 years old male patient with pachydermodactyly associated with repeated trauma related to their work.A paquidermodactilia é uma fibromatose superficial benigna rara, indolor e assintomática, caracterizada pelo aumento difuso do tecido conjuntivo na pele das partes laterais das articulações interfalangeanas proximais do segundo, terceiro e quarto quirodáctilos, de caráter simétrico, geralmente associada a traumatismo. A histopatologia não é específica, mostrando hiperplasia epidérmica, aumento do colágeno na derme e ligeiro aumento do número de fibroblastos. Os autores apresentam o caso de uma paciente masculino de 27 anos com paquidermodactilia associada a traumatismos repetidos relacionados ao seu trabalho

Trigeminal Schwannomas

Trigeminal schwannomas (TS) are rare entities occurring in various trigeminal nerve locations and present a peak incidence between the fourth and fifth decades of life, being more common in women. Patients usually present with symptoms of trigeminal nerve dysfunction. Depending on the tumor’s topography, various approaches might be used to obtain its gross total resection. Trigeminal schwannoma’s classification, nuances of the approaches, pathology, postoperative care, and outcomes are revised as follows. In conclusion, anatomical knowledge and the disease’s comprehension are essential when dealing with such lesions, and despite their rarity, we must be obstinately committed to the surgical technique and devoted to the patient’s functional postoperative outcome

EXTENSIVE PYODERMA GANGRENOSUM IN A PATIENT NONADHERENT TO THE TREATMENT

Fundamentos e Objetivos: Apesar do trauma térmico no grande queimado ser agudo e do pioderma gangrenoso ser uma doença imunomediada, muitos aspectos são comuns nesses dois grupos de pacientes. Defendemos que as regras usadas na determinação da percentagem de pele acometida no grande queimado sejam também usadas nos casos extensos de pioderma gangrenoso. Bem como uma rotina de suporte clínico - claramente seguida nos queimados - mas nem sempre nos pacientes com pioderma gangrenoso.Relato de caso: Paciente masculino com quadro clínico extenso de pioderma gangrenoso, não aderente ao tratamento, apresentava lesões úlcero vegetantes e cicatrizes cribiformes. Após apresentar melhora clínica, não retornou em consulta.Conclusões: Em casos graves e extensos, nos quais a percentagem de acometimento da pele supere 20% da superfície corporal, a abordagem do pioderma gangrenoso deve ser semelhante a de um grande queimado, com exame clínico e avaliação da hidratação corporal periódicos.Background and Objectives: Despite the thermal injury in severe burn be acute and the pyoderma gangrenosum be an immune-mediated disease, many aspects are common in these two groups of patients. The authors argue that the rules used in the percentage determination of the skin involved in major burn are also used in extensive pyoderma gangrenosum cases. As well as a clinical support routine - used in the burned - but not always in patients with pyoderma gangrenosum.Case report: Male patient with extensive pyoderma gangrenosum clinical presentation, non-adherent to the treatment, presented ulcerated and vegetating lesions and cribiform scars. After clinical improvement, not returned in the medical appointment.Conclusions: In severe and extensive pyoderma gangrenosum cases, in which the percentage of cutaneous involvement exceeds 20% of the body surface, the approach of pyoderma gangrenosum should be similar to a major burn, with periodicals clinical examination and assessment of body hydration

HYPERKERATOTIC NODULES ON HANDS DUE TO INJURIES CAUSED BY SEA URCHINS

Os autores apresentam o caso de um paciente masculino de 19 anos, com múltiplas lesões nas mãos provocadas por traumatismos com diversos ouriços-do-mar. Clinicamente apresentava nódulos eritêmato violáceos de superfície ceratósica no dorso das mãos e edema do terceiro quirodáctilo direito com um mês de evolução. As biópsias das duas lesões revelaram processo inflamatório granulomatoso do tipo corpo estranho. Acidentes desta natureza são responsáveis pela metade dos atendimentos relacionados a animais aquáticos nos prontos socorros do litoral brasileiro.The authors present the case of a 19 year old male patient, with multiple hand injuries caused by trauma with several sea urchins. Clinically, he presented erythematous violaceous nodules with keratotic surface on the dorsum of the hands and edema of the third right hand finger with a month of evolution. The biopsy of the lesions revealed granulomatous response pattern. Accidents of this nature are responsible for half of the cases related to aquatic animals in the emergency rooms of the Brazilian coast

DISSEMINATED INTERSTITIAL GRANULOMA ANNULARE

Relatamos um caso clínico-patológico de uma paciente de 62 anos com diagnóstico de granuloma anular intersticial, cujas lesões possuíam aspecto de pápulas agrupadas, sem atrofia central, distribuídas em membros inferiores, nádegas e dorso. O estudo histopatológico foi fundamental para conclusão diagnóstica uma vez que na avaliação inicial essa doença não estava entre as hipóteses iniciais.We report a clinicopathological case of a 62-year-old patient with a diagnosis of interstitial granuloma annulare, characterized by grouped papules without central atrophy, distributed in the lower limbs, buttocks and back. Histopathology was essential for diagnostic conclusion, since the initial assessment, the disease was not among the clinical hypotheses

Effect of sulphur dose on the productivity and quality of onions

Abstract Onions have a high demand for sulphur (S), which affects bulb productivity and quality. S, however, should be carefully applied to onion crops because it may acidify the soil and adversely affect the plants. This study evaluated the effects of S dose (0, 15, 30, 45, 60, and 90 kg ha -1 ) on the soil and the development, productivity, and quality of the 'Perfecta' onion cultivar. The experiment was conducted in Jaboticabal, Brazil, from 30 May to 10 October 2011. Maximum height (0.76 m), number of leaves per plant (7.2), dry weight of leaves (201.6 g), and productivity (79 t ha -1 ) of the 'Perfecta' onions were obtained with doses of 57, 41, 47, and 45 kg S ha -1 , respectively. Onion productivity was 16% lower, when S was not applied. About 47% of total production of bulbs was ranked in classes 3 and 4, with higher commercial value. The highest percentage of bulbs (63%) in classes 3 and 4 was obtained with 47 kg S ha -1 . Maximum pungency (1.5 µmol g -1 ) was obtained with 65 kg S ha -1 , ca. 55% higher than when S was not applied. The levels of pyruvic acid, however, were low in all treatments, which ranked the cultivar as very mild with an extra-sweet flavour when provided with up to 90 kg S ha -1 . The interaction between S dose and period of evaluation influenced the soil pH and S content. The increased S supply increased the levels of foliar N and S-SO 4 2-and decreased Ca 2+ and Mg 2+

DERMOSCOPY AS AN AUXILIARY TOOL IN THE DIAGNOSIS OF DISSEMINATED SUPERFICIAL POROKERATOSIS

A poroceratose superficial disseminada faz parte de um grupo de doenças em que há distúrbio de ceratinização epidérmica, caracterizada por numerosas lesões cujos limites são dados por um muro ceratósico. A descrição de novos padrões dermatoscópicos tem sido cada vez mais relatada e sua contribuição nesta dermatose é uma realidade. Os autores descrevem um caso típico da doença, apresentam seus achados dermatoscópicos, comparando com o que há descrito na literatura e incluem a presença de poros dilatados no interior das lesões como mais um achado na caracterização da doença.Superficial disseminated porokeratosis is part of a group of diseases where there is epidermal keratinization disorder, it is characterized by numerous lesions whose boundaries are given by a wall keratotic. The description of new dermoscopic patterns has been increasingly reported and its contribution in this dermatosis is a reality. The authors describe a typical case of the disease, present their dermoscopic findings, comparing with what there is described in the literature and include the presence of enlarged pores within the lesions as an additional finding in the characterization of the disease