Evaluation of treatment with carboxymethylcellulose on chronic venous ulcers

Abstract BACKGROUND: Among the chronic leg ulcers, venous ulcers are the most common and constitute a major burden to public health. Despite all technology available, some patients do not respond to established treatments. In our study, carboxymethylcellulose was tested in the treatment of refractory chronic venous ulcers. OBJECTIVE: To evaluate the efficacy of carboxymethylcellulose 20% on the healing of chronic venous ulcers refractory to conventional treatments. METHODS: This is an analytical, pre-experimental study. Thirty patients were included with refractory venous ulcers, and applied dressings with carboxymethylcellulose 20% for 20 weeks. The analysis was based on measurement of the area of ulcers, performed at the first visit and after the end of the treatment. RESULTS: There was a reduction of 3.9 cm2 of lesion area (p=0.0001), corresponding to 38.8% (p=0.0001). There was no interruption of treatment and no increase in lesion area in any patient. CONCLUSIONS: Carboxymethylcellulose 20% represents a low cost and effective therapeutic alternative for the treatment of refractory chronic venous ulcers. However, controlled studies are necessary to prove its efficacy.

Hemangioma glomeruloide e a síndrome POEMS: relato de dois casos e revisão da literatura / Glomeruloid hemangioma in POEMS syndrome: a report on two cases and a review of the literature

O hemangioma glomeruloide caracteriza-se por enovelados capilares contidos em espaços vasculares dilatados reminiscentes de glomérulos renais, sendo fortemente associado à síndrome POEMS (polineuropatia, organomegalia, endocrinopatia, gamopatia monoclonal e alterações cutâneas). Relatamse dois casos da síndrome associados a hemangiomas glomeruloides e faz-se uma revisão da literatura. O primeiro é uma paciente feminina, 63 anos, internada para investigação de ascite, hepatoesplenomegalia, dificuldade de deambulação e hemangiomas cutâneos. A histopatologia de uma dessas lesões estabeleceu o diagnóstico de hemangioma glomeruloide e direcionou a investigação, que revelou polineuropatia sensitivo-motora, plasmocitoma kappa-positivo em L4 e Diabetes mellitus, permitindo o diagnóstico da síndrome. O segundo caso é de uma paciente feminina, 39 anos, com edema, ascite, derrame pleural, hemangiomas glomeruloides e linfonodomegalias (doença de Castleman). Havia um componente monoclonal de IgG-lambda e lesões blásticas no ilíaco direito e em L4, assim como lesão desmielinizante sensitivo-motora nos quatro membros, compondo o diagnóstico de síndrome POEMS.

Glomeruloid hemangioma is characterized by coiled capillary vessels contained within enlarged vascular spaces displaying an architecture that resembles renal glomeruli. The condition is strongly associated with POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes). The present paper reports on two cases of glomeruloid hemangiomas associated with POEMS syndrome, and includes a review of the literature. Case one refers to a 63-year old female patient admitted to hospital with ascites, hepatosplenomegaly, walking difficulties and cutaneous hemangiomas. Histopathology revealed a diagnosis of glomeruloid hemangioma and served to guide the clinical work-up, which revealed sensorimotor polyneuropathy, a plasmacytoma in the L4 vertebra with tumor cells positive for kappa chain, and diabetes mellitus. These findings permitted a diagnosis of POEMS syndrome to be reached. The second case consisted of a 39-year old woman admitted to hospital with edema, ascites, pleural effusion, glomeruloid hemangiomas and lymphadenopathy (Castleman's disease). Additional findings included monoclonal IgG-lambda paraproteinemia, blastic lesions in the right iliac bone and L4 vertebra, and demyelinating sensorimotor neuropathy affecting all four limbs. The final diagnosis in this case was POEMS syndrome associated with Castleman's disease.