Diagnóstico e tratamento de úlcera hipertensiva de Martorell: artigo de revisão / Diagnóstico y tratamiento de la úlcera hipertensiva de Martorell: artículo de revisión / Diagnosis and treatment of Martorell's hypertensive ulcer: review article

Introdução: A úlcera hipertensiva de Martorell é uma ferida crônica, associada a hipertensão arterial sistêmica, dedifícil manejo clínico e subdiagnosticada. Objetivo: Investigar os métodos de diagnóstico e os tratamentos existentes para a UHM. Método: Estudo descritivo e qualitativo de revisão integrativa com a análise sistemática de referências bibliográficas nas bases de dados PubMed, SciELO, MEDLINE e LILACS no período de 2016 e 2021, e periódicos da CAPES. Resultados: Clinicamente o paciente apresenta uma ferida pequena, de forma arredondada, superficial, com margens necróticas e cianóticas e eritema perilesional eventual. Os pulsos distais usualmente estão presentes e há ausência de edema e varizes locais. De todos os sinais e sintomas relatados, destaca-se a dor, descrita como intensa e desproporcional à sua dimensão. Conclusão: O cerne ao diagnóstico é avaliação clínica e o tratamento é a normalização da pressão arterial sistêmica e curativos regulares e, uso de analgésicos, antibióticos e vasodilatadores periféricos.(AU)

lntroduction: Martorell's hypertensive ulcer is a chronic wound, associated with systemic hypertension withdifficult clinicai management and it is often underdiagnosed. Goal: To investigate the diagnostic method and current treatments for Martorell's hypertensive ulcer disease. Method: A descriptive and qualitative study of integrative literature review with a systematic analysis of bibliographic references from PubMed, SciELO, MEDLINE and LILACS databases, ranging from 2016 to 2021, as well as selected articles from CAPES journals. Results: patients usually present with a small, rounded and superficial wound with cyanotic and necrotic edges and occasional perilesional erythema. Distal pulses are usually present and there is an absence of edema and local varicose veins. From all the signs and symptoms reported by patients with this type of injury, it is possible to point out that the pain is intense and disproportionate to its dimension. Conclusion: The core of diagnosis is the clinicai evaluation and the treatment is controlled systemic blood pressure, regular bandages and, if needed, analgesics, antibiotics and peripheral vasodilators. (AU)

lntrodución: La úlcera hipertensiva de Martorell es una herida crónica, asociada a la hipertensión arterial sistémica,de difícil manejo clínico y muchas veces subdiagnosticada. Objetivo: Investigar los métodos de diagnóstico y tratamientos existentes para este tipo de lesión. Método: Se realizá un análisis sistemático de referencias bibliográficas en las bases de datas PubMed, SciELO, MEDLINE y LILACS en el período de publicación entre 2016 y 2021, además de artículos seleccionados de revistas CAPES. Resultados: Clínicamente el paciente suele presentarse con una pequena herida, redondeada, superficial, con márgenes necróticos y cianóticos con eritema perilesional ocasional. Los pulsos distales suelen estar presentes y hay ausencia de edema y venas varicosas locales. De todos los signos y síntomas reportados por los pacientes con este tipo de lesiones, se destaca el dolor, que se describe como intenso y desproporcionado con la zona de la herida y su tamafio. Conclusión: La base dei tratamiento es la normalización de la presión arterial sistémica y los apósitos regulares y, si necesario, analgésicos, antibióticos y vaso dilatadores periféricos(AU)

Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology

Abstract Background: Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. Objective: To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. Methods: Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. Results: The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. Conclusion: This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.

Indicadores psicométricos do saber e o fazer de enfermeiros nos cuidados paliativos à pessoa com ferida tumoral / Indicadores psicométricos del saber y el quehacer de enfermeros en los cuidados paliativos a la persona con herida tumoral / Psychometric Indicators of Nurses' Knowledge and Work in the Palliative Care of Individuais with a Malignant Wound

RESUMO Objet¡vo: verificar a discriminação de itens, a representatividade do conteúdo e a fidedignidade da medida acerca dosabere dofazerde enfermeiros nos cuidados paliativos destinados à pessoa com ferida tumoral maligna cutânea. Material e método: trata-se de estudo metodológico, descritivo e correlacional, realizado com 51 enfermeiros de um hospital filantrópico da Paraíba, Brasil, durante os meses de junho e julho de 2017. Esses profissionais responderam a um instrumento validado com 84 itens referentes ao saber e ao fazer nos cuidados paliativos destinados à pessoa com ferida tumoral maligna cutânea. Na análise dos dados, foi utilizado o programa SPSS for Windows, versão 22.0, com análises descritivas e psicométricas. Resultados: ao se verificarem as propriedades psicométricas, a fidedignidade dos itens apresentou alfa de Cronbach superior a 0,70 em todos os domínios. Assim, foi possível elaborar um pressuposto teórico sobre o fenômeno, no qual quanto maior for o saber relacionado aos cuidados paliativos destinados à pessoa com ferida tumoral maligna cutânea, maior será o fazer desses cuidados. Conclusões: esse instrumento possibilita que outros profissionais possam adequar a mesma metodologia para outras temáticas e identificar as especificidades do saber e do fazer, o que preencheria as lacunas na área de educação em enfermagem, sobretudo na temática de cuidados paliativos.

RESUMEN Objetivo: verificar la discriminación de ítems, la relevancia del contenido y la fidelidad de la medida, acerca delsaberydelhacerdeenfermeros, en los cuidados paliativos a las personas con herida tumoral maligna cutánea. Material y método: estudio metodológico, descriptivo y correlacional, realizado con 51 enfermeros de un hospital filantrópico de Paraíba, Brasil, durante junio y julio de 2017, quienes contestaron a un instrumento con 84 ítems referentes al saber y el hacer en los cuidados paliativos, destinados a la persona con herida tumoral maligna cutánea. En el análisis de los datos se utilizó el programa SPSS para Windows, versión 22.0, con análisis descriptivos y psicométricos. Resultados: al verificar las propiedades psicométricas, la autenticidad de los ítems presentó alfa de Cronbach superior a 0,70 en todos los dominios. Por lo tanto, fue posible elaborar un presupuesto teórico sobre el fenómeno, en lo que, cuanto mayor sea el saber relacionado a los cuidados paliativos a la persona con herida tumoral maligna cutánea, mayor será la acción de estos cuidados. Conclusiones: este instrumento posibilita que otros profesionales puedan adecuar la misma metodología a otras temáticas e identificar las especificidades del saber y del hacer, lo que podría llenar los vacíos en el área de educación en enfermería, sobre todo en la temática de cuidados paliativos.

ABSTRACT Objective: To verify item discrimination, content relevance and measurement reliability of nurses' knowledge and work in the palliative care of individuals with a cutaneous malignant wound. Materials and methods: Methodological, descriptive, correlational study carried out with 51 nurses from a philanthropic hospital in Paraiba, Brazil, during June and July of 2017, who answered an instrument with 84 items referring to knowledge and work in the palliative care of individuals with a cutaneous malignant wound. For data analysis, SPSS for Windows, version 22.0, was used with descriptive and psychometric statistics. Results: In verifying psychometric properties, item authenticity had a Cronbach's alpha higher than 0.70 in all domains; therefore, we could make a theoretical assumption on the phenomenon, in which the more the knowledge of the palliative care of a person with a cutaneous malignant wound, the more the action of this care. Conclusions: This instrument enables other professionals to adapt the same methodology to other themes and to identify the specificities of knowledge and work, which could bridge the gaps in nursing education, especially palliative care.

Inusual presentación de un Linfoma B cutáneo en un paciente joven / Unusual presentation of a cutaneous B Lymphoma in a young male

Se reporta el caso de un paciente masculino de 23 años de edad, que se presenta con una úlcera de región latero cervical, única, sin compromiso del estado general. Se solicita estudio histopatológico de la lesión e inmunomarcación, con diagnóstico de Linfoma no Hodgkin B de células grandes cutáneos primarios. Se realiza una revisión sobre los Linfomas no Hodgkin B de células grandes cutáneos primarios, siendo anecdótica la presentación en pacientes jóvenes.

We report a case of a 23 year old male with a lateral cervical ulcer, without general involvement. Histophatological study and immunomarcation were positive to non Hodgkin Difuse Primary Cutaneous Large B-Cell Lymphoma. A revision was made about Primary Cutaneous B-Cell Lymphomas, being unusual this presentation in young people.

A Case of Antiphospholipid Syndrome in A Patient with Leg Ulcer and Previous History of Deep Vein Thrombosis / 대한피부과학회지

The antiphospholipid syndrome is a multiple-system disorder characterized by persistently elevated antiphospholipid antibodies and/or arterial or venous thrombosis, thrombocytopenia, or recurrent spontaneous abortion. Various cutaneous manifestations have been associated with this disease and may be the first sign of the underlying problem. We report a case of antiphospholipid syndrome with cutaneous ulcer on the left calf of a 21-year-old woman, who has been treated with deep vein thrombosis.

A Case of Adult Dermatomyositis with Cutaneous Ulcer / 대한류마티스학회지

Dermatomyositis (DM) is a connective tissue disorder characterized by inflammatory myopathy and prominent cutaneous features. Although cutaneous vasculitis has been noted frequently in child-onset DM, it rarely occurs in adult-onset DM. The clinical features of adult-onset DM showing cutaneous vasculitis have not been well characterized. A 60-year-old female patient presented with multiple deep cutaneous ulcers in both hands, elbows and foot. She was diagnosed as dermatomyositis 18 months before admission. Angiogram showed no definite arterial obstructive lesion and thrombus in both wrist and elbow, but decreased vascularity was seen in digits of both hands. Cutaneous ulceration was thought to be caused by vasculitis. Cutaneous ulceration was a rare manifestation of adult-onset DM patients, and we report this case with a review of literature.

Cutaneous Ulcer Due to Candida Infection / 대한의진균학회지

Cutaneous ulcers due to candida infection are very rare condition, occurring almost in immunocompromised host or occurring as cutaneous manifestation of systemic candidal infection. A 52-year-old woman presented with cutaneous ulcer on dorsum of left hand which had lasted for about 15 days. Bacterial culture showed nonpathogenic organism, Enterobacter cloacae. Mycologic studies including KOH mount and fungus culture were positive for pseudohyphae and colonies of Candida species. A biopsy specimen from the center of ulcer revealed numerous spores and fungal hyphae in the upper dermis and necrotic epidermis. Bacterial culture and fungus culture of patient's serum and urine were negative. Initial treatment with antibiotics had no effectiveness for 2 weeks. After then we treated with antifungal drug, itraconazole 100mg/day. After 6 weeks of antifungal therapy, the skin lesion was much improved. We report this case, because it showed cutaneous ulcer due to candida infection but had neither systemic candidal infection nor clinical sign of immunosuppression.