Rabdomiosarcoma alveolar con metástasis cardíaca en un paciente pediátrico / Alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient

El rabdomiosarcoma es el tumor maligno de partes blandas más frecuente en la edad pediátrica. Puede afectar cualquier localización anatómica. El subtipo histológico alveolar suele causar lesiones en las extremidades en niños de mayor edad. Los sitios metástasicos más frecuentes son el pulmón, la médula ósea, el hueso y los ganglios linfáticos. Describimos el caso de un paciente con rabdomiosarcoma alveolar (RA) con metástasis cardíaca, una presentación poco frecuente de la patología.

Rhabdomyosarcoma is the most common malignant soft tissue tumor in pediatric age. It can affect any anatomical location. Alveolar histological subtype usually presents lesions on the extremities in older children. The most common metastatic sites are the lung, bone marrow, bone and lymph node. We describe a case of alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient, a rare presentation of the pathology.

Papillary intralymphatic angioendothelioma: Dabska tumor

Abstract Papillary intralymphatic angioendothelioma (Dabska tumor) is a rarely metastasizing lymphatic vascular neoplasm that usually affects children and young adults. The majority of these cases occur in soft tissues of extremities, and to date less than 40 cases have been described. Despite the generally indolent evolution, can be locally invasive with the potential to metastasize. We describe a case of a young woman presenting with a plantar lesion, for 9 months and histological diagnosis of Dabska tumor. This neoplasm should be considered in the differential diagnosis of vascular dermatoses, allowing early diagnosis and treatment. Long-term follow-up should be performed.

Actinomicetoma plantar en un paciente sin factores de riesgo / Plantar actinomycetoma in a patient without risk factors

Resumen Se presenta un caso clínico de un actinomicetoma plantar en un paciente sin factores de riesgo, cuyo diagnóstico fue realizado mediante una biopsia de tejido plantar por sospecha de una neoplasia. Dado que el paciente no respondió satisfactoriamente a la terapia de primera línea, debió completar 24 semanas de tratamiento con doxiciclina, a lo cual evolucionó favorablemente. Finalmente, se desarrolla una breve discusión sobre los micetomas plantares.

A case of plantar actinomycetoma without risk factors is presented, which was diagnosed by hystopatological analysis of a foot biopsy because of the suspicion of neoplasia. Since the patient did not fully respond to the first-line therapy antibiotics, a 24-weeks doxycycline regime was started, achieving a satisfactory response. Finally, a brief discussion on plantar mycetomas is presented.

Impact of shoe size in a sample of elderly individuals / Impacto do tamanho do calçado em uma amostra de idosos

Summary Introduction: The use of an improper shoe size is common in older people and is believed to have a detrimental effect on the quality of life related to foot health. The objective is to describe and compare, in a sample of participants, the impact of shoes that fit properly or improperly, as well as analyze the scores related to foot health and health overall. Method: A sample of 64 participants, with a mean age of 75.3±7.9 years, attended an outpatient center where self-report data was recorded, the measurements of the size of the feet and footwear were determined and the scores compared between the group that wears the correct size of shoes and another group of individuals who do not wear the correct size of shoes, using the Spanish version of the Foot Health Status Questionnaire. Results: The group wearing an improper shoe size showed poorer quality of life regarding overall health and specifically foot health. Differences between groups were evaluated using a t-test for independent samples resulting statistically significant (p<0.05) for the dimension of pain, function, footwear, overall foot health, and social function. Conclusion: Inadequate shoe size has a significant negative impact on quality of life related to foot health. The degree of negative impact seems to be associated with age, sex, and body mass index (BMI).

Resumo Introdução: o uso de sapatos com tamanhos inadequados é comum em pessoas idosas e acredita-se resultar em efeito negativo sobre a qualidade de vida relacionada à saúde do pé. O objetivo é descrever e comparar o impacto de uma amostra de participantes usando calçados de tamanho adequado e indivíduos com calçados de tamanho inadequado, e as pontuações relacionadas com a saúde do pé e geral. Método: de uma amostra de 64 participantes, com idade média de 75,3±7,9, de um centro ambulatorial, dados de autorrelato foram registrados e medidas do tamanho dos pés e dos calçados foram determinadas. Os escores foram comparados pelo Foot Health Status Questionnaire, na versão em espanhol, entre os grupos que usavam sapatos de tamanhos corretos e incorretos. Resultados: o grupo que utilizava sapatos inadequados mostrou pior qualidade de vida relacionada à saúde geral e no pé. Diferenças entre os grupos foram avaliadas utilizando o teste t para amostras independentes, sendo estatisticamente significativas (p<0,05) para dimensão da dor, função, calçados, saúde geral, do pé e função social. Conclusão: o uso de calçado inadequado tem um impacto negativo significativo sobre a qualidade de vida relacionada à saúde do pé. O grau de impacto negativo parece estar associado com idade, sexo e índice de massa corpórea (IMC).

Alterações podais e mobilidade em idosos atendidos em um ambulatório de geriatria / Modificaciones podales y movilidad en ancianos asistidos en un ambulatorio de geriatría / Podal changes and mobility in elderly assisted in geriatric outpatient clinic

Objective: to determine the most frequentpodal changes and their harm in the mobility in elderly outpatients. Method: this descriptive study was conducted with 121 elderly people who were treated in a geriatric outpatient clinic of a university hospital. Data were collected through interviews subsidized by structured tool and analyzed using descriptive and inferential statistics. Results: we observed high incidence of feet problems, especially in women and the young elderly, highlighting foot pain in the majority of respondents. There was also a predominance of elderly with partial independence. Conclusion: it is identified the need for special attention to the health of aged people who reports pain in feet, since this tends to restrict their usual activities, causing decreased quality of life, immobilization and possible falls.

Objetivo: verificar alterações podais mais frequentes e o prejuízo destas na mobilidade de idosos em atendimento ambulatorial. Método: estudo descritivo, realizado com 121 idosos que foram atendidos em um ambulatório de geriatria de um hospital universitário. Os dados foram coletados através de entrevista subsidiada por instrumento estruturado e analisados por meio de estatística descritiva e inferencial. Resultados: verificou-se alta incidência de problemas podais, especialmente nas mulheres e idosos jovens, destacando a ocorrência do pé doloroso na maioria dos entrevistados. Houve também predominância de idosos com independência parcial. Conclusão: identifica-se a necessidade de atenção especial à saúde do idoso que relata dor nos pés, visto que este tende a restringir suas atividades habituais, causando diminuição da qualidade de vida, imobilização e possíveis episódios de quedas.

Objetivo: verificar las modificaciones podales más frecuentes y el perjuicio de estas en la movilidad de ancianos en una clínica geriátrica. Método: estudio descriptivo, realizado con 121 ancianos que fueron asistidos en un ambulatorio de geriatría de un hospital universitario. Los datos fueron recolectados através de entrevistas subvencionadas por instrumento estructurado y analizados mediante estadística descriptiva e inferencial. Resultados: se verificó alta incidencia podales, especialmente entre las mujeres y ancianos jóvenes, destacando la ocurrencia del pie doloroso en la mayoría de los encuestados. También hubo un predominio de pacientes de edad avanzada con independencia parcial. Conclusión: se identifica la necesidad de prestar especial atención a salud del anciano que relata dolor en los pies, ya que este tiende a restringir sus actividades diarias, causando disminución de la calidad de vida, inmovilización y posibles episodios de caídas.

Hamartoma fibroso de la infancia: informe de un caso / Fibrous hamartoma of infancy: case report

Introducción: El hamartoma fibroso de la infancia es una proliferación benigna de los tejidos blandos, de presentación infrecuente; 91 % de los casos ocurre durante el primer año de edad y afecta más frecuentemente al sexo masculino. Se caracteriza por ser una lesión subcutánea de morfología característica con patrón de crecimiento organoide trifásico. Caso clínico: Lactante masculino de seis meses de edad, con tumor en la región plantar medial del pie izquierdo, el cual fue resecado completamente. En el estudio histopatológico se informó como hamartoma fibroso de la infancia. Conclusiones: Puede localizarse en cualquier sitio anatómico, aunque 5 a 10 % afecta las extremidades inferiores existen pocos casos informados en el pie. En biopsias pequeñas es importante su diagnóstico diferencial con otras lesiones fibroadiposas para el adecuado tratamiento. La resección quirúrgica amplia con márgenes libres de lesión confiere un buen pronóstico a los pacientes.

BACKGROUND: Fibrous hamartoma of infancy (FHI) is an infrequent benign proliferation of the soft tissues. Ninety one percent of cases occur during the first year of life. FHI is characterized as a subcutaneous lesion with characteristic morphology with a triphasic organoid growth pattern. CLINICAL CASE: We present the case of a 6-month-old male infant with a tumor in the medial plantar region of the left foot, which was completely withered. Histopathological study reported a fibrous hamartoma of infancy. CONCLUSIONS: Fibrous hamartoma of infancy most frequently affects males. It may be localized at any anatomic site, although 5-10% of cases affect the lower limbs. Few cases are reported in the foot. This is a lesion with a characteristic morphological pattern; however, in small biopsies, its differential diagnosis is important with other fibroadipose lesions for appropriate treatment. Ample surgical resection with lesion-free borders confers a good prognosis for these patients.

Brazilian version of the foot health status questionnaire (FHSQ-BR): cross-cultural adaptation and evaluation of measurement properties

OBJECTIVE: To conduct a cross-cultural adaptation of the Foot Health Status Questionnaire into Brazilian-Portuguese and to assess its measurement properties. INTRODUCTION: This instrument is an outcome measure with 10 domains with scores ranging from 0-100, worst to best, respectively. The translated instrument will improve the examinations and foot care of rheumatoid arthritis patients. METHODS: The questions were translated, back-translated, evaluated by a multidisciplinary committee and pre-tested (n = 40 rheumatoid arthritis subjects). The new version was submitted to a field test (n = 65) to evaluate measurement properties such as test-retest reliability, internal consistency and construct validity. The Health Assessment Questionnaire, Numeric Rating Scale for foot pain and Sharp/van der Heijde scores for foot X-rays were used to test the construct validity. RESULTS: The cross-cultural adaptation was completed with minor wording adaptations from the original instrument. The evaluation of measurement properties showed high reliability with low variation coefficients between interviews. The a-Cronbach coefficients varied from 0.468 to 0.855, while correlation to the Health Assessment Questionnaire and Numeric Rating Scale was statistically significant for five out of eight domains. DISCUSSION: Intra- and inter-observer correlations showed high reliability. Internal consistency coefficients were high for all domains, revealing higher values for less subjective domains. As for construct validity, each domain revealed correlations with a specific group of parameters according to what the domains intended to measure. CONCLUSION: The FHSQ was cross-culturally adapted, generating a reliable, consistent, and valid instrument that is useful for evaluating foot health in patients with rheumatoid arthritis.

Atypical Angioma Serpiginosum

Angioma serpiginosum is an uncommon, acquired vascular nevoid disorder with capillary dilation and proliferation in the papillary dermis. The eruptions are asymptomatic and characterized by grouped, erythematous to violaceous, serpiginous and punctate macules. The condition usually appears in females during adolescence on unilateral lower extremities and the buttocks. We report a rare case with a late onset and atypical distribution of lesions in a 48-year-old female patient who had groups of punctate lesions on her left foot for four to five years. Histopathological examination showed hyperkeratosis and multiple dilated and proliferated capillaries in the papillary dermis. Inflammation and extravasation of red blood cells were not found. According to the clinical and pathological findings, we established a diagnosis of angioma serpiginosum. She was treated with a pulsed dye laser, and the angiomatous lesions subsequently improved.

Polyphenotypic peripheral neuroepithelioma occuring in the foot: a case report.

Peripheral neuroepithelioma of the soft tissues is an uncommon member of primitive neuroectodermal tumors. Divergent differentiation and polyphenotypia is known in peripheral neuroepithelioma. We report one such recurrent peripheral neuroepithelioma in an infant which was detected at one month of age, in the foot. Microscopically, it showed tumor cells in nests and lobules with abundant Homer-Wright rosettes. Immunohistochemically, tumor cells were immunoreactive for neural markers but also displayed an aberrant myoid phenotype. The prognostic implications of this anomalous phenotype are unclear as of now, but documentation of this is necessary for possible future references.

Morton Neuroma: Evaluated with Ultrasonography and MR Imaging

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy of both ultrasonography (US) and magnetic resonance imaging (MRI) for the assessment of Morton neuroma. MATERIALS AND METHODS: Our study group was comprised of 20 neuromas from 17 patients, and the neuromas were confirmed on surgery following evaluation with US, MRI, or both US and MRI. The diagnostic criterion for Morton neuroma, as examined by US, was the presence of a round or ovoid, well-defined, hypoechoic mass. The diagnostic criterion, based on MR imaging, was a well defined mass with intermediate to low signal intensity on both the T1- and T2-weighted images. The retrospective comparison between the sonographic and MR images was done by two experienced radiologists working in consensus with the surgical and pathologic correlations. RESULTS: The detection rate of Morton neuroma was 79% for 14 neuromas from 11 patients who had undergone US followed by an operation. The detection rate was 76% for 17 neuromas from 15 patients who had undergone MRI and a subsequent operation. The mean size of the examined neuromas was 4.9 mm on the US images and it was 5.1 mm on the MRI studies. Ten neuromas (71%) were 5 mm or less as measured by US, and three neuromas were not detected, whereas on the MRI analysis, 10 neuromas (59%) were 5 mm or less and four neuromas were not visualized. Among the patients examined during postoperative follow-up, symptoms were completely relieved in 85% and the symptoms were partially relieved in 15%. CONCLUSION: US and MR imaging are comparable modalities with high detection rate for the evaluation of Morton neuroma.

Metatarsalgias: diagnóstico diferencial por meio da ressonância magnética / Metatarsalgias: differential diagnosis with magnetic resonance imaging

Várias lesões podem causar metatarsalgia, cujas manifestações clínicas podem ser inespecíficas. As imagens de ressonância magnética, associadas a outros métodos de imagem e dados clínicos, freqüentemente podem contribuir na detecção dessas lesões e possibilitar que um diagnóstico relativamente preciso seja considerado. Nosso objetivo é descrever e ilustrar, por meio de imagens de ressonância magnética, as principais doenças que causam metatarsalgia.

Several lesions may cause metatarsalgia whose clinical manifestations may be non-specific. Magnetic resonance imaging associated with other imaging methods and clinical data frequently can contribute to detection of these lesions, allowing a reasonably precise diagnosis to be considered. Our purpose is to describe and illustrate, by means of magnetic resonance imaging, main diseases causing metatarsalgia.

Osteoporosis regional transitoria y distrofia simpática refleja: una misma enfermedad? / Regional transient osteoporosis, and reflex sympathetic dystrophy: the same disease?

Complex regional pain syndrome, reflex sympathetic dystrophy, regional, transient and migratory osteoporosis, are known as a spectrum of medical conditions that present with pain, edema, erythema, localized osteoporosis and sometimes sympathetic dysfunction. Many factors which are present in these conditions, such as clinical presentation, radiologic findings and a variety of still unclear physiopathologic mechanisms are correlated. We propose that all these conditions are different periods of the same pathology.

Síndrome doloroso regional complejo, distrofia simpática refleja, osteoporosis regional, transitoria, y migratriz, representan un espectro de alteraciones que se presentan con dolor, edema, eritema, osteoporosis localizada y en ocasiones disfunción simpática descripta en muchos sitios esqueléticos. Muchosfactores, tales como la forma de presentación clínica, los hallazgos radiológicos y la fisiopatología desconocida de estas enfermedades las correlacionan íntimamente. Proponemos entonces, mediante la presentación de uncaso clínico, que dichas entidades son estadios y presentaciones diferentes de una misma enfermedad.

Pés reumatóides: avaliação pela podobarometria dinâmica computadorizada e restauração funcional com órteses plantares / Rheumatoid feet: evaluation with computerized dynamic pedobarography and functional restauration with foot orthosis

Os pés são comumente acometidos na artrite reumatóide (AR), contribuindo em muito na dor e incapacidade observadas nessa doença. Este artigo descreve uma paciente com pés reumatóides, tratada com órteses para os pés. Foram discutidas as alterações mais freqüentes observadas nessa patologia, o tratamento com palmilhas e o uso da podobarometria dinâmica computadorizada (F-Scan) como método auxiliar diagnóstico e de acompanhamento.

Giant cell tumour of talar body.

Giant cell tumour (osteoclastoma) of talar bone is a rare entity and is seen more commonly in the third decade of life. We report this disease entity in a 17-years-old girl. The patient presented with painful swelling of the left ankle with an osteolytic lesion in the talus on conventional radiographs. Intralesional curettage and autologous bone grafting was performed following which patient's pain and swelling disappeared. Complete range of movement at the ankle joint was regained with minimal restriction at the subtalar joint. There is no evidence of relapse at six months follow up.