Surgical pathology to describe the clinical margin of debridement of chronic wounds using a wound electronic medical record.

BACKGROUND: Chronic wounds, including diabetic foot ulcers (DFU), pressure ulcers (PU), and venous ulcers (VU) result from multiple physiologic impairments. Operative debridement is a mainstay of treatment to remove nonviable tissue and to stimulate wound healing. Unlike tumor resection, however, operative wound specimens are not routinely sent for pathology. The objective of this study was to describe the pathology present in chronic wounds. STUDY DESIGN: Pathology reports of the skin edge and wound base from 397 initial debridements in 336 consecutive patients with chronic wounds were retrospectively reviewed. All data were entered and stored in a Wound Electronic Medical Record. Pathology data were extracted from the Wound Electronic Medical Record, coded, and quantified. RESULTS: Up to 15 distinct histopathologic findings across 7 tissue types were observed after review of pathology reports from chronic wounds. Specifically, the pathology of epidermis revealed hyperkeratosis: 66% in DFUs, 31% in PUs, and 29% in VUs. Dermal pathology revealed fibrosis in 49% of DFUs, 30% of PUs, and 15% of VUs. Wound bed pathology revealed necrosis in the subcutaneous tissue in 67% of DFUs, 55% of PUs, and 19% of VUs. Fibrosis was reported in between 19% and 52% of all wound types. Acute osteomyelitis was present in 39% of DFUs, 33% of PUs, and 29% of VUs. CONCLUSIONS: This observational study of the histopathology of initial surgical debridement of chronic wounds revealed a wide range of findings across multiple tissue levels. Although certain findings such as osteomyelitis and gangrene have been shown to directly relate to impaired wound healing and amputation, other findings require additional investigation. To rigorously define a margin of debridement, a prospective study relating histopathology and clinical outcomes such as healing rates and amputation is needed.

An assist to the next (10th) edition of Lever's Histopathology of the Skin.

Lever's Histopathology of the Skin, regarded as the gold standard textbook in the field of dermatopathology, claims to cut a swath through the discipline. In the last two editions, however, it appears to be declining in its overall scientific quality and academic mentality by failing to include different points of view set forth by other authors. Some ideas of a single author, coupled with appropriate references, are offered by me now for consideration for inclusion in the next (10th) edition of Lever's text.

Vasculite livedóide com anticorpo antifosfolipídio / Livedoid vasculitis with antiphospholipid antibodies

No disponible

The authors report a case of a 79-year-old woman presenting livedoid vasculitis. This is a painfull clinical entity, characterized by purpuric lesions with shaped ulcers and atrophie blanche. Raised anticardiolipin antibody titers are associated at the present case. The ethiopatogenic mecanisms and the different denominations for the disease are discussed

Diagnostico precoce da hanseniase: identificacao de lesao cutanea inicial pela populacao de regiao metropolitana do Rio de Janeiro / Early diagnosis on Hansen's disease: identification of skin lesions by a population in the metropolitan region of Rio de Janeiro State

A hanseniase continua sendo um importante problema de saude publica no Brasil. O objetivo deste estudo é avaliar o grau de conhecimento sobre a doenca na populacao de areas adstritas a 8 unidades basicas de saude de duas regioes metropolitanas do RJ, com enfoque na identificacao de seus sinais precoces. Ao longo de 2002, foram entrevistados 800 mulheres, e apresentadas quatro imagens de lesoes cutaneas (vitiligo, hanseniase indeterminada, mal perfurante plantar e hanseniase dimorfa) visando a sua impressao diagnostica. Observou-se que 54,9% dos entrevistados conheciam o termo hanseniase (particularmente os de escolaridade alta), enquanto 45,1% o termo lepra. A doenca foi reconhecida, na maior parte das vezes (23,4% dos casos) quando se encontrava em fase avancada. Apenas 5,9% identificaram a lesao precoce. Os resultados indicam desconhecimento da hanseniase por parte desta populacao, especialmente em suas manifestacoes iniciais. Observa-se ainda que as estrategias de difusao da nova terminologia hanseniase nao foram eficazes. Consideramos que a capacidade de suspeicao da doenca deve pertencer nao apenas ao profissional de saude, e sim a todos, na forma de um saber comum.