Superficial Acral Fibromyxoma is a rare tumor of soft tissues. It is a relatively new entity described in 2001 by Fetsch et al. It probably represents a fibrohistiocytic tumor with less than 170 described cases. We bring a new case of SAF on the 5th toe of the right foot, in a 43-year-old woman. After surgical excision with safety margins which included the nail apparatus, it has not recurred (22 months of follow up). We carried out a review of the location of all SAF published up to the present day.

CONTEXTO E OBJETIVO: Hemangiomas são os tumores vasculares mais comuns da infância. Em 2008, foi demonstrado o efeito do propranolol no tratamento de hemangiomas capilares. Outros relatos similares seguiram-se, demonstrando seu rápido efeito na redução do volume das lesões. O objetivo foi avaliar crianças e adolescentes com hemangioma tratadas com propranolol. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, conduzido em hospital infantil. MÉTODOS: Foram incluídos pacientes entre 0-19 anos, com ou sem tratamento prévio, tratados entre janeiro de 2009 e dezembro de 2010. A resposta foi avaliada comparando-se o aspecto da lesão entre o início do tratamento e a última consulta. Consideramos resposta parcial ou completa como resposta ao tratamento. RESULTADOS: Sessenta e nove pacientes foram incluídos, com uma mediana de acompanhamento de 11 meses (idade média: 31 meses). Destes, 58 pacientes eram recém-diagnosticados e 11 tinham tratamento prévio. Resposta (parcial ou completa) foi verificada em 60 pacientes (87%). Entre os hemangiomas capilares, a resposta foi de 50 em 53 (94%), enquanto em outros tipos de lesões, a resposta foi de 10 em 16 (63%) (P = 0,3; teste de qui-quadrado). A resposta em pacientes com até 1 ano de idade foi de 37 em 38 (97%), e naqueles com mais de 1 ano foi de 23 em 31 (74%) (P = 0,4; qui-quadrado). Efeitos colaterais foram incomuns e leves. CONCLUSÕES: Propranolol parece ser efetivo no tratamento de hemangiomas em crianças e adolescentes, não apenas na fase proliferativa, com resposta em quase todos os pacientes.

CONTEXT AND OBJECTIVE: Hemangiomas are the commonest vascular tumors during childhood. In 2008, the effect of propranolol for treating capillary hemangiomas was demonstrated. Other similar results followed, showing that it rapidly reduces lesion volume. The objective here was to evaluate children and adolescents with hemangiomas that were treated with propranolol. DESIGN AND SETTING: Retrospective study, conducted in a children's hospital. METHODS : Patients aged 0-19 years with or without previous treatment, who were treated between January 2009 and December 2010, were included. The response was assessed by comparing the lesion appearance between the start of treatment and the last consultation. We considered partial or complete responses as the response to treatment. RESULTS : Sixty-nine patients with a median follow-up of 11 months (mean age: 31 months) were included. Of these, 58 patients were recently diagnosed and 11 had had previous treatment. A response (partial or complete) was seen in 60 patients (87%). Among the capillary hemangioma cases, responses were seen in 50 out of 53 (94%), while in other lesion types, it was 10 out of 16 (63%) (P = 0.3; chi-square). Responses in patients less than one year of age were seen in 37 out of 38 (97%), whereas in those over one year of age, in 23 out of 31 (74%) (P = 0.4; chi-square). Side effects were uncommon and mild. CONCLUSIONS: Propranolol seemed to be effective for treatment of hemangiomas in children and adolescents, and not just in the proliferative stage, with responses in almost all the patients.

The mental foramen has been reported to vary in position in different ethnic groups. Repeated failures during injections and operative procedures involving the mental foramen suggest the presence of local differences in a given population. The aim of the present study was to determine the position of mental foramen (MF) in a sample of one hundred seventy Brazilian adult dry mandible, being 79 edentulous and 91 dentate. The assessment was made, having as it referential, the base of the mandible (BM) and the mandibular symphisis (MS), whereby the comparisons were carried out considering genders, the mandible side (left or right), and dentition (dentate or edentulous). The statistical analysis was performed using multifatorial ANO VA (alpha=5%). It was found the male mandibles presented higher valúes of MF-MS than the female ones and the dentate presented higher valúes when compared to edentulous ones (p<0.0001). No difference was observed between left and right sides (p=0.2990), as well, as concerning to gender (p=0.152). The most frequent position of MF was in the long axes of the second premolar for male (p<0.0001) and female (p=0.0004). No statistical difference (p>0.05) was found between right and left sides comparing male to female. It was concluded the position of the mental foramen is mainly altered in edentulous subjects as it is consider a symmetric structure in Brazilian population and its most common position is in the long axes of the secondpremolar.

El foramen mental ha sido reportado variablemente en diferentes posiciones, según los grupos étnicos. Repetidos errores durante el procedimiento anestésico, que involucran al foramen mental, sugieren la presencia de diferencias locales en una determinada población. El objetivo del presente estudio fue determinar la posición del foramen mental (MF) en una muestra de 170 mandíbulas secas de la población brasileña, siendo 79 desdentadas y 91 dentadas. La evaluación fue hecha teniendo como referencia la base de la mandíbula (BM) y la sínfisis mandibular (MS). La comparación fue dada y llevada por géneros, según el lado de la mandíbula (izquierdo o derecho) y la dentición (dentada o desdentada). El análisis estadístico fue realizado usando el test multifactorial ANOVA (alpha 5%). Mandíbulas masculinas presentaron valores mayores que el grupo femenino y las mandíbulas dentadas presentaron valores superiores, cuando fueron comparadas con las mandíbulas desdentadas (p<0.0001). Ninguna diferencia fue observada entre los lados derecho e izquierdo (p=0.2990), como tampoco para los géneros masculino y femenino (p=0.152). La posición más frecuente de MF para las mandíbulas masculinas fue a lo largo del eje del segundo premolar (p<0.0001), así como para las mandíbulas femeninas (p=0.0004). No fueron encontradas diferencias estadísticamente significativas (p>0.05) entre los lados derecho e izquierdo, comparando mandíbulas masculinas y femeninas. Se concluye que la posición del foramen mental es principalmente alterada en sujetos desdentados, es considerada una estructura simétrica en la población brasilera y más comúnmente localizado a lo largo del eje del segundo premolar.

OBJETIVO: Apresentar um estudo retrospectivo sobre os resultados cosméticos e funcionais da genitoplastia feminizante em pacientes com hiperplasia adrenal congênita virilizante. MÉTODOS: Trinta e quatro pacientes com idade média de 3,35 ± 2,5 anos com ambigüidade genital classificada de acordo com os estádios de Prader foram selecionados. O seguimento pós-operatório foi de 2 a 16 anos. O tamanho do clitóris variou de 1,9 a 5,0 cm; 28 pacientes tinham orifício único perineal e 6 tinham dois orifícios. A técnica cirúrgica incluiu clitorovaginoplastia em tempo único e foi realizada antes dos dois anos de idade em 18 pacientes. A clitoroplastia preservou a glande, a qual teve seu suprimento sanguíneo mantido em 97% dos casos pela mucosa do freio e no demais casos com a manutenção do feixe vasculo-nervoso dorsal. Duas técnicas foram utilizadas para a ampliação do seio urogenital: o retalho perineal em "Y-V" em 25 pacientes e a incisão longitudinal posterior em 8 pacientes. RESULTADOS: As complicações cirúrgicas ocorreram em 20,5% dos casos: sangramento, necrose da glande e estenose vaginal. Foram necessárias dilatações vaginais com moldes de acrílico no período pós puberal em 3 das pacientes com estenose, com bons resultados funcionais. CONCLUSÃO: As técnicas utilizadas seguidas pelas dilatações, permitiram bons resultados cosméticos e funcionais em 67% dos casos apresentando poucas complicações e evitando a necessidade de neovagina inclusive nos pacientes com inserção alta do intróito vaginal.

The ideal surgical technique and appropriate age for performing feminizing genitoplasty are debatable, and few long-term outcome studies have been reported. PURPOSE: To report a retrospective study on anatomical and functional outcomes of feminizing genitoplasty in patients with virilizing congenital adrenal hyperplasia. METHODS: We selected 34 patients (mean age = 3.4 ± 2.5 yr) with genital ambiguity classified according to Prader stage. Follow-up ranged from 2 to 16 years. Clitoral length ranged from 1.9 to 5.0 cm; 28 patients had a single perineal orifice, and 6 had a double orifice. The surgical technique included clitorovaginoplasty in a single procedure and was carried out before 2 years of age in 18 patients. Clitoroplasty was performed with glans preservation in all patients. Blood supply was exclusively maintained by the frenular pedicle in 97% of the cases, whereas clitoral dorsal nerves and vessels were preserved in the remaining 3%. The opening of the urogenital sinus was performed using either the Y-V perineal flap procedure (25 patients) or the cut-back incision procedure (8 patients). RESULTS: Good morphological and functional results were achieved in 68% of the patients; 21% of the patients had surgical complications, such as incision bleeding (2 cases), glans necrosis (1 girl with Prader V), and vaginal introitus stenosis (4 cases). Three of the latter underwent dilation with acrylic molds in the post-pubertal period with good functional results. CONCLUSIONS: We conclude that single-stage feminizing genitoplasty consisting of vulvoplasty, clitoroplasty, and Y-V perineal flap produced good cosmetic and functional results in virilized girls with congenital adrenal hyperplasia, with few complications. In addition, this surgical approach prevented the need for neovaginaplasty even in patients with high vaginal insertion.