[Complications Following Treatment for Excessive Axillary Sweating With Microwaves: A Case Report]

Excessive axillary sweating is a frequent reason for seeking consultation in aesthetic medicine. Botulic toxin therapies have been used for years for this condition. A microwave-based treatment (MiraDry®) has been used in France since 2011. We present the case of a patient who developed complications following such a treatment for excessive axillary sweating, namely dermal detachment, subcutaneous collections, dermal thickening, retractile scars responsible for pain and limitation of axillary amplitudes. These complications mimic the natural evolution of deep axillary burns. In this paper, we propose a management method for patients with this type of complication.

SARS-CoV-2 T Cell Response in Severe and Fatal COVID-19 in Primary Antibody Deficiency Patients Without Specific Humoral Immunity

Morbidity and mortality of COVID-19 is increased in patients with inborn errors of immunity (IEI). Age and comorbidities and also impaired type I interferon immunity were identified as relevant risk factors. In patients with primary antibody deficiency (PAD) and lack of specific humoral immune response to SARS-CoV-2, clinical disease outcome is very heterogeneous. Despite extensive clinical reports, underlying immunological mechanisms are poorly characterized and levels of T cellular and innate immunity in severe cases remain to be determined. In the present study, we report clinical and immunological findings of 5 PAD patients with severe and fatal COVID-19 and undetectable specific humoral immune response to SARS-CoV-2. Reactive T cells to SARS-CoV-2 spike (S) and nucleocapsid (NCAP) peptide pools were analyzed comparatively by flow cytometry in PAD patients, convalescents and naïve healthy individuals. All examined PAD patients developed a robust T cell response. The presence of polyfunctional cytokine producing activated CD4⁺ T cells indicates a memory-like phenotype. An analysis of innate immune response revealed elevated CD169 (SIGLEC1) expression on monocytes, a surrogate marker for type I interferon response, and presence of type I interferon autoantibodies was excluded. SARS-CoV-2 RNA was detectable in peripheral blood in three severe COVID-19 patients with PAD. Viral clearance in blood was observed after treatment with COVID-19 convalescent plasma/monoclonal antibody administration. However, prolonged mucosal viral shedding was observed in all patients (median 67 days) with maximum duration of 127 days. PAD patients without specific humoral SARS-CoV-2 immunity may suffer from severe or fatal COVID-19 despite robust T cell and normal innate immune response. Intensified monitoring for long persistence of SARS-CoV-2 viral shedding and (prophylactic) convalescent plasma/specific IgG as beneficial treatment option in severe cases with RNAemia should be considered in seronegative PAD patients.

[Fasciocutaneous flap reliable by deep femoral artery perforator for the treatment of ischial pressure ulcers]

INTRODUCTION

The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers.

PATIENTS AND METHOD

A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily.

RESULTS

A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory.

CONCLUSION

Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.

[Living conditions and mortality in the elderly after surgical management of para-articular hip fractures]

While hemiendoprothesis has been established in the treatment of hip fractures of aged people because of less operative trauma, better effectiveness and satisfying functionality, surgical management of trochanteric fractures is still in discussion. In our study, we found no severe difference of living conditions or mortality after operating elderly patients with proximal femoral fractures comparing Hemiprotheses versus Endernails versus Dynamic Hip Screws.

[Simultaneous corpus fractures of the os triquetrum and os hamatum diagnosed by magnetic resonance tomography. A case report]

We are reporting the case of a patient with a rare fracture of the corpus of the triquetrum after falling on the ulnar abducted and extended hand. The magnetic resonance imaging (MRI) of the wrist surprisingly showed an additional fracture of the hamate.

[Isolated proximal fibula fracture in Marfan syndrome]

An isolated fracture of the proximal fibular shaft without associated tibial or ankle injury and without resulting from direct violence is extremely rare. This report presents a case of an unusual isolated proximal fibular fracture (stress-fracture) in a female tennis-player with Marfan-syndrome. The literature is reviewed and diagnosis, treatment and etiology are discussed.