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Chen J, Huang Y, Chen J, Qi X, Ma Y, Wang M, Liu F. Differential diagnosis of rare adrenal cellular schwannomas: A case report. Medicine (Baltimore) 2024; 103:e37452. [PMID: 38518040 PMCID: PMC10956987 DOI: 10.1097/md.0000000000037452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Adrenal cellular schwannomas are exceptionally rare stromal tumors that are often misdiagnosed due to the lack of specific radiological, serological, or clinical features. In this report, we describe the differential diagnosis of a rare adrenal cellular schwannoma. METHODS A 69-year-old man with a history of persistent hypertension, chronic kidney disease, hypertensive heart disease, and cardiac insufficiency was hospitalized due to bilateral lower extremity edema lasting for 3 months. Plain computed tomography at that time revealed a space-occupying lesion in the right adrenal gland. As serum levels of catecholamines, cortisol, and adrenocorticotropic hormone were within normal ranges, the edema was attributed to the chronic kidney disease and cardiac insufficiency, and the patient was referred to our hospital for surgical treatment. Contrast-enhanced computed tomography revealed heterogeneous enhancement in the adrenal mass indicating pheochromocytoma. An irregularly shaped 5 cm mass with a complete capsule in the right adrenal gland was laparoscopically resected. The postoperative histopathological diagnosis was adrenal cellular schwannoma. RESULTS The postoperative course was unremarkable and the tumor did not recur during 5 years of follow-up. CONCLUSION Adrenal cellular schwannoma is a very rare tumor that is extremely difficult to preoperatively diagnose. Histological and immunohistochemical analyses are required for differential diagnosis and confirmation. Cellular schwannomas can transform into malignant peripheral nerve sheath tumors, but not often. Consequently, regular postoperative follow-up is required for such patients, especially imaging.
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Affiliation(s)
- Jiali Chen
- Department of Pathology, First People’s Hospital of Linping District, Hangzhou, China
| | - Yan Huang
- Department of Pathology, First People’s Hospital of Linping District, Hangzhou, China
| | - Jingjing Chen
- Department of Pathology, Taizhou People’s Hospital of Jiangsu Province, China
| | - Xianzhong Qi
- Department of Pathology, First People’s Hospital of Linping District, Hangzhou, China
| | - Yue Ma
- Department of Pathology, First People’s Hospital of Linping District, Hangzhou, China
| | - Miaoyan Wang
- Department of Pathology, First People’s Hospital of Linping District, Hangzhou, China
| | - Fufeng Liu
- Department of Pathology, First People’s Hospital of Linping District, Hangzhou, China
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Logger JGM, Liberton EHCJ, Vogels RJC, van der Wolk S. [A hard subcutaneous swelling: not always as malignant as it seems]. Ned Tijdschr Geneeskd 2024; 168:D7724. [PMID: 38470264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Nodular fasciitis is a rare, benign soft tissue tumor in young adults on the arms or trunk. CASE DESCRIPTION A 24-year-old woman with previous pretibial melanoma in situ presented with a painless, rapidly growing subcutaneous hard swelling on the right forearm since two weeks. Ultrasound showed a subcutaneous, irregularly shaped, vascularized mass, suspicious for malignancy. Three days later, the swelling had subsided spontaneously. A new ultrasound showed a smaller, oval, sharply demarcated lesion with an inflammatory aspect. Histopathological-immunohistochemical examination of a biopsy showed a spindle cell lesion consisting of (myo)fibroblasts with some erythrocyte extravasation, consistent with nodular fasciitis. Three months later the nodule was resolved spontaneously without treatment. CONCLUSION Nodular fasciitis should be included in the differential diagnosis in case of hard, fast-growing, subcutaneous bumps in young adults. By ultrasound, it is difficult to differentiate from a malignant soft tissue tumor. A biopsy is necessary to confirm the diagnosis with certainty.
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Farhat M, Soutou B. Case report: A case of resistant anti-SAE1 dermatomyositis with severe periorbital edema after hydroxychloroquine that responded to adalimumab. Int J Rheum Dis 2024; 27:e15125. [PMID: 38501604 DOI: 10.1111/1756-185x.15125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Maria Farhat
- Dermatology Department, Faculty of Medicine, Saint Joseph University, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Boutros Soutou
- Dermatology Department, Faculty of Medicine, Saint Joseph University, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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Mazurek-Durlak Z, Mularczyk K, Kwinta P, Lis G, Cichocka-Jarosz E. Omalizumab in the treatment of Morbihan syndrome in an adolescent girl - case report and literature review. Allergol Immunopathol (Madr) 2024; 52:23-31. [PMID: 38459887 DOI: 10.15586/aei.v52i2.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/15/2023] [Indexed: 03/11/2024]
Abstract
Morbihan syndrome (MS) is characterized by solid facial edema, usually related to rosacea or acne vulgaris. The facial edema deforms the patient's features, can impair peripheral vision, and affects quality of life. Its pathophysiology remains unclear. The disease usually has a slow and chronic course. MS most commonly affects middle-aged Caucasian men with rosacea and is rare in people below 20 years of age. MS is a diagnosis of exclusion. There is no standard treatment for MS, though systemic isotretinoin and antihistamines are mainly used. We present the case of an adolescent girl with MS nonresponding to 19 months of isotretinoin treatment with add-on antihistamines. Therapy with monthly administration of omalizumab (anti-IgE) for 6 months was an effective therapeutic option, improving the quality of life. Our case is the second description of omalizumab use in Morbihan syndrome, the first in an adolescent.
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Affiliation(s)
- Zofia Mazurek-Durlak
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland;
| | - Katarzyna Mularczyk
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland
| | - Przemko Kwinta
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland
| | - Grzegorz Lis
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland
| | - Ewa Cichocka-Jarosz
- Faculty of Medicine, Department of Pediatrics, Jagiellonian University Medical College, 265, Wielicka Str. 30-663 Krakow, Poland
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Tome J, Reichard KK, Wang XJ. Now You See Me: Acute and Recurrent Severe Abdominal Pain Associated With Bowel Edema. Gastroenterology 2024; 166:e10-e12. [PMID: 37926127 DOI: 10.1053/j.gastro.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Affiliation(s)
- June Tome
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Xiao Jing Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Warner EJ. Laser in Situ Keratomileusis Flap Free-Floating on Interface Edema in Acute Corneal Hydrops. JAMA Ophthalmol 2024; 142:e234806. [PMID: 38512159 DOI: 10.1001/jamaophthalmol.2023.4806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
This case report describes a patient with a history of laser in situ keratomileusis who presented with pain, photophobia, and blurred vision secondary to a corneal flap free-floating on interface edema in the setting of acute hydrops.
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Affiliation(s)
- Evan J Warner
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison
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Sinha P, Singh S. Sarcoidosis Presenting as Isolated Lower Eyelid Edema. Ophthalmic Plast Reconstr Surg 2024; 40:227-229. [PMID: 38427837 DOI: 10.1097/iop.0000000000002603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
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8
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Vignes S, Essig M. [Localized or generalized edema of the lower limbs]. Rev Prat 2024; 74:333-341. [PMID: 38551882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
| | - Marie Essig
- Service de néphrologie, hôpital Ambroise-Paré, Boulogne-Billancourt
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Jamali Z, Shafie'ei M, Soltani Nejad N. Neonatal pyocele originating from a urinary tract infection: a case report. J Med Case Rep 2024; 18:111. [PMID: 38414046 PMCID: PMC10900702 DOI: 10.1186/s13256-024-04416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The origins of pyocele are primarily idiopathic, with reports suggesting the spread from intraperitoneal or hematogenous infection. However, we found no information in the literature regarding the pathogen's spread from the urinary tract. CASE PRESENTATION We report here a case of a 23-day-old term Iranian boy (Fars ethnicity) with complaints of new-onset fever, irritability, poor feeding, right hemiscrotal erythema, and edema. Moreover, the physical examination revealed an enlarged, erythematous, tender right hemiscrotum and edematous scrotal walls. Along with leukocytosis and elevated C-reactive protein levels, the urine culture indicated an infection with Escherichia coli. However, as the color Doppler ultrasonographic examination was inconclusive, he underwent surgical exploration on which a hydrocele sac with reddish cloudy pus fluid was noted, with its culture indicating growth with the same mentioned pathogen. Therefore, an appropriate antibiotic regimen was administered, and the patient was discharged a few days later after achieving full recovery and demonstrating no urinary tract structural abnormalities. CONCLUSION In neonatal pyocele, the spectrum of evaluating the source of the infection should also be extended to the urinary tract. Moreover, administering suitable antibiotics would produce favorable results in cases with no structural abnormalities.
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Affiliation(s)
- Zahra Jamali
- Department of Pediatrics, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shafie'ei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Shirakashi M, Nishida Y, Nakashima R, Fujimoto M, Hiwa R, Tsuji H, Kitagori K, Akizuki S, Morinobu A, Yoshifuji H. TAFRO syndrome is associated with anti-SSA/Ro60 antibodies, in contrast to idiopathic castleman disease. Sci Rep 2024; 14:2889. [PMID: 38311632 PMCID: PMC10838910 DOI: 10.1038/s41598-024-53413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/31/2024] [Indexed: 02/06/2024] Open
Abstract
TAFRO syndrome is an acute systemic inflammatory disease characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, and organomegaly. There have been increasing reports that TAFRO is a disease distinct from idiopathic multicentric Castleman disease and that TAFRO patients may be positive for anti-SSA antibodies. To assess anti-SSA antibody positivity and the clinical characteristics of the two diseases, we retrospectively compared 7 TAFRO and 10 iMCD patients in our hospital. The mean age of onset of TAFRO and iMCD was 48.0 (interquartile range [IQR], 41-53) and 45.0 (IQR, 35-53) years, respectively. The TAFRO and iMCD groups had 6 (86%) and 4 (40%) male patients, respectively, and the following pretreatment laboratory values: platelet count, 3.8 (IQR, 2.2-6.4) and 35.5 (IQR, 22.2-42.8) × 104/μL, respectively; C-reactive protein, 10.2 (IQR, 6.8-21.4) and 9.5 (IQR, 6.2-13.6) mg/dL, respectively; IgG, 1431 (IQR, 1112-1815) and 4725 (IQR, 3755-5121) mg/dL, respectively. RNA immunoprecipitation (5 cases for anti-SSA) or protein array (5 cases for anti-SSA/Ro60) detected anti-SSA antibodies in six (86%) TAFRO patients but not in iMCD patients; it did not detect anti-SSB antibodies in any of the patients. None of the patients were diagnosed with Sjögren syndrome. All iMCD patients treated with tocilizumab (TCZ) responded well. Meanwhile, two of six TAFRO patients treated with TCZ showed inadequate responses; thus, both patients were switched to rituximab, following which they achieved remission. TAFRO and iMCD have different clinical features. TAFRO may be categorized as a severe phenotype of the anti-SSA antibody syndrome.
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Affiliation(s)
- Mirei Shirakashi
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuri Nishida
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Hiwa
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hideaki Tsuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koji Kitagori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuji Akizuki
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
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Meena A, Agrawal A, Parmar G, Gurnani B. Subconjunctival dexamethasone-assisted conjunctival autograft harvesting versus normal saline during pterygium surgery - A randomized clinical trial. Indian J Ophthalmol 2024; 72:217-222. [PMID: 38099381 PMCID: PMC10941926 DOI: 10.4103/ijo.ijo_969_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To evaluate the effect of subconjunctival dexamethasone compared to normal saline on conjunctival autograft harvesting in patients undergoing pterygium surgery. METHODS Fifty-two eyes of 52 patients who underwent pterygium excision combined with autologous conjunctival graft (CAG) using releasable suture were included in this prospective interventional study. The patients were randomized into two groups of 26 patients each. Group A consisted of patients in whom CAG was harvested using subconjunctival 0.5 ml of 0.4% dexamethasone sodium phosphate and in group B patients, normal saline was used. The patients were assessed for postoperative pain, foreign body sensation, and watering as the subjective signs of inflammation and conjunctival inflammation and lid edema as the objective signs of inflammation at 12 and 24 h postsurgery. RESULTS The mean age of group A and B patients was 47.69 + 13.09 and 46.00 + 10.76 years, respectively. The male:female ratio was 1.6:1 in group A and 1.1:1 in group B. The mean surgical time in group A was 243.96 ± 52.13 s and in group B was 258.08 ± 43.99 s. Postoperative pain, foreign body sensation, and watering were significantly lower in group A patients than in group B patients at both 12 and 24 h postoperatively (group A: 4.65 ± 1.33, 4.88 ± 1.73, and 3.85 ± 1.43, respectively, at 12 h; 1.89 ± 1.03, 1.69 ± 1.09, and 1.69 ± 0.97, respectively, at 24 h and group B: 6.42 ± 0.95, 6.65 ± 0.98, and 6.27 ± 1.40, respectively, at 12 h; 3.27 ± 1.43, 3.12 ± 1.25, 2.58 ± 1.14, respectively, at 24 h) ( P < 0.001). Conjunctival inflammation was significantly lower in group A at 12 h ( P < 0.05) and 24 h ( P < 0.05) after surgery compared to group B. Lid edema failed to show any significant ( P = 0.17) difference with respect to severity in both the groups at 12 and 24 h ( P = 0.699). CONCLUSION Subconjunctival dexamethasone decreased patient discomfort following pterygium surgery. The dexamethasone group had reduced conjunctival inflammatory signs without any notable complications.
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Affiliation(s)
- Ashok Meena
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Ashish Agrawal
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Gautam Parmar
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Bharat Gurnani
- Department of Cornea and Refractive Services, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
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Grøvle L, Haugen AJ, Johansen M, Hasvik E. The terminologies of transient, migratory, or localized osteoporosis, and bone marrow edema syndrome: a scoping review. Osteoporos Int 2024; 35:217-226. [PMID: 37814095 PMCID: PMC10837245 DOI: 10.1007/s00198-023-06929-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023]
Abstract
There is no formally defined terminology for the related entities transient osteoporosis of the hip (TOH), localized or regional migratory osteoporosis (RMO) and bone marrow edema syndrome (BMES). This study aimed to map the diversity and frequency of diagnostic terms and vocabulary utilized in the literature. A comprehensive search of electronic databases and reference lists was conducted. Publications that reported on patients with TOH, RMO, BMES, or related variants were eligible for inclusion. The terminologies were categorized based on the wording of the titles, abstracts, or texts. We included 561 publications, of which 423 were case reports, involving 2921 patients. Overall, TOH was the most commonly used term, occurring in 257 (45.8%). RMO was used in 34 (6.1%) and BMES in 57 (10.2%). The remaining used various combinations of transient, migratory, and regional in conjunction with either osteoporosis or bone marrow edema. Localized osteoporosis was not used. We identified three different terms related to pregnancy. In 76.3% of the publications, the terminology was related to osteoporosis and in 18.2% to bone marrow edema, although terminology did not correspond to actual findings. Bone marrow edema occurred as often as osteoporosis, and osteoporosis was generally ascertained by visual inspection of radiographs, seldom by bone densitometry. Many publications used osteoporosis-related terms without evidence that osteoporosis had been detected. The terminology of these closely related entities is confusing and unstandardized. The lack of formal definitions impedes accurate diagnosis, research on disease mechanisms, and effective treatment.
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Affiliation(s)
- Lars Grøvle
- Department of Rheumatology, Østfold Hospital Trust, Grålum, Norway.
| | | | | | - Eivind Hasvik
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
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Latimer SL, Bone M, Walker RM, Thalib L, Gillespie BM. Inter-device agreement of sacral subepidermal oedema measurement in healthy adults during prolonged 60° head of bed elevation. Nurs Open 2024; 11:e2103. [PMID: 38391104 PMCID: PMC10830921 DOI: 10.1002/nop2.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/13/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
AIM To investigate the level of agreement between the SEM 200 and Provisio® subepidermal moisture sacral delta measurements, which may indicate increased pressure injury risk, in healthy adults during 120 min of prolonged 60° head of bed elevation. This position, which requires the elevation of the patient's upper body at a 60° angle above the horizontal plane for an extended period, is used by clinicians to prevent or manage a patient's medical or surgical conditions. DESIGN This prospective exploratory study recruited 20 healthy adults during October 2021 and collected sacral subepidermal moisture delta measurements using the SEM 200 and Provisio® devices. METHODS Delta measurements were taken at 20-min intervals over 120 min resulting in seven data collection timepoints. Descriptive statistics and a Bland Altman plot analysis were conducted. RESULTS A total of 280 sacral subepidermal moisture delta measurements were gathered or 140 per device. There were good levels of agreement between the two devices at baseline (T0) [mean 0.025; SD 0.137] and following 60- (T3) [mean 0.025; SD 0.111], 80- (T4) [mean -0.01; SD 0.177] and 100 min (T5) [mean 0.01; SD 0.129] of prolonged 60° head of bed elevation. Head of bed elevations can increase a patient's risk of sacral pressure injuries. In some countries, nurses have access to the SEM 200 and/or the Provisio® device, so our findings may increase nurses' confidence in the interchangeability of the device measurements, although further research is needed to confirm this. The SEM 200 and Provisio® subepidermal moisture scanners show promise in gathering similar objective pressure injury risk data which could prompt clinicians to implement prevention strategies. IMPACT Current pressure injury risk assessment is largely subjective in nature. This quantitative study on healthy human sacral tissue found a good level of agreement in the SEM 200 and Provisio® subepidermal moisture scanners, which may increase nurses' confidence in the interchangeability of the devices in clinical practice.
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Affiliation(s)
- Sharon L. Latimer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wounds CareGriffith UniversitySouthportQueenslandAustralia
| | - Madeline Bone
- School of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia
| | - Rachel M. Walker
- School of Nursing and Midwifery, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wounds CareGriffith UniversityNathanQueenslandAustralia
- Metro South HealthBrisbaneQueenslandAustralia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of MedicineIstanbul Aydin UniversityIstanbulTurkey
| | - Brigid M. Gillespie
- School of Nursing and Midwifery, Menzies Health Institute Queensland, NHMRC Centre of Research Excellence in Wiser Wounds CareGriffith UniversitySouthportQueenslandAustralia
- Gold Coast Hospital and Health ServiceSouthportQueenslandAustralia
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Jayaraj D, Ramdas V, Al-Balushi AA, Al Asiry S, Al Yahmadi M, Malviya MN. A 3-day-old Neonate with Generalized Edema and a Bullous Rash. Neoreviews 2024; 25:e122-e126. [PMID: 38296793 DOI: 10.1542/neo.25-2-e122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
| | - Vidya Ramdas
- Department of Pediatrics, Khoula Hospital, Muscat, Oman
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Aday AW, Donahue PMC, Garza M, Crain VN, Patel NJ, Beasley JA, Herbst KL, Beckman JA, Taylor SL, Pridmore M, Chen SC, Donahue MJ, Crescenzi R. National survey of patient symptoms and therapies among 707 women with a lipedema phenotype in the United States. Vasc Med 2024; 29:36-41. [PMID: 37844030 PMCID: PMC10858625 DOI: 10.1177/1358863x231202769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND National survey data exploring the patient experience with lipedema are lacking. METHODS We conducted national surveys from 2016 to 2022 of women with lipedema as well as female controls. Surveys collected information on symptomatology, pain, and therapies. We performed logistic regression comparing symptoms among those with lipedema versus controls adjusting for age and BMI. RESULTS A total of 707 women with lipedema and 216 controls completed the surveys. Those with lipedema had a mean age of 48.6 years and mean BMI of 40.9 kg/m2. Lipedema symptom onset occurred frequently at puberty (48.0%) or pregnancy (41.2%). Compared to controls, women with lipedema were more likely to report leg swelling in heat (odds ratio [OR], 66.82; 95% CI, 33.04-135.12; p < 0.0001), easy bruising (OR, 26.23; 95% CI, 15.58-44.17; p < 0.0001), altered gait (OR, 15.54; 95% CI, 7.58-31.96; p < 0.0001), flu-like symptoms (OR, 12.99; 95% CI, 4.27-39.49; p < 0.0001), joint hypermobility (OR, 12.88; 95% CI, 6.68-24.81; p < 0.0001), cool skin (OR, 12.21; 95% CI, 5.20-28.69; p < 0.0001), varicose veins (OR, 11.29; 95% CI, 6.71-18.99; p < 0.0001), and fatigue (OR, 9.59; 95% CI, 6.10-15.09; p < 0.0001). Additionally, 70.3% had upper arm involvement, 21.2% reported foot swelling, and 16.6% reported foot pain. Most (52.2%) reported no symptom improvement with diet or exercise. Common therapies used included compression therapy (45.0%), gastric bypass (15.7%), and lower-extremity liposuction (14.0%). CONCLUSION In a large, national, symptom survey, women with lipedema reported excess pain, swelling, and fat in the legs along with numerous symptoms beyond those classically described. Symptom responses to common therapies remain understudied.
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Affiliation(s)
- Aaron W Aday
- Division of Cardiovascular Medicine, Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paula MC Donahue
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
- Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Maria Garza
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vanessa N Crain
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J Patel
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John A Beasley
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen L Herbst
- Total Lipedema Care, Beverly Hills, CA and Tucson, AZ, USA
| | - Joshua A Beckman
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shannon L Taylor
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Pridmore
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rachelle Crescenzi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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16
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Sato R, Sawaya Y, Ishizaka M, Yin L, Shiba T, Hirose T, Urano T. Neck circumference is a highly reliable anthropometric measure in older adults requiring long-term care. PeerJ 2024; 12:e16816. [PMID: 38313007 PMCID: PMC10838066 DOI: 10.7717/peerj.16816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
The reliability of neck circumference measurement as an assessment tool for older adults requiring long-term care remains unknown. This study aimed to evaluate the reliability of neck circumference measurement in older adults requiring long-term care, and the effect of edema on measurement error. Two physical therapists measured the neck circumference. Intraclass correlation coefficient (ICC) and Bland-Altman analyses were performed to examine the reliability of neck circumference measurement. Correlation analysis was used to evaluate the relationship between edema values (extracellular water/total body water) and neck circumference measurement difference. For inter-rater reliability of neck circumference measurement, the overall ICC (2,1) was 0.98. The upper and lower limits of the difference between examiners ranged from -0.9 to 1.2 cm. There was no association between edema values and neck circumference measurement error. Thus, measurement of the neck circumference in older adults requiring long-term care is a reliable assessment tool, with a low error rate, even in older adults with edema.
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Affiliation(s)
- Ryo Sato
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
| | - Yohei Sawaya
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Masahiro Ishizaka
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Lu Yin
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
| | - Takahiro Shiba
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
| | - Tamaki Hirose
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Tomohiko Urano
- Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en", Nishinasuno General Home Care Center, Nasushiobara, Tochigi, Japan
- Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
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17
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Herlihy M, Duff E, Sadlier M. Olanzapine-induced progressive facial oedema mimicking Morbihan disease. Clin Exp Dermatol 2024; 49:197-199. [PMID: 37935056 DOI: 10.1093/ced/llad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
We present the case of a 55-year-old man with a 20-year history of olanzapine-induced progressive solid facial oedema mimicking Morbihan disease. Olanzapine was not initially considered as the cause of his facial oedema as he had been on treatment for years prior to disease onset. This case reminds us to do a thorough drug review to rule out an iatrogenic cause before making a diagnosis of Morbihan disease.
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Affiliation(s)
- Maeve Herlihy
- Dermatology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Eimaer Duff
- Dermatology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Muriel Sadlier
- Dermatology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
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18
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McGonagle D, Ramonda R, Scagnellato L, Scriffignano S, Weddell J, Lubrano E. A strategy towards disentangling treatment refractory from misdiagnosed axial Spondyloarthritis. Autoimmun Rev 2024; 23:103405. [PMID: 37543288 DOI: 10.1016/j.autrev.2023.103405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
Axial spondyloarthritis (axSpA) encompasses radiographic axial SpA (r-axSpA), formally designated as ankylosing spondylitis (AS) and non-radiographic axial SpA (nr-axSpA). The advent of MRI permitted the description of the "pre-radiographic" (nr-AxSpA) stage characterized by bone marrow oedema lesions, histologically an osteitis, not yet visible on X-rays. Most subjects with a diagnosis of nr-axSpA do not progress to r-axSpA and the risk of misdiagnosis of nr-axSpA is considerable because back pain related to malalignment, degenerative conditions or biomechanical stress including intense exercise may lead to positive MRI scans. Even when nr-axSpA or r-axSpA are accurately diagnosed only about 40-50% achieve the ASAS40 responses with licensed therapies. It is likely that spinal enthesitis/osteitis leading to structural damage and associated damage contributes to post inflammatory disc territory secondary pain responses. Things are complicated as the concept of refractory axSpA itself is not well defined since there is no gold standard test to capture the full burden of inflammatory disease and, in any event, MRI has not been systematically applied. Nevertheless, there is sufficient evidence to borrow from the refractory rheumatoid arthritis field to propose two types of refractory axial SpA- a persistent inflammatory refractory ax-SpA (PIRaxSpA) and non-inflammatory refractory ax-SpA (NIRaxSpA). Both axSpA refractoriness and misdiagnosis need careful considerations when evaluating treatment failure. The immunological basis for axSpA immunotherapeutics non-responses is still rudimentary beyond the knowledge of HLA-B27 positivity status, CRP elevation, and MRI bone oedema that represents osteitis being equated with responder status.
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Affiliation(s)
- Dennis McGonagle
- University of Leeds, Leeds Institute of Rheumatic and Musculosckeletal Medicine, Leeds, United Kingdom.
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy.
| | - Laura Scagnellato
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Silvia Scriffignano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy; Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven University, Leuven, Belgium
| | - Jake Weddell
- University of Leeds, Leeds Institute of Rheumatic and Musculosckeletal Medicine, Leeds, United Kingdom
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy; Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven University, Leuven, Belgium
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19
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Chiaradia F, Lorthioir F, Bertrand X. [Cockett's syndrome, a rare differential diagnosis of unilateral inferior member oedema]. Rev Med Liege 2024; 79:4-5. [PMID: 38223962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
We present here a typical picture of May-Thurner syndrome, rare but treatable etiology with specific treatment, of unilateral leg oedema and thromboembolic disease of the young woman.
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20
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Podzimek J, Jecker P, Koscielny S. [Painful swelling on the forehead in childhood]. HNO 2024; 72:51-53. [PMID: 37592095 DOI: 10.1007/s00106-023-01347-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/19/2023]
Affiliation(s)
- J Podzimek
- Klinik für HNO und plastische Kopf-Halschirurgie, Klinikum Bad Salzungen, Lindigallee 3, 36433, Bad Salzungen, Deutschland.
| | - P Jecker
- Klinik für HNO und plastische Kopf-Halschirurgie, Klinikum Bad Salzungen, Lindigallee 3, 36433, Bad Salzungen, Deutschland
| | - S Koscielny
- Klinik für HNO und plastische Kopf-Halschirurgie, Universitätsklinikum Jena, Jena, Deutschland
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21
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Dai Y, Yuan W, Chen Y, Lan Q, Qin F, Ding H, Zhang H, Lei Y, Long L. Value of Magnetic Resonance T1 Mapping in Evaluating the Early Response to Treatment for Rheumatoid Arthritis. Curr Med Imaging 2024; 20:1-9. [PMID: 38389340 DOI: 10.2174/0115734056252909230925060431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/22/2023] [Accepted: 08/25/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) is usually used for the semi-quantitative evaluation of joint changes in Rheumatoid Arthritis (RA). However, this method cannot evaluate early changes in bone marrow edema (BME). OBJECTIVE To determine whether T1 mapping of wrist BME predicts early treatment response in RA. METHODS This study prospectively enrolled 48 RA patients administered oral anti-rheumatic drugs. MRI of the most severely affected wrist was performed before and after 4 (48 patients) and 8 weeks of treatment (38 patients). Mean T1 values of BME in the lunate, triangular, and capitate bones; RAMRIS for each wrist; Erythrocyte-Sedimentation Rate (ESR); and 28-joint Disease Activity Score (DAS28)-ESR score were analyzed. Patients were divided into responders (4 weeks, 30 patients; 8 weeks, 32 patients) and non-responders (4 weeks, 18 patients; 8 weeks, 6 patients), according to EULAR response criteria. Receiver operating characteristic (ROC) curves were used to evaluate the efficacy of T1 values. RESULTS ESR and DAS28-ESR were not correlated with T1 value and RAMRIS at each examination (P > 0.05). Changes in T1 value and DAS28-ESR relative to the baseline were moderately positively correlated with each other at 4 and 8 weeks (r = 0.555 and 0.527, respectively; P < 0.05). At 4 weeks, the change and rate of change in T1 value significantly differed between responders and non-responders (-85.63 vs. -19.92 ms; -12.89% vs. -2.81%; P < 0.05). The optimal threshold of the rate of change in T1 value at 4 weeks for predicting treatment response was -5.32% (area under the ROC curve, 0.833; sensitivity, 0.900; specificity, 0.667). CONCLUSION T1 mapping provides a new imaging method for monitoring RA lesions; changes in wrist BME T1 values reflect early treatment response.
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Affiliation(s)
- Yi Dai
- Department of Radiology, The Second Affiliated Hospital of Guangxi Medical University, No. 166 Daxuedong Road, Nanning, Guangxi - 530007, China
| | - Wenzhao Yuan
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Yidi Chen
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
- Department of Radiology, West China Hospital, Sichuan University, No.37 Guoxue Road, Chengdu-610041, China
| | - Qiaoqing Lan
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Fang Qin
- Department of Rheumatology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Hao Ding
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthineers Ltd., No.99 Zhongnan Road, Wuhan, Hubei-430071, China
| | - Yiwu Lei
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi - 530021, China
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22
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Taguchi H, Shirota S, Sumitomo S, Hara S, Ohmura K, Nishioka H. Immunoglobulin-A vasculitis manifesting as edema in the scalp, face, and sternocleidomastoid muscle. Int J Rheum Dis 2024; 27:e14950. [PMID: 37875280 DOI: 10.1111/1756-185x.14950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Hirokazu Taguchi
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Rheumatology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shogo Shirota
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shuji Sumitomo
- Department of Rheumatology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shigeo Hara
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koichiro Ohmura
- Department of Rheumatology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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23
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Plemel DJA, Weis E, Punja KG, Ashenhurst ME, Mai DD, Kulaga A. Primary Periocular Orofacial Granulomatosis: Case Series and Systematic Review. Ophthalmic Plast Reconstr Surg 2024; 40:11-17. [PMID: 37486339 DOI: 10.1097/iop.0000000000002478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
PURPOSE There is no known optimal treatment for primary periocular orofacial granulomatosis (PPOFG), a disorder that results in periocular edema. This case series and systematic review identifies management strategies and their reported improvement. METHODS Systematic review and case series. PubMed and MEDLINE databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify published cases of PPOFG. Cases were included when edema involved the periocular tissues and when a biopsy was interpreted to be PPOFG. Cases were excluded when edema did not involve the periocular tissues or when the edema was secondary to another process. The electronic medical records of the pathology department were studied to identify cases that were in keeping with PPOFG. The clinical charts were examined to confirm the diagnosis and provide a local case series. RESULTS There are 38 published cases of PPOFG. An additional 9 cases were identified locally. These cases were combined and analyzed. Most PPOFG has eyelid swelling in isolation, without other facial swelling (36/47; 76.6%). It is most commonly a bilateral disease (30/47; 63.8%). Fissured tongue and facial nerve palsy occur, just as they do in other cases of orofacial granulomatosis. Treatment with surgical debulking or intralesional steroids resulted in high rates of symptomatic improvement of eyelid swelling, but recurrences were common. CONCLUSIONS In light of no curative or highly successful treatment currently available, intralesional steroids and/or surgical debulking are therapies in the treatment of eyelid swelling associated with PPOFG that demonstrate reasonable short- and medium-term results. There is no established therapy that can offer disease remission or long-term symptom improvement.
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Affiliation(s)
- David J A Plemel
- Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary
| | - Ezekiel Weis
- Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary
- Department of Ophthalmology and Visual Sciences, University of Alberta, Alberta
| | - Karim G Punja
- Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary
| | | | - Derek D Mai
- Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary
| | - Andrzej Kulaga
- Department of Laboratory Medicine and Pathology, University of Calgary, Calgary, Canada
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24
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Coble K, Provost A. Facial Swelling in a Young Traveler. Am Fam Physician 2023; 108:621-622. [PMID: 38215425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
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25
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Leung BW, Fay CJ, Said JT, Sheets AR, Lian CG, Brown JR, Castillo JJ, Sarosiek S, Flynn C, LeBoeuf NR. Localized upper extremity edema secondary to Bruton's tyrosine kinase inhibition. Leuk Lymphoma 2023; 64:2047-2050. [PMID: 37671695 DOI: 10.1080/10428194.2023.2245091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Bonnie W Leung
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christopher J Fay
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jordan T Said
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anthony R Sheets
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer R Brown
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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26
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West BA, Hoesly PM, LeBoit PE, Homer NA. Cutaneous angiosarcoma presenting as bilateral periorbital edema. Orbit 2023; 42:621-623. [PMID: 35467482 DOI: 10.1080/01676830.2022.2056901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
A 66-year-old man presented with chronic bilateral periorbital edema with associated yellowish hue, scattered violaceous smooth macules and contracture of the forehead. He had undergone dental surgery 3 months prior to symptom onset. Laboratory workup for common causes of eyelid edema was unremarkable and MRI of the orbits was unrevealing. The patient did not respond to oral corticosteroids or antibiotics. Punch biopsies were obtained which revealed atypical lymphatic endothelial cells consistent with a diagnosis of cutaneous angiosarcoma.The patient was deemed not to be a surgical candidate and underwent 3 cycles of immunotherapy with limited response. He declined further treatment and transitioned to hospice care. Although cutaneous angiosarcoma uncommonly involves the periorbital region, it should be considered in the differential diagnosis of eyelid edema as early recognition and treatment are critical to prevent rapid intradermal spread and metastases.
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Affiliation(s)
- Benjamin A West
- Department of Ophthalmology, University of California at Davis, Sacramento, California, USA
| | - Paul M Hoesly
- Department of Dermatology, University of California at Davis, Sacramento, California, USA
| | - Philip E LeBoit
- Department of Dermatology, Division of Dermatopathology, University of California at San Francisco, San Francisco, California, USA
| | - Natalie A Homer
- Department of Ophthalmology, University of California at Davis, Sacramento, California, USA
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27
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Godron J, de Lambilly C, Cournac JM, Valois A, Tuan Nguyen A, Michoud G, Samy J, Cazes N, Comat G. [Edema of limbs indicative of leprosy]. Rev Prat 2023; 73:988-990. [PMID: 38294453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Jean Godron
- Hôpital d'instruction des armées Sainte-Anne, Toulon, France
| | | | - Jean-Marie Cournac
- Service de médecine interne, hôpital d'instruction des armées Percy, Clamart, France
| | - Aude Valois
- Service de dermatologie, centre hospitalier de Cayenne, Guyane, France
| | - Anh Tuan Nguyen
- Service d'anato - mopathologie, hôpital d'instruction des armées Bégin, Saint-Mandé, France
| | | | - Julien Samy
- 138e antenne médicale, camp Raffalli, Calvi, France
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28
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Zhang W, Du G, Li R, Zheng S, Hu S, Lin J, Wang Y. The culprit behind pitting edema. Int J Rheum Dis 2023; 26:2320-2322. [PMID: 37358294 DOI: 10.1111/1756-185x.14804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Weijin Zhang
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, China
| | - Guangzhou Du
- Department of Radiology, Shantou Central Hospital, Shantou, China
| | - Ruixiong Li
- Department of Cardiothoracic Surgery, Shantou Central Hospital, Shantou, China
| | - Shaoyu Zheng
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, China
| | - Shijian Hu
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, China
| | - Jianqun Lin
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, China
| | - Yukai Wang
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, China
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Brunetti G, Patton D, Moore Z, Palomeque-Chavez JC, O'Brien FJ, Boyle CJ. Validation of a sub-epidermal moisture scanner for early detection of pressure ulcers in an ex vivo porcine model of localized oedema. J Tissue Viability 2023; 32:508-515. [PMID: 37442720 DOI: 10.1016/j.jtv.2023.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Pressure ulcers (PUs) remain a chronic health problem with severe impacts on healthcare systems. Early detection is crucial to providing effective interventions. However, detecting PUs currently relies on subjective tissue evaluations, such as visual skin assessment, precluding interventions prior to the development of visible tissue damage. There is an unmet need for solutions that can detect early tissue damage before visual and tactile signs occur. Assessments based on sub-epidermal moisture (SEM) measurements represent an opportunity for robust and objective early detection of PUs, preventing broken skin PUs in more high-risk patients at high-risk anatomical locations. While SEM assessment technology has been validated in computational, bench and tissue phantom models, validation in soft tissue was absent. In this study, we successfully validated the ability of a commercially available SEM assessment device to measure and detect sub-epidermal moisture changes in a novel ex vivo porcine soft tissue model of localised oedema. When controlled and incremental fluid volumes (Phosphate Buffer Solution) were injected into porcine soft tissues, statistically significant differences were found in SEM values between fluid-injected sites, representing an inflammatory oedematous condition, and healthy tissue control sites, as measured by the SEM device. The device provided reproducible readings by detecting localised oedema changes in soft tissues, reflecting the build-up of fluid as small as 1 ml into the underlying tissue. Spatial characterization experiments described the ability of the device technology to differentiate between healthy and oedematous tissue. Our findings validate the use of SEM assessment technology to measure and quantify localized oedema.
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Affiliation(s)
- G Brunetti
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland.
| | - D Patton
- Skin Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
| | - Z Moore
- Skin Wounds and Trauma Research Centre, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
| | - J C Palomeque-Chavez
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
| | - F J O'Brien
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
| | - C J Boyle
- Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St Stephen's Green, Dublin 2, Ireland
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Gibson TM. Fluctuant labial swelling and Wrinkled labial lesion. Gen Dent 2023; 71:78-80. [PMID: 37889249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
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Oehring R, Farke S. [Unclear groin pain and swelling in woman]. Chirurgie (Heidelb) 2023; 94:948-950. [PMID: 37615713 DOI: 10.1007/s00104-023-01941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Robert Oehring
- Klinik für Allgemein- und Viszeralchirurgie, minimal-invasive Chirurgie und Koloproktologie, St. Marienkrankenhaus Berlin, Berlin, Deutschland.
- Klinik für Chirurgie, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, Berlin, Deutschland.
- Allgemein- und Viszeralchirurgie, Städtisches Klinikum Braunschweig GmbH, Salzdahlumer Straße 90, 38126, Braunschweig, Deutschland.
| | - Stefan Farke
- Klinik für Allgemein- und Viszeralchirurgie, minimal-invasive Chirurgie und Koloproktologie, St. Marienkrankenhaus Berlin, Berlin, Deutschland
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Yu H, Chen M, Huang Y, Wang P, Li J, Li Q, Jiang R. Differential Diagnosis of Intracranial Malignant Tumors Using MRI Based on Morphological Features and Signal Intensity Ratio of Lesions. Altern Ther Health Med 2023; 29:816-821. [PMID: 37773646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Objective To investigate the clinical value of conventional MRI morphological features and signal intensity ratio in the differential diagnosis of intracranial malignant tumors (high-grade glioma (HGG), primary central nervous system Lymphoma (PCNSL) and single brain metastasis (BM). Methods Retrospective analysis of 92 cases of HGG, 27 cases of PCNSL, and 35 cases of BM. MRI data in The General Hospital of Western Theater Command from August 2014 to December 2021, comparative analysis of morphological characteristics of tumors and lesion/normal brain parenchyma signal ratio (lesiontonormal parenchymaratio, LNR), five indexes were included T1WI signal ratio (LNRT1), T2WI signal intensity ratio (LNRT2), T2WI/T1WI signal ratio (LNRT2/T1), T1WI enhanced signal ratio (LNRT1CE) and contrast enhancement ratio (CER). The differential diagnostic performance was also assessed by subject operating characteristic (ROC) curves. Results HGG, PCNSL, and BM were all seen more frequently in the supratentorial region, More than 50% of HGG mainly showed irregular morphology, intratumoral necrosis, cystic degeneration, peritumoral severe edema, cyclic uneven enhancement after enhancement, PCNSL significantly enhanced the main uniformity, necrosis cyst became rare, BM group showed uneven enhancement, no obvious specificity, and the differences in tumor morphology, peritumor edema, intratumor hemorrhage, necrotic cystic lesions, and enhancement patterns were statistically significant among the three (P < .05). PCNSL LNRT1 and its LNRT1CE (LNRT1: 0.558 ± 0.050, LNRT1CE: 1.637 ± 0.125) were significantly higher than those of HGG (LNRT1: 0.480 ± 0.077, LNRT1CE: 1.425 ± 0.160) and BM (LNRT1: 0.514 ± 0.120, LNRT1CE: 1.375 ± 0.122), while LNRT2 and LNRT2/T1 (LNRT2: 1.389 ± 0.086, LNRT2/T1: 2.511 ± 0.295) were significantly lower than those of HGG (LNRT2: 1.527 ± 0.191, LNRT2/T1: 3.263 ± 0.657), and BM (LNRT2: 1.504 ± 0.089, LNRT2/T1: 3.103 ± 0.830). There was no significant difference in CER among the three groups (P > .05). ROC curve analysis of LNRT1, LNRT2, LNRT1CE, and LNRT2/T1 could be used to discriminate PCNSL from HGG and BM, with LNRT1CE having the largest area under the curve of 0.873, sensitivity of 0.963 and specificity of 0.669. Conclusion MRI lesion morphological features and signal intensity ratio are important for discriminating HGG from PCNSL and BM. As a quantitative parameter, tumor signal intensity ratio can provide an important supplement for subjective judgment, to improve the accuracy of tumor qualitative diagnosis and differential diagnosis.
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Di Martino A, Brunello M, Villari E, Cataldi P, D'Agostino C, Faldini C. Bone marrow edema of the hip: a narrative review. Arch Orthop Trauma Surg 2023; 143:6901-6917. [PMID: 37378892 DOI: 10.1007/s00402-023-04961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
Bone marrow edema (BME) of the hip is a radiological-clinical condition with symptoms ranging from asymptomatic to severe, and it is characterized by increased interstitial fluid within the bone marrow, usually at the femur. Depending on the etiology it can be classified as primary or secondary. The primary cause of BME is unknown, while the secondary forms include traumatic, degenerative, inflammatory, vascular, infectious, metabolic, iatrogenic, and neoplastic etiologies. BME could be classified as reversible or progressive. Reversible forms include transient BME syndrome and regional migratory BME syndrome. Progressive forms include avascular necrosis of the femoral head (AVNH), subchondral insufficiency fracture, and hip degenerative arthritis. The diagnosis can be difficult, because at the beginning, the outbreak of hip pain, typically acute and disabling without any prior trauma or exceptional physical activity, is poorly supported by radiographic findings. MRI is the gold standard, and it shows an area of intermediate signal on T1-weighted MRI scans and a high signal on T2-weighted scans, usually lacking sharps margins. In the reversible form, BME is typically self-limiting, and it can be managed conservatively by means of pharmacological and physical therapy. Surgery is generally required for progressive forms in patients who failed non-operative treatment, and it ranges from femoral head and neck core decompression to total hip arthroplasty.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy.
| | - Matteo Brunello
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Eleonora Villari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Piergiorgio Cataldi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Claudio D'Agostino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Sato H, Kanno A, Sato M, Endo A, Ito H, Ohara T, Shirota Y, Sumitomo K, Mori T, Furukawa K. Case Report: A case of TAFRO syndrome with severe and prolonged thrombocytopenia: diagnostic pitfalls. Front Immunol 2023; 14:1266187. [PMID: 37901232 PMCID: PMC10611515 DOI: 10.3389/fimmu.2023.1266187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome is a rare condition with diverse clinical and pathological characteristics related to multi-organ damage. We report a case of TAFRO syndrome complicated by immune thrombocytopenia with prolonged fever and thrombocytopenia for several weeks. A 61-year-old man was transferred with sepsis caused by Enterococcus faecalis, and developed disseminated intravascular coagulation. Antibiotics treatment was initiated: however, low-grade fever and thrombocytopenia persisted despite the adequate antimicrobial treatment. Systemic edema, pleural effusion, and ascites had developed before hospitalization, and renal and liver function had deteriorated, resulting in progressive multi-organ damage. Prednisolone 40 mg/day was initiated based on the assumption of a condition in which excessive production of inflammatory cytokines would lead to systemic deterioration and fatal organ damage. Subsequently, the fever resolved, and renal function began to normalize. However, thrombocytopenia did not show much recovery trend after Helicobacter pylori eradication therapy and initiation of thrombopoietin receptor agonists. Bone marrow biopsy results showed normal bone marrow with no malignant findings. Alternatively, significant clinical signs met the diagnostic criteria for TAFRO syndrome, and a renal biopsy revealed thrombotic microangiopathy, which is also reasonable for renal involvement in TAFRO syndrome. The use of cyclosporine remarkably corrected the thrombocytopenia. We considered this a case of TAFRO syndrome that developed after sepsis with disseminated intravascular coagulation and performed the differential diagnosis of prolonged thrombocytopenia and excluded it. Although TAFRO syndrome is a unique disease concept, diagnostic criteria may consist of nonspecific elements such as generalized edema, thrombocytopenia, persistent fever, and elevated inflammatory response, and there are many differential conditions to exclude, requiring caution in diagnosing TAFRO syndrome.
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Affiliation(s)
- Hironori Sato
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Atsuhiro Kanno
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Minato Sato
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Akari Endo
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroki Ito
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takahiro Ohara
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yuko Shirota
- Division of Hematology and Rheumatology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kazuhiro Sumitomo
- Department of Community and General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Takefumi Mori
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Katsutoshi Furukawa
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Sha Z, Song Y, Wu Y, Sha P, Ye C, Fan G, Gao S, Yu R. The value of texture analysis in peritumoral edema of differentiating diagnosis between glioblastoma and primary brain lymphoma. Br J Neurosurg 2023; 37:1074-1077. [PMID: 33307833 DOI: 10.1080/02688697.2020.1856783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the value of texture analysis of routine MRI image in peritumoral edema of differentiating diagnosis between glioblastoma (GBM) and primary brain lymphoma (PBL). METHODS The MRI imaging data of 22 patients with glioblastoma and 21 patients with PBL who were hospitalized in our hospital from January 2010 to October 2018 were selected. All the patients were pathologically diagnosed as glioblastoma or PBL, and MRI plain scan and enhanced examination were performed before operation. FireVoxel software was used to delineate the region of interest (ROI) on the most obvious level of peritumoral edema based on T1WI enhancement. Texture parameters were extracted and compared between glioblastoma and PBL. RESULTS In the glioblastoma group, the inhomogeneity, kurtosis and entropy texture parameters were statistically different from those in the PBL group. The entropy parameter area under the curve (AUC) (0.903) was significantly better than the kurtosis parameter AUC (0.859) and the inhomogeneity parameter AUC (0.729). When the entropy parameter Cut-off point = 3.883, the sensitivity, specificity and accuracy of glioblastoma and PBL were 85.7, 86.4 and 86.0%, respectively, by differential diagnosis. CONCLUSION Texture analysis of tumor peritumoral edema provided quantifiable information, which might be a new method for differentiating glioblastoma from PBL.
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Affiliation(s)
- Zhuang Sha
- Institute of Nervous System Diseases, Xuzhou Medical University, Xuzhou, China
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yunnong Song
- Institute of Nervous System Diseases, Xuzhou Medical University, Xuzhou, China
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yihao Wu
- Institute of Nervous System Diseases, Xuzhou Medical University, Xuzhou, China
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Pei Sha
- Department of Orthopedic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chengkun Ye
- Institute of Nervous System Diseases, Xuzhou Medical University, Xuzhou, China
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Guangwei Fan
- Institute of Nervous System Diseases, Xuzhou Medical University, Xuzhou, China
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shangfeng Gao
- Institute of Nervous System Diseases, Xuzhou Medical University, Xuzhou, China
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Rutong Yu
- Institute of Nervous System Diseases, Xuzhou Medical University, Xuzhou, China
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Migliorini F, Vecchio G, Weber CD, Kämmer D, Bell A, Maffulli N. Management of transient bone osteoporosis: a systematic review. Br Med Bull 2023; 147:79-89. [PMID: 37328938 PMCID: PMC10788841 DOI: 10.1093/bmb/ldad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Transient bone osteoporosis (TBO) is characterized by persistent pain, loss of function, no history of trauma and magnetic resonance image (MRI) findings of bone marrow edema. SOURCE OF DATA PubMed, Google scholar, EMABSE and Web of Science were accessed in February 2023. No time constrains were used for the search. AREAS OF AGREEMENT TBO is rare and misunderstood, typically affecting women during the third trimester of pregnancy or middle-aged men, leading to functional disability for 4-8 weeks followed by self-resolution of the symptoms. AREAS OF CONTROVERSY Given the limited evidence in the current literature, consensus on optimal management is lacking. GROWING POINTS This systematic review investigates current management of TBO. AREAS TIMELY FOR DEVELOPING RESEARCH A conservative approach leads to the resolution of symptoms and MRI findings at midterm follow-up. Administration of bisphosphonates might alleviate pain and accelerate both clinical and imaging recovery.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy
| | - Christian David Weber
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074 Aachen, Germany
| | - Daniel Kämmer
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152 Simmerath, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152 Simmerath, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB Stoke on Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mar y University of London, 275 Bancroft Road, London E1 4DG, UK
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Biswas S, Gomez J, Horgan R, Sibai BM, Saad A, Powel JE, Al-Kouatly HB. Mirror syndrome: a systematic literature review. Am J Obstet Gynecol MFM 2023; 5:101067. [PMID: 37385374 DOI: 10.1016/j.ajogmf.2023.101067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE This study aimed to review the diagnostic criteria for mirror syndrome and describe its clinical presentation. DATA SOURCES Databases from PubMed, Scopus, Cochrane Library, ClinicalTrials.gov, and CINAHL were inquired for case series containing ≥2 cases of mirror syndrome from inception to February 2022. STUDY ELIGIBILITY CRITERIA Studies were included if they reported ≥2 cases of mirror syndrome and included case reports, case series, cohort studies, and case-control studies. STUDY APPRAISAL AND SYNTHESIS METHODS The studies' quality and risk of bias were independently assessed. Data were tabulated using Microsoft Excel and summarized using narrative review and descriptive statistics. This systematic review was conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement. All eligible references were assessed. Screening of records and data extraction were independently performed, and a third author resolved disagreements. RESULTS Of 13 citations, 12 studies (n=82) reported diagnostic criteria for mirror syndrome: maternal edema (11/12), fetal hydrops (9/12), placental edema (6/12), placentomegaly (5/12), and preeclampsia (2/12); 12 studies (n=82) described the clinical presentation of mirror syndrome as maternal edema (62.2%), hypoalbuminemia (54.9%), anemia (39.0%), and new-onset hypertension (39.0%); 4 studies (n=36) reported that hemodilution was present in all patients; 8 studies (n=36) reported the etiology of fetal hydrops, with the most common being structural cardiac malformations (19.4%), alpha thalassemia (19.4%), Rh isoimmunization (13.9%), and nonimmune hydrops fetalis (13.9%); and 6 studies (n=47) reported maternal complications, 89.4% of which were major: postpartum hemorrhage (44.7%), hemorrhage requiring blood transfusion (19.1%), intensive care unit admission (12.8%), heart failure (10.6%), pulmonary edema (8.5%), and renal dysfunction (8.5%). In 39 cases, the reported fetal outcomes were stillbirth (66.6%) and neonatal or infant death (25.6%). The overall survival rate among continued pregnancies was 7.7%. CONCLUSION The diagnostic criteria of mirror syndrome differed considerably among studies. Mirror syndrome clinical presentation overlapped with preeclampsia. Only 4 studies discussed hemodilution. Significant maternal morbidity and fetal mortality were associated with mirror syndrome. Further research is warranted to elucidate the pathogenesis of mirror syndrome to better guide clinicians in identifying and managing the condition.
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Affiliation(s)
- Sonia Biswas
- Department of Obstetrics and Gynecology, Monmouth Medical Center, Long Branch, NJ (Dr Biswas)
| | - Julie Gomez
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (Dr Gomez)
| | - Rebecca Horgan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Dr Horgan)
| | - Baha M Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX (Dr Sibai)
| | - Antonio Saad
- Department of Obstetrics and Anesthesia, The University of Texas Medical Branch, Galveston, TX (Dr Saad)
| | - Jennifer E Powel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ (Dr Powel)
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (Dr Al-Kouatly).
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Dosemane D, Khadilkar MN, Sriperumbudur S, Aggarwal I. Unusual cause of unilateral facial oedema: intramuscular dirofilariasis. Eur Arch Otorhinolaryngol 2023; 280:4291-4293. [PMID: 37310453 PMCID: PMC10382336 DOI: 10.1007/s00405-023-08057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Unilateral facial oedema may occur due to inflammatory, infective, or cystic pathology; patients often seek medical help at an early stage. CASE REPORT We report one such case caused mimicking a parotid abscess, caused by dirofilariasis. CONCLUSION Dirofilariasis is an emerging zoonosis and should be considered a differential diagnosis of atypical facial swelling. It is equally important for clinicians, radiologists, and pathologists to be familiar with the diagnostic characteristics to avoid misdiagnosis.
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Affiliation(s)
- Deviprasad Dosemane
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001, India
| | - Meera Niranjan Khadilkar
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001, India.
| | - Susmita Sriperumbudur
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001, India
| | - Ishaan Aggarwal
- Department of Otorhinolaryngology and Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001, India
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Tane M, Kosako H, Hosoi H, Tabata K, Hiroi T, Osawa K, Iwamoto R, Murata S, Mushino T, Murata SI, Araki SI, Fujii T, Sonoki T. Severe systemic inflammation mimicking TAFRO syndrome following COVID-19. Int J Hematol 2023; 118:374-380. [PMID: 37000328 PMCID: PMC10063432 DOI: 10.1007/s12185-023-03589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
TAFRO syndrome is a rare systemic inflammatory disease. Its pathogenesis mainly involves excessive cytokine secretion and autoimmune dysfunction. Although its etiology is unclear, some viral infections have been reported to cause it. Here, we report a case of severe systemic inflammation mimicking TAFRO syndrome that arose after COVID-19. A 61-years-old woman suffered from a continuous fever, ascites, and edema after contracting COVID-19. She developed progressive thrombocytopenia, renal failure, and elevated C-reactive protein levels. She was tentatively diagnosed with multisystem inflammatory syndrome in adults (MIS-A) and received steroid pulse therapy. However, she exhibited worsening fluid retention and progressive renal failure, which are not typical of MIS-A. A bone marrow examination showed reticulin myelofibrosis and an increased number of megakaryocytes. Although a definitive diagnosis of TAFRO syndrome was not made according to current diagnostic criteria, we determined that her symptoms were clinically consistent with those of TAFRO syndrome. Combination therapy, including steroid pulse therapy, plasma exchange, rituximab, and cyclosporine, improved her symptoms. There are pathological similarities between hyperinflammation that arises after COVID-19 and TAFRO syndrome in terms of the associated cytokine storms. COVID-19 may have triggered the development of systemic inflammation mimicking TAFRO syndrome in this case.
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Affiliation(s)
- Misato Tane
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
| | - Hideki Kosako
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
| | - Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan.
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan.
| | - Kayoko Tabata
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | - Takayuki Hiroi
- Department of Internal Medicine, Kainan Municipal Medical Center, Wakayama, Japan
| | - Kosuke Osawa
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Ryuta Iwamoto
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | - Shogo Murata
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
| | - Toshiki Mushino
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | - Shin-Ichi Araki
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Takao Fujii
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8510, Japan
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Muldoon J. Timescaled monitoring to manage venous leg ulcers and chronic oedema. Br J Community Nurs 2023; 28:S24-S30. [PMID: 37643115 DOI: 10.12968/bjcn.2023.28.sup9.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Venous leg ulcers and chronic oedema including lymphoedema are lifelong conditions that cause great distress to sufferers due to psychophysical symptoms. Time and resources spent on managing chronic wounds place an economic burden on healthcare providers, particularly with an anticipated increase in an ageing population and diminishing numbers of those providing long-term care. Resources are further challenged if wounds remain unhealed. The human costs are even greater, with patients often facing a lifetime of discomfort due to low awareness of venous disease, despite epidemiological studies. Possible causes of persistent venous disease may be misdiagnosis, mismanagement, or simply, no management if help is not sought. Therefore, it is important that chronic leg ulcers are managed with clinically effective regimes, reassessment, monitoring and appropriate referrals for adjunct management, alongside patient education. This article provides simple timescaled measurements to ensure timely interventions and appropriate care at each stage.
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Dallazen E, Baccaro GC, Santos AMDS, Queiroz ME, Santiago Junior JF, Hochuli-Vieira E, Faverani L. Comparison of Manual (2D) and Digital (3D) Methods in the Assessment of Simulated Facial Edema. J Oral Maxillofac Surg 2023; 81:1146-1154. [PMID: 37308089 DOI: 10.1016/j.joms.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND An edema assessment following dental surgeries is essential to improving the dental surgeon's technique and, consequentially, patient comfort. PURPOSE Two-dimensional (2D) methods are limited in analyzing 3-dimensional (3D) surfaces. Currently, 3D methods are used to investigate postoperative swelling. However, there are no studies that directly compare 2D and 3D methods. The goal of this study is to directly compare 2D and 3D methods used in the assessment of postoperative edema. STUDY DESIGN AND SAMPLE The investigators implemented a prospective, cross-sectional study with each subject serving as its own control. The sample was composed of dental student volunteers without facial deformities. PREDICTOR VARIABLE The predictor variable is the method used to measure edema. After simulating edema, manual (2D) and digital (3D) techniques were used to measure edema. The manual method used direct facial perimeter measurements. The two digital methods were photogrammetry using a smartphone (iPhone 11, Apple Inc, Cupertino, California), and facial scanning with a smartphone application (Bellus3D FaceApp, Bellus3D Inc, Campbell, California) [3D measurements] MAIN OUTCOME VARIABLE: The coefficient of variation (CV) (CV = standard deviation /mean) was used to assess homogeneity of edema measurements. ANALYSIS The Shapiro-Wilk and equal variance tests were applied to assess data homogeneity. Next, one-way analysis of variance was performed, followed by a correlation analysis. Finally, the data were submitted to Tukey's test. The statistical significance threshold was set at 5% (P < .05). RESULTS The sample was composed of 20 subjects aged 18-38 years. The CV showed higher values using the manual (2D) method (47%; 4.88% ± 2.99), compared with the photogrammetry method (18%; 8.55 mm ± 1.52) and the smartphone application (21%; 8.97 mm ± 1.93). A statistically significant difference was observed between the manual method values and those of the other two groups (P < .001). There was no difference between the facial scanning and photogrammetry groups (3D methods) (P = .778) CONCLUSION AND RELEVANCE: Both digital measuring methods (3D) demonstrated greater homogeneity than the manual method in analyzing facial distortions caused by the same swelling simulation. Therefore, it can be affirmed that digital methods may be more reliable that manual methods for assessing facial edema.
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Affiliation(s)
- Eduardo Dallazen
- PhD Student, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Gabriela Cristina Baccaro
- DDS Student, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Anderson Maikon de Souza Santos
- PhD Student, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil; Assistant Professor, Division of Oral Surgery, Paraíba State University, Araruna, Brazil
| | - Mariana Elias Queiroz
- PhD Student, Department of Dental Materials and Prosthesis, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | | | - Eduardo Hochuli-Vieira
- Associate Professor, Department of Diagnosis and Surgery, Araraquara Dental School, São Paulo, Brazil
| | - Leonardo Faverani
- Associate Professor, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil.
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Lee J, Kim GH, Her SH, Yi JE, Mok JS, Kim MS. Case 13: A 60-Year-Old Woman Presented With Dyspnea and Generalized Edema. J Korean Med Sci 2023; 38:e262. [PMID: 37582503 PMCID: PMC10427212 DOI: 10.3346/jkms.2023.38.e262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
- Jaewoo Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gee-Hee Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Ho Her
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Eun Yi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Su Mok
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Sik Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Research Institute for Intractable Cardiovascular Disease (CRID), College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Creech-Organ JA, Rivers R. Edematous Lower Lip. Am Fam Physician 2023; 108:199-200. [PMID: 37590866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
| | - Reid Rivers
- Saint Louis University (Southwest Illinois) Family Medicine Residency, O'Fallon, Illinois
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Nishioka H, Shindo T, Shimizu H. Dermatomyositis Presenting with Generalized Subcutaneous Edema. Intern Med 2023; 62:2273-2277. [PMID: 37532515 PMCID: PMC10465278 DOI: 10.2169/internalmedicine.0687-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/03/2022] [Indexed: 08/04/2023] Open
Abstract
Generalized subcutaneous edema is rare in dermatomyositis. We herein report an 82-year-old woman with dermatomyositis who presented with generalized subcutaneous edema. Three weeks before admission, she first noticed facial edema, and the symptoms exacerbated, with limb edema occurring. On admission, muscle weakness in the limbs and skin rash were noted. Her muscle enzyme levels were elevated, and serum anti-transcriptional intermediary factor 1-γ antibody was detected. She was diagnosed with dermatomyositis and treated with corticosteroids and tacrolimus, which improved her muscle weakness, muscle enzymes, and edema. Thus, generalized subcutaneous edema can occur during dermatomyositis, with facial edema as the initial symptom.
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Affiliation(s)
- Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Tatsuya Shindo
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Hayato Shimizu
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
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Gomez D, Perazella MA. A Patient with an Unusual Cause of AKI and Scrotal Swelling. Kidney360 2023; 4:1188-1189. [PMID: 37651667 PMCID: PMC10484347 DOI: 10.34067/kid.0000000000000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Daniel Gomez
- Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Mark A. Perazella
- Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
- VA Medical Center, West Haven, Connecticut
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Chen T, Feng C, Zhang X, Zhou J. TAFRO syndrome: A disease that known is half cured. Hematol Oncol 2023; 41:310-322. [PMID: 36148768 DOI: 10.1002/hon.3075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/22/2022] [Accepted: 09/17/2022] [Indexed: 11/10/2022]
Abstract
Thrombocytopenia, anasarca, fever, reticulin fibrosis/renal failure, and organomegaly (TAFRO) syndrome is rare in clinical practice. It is a systemic inflammatory disease caused by a cytokine storm. Its clinical manifestations include thrombocytopenia, systemic edema, fever, bone marrow fibrosis, renal insufficiency, and organ enlargement. The high mortality rate of TAFRO syndrome is due to the difficulty of acquiring biopsy samples for diagnosis and the rapid disease progression. This disease is poorly understood by clinicians. Early detection, accurate diagnosis, and timely treatment play key roles in prolonging the survival of the patients. This review summarizes the latest progress in the pathogenesis, diagnostic criteria, and treatment regimens of TAFRO syndrome, aiming to help clinicians better understand TAFRO syndrome and improve its diagnosis and treatment.
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Affiliation(s)
- Tingting Chen
- Department of Hematology, The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Chun Feng
- Department of Hematology, The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Hematology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xinyou Zhang
- Department of Hematology, The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Hematology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Jihao Zhou
- Department of Hematology, The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Hematology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
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Cornell G, Fahs F. Genital Ulcerations With Swelling. Cutis 2023; 112:E7-E9. [PMID: 37611300 DOI: 10.12788/cutis.0814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Georgeanne Cornell
- Dr. Cornell is from the Department of Academic Dermatology, Trinity Health, Ypsilanti, Michigan. Dr. Fahs is from Hamzavi Dermatology, Canton, Michigan
| | - Fatima Fahs
- Dr. Cornell is from the Department of Academic Dermatology, Trinity Health, Ypsilanti, Michigan. Dr. Fahs is from Hamzavi Dermatology, Canton, Michigan
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Abarbanell NR, Abarbanell A. 30-year-old woman • progressive dyspnea and peripheral edema • 35th week of gestation with a history of mild preeclampsia • Dx? J Fam Pract 2023; 72:266-268. [PMID: 37549406 DOI: 10.12788/jfp.0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
► progressive dyspnea and peripheral edema ► 35th week of gestation with a history of mild preeclampsia.
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Janchevska A, Jovanovska V, Jordanova O, Beqiri-Jashari A, Krstevska-Konstantinova M, Tasic V, Gucev ZS. Peripheral Insulin Edema and Pericardial Effusion in a 12-Year-Old Newly Diagnosed Girl with Type 1 Diabetes. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:171-174. [PMID: 37453114 DOI: 10.2478/prilozi-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Introduction: Insulin induced edema (IIE) is a rare condition, usually found in newly diagnosed diabetes patients, either after insulin treatment initiation or after dose increment. It is a self-limited process, rarely associated with serosal effusions. Teenage girls with type 1 diabetes (T1DM) are most commonly affected. Patient and Methods: A 12-year-old girl was diagnosed with ketoacidosis (DKA). Seven days after initiation of the insulin treatment, at a stable total daily dose of insulin (TDDI) of 0.55 IU/kg, she came with two kilograms weight gain in only two days and edema of the feet and calves. Ultrasound of the heart found a 7 mm pericardial effusion. The diagnostic workout included clinical examination, biochemical, hormonal, allergen analyses and imaging which excluded other known causes of swelling. Conclusions: We describe an adolescent girl with newly diagnosed T1DM and a rare association of peripheral insulin-induced edema and pericardial effusion. Short-term diuretic treatment and salt restriction resolved this rare complication of insulin treatment.
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Affiliation(s)
- Aleksandra Janchevska
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Valentina Jovanovska
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Olivera Jordanova
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Ardiana Beqiri-Jashari
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | | | - Velibor Tasic
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
| | - Zoran S Gucev
- 1University Children's Hospital, Skopje, RN Macedonia
- 2Medical Faculty, Skopje, RN Macedonia
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50
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Spadaro JZ, Chow R, Sinard JH, Watsky K, Habib L. Chronic Lymphocytic Leukemia Presenting as Bilateral Periorbital Edema Treated With Low-dose Radiation Therapy. Ophthalmic Plast Reconstr Surg 2023; 39:e78-e81. [PMID: 36852835 DOI: 10.1097/iop.0000000000002338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Ocular manifestations in chronic lymphocytic leukemia (CLL) have been reported in 30% to 40% of patients and may be a result of direct tissue infiltration, concomitant blood dyscrasias, or a result of therapeutic intervention. Leukemia cutis, defined as infiltration of the epidermis or dermis by neoplastic lymphocytes, is rare. Herein, we present a case report of a patient with leukemia who presented with periorbital edema and ecchymosis. This is the first known case to date of periorbital CLL successfully treated with low-dose radiation therapy (4 Gy in 2 fractions). Clinicians should be aware of the possibility of ocular involvement from CLL, given the importance of prompt diagnosis and treatment.
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Affiliation(s)
- Jane Z Spadaro
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Ryan Chow
- Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - John H Sinard
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, U.S.A
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Kalman Watsky
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, U.S.A
| | - Larissa Habib
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, U.S.A
- Smilow Cancer Hospital at Yale New Haven, New Haven, Connecticut, U.S.A
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