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Ge S, Tang D, Gao Y, Zeng M. A case report of snakebite-causing skin and soft tissue necrosis over the right forearm. Asian J Surg 2024; 47:2512-2514. [PMID: 38290951 DOI: 10.1016/j.asjsur.2024.01.081] [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: 12/28/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Shiliang Ge
- Department of Burn Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
| | - Dongmei Tang
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Yingzheng Gao
- Central laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China
| | - Ming Zeng
- Department of Burn Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, China.
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HO JW, Kim JY, Lee YK. Acute blockage of forearm supination due to flap tear of the triangular fibrocartilage disc: A case report. Medicine (Baltimore) 2024; 103:e37915. [PMID: 38640286 PMCID: PMC11029995 DOI: 10.1097/md.0000000000037915] [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: 01/08/2024] [Accepted: 03/26/2024] [Indexed: 04/21/2024] Open
Abstract
RATIONALE Acute blockage of forearm supination has been reported in several studies. It is caused by loose bodies in the wrist joint, extensor carpi ulnaris tendon interposition, and distal radioulnar joint (DRUJ) injuries, including forearm bone fractures. Some studies have reported cases of DRUJ injuries caused by triangular fibrocartilage complex (TFCC) tears.We report a case of acute blockage of forearm supination after minor trauma and suggest a possible TFCC tear when a patient complains of forearm supination blocking. In addition, we present a comparison between our case and other reports on etiology, magnetic resonance imaging (MRI) findings, and arthroscopic findings, and show the specific characteristics of our case. PATIENTS CONCERNS A 22-year-old male presented with left wrist pain as the chief complaint. He was injured 2 months prior to pushing his left hand on the floor during exercise. Physical examination showed a relative limitation of range of motion (ROM) in the left wrist of about 10° in flexion and about 15° in extension compared with the right side. The patient also complained of supination limitation and volar side wrist pain during supination. The patient showed tenderness in the axial compression test. DIAGNOSES Plain radiographs showing no abnormalities. MRI showed a TFCC tear in the central portion. A torn flap of the TFCC was interposed on the volar side of the DRUJ. INTERVENTIONS Arthroscopic surgery of the left wrist joint was performed. Arthroscopic examination revealed a tear in the TFCC on the radial side. A torn flap was interposed on the volar side of the DRUJ. We removed the flap from the DRUJ using an arthroscopic grasper and partially resected it. OUTCOMES Intraoperative tests showed no locking and the forearm was well supinated. Two months after the surgery, the patient had no pain and showed full forearm supination. LESSONS DRUJ blocking due to a TFCC tear should be suspected when acute blockage of forearm supination occurs after minor trauma. MRI is helpful for diagnosis; however, we suggest that the diagnosis should be confirmed through arthroscopy. Symptoms can be resolved by surgical treatment using arthroscopy.
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Affiliation(s)
- Ji Woong HO
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Jee Yune Kim
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Young-Keun Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
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3
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Aggarwal VA, Thakur U, Silva FD, Ray G, Weinschenk C, Gandy M, Xi Y, Chhabra A. Flexed elbow, abducted shoulder, forearm supinated (FABS) reconstruction from three-dimensional elbow MRI: diagnostic performance assessment in biceps head anatomy and pathology. Clin Radiol 2024; 79:e567-e573. [PMID: 38341341 DOI: 10.1016/j.crad.2023.12.018] [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: 08/18/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024]
Abstract
AIM To determine inter-reader analysis and diagnostic performance on digitally reconstructed virtual flexed, abducted, supinated (FABS) imaging from three-dimensional (3D) isotropic elbow magnetic resonance imaging (MRI). MATERIALS AND METHODS Six musculoskeletal radiologists independently evaluated elbow MRI images with virtual FABS reconstructions, blinded to clinical findings and final diagnoses. Each radiologist recorded a binary result as to whether the tendon was intact and if both heads were visible, along with a categorical value to the type of tear and extent of retraction in centimetres where applicable. Kappa and interclass correlation (ICC) were reported with 95% confidence intervals. Areas under the receiver operating curve (AUC) were reported. RESULTS FABS reconstructions were obtained successfully in all 48 cases. With respect to tendon intactness, visibility of both heads, and type of tear, the Kappa values were 0.66 (0.53-0.78), 0.24 (0.12-0.37), and 0.55 (0.43-0.66), respectively. For the extent of retraction, the ICC was 0.85 (0.79-0.91) when including the tendons with and without retraction and 0.78 (0.61-0.91) when only including tendons with retraction. For tear versus no tear, AUC values were 0.82 (0.74-0.89) to 0.96 (0.91-1.01). CONCLUSION Digital reconstruction of FABS positioning is feasible and allows good assessment of individual tendon head tears and retraction with high diagnostic performance.
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Affiliation(s)
- V A Aggarwal
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA.
| | - U Thakur
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - F D Silva
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - G Ray
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - C Weinschenk
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - M Gandy
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Y Xi
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - A Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Singh RP, Maurya AP, Rout AK, Singh S. Carpal tunnel syndrome secondary to a giant lipoma of the wrist and distal forearm. BMJ Case Rep 2024; 17:e256971. [PMID: 38373813 PMCID: PMC10882456 DOI: 10.1136/bcr-2023-256971] [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: 02/21/2024] Open
Abstract
In up to 2% of the population, benign tumours called lipomas can develop. When they are more than 5 cm, they are considered giant lipomas. Giant lipomas of the distal forearm and hand may cause compression to the underlying tissues, nerves and muscles, even though they are typically asymptomatic. An older woman with soft tissue swelling in her right wrist and forearm, and numbness and pain in her right hand presented to the general surgery outpatient clinic. Her numb fingers indicated that the median nerve was compressed, and an MRI scan of her wrist and forearm revealed median nerve compression due to a giant lipoma with a dimension of about 9.2×3.4×4 cm. A surgical excision was done with an intraoperative nerve stimulator, and the specimen sent for histopathology confirmed the diagnosis of lipoma. Pain, numbness and motor power improved within 1 week postoperatively, and the patient was discharged.
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Affiliation(s)
| | | | | | - Sourabh Singh
- General Surgery, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
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Goel A, Kapatia G, Mir MA, Rana MK. Isolated intramuscular cysticercosis of the forearm masquerading as malignancy. BMJ Case Rep 2024; 17:e256110. [PMID: 38320826 PMCID: PMC10859991 DOI: 10.1136/bcr-2023-256110] [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: 02/15/2024] Open
Abstract
A woman in her mid-20s presented to an Indian tertiary care hospital with pain in her left forearm. Extensive initial investigations led to a suspected diagnosis of a peripheral nerve sheath tumour; however, the pathological investigation of the excised tumour mass revealed it to be a case of isolated intramuscular cysticercosis in the forearm. Treatment for cysticercosis was commenced and the patient made a full recovery. Isolated intramuscular cysticercosis without the involvement of other organs is a rare presentation and has only been reported in a handful of case reports. We suggest that isolated intramuscular cysticercosis be considered a differential diagnosis in patients with isolated pain in their muscles and with no other symptoms, in patients with a presentation of solitary swelling and in patients at risk of parasitic infection. In addition, we emphasise the importance of histopathological examination due to the varied presentation of cysts.
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Affiliation(s)
- Archit Goel
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gargi Kapatia
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Mohd Altaf Mir
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Manjit Kaur Rana
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
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6
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Eubanks BN, Mescher JA, Royer MC, Simpson MM. Blue Nodules on the Forearms in an Active-Duty Military Servicemember. Cutis 2023; 112:E26-E28. [PMID: 37988315 DOI: 10.12788/cutis.0886] [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: 11/23/2023]
Affiliation(s)
- Bianca N Eubanks
- Dr. Eubanks is from the San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas. Drs. Mescher and McGinley Simpson are from the Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland. Dr. Royer is from the Division of Dermatopathology, The Joint Pathology Center, Silver Spring, Maryland
| | - Jaclyn A Mescher
- Dr. Eubanks is from the San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas. Drs. Mescher and McGinley Simpson are from the Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland. Dr. Royer is from the Division of Dermatopathology, The Joint Pathology Center, Silver Spring, Maryland
| | - Michael C Royer
- Dr. Eubanks is from the San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas. Drs. Mescher and McGinley Simpson are from the Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland. Dr. Royer is from the Division of Dermatopathology, The Joint Pathology Center, Silver Spring, Maryland
| | - Meagan McGinley Simpson
- Dr. Eubanks is from the San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas. Drs. Mescher and McGinley Simpson are from the Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland. Dr. Royer is from the Division of Dermatopathology, The Joint Pathology Center, Silver Spring, Maryland
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Abstract
Hourglass-like constriction (HLC) is an uncommon spontaneous mononeuropathy that is typically characterised by a sudden onset of pain followed by palsy, affecting branches of the radial (posterior interosseous nerve) and median nerves (anterior interosseous nerve). HLC of the radial nerve (RN) is rare, with only a few reported cases. Here, we report a case of a man who presented with acute wrist and finger drop due to the HLC of the RN. Surgery was recommended 5 months after clinical observation, when the lesion was resected and primarily repaired, resulting in satisfactory recovery. There is still much that remains unknown about HLC, especially for RN. The current understanding points out an inflammatory disease that should be treated conservatively for 3-7 months. The surgical technique depends mostly on the severity and extent of constriction; however, considering only RN constrictions, primary repair by neurorrhaphy or nerve grafts resulted in better functional outcomes.
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Affiliation(s)
- Fernanda Bretas
- Division of Hand Surgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | - Gabriel Costa Serrão de Araújo
- Division of Hand Surgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
| | | | - Marcus André Acioly
- Division of Neurosurgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
- Division of Neurosurgery, Department of Surgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Natsis K, Achlatis V, Piagkou M, Totlis T. A Giant Lipoma in the Distal Forearm of a Cadaver. Acta Med Acad 2023; 52:142-145. [PMID: 37933511 DOI: 10.5644/ama2006-124.414] [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: 12/21/2022] [Accepted: 03/26/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE Lipomas are very common tumors which usually prefer the upper limbs and, depending on their size, may cause nerve compression, or may be asymptomatic. The current cadaveric report describes a giant lipoma in the distal forearm area. CASE REPORT A large mass (5.1 × 3.2 × 1.6 cm) was identified on the palmar surface of the distal forearm, during dissection of a 63-year-old male cadaver. The mass caused anteromedial displacement and flattening of the median nerve (MN). Despite the lack of information about the subject's medical history, MN compression was assumed on the basis of the lipoma's size, its vicinity to neural structures, and the MN displacement and flattening. CONCLUSION The enlarged distal forearm lipoma, located adjacent to the carpal tunnel, displaced and flattened the MN. The cadaveric finding described is clinically relevant for both differential diagnosis and surgical treatment of carpal tunnel syndrome.
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Affiliation(s)
- Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Vlasios Achlatis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Trifon Totlis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.
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Soqia J, Aloqla NA, Janoud O, Al-shafie M, Nader M. Rhabdomyosarcoma or Fibrosarcoma? A Case of Large Ulcerated and Necrotic Lesion on the Forearm of a Newborn. J Investig Med High Impact Case Rep 2023; 11:23247096231209541. [PMID: 37919979 PMCID: PMC10623988 DOI: 10.1177/23247096231209541] [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: 08/05/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023] Open
Abstract
Congenital infantile fibrosarcoma (CIFS) is a rare malignant soft tissue tumor. The incidence of fibrosarcoma is estimated to be 0.3 per 100 000 population per year, and it accounts for less than 1% of all soft tissue sarcomas. We present a case of a 7-day-old newborn with a large ulcerated and necrotic lesion on the left forearm, which was initially misdiagnosed as rhabdomyosarcoma. Magnetic resonance imaging (MRI) revealed a soft tissue mass with cystic components affecting the forearm and distal humerus muscles. Fine-needle biopsy was performed and initially diagnosed as rhabdomyosarcoma but later confirmed as low-grade fibrosarcoma with positive immunostaining for vimentin. The patient underwent a transhumeral amputation with follow-up chemotherapy at a specialized oncology center. This case underscores the importance of interdisciplinary collaboration and specialized care in managing complex medical conditions in infants. Early detection and appropriate management of these tumors are essential for improving outcomes and reducing morbidity and mortality. Despite the rarity of this case, it serves as a reminder of the importance of considering neoplastic lesions in the differential diagnosis of soft tissue masses in newborns.
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10
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Kostas-Agnantis I, Gkiatas I, Korompilia M, Kosmas D, Motsis E, Pakos E, Korompilias A. Lipoma Arborescens of the Upper Extremity With Anatomic Variation of the Palmaris Longus: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00045. [PMID: 36099386 DOI: 10.2106/jbjs.cc.22.00334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/04/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
CASE We present a case of a patient who suffered from wrist swelling and had symptoms of carpal tunnel syndrome. The patient underwent ultrasound and magnetic resonance imaging, in which signs of joint effusion and a fatty synovial lesion were presented. The treatment included open excision of the tumor. In addition, the palmaris longus muscle had an anatomic variation with proximal and distal tendon portions. The histopathological examination disclosed lipoma arborescens of the synovial membranes of the joints. CONCLUSION The recognition of this entity and its characteristics are important not only for correct diagnosis but also for the appropriate treatment.
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Affiliation(s)
- Ioannis Kostas-Agnantis
- Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, Greece
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Dorado-Fernández E, Aso-Escario J, Aso-Vizán A, Ramírez-González I, Carrillo-Rodríguez MF, Cáceres-Monllor D, Murillo-González J. A Case of Acute Plastic Deformation of the Forearm in a Medieval Hispano-Mudejar Skeleton (13-14th Centuries AD). Pathobiology 2022; 90:56-62. [PMID: 35504265 DOI: 10.1159/000524452] [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: 11/10/2021] [Accepted: 04/01/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Acute plastic deformation refers to a traumatic bending or bowing without a detectable cortical defect. CASE PRESENTATION AND DISCUSSION We describe a rare case from an individual that was exhumed from the Hispano-Mudejar necropolis in Uceda (Guadalajara, Spain) dated between the 13th and 14th centuries AD. The case corresponds to an adult woman, with a bowing involvement of the left ulna and radius. After making the differential diagnosis with various pathologies likely to present with this alteration, we reached the diagnosis of acute plastic deformation of the forearm through external and radiological examination and comparison with the healthy contralateral forearm. CONCLUSIONS Acute plastic deformation is a rare traumatic injury, not described until the last century and only rarely described in palaeopathological contexts. We contribute a new case, the first being sufficiently documented, contributing to the knowledge and diagnosis of this type of trauma in the ancient bone, while deepening the knowledge of the living conditions of the medieval Mudejar population of Uceda.
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Affiliation(s)
- Enrique Dorado-Fernández
- Forensic Anthropology Department, Institute of Legal Medicine, Madrid, Spain
- Faculty of Medicine, Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid, Spain
| | | | - Alberto Aso-Vizán
- Orthopedic Surgery and Traumatology Service, Hospital General de la Defensa, Zaragoza, Spain
| | - Ildefonso Ramírez-González
- Grupo 365 Arqueología, Guadalajara, Spain
- Escuela Politécnica, Universidad Europea de Madrid, Madrid, Spain
| | - Manuel F Carrillo-Rodríguez
- Faculty of Medicine, Department of Surgery, Medical and Social Sciences, University of Alcalá, Madrid, Spain
| | | | - Jorge Murillo-González
- Faculty of Medicine, Department of Anatomy and Embryology, Complutense University of Madrid, Madrid, Spain
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Abdelnaby R, Mohamed KA, Elgenidy A, Sonbol YT, Bedewy MM, Aboutaleb AM, Ebrahim MA, Maallem I, Dardeer KT, Heikal HA, Gawish HM, Zschüntzsch J. Muscle Sonography in Inclusion Body Myositis: A Systematic Review and Meta-Analysis of 944 Measurements. Cells 2022; 11:cells11040600. [PMID: 35203250 PMCID: PMC8869828 DOI: 10.3390/cells11040600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 01/14/2023] Open
Abstract
Inclusion body myositis (IBM) is a slowly progressive muscle weakness of distal and proximal muscles, which is diagnosed by clinical and histopathological criteria. Imaging biomarkers are inconsistently used and do not follow international standardized criteria. We conducted a systematic review and meta-analysis to investigate the diagnostic value of muscle ultrasound (US) in IBM compared to healthy controls. A systematic search of PubMed/MEDLINE, Scopus and Web of Science was performed. Articles reporting the use of muscle ultrasound in IBM, and published in peer-reviewed journals until 11 September 2021, were included in our study. Seven studies were included, with a total of 108 IBM and 171 healthy controls. Echogenicity between IBM and healthy controls, which was assessed by three studies, demonstrated a significant mean difference in the flexor digitorum profundus (FDP) muscle, which had a grey scale value (GSV) of 36.55 (95% CI, 28.65–44.45, p < 0.001), and in the gastrocnemius (GC), which had a GSV of 27.90 (95% CI 16.32–39.48, p < 0.001). Muscle thickness in the FDP showed no significant difference between the groups. The pooled sensitivity and specificity of US in the differentiation between IBM and the controls were 82% and 98%, respectively, and the area under the curve was 0.612. IBM is a rare disease, which is reflected in the low numbers of patients included in each of the studies and thus there was high heterogeneity in the results. Nevertheless, the selected studies conclusively demonstrated significant differences in echogenicity of the FDP and GC in IBM, compared to controls. Further high-quality studies, using standardized operating procedures, are needed to implement muscle ultrasound in the diagnostic criteria.
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Affiliation(s)
- Ramy Abdelnaby
- Department of Neurology, RWTH Aachen University, Pauwels Street 30, 52074 Aachen, Germany;
| | - Khaled Ashraf Mohamed
- Faculty of Medicine, Cairo University, 1 Gamaa Street, Cairo 12613, Egypt; (K.A.M.); (A.E.); (Y.T.S.); (M.M.B.); (M.A.E.); (K.T.D.); (H.A.H.); (H.M.G.)
| | - Anas Elgenidy
- Faculty of Medicine, Cairo University, 1 Gamaa Street, Cairo 12613, Egypt; (K.A.M.); (A.E.); (Y.T.S.); (M.M.B.); (M.A.E.); (K.T.D.); (H.A.H.); (H.M.G.)
| | - Yousef Tarek Sonbol
- Faculty of Medicine, Cairo University, 1 Gamaa Street, Cairo 12613, Egypt; (K.A.M.); (A.E.); (Y.T.S.); (M.M.B.); (M.A.E.); (K.T.D.); (H.A.H.); (H.M.G.)
| | - Mahmoud Mostafa Bedewy
- Faculty of Medicine, Cairo University, 1 Gamaa Street, Cairo 12613, Egypt; (K.A.M.); (A.E.); (Y.T.S.); (M.M.B.); (M.A.E.); (K.T.D.); (H.A.H.); (H.M.G.)
| | | | - Mohamed Ayman Ebrahim
- Faculty of Medicine, Cairo University, 1 Gamaa Street, Cairo 12613, Egypt; (K.A.M.); (A.E.); (Y.T.S.); (M.M.B.); (M.A.E.); (K.T.D.); (H.A.H.); (H.M.G.)
| | - Imene Maallem
- Faculty of Medicine, Pharmacy Department, University Badji Mokhtar Annaba, Zaafrania Street, Annaba 23000, Algeria;
| | - Khaled Tarek Dardeer
- Faculty of Medicine, Cairo University, 1 Gamaa Street, Cairo 12613, Egypt; (K.A.M.); (A.E.); (Y.T.S.); (M.M.B.); (M.A.E.); (K.T.D.); (H.A.H.); (H.M.G.)
| | - Hamed Amr Heikal
- Faculty of Medicine, Cairo University, 1 Gamaa Street, Cairo 12613, Egypt; (K.A.M.); (A.E.); (Y.T.S.); (M.M.B.); (M.A.E.); (K.T.D.); (H.A.H.); (H.M.G.)
| | - Hazem Maher Gawish
- Faculty of Medicine, Cairo University, 1 Gamaa Street, Cairo 12613, Egypt; (K.A.M.); (A.E.); (Y.T.S.); (M.M.B.); (M.A.E.); (K.T.D.); (H.A.H.); (H.M.G.)
| | - Jana Zschüntzsch
- Clinic for Neurology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
- Correspondence:
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Kovoor CC, Jayakumar R, Manjunath S. Melanotic Neuroectodermal Tumor of Infancy in the Ulna of an Infant: A Very Rare Tumor: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00045. [PMID: 33684079 DOI: 10.2106/jbjs.cc.20.00239] [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: 11/14/2022]
Abstract
CASE A 4-month-old boy presented with a nontender swelling of the right proximal forearm of 2 months' duration. Radiological evaluation showed lytic lesion surrounded by sclerotic bone in the ulna with soft-tissue extension. Histopathological examination showed tumor of round and epithelioid cells containing melanin, interpreted as melanotic neuroectodermal tumor. The patient underwent a wide excision of the shaft of the ulna with creation of radioulnar synostosis. There is no recurrence 6 years after surgery. CONCLUSION Melanotic neuroectodermal tumor is rare in the appendicular skeleton and has to be differentiated from other round cell tumors and osteomyelitis. As far as we know, this is the first reported case in the ulna.
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Affiliation(s)
- Cherry Cheriyan Kovoor
- Department of Orthopaedics and Limb reconstruction, Specialist's Hospital, Kochi, Kerala, India
| | - R Jayakumar
- Department of Plastic and Microvascular Surgery, Specialist's Hospital, Kochi, Kerala, India
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Yang Z, Niu N, Tang J, Wu L, He J, Shi J. Reconstruction of forearm support with ulnar translocation after resection of chondrosarcoma in the proximal radius. Orthopade 2020; 49:1006-1012. [PMID: 32266431 DOI: 10.1007/s00132-020-03903-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This is a report of the reconstructive surgery of a patient with chondrosarcoma in the proximal radius. After extensive resection of the proximal radius that contained the tumor, the skeleton of the forearm was reconstructed by ulnar translocation. This patient was followed for 2 years, no recurrence of the tumor was found and the function of the forearm was nearly normal. This case is reported and discussed and a literature review is presented.
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Affiliation(s)
- Zongqiang Yang
- General Hospital of Ningxia Medical University, 750004, Yinchuan, China
| | - Ningkui Niu
- General Hospital of Ningxia Medical University, 750004, Yinchuan, China
| | - Jing Tang
- General Hospital of Ningxia Medical University, 750004, Yinchuan, China
| | - Longyun Wu
- General Hospital of Ningxia Medical University, 750004, Yinchuan, China
| | - Jinwen He
- School of Clinical Medicine, Lanzhou University, 730030, Lanzhou, China
| | - Jiandang Shi
- General Hospital of Ningxia Medical University, 750004, Yinchuan, China.
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15
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Clark D, Alomari AK, Burton K, Rahnama-Moghadam S. A case of vancomycin-induced drug rash with eosinophilia and systemic symptoms (DRESS) syndrome with failure to respond to cyclosporine treatment. Dermatol Online J 2020; 26:13030/qt1bx778dt. [PMID: 32815686] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023] Open
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare delayed drug reaction that often occurs 2-6 weeks after initiation of therapy and may develop into a life-threatening systemic reaction. Besides immediate discontinuation of the suspected inciting drug, initiation of high dose systemic corticosteroids has long been the mainstay of treatment for severe cases. Nevertheless, significant drawbacks associated with systemic corticosteroid therapy, such as the requirement of a long tapering period post resolution and extensive adverse side effects profile, have motivated clinicians to seek alternative treatment options. Over the past decade, an undisputed increasing number of favorable case reports has highlighted cyclosporine as an emerging, safe, and effective alternative despite inconsistent dosing regimens reported. Herein, we report a severe case of vancomycin-induced DRESS syndrome in which the patient failed initial intervention with cyclosporine and needed rescue with methylprednisolone. To the best of our knowledge, this constitutes the first unsuccessful report of cyclosporine treatment for DRESS syndrome.
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Abstract
RATIONALE Lipomas are common benign tumors, constituting 16% of soft tissue mesenchymal tumors. They usually occur under the skin or in the large muscles of the thigh, shoulder, or upper arm. There are few reported cases of lipomas located in the forearm and hand muscles, accounting for less than 1% of all lipomas. PATIENT CONCERNS A 47-year old man presented with a history of swelling and accompanying pain in the left wrist for 2 years. DIAGNOSES The patient was diagnosed with intramuscular lipoma in the pronator quadratus. INTERVENTIONS The mass was resected completely with wide-awake technique. OUTCOMES The patient was followed up for 2 years with no recurrence. The symptoms of swelling and pain resolved within 3 weeks post-surgery, and there was no clear abnormality in wrist and finger movement and sensation. A satisfactory outcome was achieved. LESSONS Intramuscular lipoma in the pronator quadratus is a rare benign tumor which should be distinguished from malignant tumors. Especially for patients with carpal tunnel syndrome presenting with wrist swelling, ultrasound, computed tomography, or magnetic resonance imaging can be used to assess deep tissue masses.
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Affiliation(s)
- Heng Tian
- Hand Surgery, the Second Hospital of Jilin University, No. 218, Lane Ziqiang, Nanguan District, Changchun City, Jilin
| | - Wen-rui Qu
- Hand Surgery, the Second Hospital of Jilin University, No. 218, Lane Ziqiang, Nanguan District, Changchun City, Jilin
| | - Junbo Pan
- Hand and Foot Surgery, the Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Middle Road, Yangzhou City, Jiangsu, PR China
| | - Zhe Zhu
- Hand Surgery, the Second Hospital of Jilin University, No. 218, Lane Ziqiang, Nanguan District, Changchun City, Jilin
| | - Jun Liu
- Hand Surgery, the Second Hospital of Jilin University, No. 218, Lane Ziqiang, Nanguan District, Changchun City, Jilin
| | - Rui Li
- Hand Surgery, the Second Hospital of Jilin University, No. 218, Lane Ziqiang, Nanguan District, Changchun City, Jilin
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17
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Urigo C, Moraux A, Bianchi S. Sonographic appearance of a soft-tissue gossypiboma in the forearm with pathologic correlation. J Clin Ultrasound 2020; 48:174-177. [PMID: 31737903 DOI: 10.1002/jcu.22792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/07/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
We describe the sonographic, radiologic, and histopathologic appearances of a soft tissue gossypiboma in the forearm of an 81-year-old woman with a history of a radial fracture treated with an internal fixation surgery.
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Affiliation(s)
- Carlo Urigo
- London Northwest University Healthcare Trust, London, UK
| | - Antoine Moraux
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
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18
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Santana AP, Cardoso AEC, Passos RT, Ferreira ÍSC. Case for diagnosis. Erythematous and pruritic papules on forearms. An Bras Dermatol 2020; 95:250-251. [PMID: 32171542 PMCID: PMC7175029 DOI: 10.1016/j.abd.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/18/2019] [Indexed: 11/18/2022] Open
Abstract
Gamasoidosis is a poorly known and underdiagnosed mite infestation. It is characterized by the presence of erythematous and flattened papules that are quite pruritic, and can affect any region of the body, with preference for areas of folds. This article reports a case of the disease caused by mites of the species Dermanyssus gallinae. Increasingly, the agents that cause this disease are found in urban environments, increasing the incidence of people affected by the disease. This dermatosis has a self-limiting clinical picture and the treatment is done with the use of topical corticosteroids and oral antihistamines.
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Affiliation(s)
- Aline Palitot Santana
- Dermatology Clinic, Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas, Maceió, AL, Brazil.
| | - Alberto Eduardo Cox Cardoso
- Dermatology Clinic, Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Rafaela Tenório Passos
- Dermatology Clinic, Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Íris Sampaio Costa Ferreira
- Dermatology Clinic, Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas, Maceió, AL, Brazil
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19
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Wan H, Xie Z, Zhuang K, Ran X, Ran Y. Arm Sporotrichosis Secondary to Scratching Finger Verruca Vulgaris. Mycopathologia 2020; 185:413-414. [PMID: 31974751 DOI: 10.1007/s11046-020-00426-z] [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: 12/18/2019] [Accepted: 01/13/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Huiying Wan
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Institute of Dermatovenereology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhen Xie
- Institute of Dermatovenereology, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China
| | - Kaiwen Zhuang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Ran
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuping Ran
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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20
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Ning X, Wang N, Yan H, Feng Y, Zhang Y. A nodule on the forearm. Dermatol Online J 2020; 26:13030/qt7x251867. [PMID: 32155031] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023] Open
Abstract
Glomus tumors are benign tumors of the skin. Clinically, these tumors can present as solid, painful subcutaneous nodules, frequently seen on the hand (particularly subungual region). Glomangiomyomas are the least common histological type of glomus tumor. In the literature, there are only a few glomangiomyoma cases of the forearm location. We report a patient with a painful nodule, diagnosed as glomangiomyoma. Surgical excision was performed and no recurrence was observed after 5 years' follow-up.
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Affiliation(s)
| | | | | | | | - Yanfei Zhang
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an. ,
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21
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Drabent P, Bielle F, Bernat I, Peyre M. Epineural glomus tumor of the posterior interosseous nerve: Case report. J Clin Neurosci 2020; 74:232-234. [PMID: 31917057 DOI: 10.1016/j.jocn.2019.12.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/01/2019] [Accepted: 12/30/2019] [Indexed: 11/19/2022]
Abstract
Among peripheral nerve sheath tumors, epineural glomus tumors represent a rare differential diagnosis for peripheral nerve schwannoma, displaying the same appearance on MRI. Here we present the case of a 68-year-old man complaining of pain in the left forearm, with paresthesias in the first three fingers. MRI demonstrated a round mass along the course of the posterior interosseous nerve with homogeneous contrast enhancement. Complete surgical removal successfully relieved the symptoms. Pathological analysis led to the diagnosis of glomus tumor of uncertain malignant potential. This is to our knowledge the first reported case of epineural glomus tumor of the radial nerve.
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Affiliation(s)
- Philippe Drabent
- Sorbonne Universités - Department of Neuropathology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Franck Bielle
- Sorbonne Universités - Department of Neuropathology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Isabelle Bernat
- Sorbonne Universités - Department of Electrophysiology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Matthieu Peyre
- Sorbonne Universités - Department of Neurosurgery, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France; Neurofibromatosis Type 2 and Schwannomatosis Referral Center, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France.
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22
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Afsar FS, Cun S, Seremet S. Neonatal sucking blister. Dermatol Online J 2019; 25:13030/qt33b1w59j. [PMID: 32045151] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023] Open
Abstract
Neonatal sucking blisters result from vigorous sucking on hand or forearm in utero. Clinically, one observes a tense, fluid-filled blister, which when ruptured forms an erosion. We report a female neonate with a sucking blister on the distal dorsal aspect of her left forearm. These benign bullae should be differentiated from other diseases of the newborn through their presentation, characteristic morphology, and self-limiting course.
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Affiliation(s)
- F Sule Afsar
- Department of Dermatology, Ataturk Research and Training Hospital, Izmir.
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23
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Sacchetti F, De Gori M, Grossi S, Bonadio GA, Capanna R. An exceptional case of malignant glomus tumor and a review of the literature. Acta Orthop Traumatol Turc 2019; 53:313-317. [PMID: 31155303 PMCID: PMC6739266 DOI: 10.1016/j.aott.2019.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 04/02/2019] [Accepted: 04/28/2019] [Indexed: 11/29/2022]
Abstract
Malignant glomus tumors (MGTs) are exceptional but pose diagnostic and therapeutic challenges. Wide resection is the recommended treatment method, however, no data are available concerning adjuvant therapies. We present an exceptional case of extradigital deep-seated MGT of the forearm, with an exceptional bone infiltration. Despite being treated with wide resection, the patient had an optimal functional outcome, no functional loss, no motor or sensitive deficits and has returned to his full daily activity.
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Affiliation(s)
- Federico Sacchetti
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy.
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy; Department of Orthopaedic and Trauma Surgery, Hospital of Soverato, Italy
| | - Stefano Grossi
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy
| | | | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy
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24
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Chevalier T. Trauma in the upper limb of an Upper Paleolithic female from Caviglione cave (Liguria, Italy): Etiology and after-effects in bone biomechanical properties. Int J Paleopathol 2019; 24:94-107. [PMID: 30340107 DOI: 10.1016/j.ijpp.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 06/08/2023]
Abstract
The impact of injury on the health and activities of human foragers is of great interest for understanding the adaptability of past populations to their environments. For the Gravettian female of Caviglione 1, a violent blow has been suggested as the origin of the left radial fracture, and abnormal body asymmetry has been observed. Access to high resolution CT-scans of the upper limb allows us to address new etiologic considerations and assess the after-effects of trauma on bone biomechanical properties by focusing on cortical and trabecular bones and conducting a comparative analysis of cross-sectional geometric properties in an Upper Paleolithic context. This originally right-dominant female, who became left-handed, was mainly affected by severe bone modifications on the proximal right humerus due to secondary changes following a traumatic event. The left radial fracture is very well consolidated with thick and homogeneous cortical bone. Etiological considerations point to a Galeazzi fracture for the left forearm occurring during a fall. The bone structure and robusticity of the left arm probably prove the lack of strong and enduring dependency of this female on her group for the usual cultural tasks despite the strongly limited function of the right arm.
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Affiliation(s)
- Tony Chevalier
- UMR7194/HNHP, Université de Perpignan Via Domitia, Centre Européen de Recherches Préhistoriques de Tautavel, France.
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25
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Ardeleanu V, Jecan CR, Tatu AL, Motoc AGM. A recurrent solitary glomus tumor of the forearm. Rom J Morphol Embryol 2019; 60:1019-1023. [PMID: 31912118] [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: 06/10/2023]
Abstract
Glomus tumors account for 1.6% of all soft tissue tumors and the majority are localized at the level of the fingertips and do not exceed the size of 5 mm. They are usually solitary tumors, characterized by the following clinical triad - severe pain, pinpoint tenderness, and cold intolerance. We present the case of a 63-year-old patient with a fixed tumor located in the lower third of the right forearm with a long-axis diameter of 4 cm, with irregular borders and tenderness to palpation. The tumor had been surgically removed 15 years ago, but it redeveloped two months after surgery, and grew in size until the fourth month after the surgery when it stopped growing. The preoperative ultrasound showed an expansive mass suggestive of swelling/inflammation in the adjacent soft tissue and having a mass effect on the deep muscle structures. Intraoperatively, a 3/4/3 cm (antero-posterior∕transversal∕cranio-caudal) pink tumor was found subcutaneously, with well-defined borders, which was mobile on the deep planes, apparently encapsulated. The tumor was removed with safety margins of about 1 cm and hemostasis was performed. Postoperatively, immunohistochemistry confirmed the diagnosis of glomus tumor: alpha-smooth muscle actin (α-SMA) positive in the cytoplasm of malignant cells, type IV collagen positive in the basement membrane, cluster of differentiation 34 (CD34) negative in the malignant cells, CD34 positive in endothelial cells, Ki67 positive in the 1-2% of the cancer cells nuclei. The postoperative evolution was favorable, without complications and no recurrence at six months.
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Affiliation(s)
- Valeriu Ardeleanu
- Department of Pharmacology, Faculty of Medicine and Pharmacy, "Lower Danube" University of Galaţi, Romania;
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26
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Springer Medizin. Knoten am Arm: Von der Weide mitgebracht? MMW Fortschr Med 2018; 160:51. [PMID: 30542858 DOI: 10.1007/s15006-018-1237-y] [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: 11/26/2022]
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27
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Abdelzaher E, Elwany A, Amr SA. Malignant peripheral nerve sheath tumour with perineurial differentiation and hyaline eosinophilic globules (thanatosomes): A rare tumour. Malays J Pathol 2018; 40:355-358. [PMID: 30580369] [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: 06/09/2023]
Abstract
Malignant peripheral nerve sheath tumour (MPNST) with perineurial differentiation is a rare variant of MPNST. The pathological features and clinical significance of this variant remain to be characterised. We reported the clinicoradiological and pathological features of a case of recurrent right arm mass related to the ulnar nerve in a 42-year-old female patient. On pathological examination, the tumour showed dual features of conventional and perineurial MPNST which was proven by positive immunostaining for S-100 and EMA. The pathological diagnosis was MPNST with perineurial differentiation. In addition, a peculiar and rare finding of intracytoplasmic eosinophilic hyaline globules (thanatosomes) within tumour cells is reported. We document a rare tumour with hybrid features between conventional and perineurial MPNSTs. Further studies are needed to establish its biological behaviour.
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Affiliation(s)
- E Abdelzaher
- Alexandria University, Faculty of Medicine, Department of Pathology, Egypt.
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28
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Muresan M, Muresan S, Brinzaniuc K, Sala D, Neagoe R. Durability of an Advanced Skin Protectant Compared With Other Commercially Available Products in Healthy Human Volunteers. Wounds 2018; 30:310-316. [PMID: 30256746] [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: 06/08/2023]
Abstract
BACKGROUND A new skin protectant with improved adhesion to denuded skin and resistance to wash off has been developed to protect skin from incontinence-associated dermatitis (IAD) or general loss of skin integrity. OBJECTIVE This controlled, randomized, prospective, open-label study determines the durability of the new protectant when applied to intact skin in 21 healthy human volunteers and compares it to 3 other products used for similar clinical indications. MATERIALS AND METHODS Eight 0.75-in circles of black carbon pigment were applied to the bilateral forearms (4 per arm to allow for duplicates) of the participants and covered with the various products. Participants conducted normal routine activities over 7 days. Photographs were taken and a test site assessment was completed before and after application of the products on day 0 and at days 1, 2, 3, 4, and 7 to evaluate pigment loss over time. Carbon integrated optical density (CIOD) was measured under the assumption that a loss of pigment correlated with a loss of the protective product. These data were used to calculate the percent barrier remaining over time. RESULTS The percent of intact film was significantly greater (P < .05) from day 3 onwards for the new skin protectant compared with the other 3 products. The new product showed no significant change in CIOD (P = .46) from day 1 through day 7, indicating no meaningful wear over time. The other 3 products showed significant changes in CIOD (P < .01) beginning at either day 2 or day 3. CONCLUSIONS The new skin protectant was more durable than the other products tested. It remained in place for up to 7 days for all participants, whereas the other products had < 50% remaining on the skin by that time point.
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Affiliation(s)
- Mircea Muresan
- University of Medicine and Pharmacy of Tîrgu Mureș, Târgu Mureş, Romania
| | - Simona Muresan
- University of Medicine and Pharmacy of Tîrgu Mureș, Târgu Mureş, Romania
| | - Klara Brinzaniuc
- University of Medicine and Pharmacy of Tîrgu Mureș, Târgu Mureş, Romania
| | - Daniela Sala
- University of Medicine and Pharmacy of Tîrgu Mureș, Târgu Mureş, Romania
| | - Radu Neagoe
- University of Medicine and Pharmacy of Tîrgu Mureș, Târgu Mureş, Romania
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29
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Gurbani B, Igbinigie M, Koutrouvelis A, Alperin JB, Lindsey RW. Bilateral Forearm Pseudotumors in an Adult with Hemophilia A and Ollier Disease: A Case Report. JBJS Case Connect 2018; 8:e54. [PMID: 30045077 DOI: 10.2106/jbjs.cc.17.00234] [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: 06/08/2023]
Abstract
CASE A 29-year-old man with mild hemophilia A and Ollier disease presented with bilateral atraumatic forearm pseudotumors. Both forearm pseudotumors were successfully treated surgically with staged radical extirpation and factor VIII replacement therapy. CONCLUSION Pseudotumors typically occur in adolescents with severe, poorly controlled hemophilia A. The development of factor VIII replacement therapy has progressively reduced the incidence of pseudotumors in patients in the developed world. No standardized therapy exists for pseudotumors that continue to bleed into the muscles despite nonoperative measures. Persistent masses require surgical removal with careful preoperative planning and a team approach.
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Affiliation(s)
- Barkha Gurbani
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Matthew Igbinigie
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Aristides Koutrouvelis
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Jack B Alperin
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Ronald W Lindsey
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch at Galveston, Galveston, Texas
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30
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Vitral GLN, Aguiar RAPL, de Souza IMF, Rego MAS, Guimarães RN, Reis ZSN. Skin thickness as a potential marker of gestational age at birth despite different fetal growth profiles: A feasibility study. PLoS One 2018; 13:e0196542. [PMID: 29698511 PMCID: PMC5919437 DOI: 10.1371/journal.pone.0196542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/14/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND New methodologies to estimate gestational age (GA) at birth are demanded to face the limited access to obstetric ultrasonography and imprecision of postnatal scores. The study analyzed the correlation between neonatal skin thickness and pregnancy duration. Secondarily, it investigated the influence of fetal growth profiles on tissue layer dimensions. METHODS AND FINDINGS In a feasibility study, 222 infants selected at a term-to-preterm ratio of 1:1 were assessed. Reliable information on GA was based on the early ultrasonography-based reference. The thicknesses of the epidermal and dermal skin layers were examined using high-frequency ultrasonography. We scanned the skin over the forearm and foot plantar surface of the newborns. A multivariate regression model was adjusted to determine the correlation of GA with skin layer dimensions. The best model to correlate skin thickness with GA was fitted using the epidermal layer on the forearm site, adjusted to cofactors, as follows: Gestational age (weeks) = -28.0 + 12.8 Ln (Thickness) - 4.4 Incubator staying; R2 = 0.604 (P<0.001). In this model, the constant value for the standard of fetal growth was statistically null. The dermal layer thickness on the forearm and plantar surfaces had a negative moderate linear correlation with GA (R = -0.370, P<0.001 and R = -0.421, P<0.001, respectively). The univariate statistical analyses revealed the influence of underweight and overweight profiles on neonatal skin thickness at birth. Of the 222 infants, 53 (23.9%) had inappropriate fetal growths expected for their GA. Epidermal thickness was not fetal growth standard dependent as follows: 172.2 (19.8) μm for adequate for GA, 171.4 (20.6) μm for SGA, and 177.7 (15.2) μm for LGA (P = 0.525, mean [SD] on the forearm). CONCLUSIONS The analysis highlights a new opportunity to relate GA at birth to neonatal skin layer thickness. As this parameter was not influenced by the standard of fetal growth, skin maturity can contribute to clinical applications.
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Affiliation(s)
- Gabriela Luiza Nogueira Vitral
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Regina Amélia P. Lopes Aguiar
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ingrid Michelle Fonseca de Souza
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Albertina Santiago Rego
- Department of Pediatrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rodney Nascimento Guimarães
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Zilma Silveira Nogueira Reis
- Postgraduation Program of Women’s Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Yadav P, Garg T, Sanke S, Chander R, Singh D. Systemic Lupus Erythematosus Presenting as Livedoid Vasculopathy over the Forearms. Skinmed 2018; 16:125-127. [PMID: 29911533] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
38-year-old married woman presented with multiple spontaneous painful ulcers that had involved both forearms for the previous month, along with a single episode of generalized tonic-clonic seizures, with no residual palsy or paresis. She complained of photosensitivity and diffuse hair loss for the past 6 months. She also had had arthralgia for the previous 3 years, which had initially involved the small joints of the fingers (especially the proximal interphalangeal joints) and gradually progressed to involve the larger joints. There was no history of recurrent oral ulcers, psychosis, thromboembolic events, or any other skin lesions. Two years previously, she had taken antitubercular treatment for pulmonary tuberculosis.
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Affiliation(s)
- Pravesh Yadav
- Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Suchita Kriplani Hospital, Shaheed Bhagat Singh Marg, Delhi, India;
| | - Taru Garg
- Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Suchita Kriplani Hospital, Shaheed Bhagat Singh Marg, Delhi, India
| | - Sarita Sanke
- Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Suchita Kriplani Hospital, Shaheed Bhagat Singh Marg, Delhi, India
| | - Ram Chander
- Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Suchita Kriplani Hospital, Shaheed Bhagat Singh Marg, Delhi, India
| | - Divyanshu Singh
- Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Suchita Kriplani Hospital, Shaheed Bhagat Singh Marg, Delhi, India
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Cai Y, Gan Y, Yu C, Tang J, Sun Y. A successful treatment of necrotizing fasciitis following the surgery of distal radius plate removal: A case report and literature review. Medicine (Baltimore) 2018; 97:e0305. [PMID: 29642157 PMCID: PMC5908577 DOI: 10.1097/md.0000000000010305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Necrotizing fasciitis (NF) is defined as a rare, rapidly progressive, and highly lethal skin infection characterized by necrosis of the fascia and subcutaneous tissue. PATIENT CONCERNS The present study aims to discuss the case of a 35-year-old man who developed NF following a routine sterile right distal radius bone plate removal surgery. DIAGNOSES The patient was suspected of NF based on his clinical manifestations, laboratory tests, and imaging results. The diagnosis of NF was confirmed by histological examinations. INTERVENTIONS Serial prompt and extensive debridement was performed during the rapid and aggressive extension of the skin infection, together with antibiotics and supportive treatments. OUTCOMES The condition of the patient finally improved on the sixth day of disease progression. Skin grafting of his right forearm wound was performed successfully 2 months after the admission. LESSONS NF can occur during the perioperative period for routine clean radius plate removal operation in patients with no risk factor for NF. The objective is to remind the physicians to stay aware of this disease, especially its early clinical signs and symptoms. Urgent subsequent treatment, including surgical debridement, antibiotic therapy, and supporting management, is the key to ensure the survival and better prognosis of patients.
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Kamphuis SJM, Jandali AR, Jung FJ, Sproedt J. [Compartment syndrome of the forearm after intra-arterial self-injection : With a mixture of methadone, flunitrazepam, saliva and water]. Unfallchirurg 2018; 121:669-673. [PMID: 29556689 DOI: 10.1007/s00113-018-0482-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A drug-addicted patient injected himself intra-arterially with a mixture of methadone, flunitrazepam, saliva and water. The resulting compartment syndrome could be treated by fasciotomy and multiple debridement, with which a major amputation could be prevented. The course of the treatment and the resulting functional results are described, as well as a brief overview of the literature and a treatment proposal for similar cases.
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Affiliation(s)
- S J M Kamphuis
- Klinik für Hand- und Plastische Chirurgie, Departement Chirurgie, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Schweiz.
| | - A R Jandali
- Klinik für Hand- und Plastische Chirurgie, Departement Chirurgie, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Schweiz
| | - F J Jung
- Klinik für Hand- und Plastische Chirurgie, Departement Chirurgie, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Schweiz
| | - J Sproedt
- Klinik für Hand- und Plastische Chirurgie, Departement Chirurgie, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Schweiz
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Lundekvam K, Hanlon M. [A man in his 40s with a sore on the penis and rashes on his forearm]. Tidsskr Nor Laegeforen 2018; 138:17-0128. [PMID: 29313622 DOI: 10.4045/tidsskr.17.0128] [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: 11/02/2022] Open
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Pandhi D, Kulhari A. Erythema Nodosum Leprosum Necroticans. Indian Pediatr 2017; 54:1071. [PMID: 29317571 DOI: 10.1007/s13312-017-1218-8] [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: 11/26/2022]
Affiliation(s)
- Deepika Pandhi
- Department of Dermatology and STD University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, Delhi, India.
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Abstract
INTRODUCTION Whitlow is a common disease in clinic, characterized by pain and swelling of finger. However, few articles had reported on extensive infection in the forearm caused by whitlow infected by mycobacterium tuberculosis (MTB). PATIENT CONCERNS A 70-year-old Chinese female complained of fester in back of left hand for 5 days. She had a history of recurrent whitlow for 14 months and pulmonary tuberculosis (TB). She received treatment in another hospital due to whitlow on July 2016. Then she was treated with incision and drainage. However, whitlow presented again several times before coming to our hospital. She came to our hospital on September 7, 2017 and x-ray of forearm showed that radius, ulna, and carpal were eroded. DIAGNOSES She was diagnosed with left extensive infection in the forearm caused by whitlow infection by MTB. INTERVENTIONS Considering her serious and extensive condition, we performed left forearm amputation on September 12, 2017. We collected some soft tissue cut down during surgery and conducted pathological examination. Finally, pathological result showed MTB infection. Then that patient was treated with antituberculosis therapy. OUTCOMES Up to now, illness condition has not progressed. A recent x-ray of forearm showed no osteolysis in humerus. CONCLUSIONS Extensive infection in the forearm after recurrent whitlow infection by MTB is rare. So when we face recurrent whitlow, a rapid diagnosis and treatment are required to prevent complications. This case reminds us that recurrent whitlow is dangerous. Attention must be paid to recurrent whitlow. If necessary, amputation should be considered.
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Moris V, Chapuis A, Guillier D, Jeudy G, Huther M, Auffret N, Piroth L, Blot M. Necrotizing fasciitis caused by genogroup × Neisseria meningitidis. QJM 2017; 110:589-590. [PMID: 28911029 DOI: 10.1093/qjmed/hcx109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/23/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Moris
- Service de Chirurgie Maxillo-Faciale
| | | | | | | | | | | | - L Piroth
- Service de Maladies Infectieuses et Tropicales, CHU François Mitterand, Dijon, France
| | - M Blot
- Service de Maladies Infectieuses et Tropicales, CHU François Mitterand, Dijon, France
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Biswas B, Dabkara D, Ganguly S. In-transit metastases from malignant melanoma. Natl Med J India 2017; 30:297. [PMID: 29916439 DOI: 10.4103/0970-258x.234405] [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] [Indexed: 11/04/2022]
Affiliation(s)
- Bivas Biswas
- Department of Medical Oncology, Dr B.R. Ambedkar Institue-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center 14 Major Arterial Road (EW), New Town, Rajarhat, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center 14 Major Arterial Road (EW), New Town, Rajarhat, Kolkata, West Bengal, India
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Orlic L, Mikolasevic I, Crncevic-Orlic Z, Jakopcic I, Josipovic J, Pavlovic D. Forearm bone mass predicts mortality in chronic hemodialysis patients. J Bone Miner Metab 2017; 35:396-404. [PMID: 27465914 DOI: 10.1007/s00774-016-0766-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/20/2015] [Accepted: 06/26/2016] [Indexed: 11/25/2022]
Abstract
We aim to determine the relationship between bone mineral density (BMD), measured by T- and Z-score, and mortality risk in hemodialysis (HD) patients. We also investigate which are the most suitable skeletal sites for predicting mortality rate. We analyzed the survival of 102 patients who had been treated with chronic HD according to BMD. Patients with a T-score ≤2.5 at the middle, ultradistal and proximal part of the forearm had a higher mortality risk than those with a T-score of -2.5 or higher. Furthermore, no statistically significant association was found between loss of bone mass at other measuring points-lumbar spine (anteroposterior orientation from L1-L4) and hip (neck, trochanter, intertrochanter, total and Ward's triangle)-and mortality risk. We were also interested in exploring the relationship between Z-score at different skeletal regions and mortality risk. We found that patients with a Z-score of -1 or lower at all three parts of the forearm had a greater mortality risk. It is also worth noting that the Z-score at all three parts of the forearm was a more apparent predictor of mortality, compared to the T-score at the same skeletal regions. This empirical analysis showed that BMD assessments should be obtained at the forearm, due to the good predictability of this skeletal site regarding mortality of HD patients. Moreover, data concerning bone density should be reported as Z-scores.
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Affiliation(s)
- Lidija Orlic
- Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Tome Strižića 3, Rijeka, Croatia.
| | - Ivana Mikolasevic
- Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Center Rijeka, Tome Strižića 3, Rijeka, Croatia
| | | | | | - Josipa Josipovic
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia
| | - Drasko Pavlovic
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia
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Abstract
INTRODUCTION Intramuscular hemangioma (IMH) is a rare congenital soft tissue tumor. Here, we report a case of IMH patient who had undergone several surgeries and other treatments that were all ineffective before he visited us. CLINICAL FINDINGS This IMH patient was a 16-yearold male who was born with a tumor of unknown size in his right hand and forearm. On physical examination, the tumor and skin flap complex was seen with a size of 14 cm_12 cm in his right hand, and the multiple postoperative scars were shown on his right hand and forearm. The patient was not able to raise his right shoulder, and the ranges of motion of his right elbow, wrist, and finger were almost zero degrees. INTERVENTIONS Considering that the tumor had been surgically excised for several times and the multiple recurrences had affected adversely his daily life, an amputation of his right hand, forearm, and the part of his right arm was performed. DIAGNOSES The pathological examination confirmed the diagnosis of IMH. OUTCOMES After the amputation surgery, the patient gained a functional recovery and the tumor did not recur during the 2 years after the surgery. CONCLUSION A treatment of choice should be personalized according to an IMH patient's overall situation. For an IMH patient like our case with a history of multiple tumor recurrences, we suggest that an amputation surgery should be performed as early as possible to avoid the repeated, but ineffective surgical excisions and the unnecessary sufferings.
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Affiliation(s)
- Hui Lu
- Department of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University
| | - Qiang Chen
- Department of Hand Surgery, Zhejiang Province People's Hospital, Hangzhou, Zhejiang Province, P. R. China
| | - Hu Yang
- Department of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University
| | - Hui Shen
- Department of Hand Surgery, the First Affiliated Hospital, College of Medcine, Zhejiang University
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Croci-Torti A, Guillot B, Rigau V, Bessis D. [Chronic recurrent annular neutrophilic dermatosis]. Ann Dermatol Venereol 2016; 144:362-367. [PMID: 27823912 DOI: 10.1016/j.annder.2016.09.678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/12/2016] [Revised: 07/23/2016] [Accepted: 09/22/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic recurrent annular neutrophilic dermatosis (CRAND) is a rare form of neutrophilic dermatosis characterised by chronic annular progression, histological impairment similar to that seen in Sweet's syndrome and the absence of association with generalised signs, abnormal laboratory values or underlying systemic disease. Herein we report two new cases. PATIENTS AND METHODS Case no 1. A 41-year-old woman had presented with four annular lesions on the forearms and neckline which she had had for one year. Examination revealed a 5-cm annular lesion on the right forearm and four similar adjacent lesions. The condition spontaneously resolved after 4 weeks. Treatment with hydroxychloroquine 400mg per day for three months proved ineffective in preventing a further episode. However, following treatment with colchicine at a daily dose of 1mg for two months, no further relapses in the rash occurred over a 10-year observation period. Case no 2. A 38-year-old woman consulted for recurrent annular erythema confined to the legs. Examination showed the presence of a red papular annular lesion on the right leg, encircling a yellowish macule with a central ring of fine scale; the lesion had been present for three weeks. Treatment with colchicine was initiated but the patient was lost to follow-up. In both cases, histological examination was evocative of Sweet's syndrome but no inflammatory or neutrophilic syndrome and no underlying systemic disease were demonstrated. DISCUSSION CRAND presents as a stereotypical and benign form of neutrophilic dermatosis. A diagnosis of chronic recurrent annular dermatosis with gyrate progression should be considered in the absence of general signs, neutrophilia or underlying systemic disease.
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Affiliation(s)
- A Croci-Torti
- Département de dermatologie, hôpital Saint-Eloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
| | - B Guillot
- Département de dermatologie, hôpital Saint-Eloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Université de Montpellier, 163, rue Auguste-Broussonnet, 34090 Montpellier, France; UFR de pharmacie, Inserm U1058, 15, avenue Charles-Flahaut, 34093 Montpellier cedex 5, France
| | - V Rigau
- Université de Montpellier, 163, rue Auguste-Broussonnet, 34090 Montpellier, France; Département d'anatomopathologie, hôpital Gui-de-Chauliac, CHRU de Montpellier, 34295 Montpellier, France
| | - D Bessis
- Département de dermatologie, hôpital Saint-Eloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Université de Montpellier, 163, rue Auguste-Broussonnet, 34090 Montpellier, France; UFR de pharmacie, Inserm U1058, 15, avenue Charles-Flahaut, 34093 Montpellier cedex 5, France.
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Jacquemus J, Dalle S, Faure M, Chouvet B, Beatrix O, Balme B. [Malignant transformation of an eccrine spiradenoma]. Ann Dermatol Venereol 2016; 144:203-207. [PMID: 28277254 DOI: 10.1016/j.annder.2016.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/30/2016] [Revised: 04/20/2016] [Accepted: 09/02/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Malignant eccrine spiradenoma is a rare and aggressive tumor, developed on the epithelium of eccrine sweat glands. Typically, it occurs after malignant transformation of benign eccrine spiradenoma, but sometimes it happens de novo. OBSERVATION We report a case of malignant eccrine spiradenoma in a 62-year-old woman. The patient presented a rapid increase in size of a long-standing tumoral lesion of her forearm. There was no secondary lesion on the chest, abdomen or pelvis at the CT-scanner. Cutaneous biopsy of the lesion was performed and showed a carcinoma with no contact with epidermis. On this biopsy, we could not affirm if the tumor was a metastatic process or a primary tumor of the skin. Histologic examination of the surgical removal of the tumor showed an undifferentiated carcinoma with adjacent nodules of eccrine spiradenoma. Immunohistochemical assessment of Ki67 expression showed a weak expression (5%) in the benign spiradenoma nodules and a high rate expression (80%) in the malignant neoplasm. The final diagnosis was an undifferentiated carcinoma arising from preexisting benign spiradenoma. DISCUSSION Malignant eccrine spiradenoma is not frequent and is rarely described in the international literature that may lead to diagnostic difficulties.
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Affiliation(s)
- J Jacquemus
- Service de pathologie, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - S Dalle
- Service de dermatologie, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - M Faure
- Service de dermatologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - B Chouvet
- Service de pathologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - O Beatrix
- Service de chirurgie, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - B Balme
- Service de pathologie, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Abstract
OBJECTIVES Spindle cell lipomas (SCLs) are benign lipomatous neoplasms that classically arise in the posterior neck, upper back, and shoulders of older male patients. We sought to characterize the occurrence of this entity at nonclassic sites. METHODS All cases of SCL arising at atypical sites were retrieved from our archives. RESULTS Of 439 total cases of SCL, 57 arose at atypical locations in 32 men and 25 women (age range, 27-79 years). The tumor sites included leg (n = 23), buttock/perineum/inguinal (n = 10), forearm (n = 9), finger (n = 9), foot (n = 2), toe (n = 2), hand (n = 1), and flank (n = 1). CD34 was positive staining in all cases tested (52/52), while desmin was negative in most tumors (48/50). Thirty-eight of 38 cases tested exhibited loss of Rb expression. No cases showed CPM/MDM2 amplification (0/48). No local recurrences have been reported (n = 39). CONCLUSIONS SCLs may arise in the trunk, lower extremities, and distal upper extremities. While most SCLs arising in classic sites occur in male patients, there is a relatively equal sex distribution in tumors at atypical sites. Pathologists should be aware that SCLs arise at atypical locations to avoid misclassification as other lipomatous neoplasms, including atypical lipomatous tumor.
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Affiliation(s)
- Nasir Ud Din
- From the Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | - Sarah M Jenkins
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Leona A Doyle
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
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Abstract
This study examines the presentation, management and outcomes of a series of 10 patients with giant lipomatous tumours (defined as greater than 5 cm diameter) of the hand and forearm who presented to our orthopaedic oncology service. All patients underwent local staging and were discussed at our multidisciplinary tumour meeting prior to definitive surgery. In all cases, neurovascular structures required mobilization in order to excise the tumour. Seven of the tumours were benign lipomas and one was a neural fibrolipoma. The other two were well differentiated lipoma-like liposarcomas/atypical lipomatous tumours. Giant lipomas and well differentiated lipoma-like liposarcomas/atypical lipomatous tumours of the hand and forearm present infrequently and a multidisciplinary approach is recommended in the investigation and surgical management of these patients.
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Affiliation(s)
- G L Cribb
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK
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Suyama Y, Kishimoto M, Nozaki T, Nishimoto K, Okada M. Man With Swelling in Legs and Forearms. Ann Emerg Med 2016; 68:e57-8. [PMID: 27451311 DOI: 10.1016/j.annemergmed.2016.01.029] [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: 12/21/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Yasuhiro Suyama
- Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Mitsumasa Kishimoto
- Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International University, Tokyo, Japan
| | | | - Masato Okada
- Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
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Bocsa C, Asavoaie C, Bucerzan S, Nascu I, Brumboiu I, Al-Khzouz C. Ultrasonographic evaluation of the median nerve at the level of the carpal tunnel outlet and mid forearm in patients with type II Mucopolysaccharidosis. Med Ultrason 2016; 18:36-41. [PMID: 26962552 DOI: 10.11152/mu.2013.2066.181.cob] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIMS The ultrasonographic (US) evaluation of the median nerve at the level of the carpal tunnel outlet (CTO) and mid forearm in pediatric patients with mucopolysaccharidosis type II (MPS II) and comparison with healthy subjects. MATERIAL AND METHOD Fifteen children with MPS II and 44 healthy children were included in the study and they were divided into three age groups. The cross-sectional area, the appearance of the nerve, and the ratio of the cross-sectional areas were evaluated by US. RESULTS At the level of the CTO the mean area of the nerve was increased in all MPS II groups compared with the correspondent healthy age groups and the differences were statistically significant (p<0.01). At the level of the mid forearm the differences were statistically significant only for the first age group. Other US findings at the level of the CTO in the MPS II groups were represented by hypoechogenicity (86.67 % on the right and 93.33% on the left), thickened fascicles (80% bilaterally), irregular contour (53.33% bilaterally) and the presence of the Doppler signal including the nerve (26.67 % on the right and 33.33 % on the left). The CTO/mid forearm cross-sectional area ratio was higher in all MPS II age groups and the differences were statistically significant (p<0.001). CONCLUSION In patients with MPS II there are significant US changes in the size and aspect of the median nerve.
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Affiliation(s)
- Corina Bocsa
- "Interservisan" Medical and Surgical Centre, Cluj-Napoca, Romania
| | - Carmen Asavoaie
- Emergency Children Hospital, 1st Pediatric Clinic, Department of Radiology and Imaging,Cluj-Napoca, Romania.
| | - Simona Bucerzan
- Emergency Children Hospital, 1st Pediatric Clinic, Department of Genetics, Cluj-Napoca, Romania
| | - Ioana Nascu
- Emergency Children Hospital, 1st Pediatric Clinic, Department of Genetics, Cluj-Napoca, Romania
| | - Irina Brumboiu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Epidemiology and Primary Health Care Cluj-Napoca, Romania
| | - Camelia Al-Khzouz
- Emergency Children Hospital, 1st Pediatric Clinic, Department of Genetics, Cluj-Napoca, Romania
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Honeyman CS, Wilson P. Patient with giant upper limb melanoma presenting to a UK plastic surgery unit: differentials and experience of management. BMJ Case Rep 2016; 2016:bcr2015212253. [PMID: 26838295 PMCID: PMC4746506 DOI: 10.1136/bcr-2015-212253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 11/03/2022] Open
Abstract
A 57-year-old woman was referred to our regional sarcoma unit following a 2-year history of a progressively enlarging mass on her right forearm. At 14 × 7 × 12 cm, this mass turned out to be one of the largest upper limb cutaneous malignant melanomas ever described, and, to the best of our knowledge, the first documented in the UK. Remarkably, despite having a T4 malignant tumour with a Breslow thickness of 70 mm, this patient is still alive over 4 years later with no locoregional or distant metastatic spread. We present our experience in the management of this giant malignant melanoma of the upper limb and consider important differentials.
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Affiliation(s)
| | - Paul Wilson
- Department of Plastic Surgery, North Bristol NHS Trust, Bristol, UK
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Askari M, Christensen KN, Heath S, Moran SL, Lachman N. Presentation of soft tissue anatomy of mirror hand: an anatomical case report with implications for surgical planning. Surg Radiol Anat 2016; 38:855-62. [PMID: 26787301 DOI: 10.1007/s00276-015-1611-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 08/03/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Mirror hand or ulnar dimelia is a rare and poorly studied congenital anomaly of the upper extremity. Understanding of its anatomy is limited by the rarity of the deformity and the variability in presentation. We present the case of an 80-year-old female donor with an incidental finding of mirror hand. METHODS Medical history indicated no record of any surgical procedures or interventions to the right upper extremity suggesting that the donor had lived an independent life without the need for prosthetic aids. Unfortunately, no record of a hand examination or any visit to a hand specialist was identified within the medical record. Following imaging and disarticulation of the arm at the glenohumeral joint, an anatomical dissection was performed on the right upper extremity. RESULTS Findings were recorded and compared to three earlier reports in the limited literature with a strong focus on understanding the anatomy of this deformity important for surgical planning. The anatomy is highlighted with a brief description of the embryology associated with mirror hand deformity. The case presents a classic example of ulnar dimelia. Arterial patterns compared favorably with those described in the literature. In addition an aberrant branch of the median nerve and a deep branch supplying the extensor compartment were noted. CONCLUSION Based on the observations of this study (and the previous reports) we would recommend a study of vascular tree of the hand either through conventional arteriography or CT angiography prior to pollicization. The surgeon should also be prepared to perform a microsurgical arterial anastomosis if pollicization is not possible in case of an incomplete arch similar to one we described.
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Affiliation(s)
- Morad Askari
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University of Miami Health System, Miami, USA
| | - Kevin N Christensen
- Department of Dermatology, Mohs and Dermasurgery Unit, MD Anderson Cancer Center, Houston, TX, USA
| | - Shaun Heath
- Department of Anatomy, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Steven L Moran
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nirusha Lachman
- Department of Anatomy, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.
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Jeter JM, Curiel-Lewandrowski C, Stratton SP, Myrdal PB, Warneke JA, Einspahr JG, Bartels HG, Yozwiak M, Bermudez Y, Hu C, Bartels P, Alberts DS. Phase IIB Randomized Study of Topical Difluoromethylornithine and Topical Diclofenac on Sun-Damaged Skin of the Forearm. Cancer Prev Res (Phila) 2015; 9:128-34. [PMID: 26712942 DOI: 10.1158/1940-6207.capr-15-0232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
Abstract
Prevention of nonmelanoma skin cancers remains a health priority due to high costs associated with this disease. Diclofenac and difluoromethylornithine (DFMO) have demonstrated chemopreventive efficacy for cutaneous squamous cell carcinomas. We designed a randomized study of the combination of DFMO and diclofenac in the treatment of sun-damaged skin. Individuals with visible cutaneous sun damage were eligible. Subjects were randomized to one of the three groups: topical DFMO applied twice daily, topical diclofenac applied daily, or DFMO plus diclofenac. The treatment was limited to an area on the left forearm, and the duration of use was 90 days. We hypothesized that combination therapy would have increased efficacy compared with single-agent therapy. The primary outcome was change in karyometric average nuclear abnormality (ANA) in the treated skin. Individuals assessing the biomarkers were blinded regarding the treatment for each subject. A total of 156 subjects were randomized; 144 had baseline and end-of-study biopsies, and 136 subjects completed the study. The ANA unexpectedly increased for all groups, with higher values correlating with clinical cutaneous inflammation. Nearly all of the adverse events were local cutaneous effects. One subject had cutaneous toxicity that required treatment discontinuation. Significantly more adverse events were seen in the groups taking diclofenac. Overall, the study indicated that the addition of topical DFMO to topical diclofenac did not enhance its activity. Both agents caused inflammation on a cellular and clinical level, which may have confounded the measurement of chemopreventive effects. More significant effects may be observed in subjects with greater baseline cutaneous damage.
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Affiliation(s)
- Joanne M Jeter
- Division of Hematology-Oncology, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Steven P Stratton
- Division of Hematology-Oncology, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Paul B Myrdal
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona
| | - James A Warneke
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Janine G Einspahr
- Division of Hematology-Oncology, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Hubert G Bartels
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona
| | - Michael Yozwiak
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona
| | - Yira Bermudez
- Division of Hematology-Oncology, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Chengcheng Hu
- Department of Biostatistics, University of Arizona College of Public Health, Tucson, Arizona
| | - Peter Bartels
- Optical Sciences Center, College of Optical Sciences, University of Arizona, Tucson, Arizona
| | - David S Alberts
- Division of Hematology-Oncology, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
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Ma Y, Zheng J, Yang S, Zhu H, Dong K, Xiao X, Chen L. Melanotic neuroectodermal tumor of infancy in the soft tissue of the forearm: report of a case. Int J Clin Exp Pathol 2015; 8:13584-13589. [PMID: 26722579 PMCID: PMC4680524] [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] [Received: 08/17/2015] [Accepted: 09/23/2015] [Indexed: 06/05/2023]
Abstract
Melanotic neuroectodermal tumor of infancy is rare. Only 3 cases have been reported in the soft tissue of the extremities up to date. It has a typically biphasic feature in morphology. Epithelial and melanotic markers are positive in the epitheliod cells and neuron-specific enolase or synaptophysin is positive in the small blue round cells in immunohistochemistry. Radical resection and close follow-up is the treatment strategy in general situation. Here we report one case of MNTI in the upper extremity with review of the literature. This is the first case of MNTI in the forearm.
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Affiliation(s)
- Yangyang Ma
- Department of Pathology, Children’s Hospital of Fudan UniversityShanghai, China
| | - Jicui Zheng
- Department of Surgery, Children’s Hospital of Fudan UniversityShanghai, China
| | - Shaobao Yang
- Department of Surgery, Children’s Hospital of Fudan UniversityShanghai, China
| | - Haitao Zhu
- Department of Surgery, Children’s Hospital of Fudan UniversityShanghai, China
| | - Kuiran Dong
- Department of Surgery, Children’s Hospital of Fudan UniversityShanghai, China
| | - Xianmin Xiao
- Department of Surgery, Children’s Hospital of Fudan UniversityShanghai, China
| | - Lian Chen
- Department of Pathology, Children’s Hospital of Fudan UniversityShanghai, China
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