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Archives of Plastic Surgery May 2022Aqualyx (Marllor International Ltd, Rimini, Italy) was originally developed in Italy by Professor Pasquale Motolese and has been commercially available since 2009. It is...
Aqualyx (Marllor International Ltd, Rimini, Italy) was originally developed in Italy by Professor Pasquale Motolese and has been commercially available since 2009. It is a deoxycholate, aqueous gelatinous solution mixed with saline and buffering compounds. It is the only drug approved by the European Union for the reduction in localized fat. Aqualyx is sold exclusively to doctors and nurses trained in intralipotherapy. In the case of our patient, the product administered was advertised as Aqualyx, but was not administered by a trained health professional and was administered too superficially. The patient developed severe pain following the injection and was unable to sit for several weeks. There was localized skin necrosis, and palpable collections where the injection was administered. Our initial suspicion was development of an abscess or hematoma. To characterize further, we arranged an ultrasound scan that showed a "superficial hypoechoic lesion" but no deeper infection or spread. The numerous painful nodules ruptured onto the skin surface, resulting in purulent and bleeding lesions. This case demonstrates the importance of appropriate training and competence in performing cosmetic procedures including injections and fat dissolving treatments.
PubMed: 35832164
DOI: 10.1055/s-0042-1748644 -
JBJS Essential Surgical Techniques 2022Open release of a trigger thumb has been shown to be the most reliable option to restore full interphalangeal (IP) joint extension and thus normal thumb-joint motion in...
UNLABELLED
Open release of a trigger thumb has been shown to be the most reliable option to restore full interphalangeal (IP) joint extension and thus normal thumb-joint motion in children. The aim of this procedure is to restore free gliding of the flexor pollicis longus (FPL) tendon in its canal in children with fixed IP joint flexion contractures or those in whom nonoperative treatment modalities have failed.
DESCRIPTION
The surgical procedure is easy to perform and straightforward; however, attention must be given to several details in order to avoid surgical failure and complications. General anesthesia is required for this procedure. The extremity is prepared and draped in a sterile fashion with the patient in the supine position, and a tourniquet is utilized to facilitate surgical dissection. A transverse incision is gently made just adjacent to the thumb metacarpophalangeal (MP) flexion crease, above the so-called Notta nodule. The ulnar neurovascular bundle is retracted to the side, and the Notta nodule, a local enlargement of the FPL tendon, is visualized at the A1 pulley. The pulley is incised longitudinally to allow for full IP joint extension. After verification of full passive motion, the tendon is inspected for any further abnormalities. Then, the tourniquet is released, and the wound is closed with absorbable sutures. We recommend the use of local anesthetics for postoperative pain control. In cases of a trigger thumb stuck in extension, full tenodesis flexion of the IP joint combined with smooth, full passive extension confirms a complete release.
ALTERNATIVES
Nonoperative treatment modalities mainly include watchful waiting for spontaneous resolution, occupational therapy (i.e., passive exercising), and splinting therapy. However, prolonged stretching and splinting may move the nodule to a point distal to the stenotic pulley, thus resulting in a trigger thumb locked in extension with a loss of IP flexion. Alternative surgical treatment techniques involve percutaneous trigger thumb release or open release with alternative surgical approaches (e.g., an oblique or Brunner incision).
RATIONALE
Several reports have shown that open release of a trigger thumb leads to the most reliable outcomes in terms of achievement of range of motion and complications. The main advantage of this procedure is the perfect visualization of the FPL tendon beneath the stenotic A1 pulley, which allows for a complete A1 release with clear vision. Such visualization cannot be provided with use of percutaneous techniques, which position the neurovascular bundle in potential danger for iatrogenic injury or may lead to incomplete pulley release. Moreover, the use of this procedure allows parents to avoid the prolonged therapy and splinting associated with nonoperative treatment. Formal rehabilitation is usually not necessary postoperatively.
EXPECTED OUTCOMES
Open release of a trigger thumb is a safe and reliable option that leads to full range of motion in 95% of children, which is substantially higher than for nonoperative treatment with therapy (55%) and splinting (67%). Even delayed open release may provide satisfactory outcomes. Although spontaneous resolution without surgery has been reported in 63% of cases, patients with a flexion contracture of >30° showed spontaneous resolution in only 2.5% of cases. Furthermore, the open surgical technique has been shown to have a lower rate of complications (around 3.4%) compared with percutaneous techniques, which showed a 3.29 times increased risk of recurrence and relevant injury to the neurovascular bundle. If the A1 is fully divided, recurrence is highly unlikely. Postoperative rehabilitation is very quick following open release of a trigger thumb because closure under local anesthesia provides a painless postoperative course, wounds heal within a few days, and children are allowed to resume play immediately once a bandage is applied.
IMPORTANT TIPS
The use of surgical loupes is of paramount importance to safely perform this procedure.Place the skin incision adjacent but not directly onto the palmar MP flexion crease for better scar formation.Divide the skin very gently because the A1 pulley is located directly under the skin, and the FPL and radial nerve can be harmed easily. Retract the ulnar neurovascular bundle aside so as to allow for safe preparation until A1 division.Divide the A1 pulley until the Notta nodule on the FPL can safely glide distally into full IP extension. In some cases with large, distally-sitting nodules, the pulley incision must be extended distally into the oblique bundle.A sign that the entire A1 pulley is released is seeing the corner formed by the distal edge of the pulley and the longitudinal cut in the pulley. Additionally, the cut halves of the fully released pulley will rest completely in the sagittal plane of the thumb, no longer converging over the FPL tendon.Tight bands can exist proximal and distal to the A1 pulley and should be released as well if present.Check for a tight IP volar plate following A1 division, which may require postoperative splinting.For thumbs stuck in extension, tenodesis can be utilized to verify complete A1 release.Utilize absorbable sutures, local anesthesia, and a bulky dressing to allow a comfortable postoperative course.
ACRONYMS AND ABBREVIATIONS
IP = interphalangealMP = metacarpophalangealFPL = flexor pollicis longusROM = range of motionANOVA = analysis of variance.
PubMed: 36741041
DOI: 10.2106/JBJS.ST.21.00053 -
Actas Dermo-sifiliograficas Nov 2016Dermatologic manifestations of leukemia can be both specific and nonspecific (e.g., opportunistic infections, purpura and ecchymosis, Sweet syndrome). Leukemia cutis... (Review)
Review
Dermatologic manifestations of leukemia can be both specific and nonspecific (e.g., opportunistic infections, purpura and ecchymosis, Sweet syndrome). Leukemia cutis refers to the infiltration of the skin with neoplastic leukocytes and its early diagnosis has important prognostic implications. We report on 17 cases of leukemia cutis seen in our department between 1994 and 2014 and describe the characteristics of the patients (age, sex, medical history), the morphology of the lesions, and associations with systemic disease. Most of the patients were male and the most common associated malignancy was acute myeloid leukemia. The most frequent dermatologic manifestations were nodules or erythematous papules on the limbs. We describe our experience with the diagnosis and management of leukemia cutis over a period of 20 years and emphasize the importance of clinical signs in the early diagnosis of this condition.
Topics: Aged; Aged, 80 and over; Child, Preschool; Early Detection of Cancer; Female; Humans; Infant; Leukemia, Lymphocytic, Chronic, B-Cell; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Leukemia, Myelomonocytic, Acute; Leukemic Infiltration; Male; Middle Aged; Neoplastic Stem Cells; Retrospective Studies; Skin; Skin Neoplasms; Tertiary Care Centers
PubMed: 27210518
DOI: 10.1016/j.ad.2016.02.015 -
Clinical, Cosmetic and Investigational... 2022Pilomatricoma, also known as "benign calcifying epithelioma", is an uncommon slow-growing benign adnexal skin tumor, which originates from primitive cells of the hair...
Pilomatricoma, also known as "benign calcifying epithelioma", is an uncommon slow-growing benign adnexal skin tumor, which originates from primitive cells of the hair matrix and usually appears as a solitary, firm, and asymptomatic nodule beneath the skin. Bullous pilomatricoma is a rare form of pilomatricoma, always presenting with firm subcutaneous nodules with a bullous appearance. In this study, we report a 9-year-old Chinese presenting girl with bullous pilomatricoma after influenza vaccination.
PubMed: 35444439
DOI: 10.2147/CCID.S364850 -
Frontiers in Immunology 2019Autoinflammatory diseases include disorders with a monogenic cause and also complex conditions associated to polygenic or multifactorial factors. An increased number of... (Review)
Review
Autoinflammatory diseases include disorders with a monogenic cause and also complex conditions associated to polygenic or multifactorial factors. An increased number of both monogenic and polygenic autoinflammatory conditions have been identified during the last years. Although skin manifestations are often predominant in monogenic autoinflammatory diseases, clinical and histopathological information regarding their dermatological involvement is still scarce. Monogenic autoinflammatory diseases with cutaneous expression can be classified based on the predominant lesion: (1) maculopapular rashes or inflammatory plaques; (2) urticarial rashes; (3) pustular, pyogenic or neutrophilic dermatosis-like rashes; (4) panniculitis or subcutaneous nodules; (5) vasculitis or vasculopathy; (6) hyperkeratotic lesions; (7) hyperpigmented lesions; (8) bullous lesions; and (9) aphthous lesions. By using this classification, this review intends to provide clinical and histopathological knowledge about cutaneous involvement in monogenic autoinflammatory diseases.
Topics: Autoimmune Diseases; Autoimmunity; Biomarkers; Biopsy; Dermatitis; Diagnosis, Differential; Genetic Association Studies; Genetic Predisposition to Disease; Humans; Phenotype; Skin; Symptom Assessment
PubMed: 31736939
DOI: 10.3389/fimmu.2019.02448 -
Veterinary Dermatology Jun 2021Strain elastography (SE) is a modern imaging technology that provides an additional way of evaluating the changes in soft tissue elasticity caused by pathophysiological...
BACKGROUND
Strain elastography (SE) is a modern imaging technology that provides an additional way of evaluating the changes in soft tissue elasticity caused by pathophysiological processes. Despite its widespread use in human medicine, only a few studies on the application of SE in veterinary medicine are available.
OBJECTIVES
To evaluate the potential usefulness of SE as an integrative imaging model in the standard ultrasound technique to better discriminate between inflammatory and neoplastic skin nodules in dogs.
ANIMALS
Fifty-one client-owned dogs with clinical evidence of single or multiple skin nodules detected during routine dermatological examination.
METHODS AND MATERIALS
Margins, echogenicity, echo-structure, calcification and vascularisation of 65 skin nodules were assessed with ultrasound, and SE was used to score qualitative (E-score, E-index, E2) and semiquantitative (SR) parameters. A comparison of diagnostic yields with cytological and histological findings as the gold standard was performed.
RESULTS
Mast cell and benign follicular tumours showed the highest E-scores and SRs among neoplastic nodules; statistically significant differences were not detected. Calcific and nonvascularised nodules showed significantly higher E-index values than the others. Overall, a negative correlation was observed between the longitudinal diameter of skin nodules and the qualitative elastic parameters.
CONCLUSIONS AND CLINICAL IMPORTANCE
In this study, SE proved to be useful to identify only a subset of nodules such as mast cells and hair follicular tumours. Although evidence supporting the use of SE in evaluating skin nodules was demonstrated to below, indicators to guide further research were developed.
Topics: Animals; Calcinosis; Diagnosis, Differential; Dog Diseases; Dogs; Elasticity Imaging Techniques; Sensitivity and Specificity; Thyroid Nodule; Ultrasonography
PubMed: 33830557
DOI: 10.1111/vde.12954 -
Journal of Investigative Medicine High... 2021Bullous pemphigoid (BP) is the most prevalent autoimmune blistering skin disease in the Western world affecting mainly the elderly population. The diagnosis is based on...
Bullous pemphigoid (BP) is the most prevalent autoimmune blistering skin disease in the Western world affecting mainly the elderly population. The diagnosis is based on clinical assessment along with specific immunopathologic findings on skin biopsy. Risk factors include genetic factors, environmental exposures, and several infections including hepatitis B, hepatitis C, , , and cytomegalovirus. A variety of drugs have been associated with BP including but not limited to dipeptidyl peptidase-4 inhibitors, loop diuretics, spironolactone, and neuroleptics. Associated neurologic disorders (dementia, Parkinson's disease, bipolar disorder, previous stroke history, and multiple sclerosis) have also been described. Common clinical presentation consists of extremely pruritic inflammatory plaques that resemble eczematous dermatitis or urticaria, followed by formation of tense bullae with subsequent erosions. Typical distribution involves the trunk and extremities. Mucosa is typically spared affecting only 10% to 30% of patients. Several unusual clinical presentations of BP have been described such as nonbullous forms with erythematous excoriated papules, plaques, and nodules. Other reported findings include urticarial lesions, prurigo-like nodules, multiple small vesicles resembling dermatitis herpetiformis or pompholyx, vegetating and purulent lesions localized in intertriginous areas, and even exfoliative erythroderma. Recognition and management of such cases can present a diagnostic challenge to clinicians. In this article, we describe another variant which to our knowledge is the first case to present with a cellulitis-like presentation in a patient with a known history of BP.
Topics: Aged; Blister; Cellulitis; Humans; Pemphigoid, Bullous; Skin
PubMed: 33847152
DOI: 10.1177/23247096211008585 -
Frontiers in Plant Science 2021Nitrate absorbed by soybean ( L. Merr.) roots from the soil can promote plant growth, while nitrate transported to nodules inhibits nodulation and nodule nitrogen...
Nitrate absorbed by soybean ( L. Merr.) roots from the soil can promote plant growth, while nitrate transported to nodules inhibits nodulation and nodule nitrogen fixation activity. The aim of this study was to provide new insights into the inhibition of nodule nitrogen (N) fixation by characterizing the transport and distribution of nitrate in soybean plants. In this research, pot culture experiments were conducted using a dual root system of soybeans. In the first experiment, the distribution of N derived from nitrate was observed. In the second experiment, nitrate was supplied-withdrawal-resupplied to one side of dual-root system for nine consecutive days, and the other side was supplied with N-free solution. Nitrate contents in leaves, stems, petioles, the basal root of pealed skin and woody part at the grafting site were measured. Nitrate transport and distribution in soybean were analyzed combining the results of two experiments. The results showed that nitrate supplied to the N-supply side of the dual-root system was transported to the shoots immediately through the basal root pealed skin (the main transport route was via the phloem) and woody part (transport was chiefly related to the xylem). There was a transient storage of nitrate in the stems. After the distribution of nitrate, a proportion of the nitrate absorbed by the roots on the N-supply side was translocated to the roots and nodules on the N-free side with a combination of the basal root pealed skin and woody part. In conclusion, the basal root pealed skin and woody part are the main transport routes for nitrate up and down in soybean plants. Nitrate absorbed by roots can be transported to the shoots and then retranslocated to the roots again. The transport flux of nitrate to the N-free side was regulated by transient storage of nitrate in the stems.
PubMed: 34093618
DOI: 10.3389/fpls.2021.661054 -
European Annals of Otorhinolaryngology,... Jan 2022Radiofrequency ablation for benign thyroid nodules has a low rate of complications in experienced hands for selected indications, but tracheal necrosis is a major...
INTRODUCTION
Radiofrequency ablation for benign thyroid nodules has a low rate of complications in experienced hands for selected indications, but tracheal necrosis is a major complication.
CASE REPORT
A 60 year-old female patient underwent percutaneous radiofrequency ablation of an unesthetic benign isthmic thyroid nodule. The procedure was performed with a cooled electrode, using the "moving shot" technique on a trans-isthmic approach, under general anesthesia. Postoperative course was complicated by dysphonia and cervical pain implicating a third-degree skin burn of the medial cervical region progressing to severe soft-tissue and cervical tracheal necrosis.
DISCUSSION
Risk factors in the present case included the general anesthesia, isthmic location and thyroid nodule volume. To avoid this kind of complication, the procedure should be performed under local anesthesia, using cooled dextrose solution hydrodissection between trachea, thyroid and skin. Ahead of radiofrequency ablation, patients should be informed of possible major complications, especially if the indication is cosmetic.
Topics: Catheter Ablation; Female; Humans; Middle Aged; Necrosis; Radiofrequency Ablation; Thyroid Gland; Thyroid Nodule; Trachea; Treatment Outcome
PubMed: 34412970
DOI: 10.1016/j.anorl.2021.08.004 -
Plastic and Reconstructive Surgery.... Apr 2017Keloids are a dermal fibroproliferative scar of unknown etiology. There is no good animal model for the study of keloids, which hinders the development and assessment of...
BACKGROUND
Keloids are a dermal fibroproliferative scar of unknown etiology. There is no good animal model for the study of keloids, which hinders the development and assessment of treatments for keloids.
METHODS
Human keratinocytes and dermal fibroblasts were isolated from 3 human skin tissues: normal skin, white scars, and keloids. A mixed-cell slurry containing keratinocytes and dermal fibroblasts was poured into a double chamber implanted on the back of NOD/Shi-scid/IL-2Rγnull mice. After 12 weeks, the recipient mice had developed reconstituted human skin tissues on their backs. These were harvested for histological studies.
RESULTS
Macroscopically, the reconstituted skins derived from both normal skin and white scars were similar to normal skin and white scars in humans, respectively. Keloid-derived reconstituted skins exhibited keloid-like hypertrophic nodules. Histological findings and immunohistochemical staining confirmed that the reconstituted skin tissues were of human origin and the keloid-derived reconstituted skin had the typical features of human keloids such as a hypertrophic dermal nodule, collagen type composition, orientation of collagen fibers, and versican expression.
CONCLUSION
The mouse model with humanized keloid tissue presented here should be a useful tool for future keloid research.
PubMed: 28507865
DOI: 10.1097/GOX.0000000000001304