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Dermatologic Surgery : Official... Jun 2024Lower extremity reticular and telangiectatic veins are of common cosmetic concern.
BACKGROUND
Lower extremity reticular and telangiectatic veins are of common cosmetic concern.
OBJECTIVE
To retrospectively evaluate results of lower extremity sclerotherapy using a combination of foam and liquid sclerosing agents.
METHODS
A retrospective chart review of sclerotherapy patients at a dermatology practice (January 2014 to April 2023) was performed.
RESULTS
Eight hundred and nine patients (775 women and 34 men) with a mean age of 49.6 ± 12.2 (18-84) years underwent a mean 1.4 ± 0.7 (1-7) sessions. Multiple different sclerosing agents were used, with 0.2% sodium tetradecyl sulfate foam/liquid predominating, although 72% glycerin liquid and 0.25% to 0.5% polidocanol foam/liquid were also used. Coagula occurred in 61.0% of patients at 2 weeks and 6.4% at 3 months, whereas postsclerotherapy hyperpigmentation was seen in 5.0% and 19.1% of patients at the same time points. Both were more common after first-round treatment, each with a trend toward decreased frequency with increasing session number. Telangiectatic matting was found in 2.3% of 3-month follow-up patients. Edema, superficial venous thrombophlebitis, migraines, and ulceration were rarely seen. Significant clinical improvement was noted in 72.0% of treatments.
CONCLUSION
This retrospective chart review, the largest to date of its kind, confirms the safety and efficacy of cosmetic lower extremity sclerotherapy with a combination of foam and liquid sclerosing agents.
PubMed: 38860828
DOI: 10.1097/DSS.0000000000004273 -
Qatar Medical Journal 2024Penile Mondor's disease (PMD) is a rare syndrome characterized by sclerosis after superficial thrombophlebitis of the superficial penile veins. The most usual appearance...
BACKGROUND
Penile Mondor's disease (PMD) is a rare syndrome characterized by sclerosis after superficial thrombophlebitis of the superficial penile veins. The most usual appearance of PMD is a tender, palpable, painful, and sometimes visible cord on the dorsal surface of the penis. Its pathogenesis is still unclear, and a standardized treatment has not been established.
CASE REPORT
A 54-year-old male patient presented with a left-sided indirect reducible inguinal hernia. The patient underwent Lichtenstein's procedure for inguinal hernia repair. On the tenth postoperative day, he returned with PMD confirmed by Doppler ultrasonography examination. Treatment with 4000 UI low molecular weight heparin (LMWH) daily for three weeks resolved the symptoms, but mild venous ectasia just to the proximal part of the penis remained.
DISCUSSION
The exact cause of PMD is not well understood, but various studies have identified certain factors associated with an increased risk of the condition. Out of various potential factors that could trigger PMD, the repair of an inguinal hernia has been reported only once. Treatment may involve pain management, anti-inflammatory medications, anticoagulants, and, in some cases, surgery.
CONCLUSION
PMD after open hernia repair surgery is a very rare benign condition. Correct diagnosis and prompt treatment allowed symptom resolution. Residual venous ectasia has no clinical significance other than a cosmetic appearance.
PubMed: 38859918
DOI: 10.5339/qmj.2024.25 -
BMC Musculoskeletal Disorders Jun 2024This article reports a case of a female patient admitted with swelling and subcutaneous mass in the right forearm, initially suspected to be multiple nerve fibroma.... (Review)
Review
This article reports a case of a female patient admitted with swelling and subcutaneous mass in the right forearm, initially suspected to be multiple nerve fibroma. However, through preoperative imaging and surgery, the final diagnosis confirmed superficial thrombophlebitis. This condition resulted in entrapment of the radial nerve branch, leading to noticeable nerve entrapment and radiating pain. The surgery involved the excision of inflammatory tissue and thrombus, ligation of the cephalic vein, and complete release of the radial nerve branch. Postoperative pathology confirmed the presence of Superficial Thrombophlebitis. Through this case, we emphasize the importance of comprehensive utilization of clinical, imaging, and surgical interventions for more accurate diagnosis and treatment. This is the first clinical report of radial nerve branch entrapment due to superficial thrombophlebitis.
Topics: Humans; Female; Thrombophlebitis; Nerve Compression Syndromes; Forearm; Radial Nerve; Radial Neuropathy; Middle Aged
PubMed: 38824539
DOI: 10.1186/s12891-024-07545-4 -
Medical Ultrasonography May 2024VEXAS syndrome is a recently described condition characterized by systemic inflammation, predisposition to hematologic malignancy and a high rate of venous thrombosis....
VEXAS syndrome is a recently described condition characterized by systemic inflammation, predisposition to hematologic malignancy and a high rate of venous thrombosis. Here we report the case of an elderly male with erythema nodosumlike lesions, ankle arthralgia, and general symptoms. B-mode and Doppler ultrasound of the subcutis diagnosed superficial thrombophlebitis of the lower limbs, which turned out to be the manifestation of a paucisymptomatic VEXAS syndrome. VEXAS should be considered in any patient who presents with unexplained superficial thrombophlebitis, macrocytic anemia and unexplained systemic inflammation.
PubMed: 38805617
DOI: 10.11152/mu-4384 -
Frontiers in Endocrinology 2024Craniopharyngioma (CP), although slow growing and histologically benign, has high morbidity, mostly related to hypothalamus-pituitary dysfunction and electrolyte...
BACKGROUND
Craniopharyngioma (CP), although slow growing and histologically benign, has high morbidity, mostly related to hypothalamus-pituitary dysfunction and electrolyte imbalance. Increased risk of vascular complications has been described. However, data are still poor, especially in the paediatric population. The aim of our study was to evaluate the occurrence, timing, and predisposing factors of deep venous thrombosis (DVT) and other vascular alterations in neurosurgical paediatric CP patients.
MATERIALS AND METHODS
In a single-centre, retrospective study, we investigated 19 CP patients (11 males, 8 females, mean age 10.5 ± 4.3 years), who underwent neurosurgery between December 2016 and August 2022, referred to Meyer Children's Hospital IRCCS in Florence.
RESULTS
Five patients (26.3%) presented vascular events, which all occurred in connection with sodium imbalances. Three DVT (two with associated pulmonary embolism, in one case leading to death) developed in the post-operative period, most frequently at 7-10 days. Elevated D-dimers, a reduced partial activated thrombin time and a prolonged C-reactive protein increase were highly related to thrombotic vascular events. One case of posterior cerebral artery pseudoaneurysm was described soon after neurosurgery, requiring vascular stenting. Superficial vein thrombophlebitis was a late complication in one patient with other predisposing factors.
CONCLUSION
CP patients undergoing neurosurgery are at risk of developing DVT and vascular alterations, thus careful follow-up is mandatory. In our study, we found that the phase of transition from central diabetes insipidus to a syndrome of inappropriate antidiuretic hormone secretion may be a period of significant risk for DVT occurrence. Careful vascular follow-up is mandatory in CP-operated patients.
Topics: Humans; Craniopharyngioma; Female; Male; Child; Retrospective Studies; Pituitary Neoplasms; Adolescent; Postoperative Complications; Venous Thrombosis; Neurosurgical Procedures; Child, Preschool; Vascular Diseases; Follow-Up Studies
PubMed: 38681768
DOI: 10.3389/fendo.2024.1292025 -
Acta Dermatovenerologica Croatica : ADC Dec 2023Dear Editor, Ticks carry many diseases, bacteria, and viruses and represent a very important healthcare issue both in Croatia and globally. Although most ticks are not...
Dear Editor, Ticks carry many diseases, bacteria, and viruses and represent a very important healthcare issue both in Croatia and globally. Although most ticks are not infected with pathogens dangerous to humans, some ticks can transmit infectious diseases with significant morbidity and mortality. This is caused by the increasing incidence of many tick-borne diseases over a growing geographical area. Many factors influence which species of ticks are present in a given geographical area, as well as the density of their population and the risk of human exposure to infected ticks. The average morbidity from Lyme borreliosis in the Republic of Croatia is 6.51 infected per 100,000 inhabitants. There can be no Lyme borreliosis without ticks infected by Borrelia burgdorferi (1,2). In Europe, Lyme borreliosis (LB) is caused by the Borrelia burgdorferi sensu lato complex genotype. There are three skin manifestations of LB: erythema migrans (EM), borrelial lymphocytoma (BL), and acrodermatitis chronica atrophicans (ACA) (3,4). Herein we describe a female patient with a diagnosis of Lyme disease based on the non-specific clinical picture and laboratory diagnostics, in whom successful treatment led to complete regression of all skin manifestations. The patient was a 58-year-old woman with no previous history of severe illness. Notably, the patient history showed that, eight months prior to presenting for the dermatological exam, the patient had observed the appearance of edema and demarcated macular exanthema around both ankles and subsequently on the dorsum of the right hand, which spread to the left hand and with gradual spread to both lower legs and the lower extremities, with more pronounced changes on the left leg. The initial dermatological examination found pronounced skin changes on both legs, especially the left leg, with erythematous changes in the form of figurate erythema forming confluences up to the size of a smaller palm; the skin of the left leg was partially mottled with normal turgor and elasticity (Figure 1a and Figure 1b). Inguinal lymph nodes were enlarged and painless on palpation. Changes were minimal and discrete on the right leg and were absent on the torso, upper extremities, and skin. Subjectively, there was no itching, burning, or tingling sensation in the affected areas of the skin. The patient subjectively reported feeling well. Family history showed that the patient's father had died from prostate cancer and that the mother had died from melanoma. Laboratory findings were as follows: hematological, biochemical, and immunological parameters were normal. Venous and arterial ultrasound of both legs was normal, with the presence of reactively enlarged left inguinal lymph nodes. Lyme disease was suspected based on the clinical picture, with a differential diagnosis of possible livedo reticularis. A biopsy of the skin changes was also performed, with the results showing that the histological picture in the examined material could be compatible with the provisional clinical diagnosis of livedo reticularis. IgM and IgG specific for Borrelia burgdorferi was also performed: IgG was borderline, whereas IgM was positive at 218 U/mL. Over the next 3 weeks, Amoxil 500 mg thrice daily was introduced to the treatment. After completion of the treatment, there was a gradual regression of all skin changes without the appearance of new lesions (Figure 2a and Figure 2b) (Figure 3a and Figure 3b). Patient follow-up over the next year did not find any recurrence of similar skin changes. Herein we have described the case of a patient with atypical skin changes in which the presence of antibodies for Borrelia burgdorferi was demonstrated, in which regression of all skin manifestations was achieved after diagnosis and adequate antibiotic treatment. Lyme disease has a wide spectrum of clinical manifestations that can generally be observed in three stages: the early localized stage, the early disseminated stage, and the late stage of the disease. However, it is also possible for the different stages to overlap and even for the late stage to manifest without any signs and symptoms of the earlier stages. Early localized stage. Characterized by skin changes - erythema migrans (EM) - usually manifests within a month of the tick bite (usually 7-14 days after the bite) (Figure 4 and Figure 5). EM manifests in approximately 80% of patients, but only 25% of patients can recall the tick bite. The skin changes are usually localized in the axilla, the groin, the cubital area, or around the waist. The changes are generally not painful, but can itch or be warm to the touch. They gradually spread over days or weeks and can grow to a radius of up to 20 cm. Initially, the coloration can be uniform for several days, after which the redness disappears around a central zone (4-6). Multiple skin changes are a sign of spirochetemia and not the result of multiple tick bites. Due to timely antimicrobial treatment, multiple skin changes are much rarer today. In the initial days or weeks after infection, patients with early, localized, or disseminated Lyme disease often present with non-specific signs and symptoms resembling a viral infection: fatigue, headache, loss of appetite, joint pain, and regional lymphadenopathy. Fever can be present in approximately 20% of patients. Laboratory findings in this phase are non-specific. Erythrocyte sedimentation can be slightly increased, leukocyte counts are mostly normal, and anemia and thrombocytopenia are present only rarely (7,8). Early disseminated stage. This stage is marked by numerous EM lesions (that generally appear days or weeks after the infection) and/or neurological and/or cardiac manifestations (occurring weeks or months after infection). Some of these patients have no data on the presence of early localized Lyme disease. The most common triad of neurological manifestations are meningitis, neuropathy (usually of the facial nerve) and motor or sensory radiculopathy (Bannwarth syndrome). All these manifestations can appear individually. Cranial nerve neuropathies can often be bilateral. Late-stage Lyme disease. Characterized by intermittent or permanent arthritis in one joint or several large joints, most commonly the knees, and/or more rarely by neurological symptoms such as discrete encephalopathy or polyneuropathy. Late-stage Lyme disease can develop several years after primary infection, and arthritis can be the first manifestation of the disease, with the early localized and early disseminated stages not manifesting at all. In Europe, patients with late-stage Lyme disease can present with chronic skin changes (acrodermatitis chronica atrophicans), which is not observed in the USA. It is caused by B. afzelii and is typically localized to the extensor surfaces of the hands and feet. It is most common in women >40 years of age but can also present in younger populations. However, due to early antimicrobial treatment of the earlier stages of the disease, late-stage manifestations are rare (9). The discovery of the etiology of this disease showed that some well-known clinical entities were also a manifestation of Borrelia infection. The etiology of other dermatologic diseases was thus determined, such as lymphocytoma (or lymphadenosis cutis benigna), which was recognized as an entity as early as 1884, as well as acrodermatitis chronica atrophicans, described in 1888, erythema chronicum migrans (Afzelius-Lipschütz), and the neurological disease called Bannwarth syndrome, the symptoms of which were described as early as 1922 (10,11). LB and all its dermatological manifestations occur in almost all European countries, predominantly in the central part of the continent. The annual incidence is between 9.4 cases per 100,000 inhabitants in France to 120 cases per 100,000 inhabitants in northeastern Poland, 130 cases per 100,000 inhabitants in Austria, and 155 cases per 100,000 inhabitants in Slovenia (12). The total prevalence of ACA in all European patients with LB is 1-10%, depending on the region. For example, BL and ACA comprise 0.3% of LB cases in Bulgaria. In Norway, ACA comprises 5% of all clinical LB cases, and in northern Italy that number is 2.5%. Establishing a diagnosis of ACA is much more difficult than diagnosing EM or benign lymphocytoma (BL) because the clinical manifestations of ACA can vary. Acrodermatitis chronica atrophicans is probably the most common late and chronic manifestation of LB that can be observed in European patients. The skin changes in our patient were fairly non-specific, based on descriptions from the literature, but positivity for IgM antibodies was important for establishing the diagnosis, along with the very good response to antibiotics regarding regression of skin changes as well as the histological analysis that, according to the pathohistological diagnosis, indicated livedo reticularis, which is in turn also described in the literature as a possible form of ACA depending on the stage of the disease. Skin changes on the lower extremities are often incorrectly interpreted as vascular insufficiency, e.g. chronic venous insufficiency, superficial thrombophlebitis, hypostatic eczema, obliterative arterial disease, acrocyanosis, livedo reticularis, or lymphoedema, but they can also be the result of ACA, as in our case (13-15). In cases such as the one we have described, clinical manifestations of Lyme disease can very often vary and differ greatly from the typical clinical picture. This is demonstrated by our case, which also shows that LB and its idiosyncratic manifestations can lead physicians astray in a condition where failing to establish a timely diagnosis can be fatal for the patient. This case report also serves as a reminder that Lyme disease should be considered whenever atypical skin changes are encountered. Given that ACA is a disease in the late stage of Lyme disease and that the changes in our patient were noticed at the very beginning, the disease did not develop to the later stage.
Topics: Humans; Lyme Disease; Female; Middle Aged
PubMed: 38651851
DOI: No ID Found -
North American Spine Society Journal Jun 2024Anterior cervical discectomy and fusion (ACDF) is a reliable procedure commonly performed in older patients with degenerative diseases of the cervical spine. Over...
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) is a reliable procedure commonly performed in older patients with degenerative diseases of the cervical spine. Over 130,000 procedures are performed every year with an annual increase of 5%, and overall morbidity rates can reach as high as 19.3%, indicating a need for surgeons to gauge their patients' risk for adverse outcomes. Frailty is an age-associated decline in functioning of multiple organ systems and has been shown to predict adverse outcomes following various spine procedures. There have been several proposed frailty indices of various factors including the 11-factor modified frailty index (mFI-11), which has been shown to be an effective tool for predicting complications in patients undergoing ACDF. However, there is a paucity of literature assessing the utility of the 5-factor modified frailty index (mFI-5) as a risk stratification tool for patients undergoing ACDF. The purpose of this study was to analyze the predictive capability of the mFI-5 score for 30-day postoperative adverse events following elective ACDF.
METHODS
A retrospective review was performed using the National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2019. Patients older than 50 years of age who underwent elective ACDF were identified using Current Procedural Terminology ([CPT] codes 22554, 22551, 22552, and 63075). Exclusion criteria removed patients under the age of 51, as well as those with fractures, sepsis, disseminated cancer, a prior operation in the last 30 days, ascites, wound infection, or an emergency surgery. Patients were grouped using mFI scores of 1, 2, and 3+. Univariate analysis, using chi-squared and one-way analysis of variance (ANOVA) tests, was conducted to compare demographics, comorbidities, and postoperative complications across the varying cohorts based on mFI-5 scores. Multivariate logistic regression, including patient demographics and preoperative comorbidities as covariates, was performed to evaluate if mFI-5 scores were independent predictors of 30-day postoperative adverse events. Covariates including race, BMI, sex, ASA, and comorbidities were included in regression models.
RESULTS
The 45,991 patients were identified and allocated in cohorts based on mFI-5 score. Rates for superficial surgical site infection (SSI), organ/deep space SSI, pneumonia, progressive renal insufficiency, acute renal failure (ARF), urinary tract infection (UTI), stroke/cardiovascular accident (CVA), cardiac arrest requiring cardiopulmonary resuscitation (CPR), myocardial infarction, bleeding requiring transfusions, deep vein thrombosis/thrombophlebitis, sepsis, septic shock, readmissions, reoperation, and mortality incrementally increased with mFI-5 scores from 0 to 3+. Multivariate regression analysis revealed that mFI-5 scores 1 to 3+ increased the odds, in a stepwise manner, of total complications, cardiac arrest requiring CPR, pneumonia and mortality. MFI-5 scores of 2 and 3+ were independent predictors of readmission (2: OR=1.5, p<.001; 3+: OR=2.0, p<.001) and myocardial infarction (2: OR=3.4, p=.001; 3+: OR=6.9, p<.001). A score of 3+ increased the odds of ARF (OR=9.7, p=.022), septic shock (OR=3.6, p=.036), UTI (OR=2.1, p=.007), bleeding requiring transfusions (OR=2.1, p=.016), and reoperations (OR=1.7, p=.004).
CONCLUSION
mFI-5 score is a quick and viable option for surgeons to use as an assessment tool to stratify high risk patients undergoing elective ACDF, as increasing mFI-5 scores showed significantly higher rates of all adverse outcomes accounted for in this study, except for deep incisional SSI, wound disruption, and PE. Additionally, moderate to severe mFI-5 scores of 2 or 3+ were independent predictors for 30-day postoperative ARF, UTI, MI, bleeding requiring transfusions, septic shock, reoperation, and readmissions following elective ACDF surgery in adults over 50 years old.
PubMed: 38618000
DOI: 10.1016/j.xnsj.2024.100318 -
Journal of Investigative Medicine High... 2024Breast pain is a common concern among women in primary care clinics. A rare cause of breast pain is Mondor's disease (MD), which can present as an acute, painful,...
Breast pain is a common concern among women in primary care clinics. A rare cause of breast pain is Mondor's disease (MD), which can present as an acute, painful, erythematous, cord-like induration on the breast or anterior chest wall. The disorder is caused by sclerosing superficial thrombophlebitis of the anterolateral thoracoabdominal wall veins. There does not appear to be a racial or ethnic propensity for this condition; however, it is important to understand that it may be more difficult to see in darker skin types (Fitzpatrick skin types IV-VI) and requires close attention on physical exam. The cause of MD is poorly understood but may be related to direct trauma, strenuous exercise, or hormone changes. We review a case of a 54-year-old woman who presented with an anterior chest wall palpable cord, better visualized with adequate lighting and skin traction, ultimately diagnosed as MD based on clinical findings and imaging studies. Mondor's disease often resolves spontaneously with supportive care, as in this patient's case; however, clinicians should be aware of this rare cause of breast pain and its association with hypercoagulable state, vasculitis, and breast cancer.
Topics: Female; Humans; Middle Aged; Breast; Breast Neoplasms; Mastodynia; Thoracic Wall; Thrombophlebitis
PubMed: 38606534
DOI: 10.1177/23247096241246621 -
Hemoglobin Mar 2024Hemoglobin (Hb) Volga is a rare, unstable β-chain hemoglobin variant (β27 Ala→Asp), causing chronic hemolytic anemia. This study presents two members of a Danish... (Review)
Review
Hemoglobin (Hb) Volga is a rare, unstable β-chain hemoglobin variant (β27 Ala→Asp), causing chronic hemolytic anemia. This study presents two members of a Danish family, splenectomized due to Hb Volga at and with multiple thrombotic events. The proband was diagnosed with Hb Volga 9 years old and splenectomy was performed as a part of treatment. Throughout his life, he experienced multiple superficial thrombophlebitis, two episodes of distal deep venous thrombosis (DVT) on lower extremities (age 32 and 33) and a transient ischemic attack (TIA) presented as amaurosis fugax (age 51). Thrombophilia investigation was normal. The proband's son was diagnosed with Hb Volga and underwent splenectomy at the age of 6. Despite anticoagulation therapy, he suffered from multiple venous thromboembolic events in his youth and died of chronic pulmonary embolism (PE)/pulmonary hypertension combined with infection. Given the observed propensity for multiple thromboses in these two patients, a literature review was conducted investigating reported occurrence of thrombotic events in individuals with Hb Volga. Currently 25 cases of Hb Volga are reported worldwide. The clinical symptoms primarily described are related to hemolytic anemia. Splenectomy is reported in 15 patients. Thromboses have previously been reported in only three patients who were also splenectomized. These cases involved DVT and PE, myocardial infarction, and an unspecified thrombotic event. The proband represents the first reported Hb Volga case with both venous and arterial thrombotic disorders. The exact mechanism underlying thrombotic tendency in patients with Hb Volga remains unknown, but it is probably associated with splenectomy.
Topics: Humans; Splenectomy; Male; Hemoglobins, Abnormal; Adult; Thrombosis; Middle Aged; Denmark; Venous Thrombosis; Child; Pedigree
PubMed: 38565203
DOI: 10.1080/03630269.2024.2335933 -
International Journal of Surgery Case... Apr 2024Mondor Disease is superficial thrombophlebitis mostly located in the thoracic-abdominal wall, mid-upper arm, and penis. The disease can affect all people over 30 years...
INTRODUCTION AND IMPORTANCE
Mondor Disease is superficial thrombophlebitis mostly located in the thoracic-abdominal wall, mid-upper arm, and penis. The disease can affect all people over 30 years old regardless of race, ethnicity but affects women more than men. The importance of this study case consists on being the first reported case of Mondor Disease in Albania.
CASE PRESENTATION
In this study, a case of superficial thrombophlebitis affecting the thoraco-epigastric veins in the right chest wall is reported. Evidence of a palpable cord in the inferior outer quadrant of the breast was noted. The patient, a 49-year-old female who has been in menopause from March of 2021, presented with chest pain ought to two months of exaggerated physical activity.
CLINICAL DISCUSSION
A detailed subjective and objective examination was performed. All laboratory data, including tests for COVID-19, showed normal range value except ESR. For 2 weeks under treatment with Ibuprofen, the chest pain was subsided but the palpable cord in the chest wall was persistent.
CONCLUSION
Reviewing the literature and after the Color Doppler examination it has been concluded in this diagnose. It was difficult to determine the diagnosis because of no previous experience with such clinical case.
PubMed: 38493614
DOI: 10.1016/j.ijscr.2024.109493