Blue ears: a clue to diagnosis of alkaptonuria identified via telemedicine consultation.

Alkaptonuria is a rare autosomal recessive metabolic disorder with wide systemic involvement including pigment deposition. We present an unusual case diagnosed by an image obtained via telemedicine showing pigment deposition in the earlobe. We highlight how this clue may allow prompt diagnosis of alkaptonuria and prevent disease progression. Click https://www.wileyhealthlearning.com/#/online-courses/5da3bb51-40d1-4d42-9c4b-610d68106e25 for the corresponding questions to this CME article.

Surgical treatment for an uncommon headache: A gap of 4800 years.

Background Surgical management of headache due to anomalies in the cervical spine is uncommon, as most cases improve with drugs and/or physical therapy. Case We report two instances of a very uncommon congenital upper cervical spine anomaly due to the presence of a pseudoarthrosis between a unilateral paracondylar process in the base of the skull and an epitransverse process arising from the transverse apophysis (PCP/ETA). The first one corresponds to a male on whom an endoscopic guided puncture was performed, and the second to an adult male from the Neolithic period who showed two cranial trepanations together with the presence of morphine metabolites in both bones and dental calculus. Discussion We draw a parallel between the treatment of two individuals separated by a gap of more than 4800 years: contemporary direct vision of the false joint through a small endoscope, which provides an accurate puncture, and ancient double trepanation with clear signs of bone eburnation.

[Sentinel node biopsy in patients with oral cancer: a pilot study]. / Biopsia selectiva del ganglio centinela en pacientes con carcinoma oral: estudio piloto.

BACKGROUND AND OBJECTIVE: Sentinel node (SN) biopsy represents an alternative to full lymph node dissection in the surgical treatment of several malignant tumors. PATIENTS AND METHOD: Prospective study of 32 consecutive patients with clinically node-negative oral cancer comparing SN biopsy results with standard neck dissection. RESULTS: An effective SN localization was achieved in 31 patients (97%) and a complete agreement with neck dissection was observed: 16 were true negative and 15 were true positive. In 11 out of the 15 positive cases, the SN was the only node containing metastasis (73%). CONCLUSION: SN biopsy predicts the subclinical lymph node status in oral cancer patients.