Marjolin's ulcer in an ischial pressure sore presented with necrotizing soft tissue infection: A case report.

RATIONALE: Marjolin's ulcer (MU) is a rare skin malignancy derived from a chronic wound. Pressure ulcer related MU possesses poor prognosis and high metastatic rate, and it is difficult to be differentiated, especially when superimposed infection. PATIENT CONCERNS: Here we report a case with pressure ulcer related MU which presented as necrotizing soft tissue infection (NSTI) to demonstrate the manifestation, treatment, and prognosis of this rare disease. DIAGNOSES: A 45-year-old male patient had spinal cord injury at age 2 years. He presented ischial pressure sore complicated with NSTI initially. After serial debridements and antibiotic treatment, the infection subsided. For the persistent verruca-like skin lesion, he underwent wide excision which revealed well-differentiated squamous cell carcinoma. Further image studies showed localized residual tumor without distant metastasis. INTERVENTIONS: He then underwent hip disarticulation and anterior thigh fillet flap reconstruction. Local recurrence developed 3 months later, and re-wide excision and inguinal lymph node dissection were performed. No lymph node metastasis was noted and adjuvant radiotherapy was given. OUTCOMES: He was followed for 34 months and no recurrence or metastasis was found. The patient can move with a wheelchair or a hip prosthesis, and is partially dependent for daily activities. LESSONS: MU can masquerade as NSTI and one should be alert to its malignant potential. Due to its aggressive nature, limb sacrifice can be considered in circumstances of profound involvement. As for the reconstruction method, pedicled fillet flap provided good wound coverage.

Pulmonary function in school-age children following intravitreal injection of bevacizumab for retinopathy of prematurity.

The effect of anti-vascular endothelial growth factor on neonatal lung development was inconclusive. To evaluate pulmonary function in school-age children who have received intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP), this study included 118 school-aged children who were grouped into three groups: full-term control children (group 1), preterm children who had not received IVB treatment (group 2) and preterm children with ROP who had received IVB treatment (group 3). Pulmonary function was measured by spirometry and impulse oscillometry. Pulmonary function was significantly better in group 1 than in groups 2 and 3 (all p < 0.05 in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow between 25 and 75% of FVC (FEF25-75), and respiratory resistance at 5 Hz and difference between respiratory resistance at 5 and 20 Hz (R5-R20). There were no statistically significant differences between group 2 and group 3 in all pulmonary function parameters, including FVC, FEV1, ratio of FEV1 to FVC, FEF25-75, R5, R20, R5-R20, and respiratory reactance at 5 Hz. In conclusion, our study revealed that preterm infants receiving IVB for ROP had comparable pulmonary function at school age to their preterm peers who had not received IVB treatment.

Prediction of visual outcomes by an artificial neural network following intravitreal injection and laser therapy for retinopathy of prematurity.

AIMS: To construct a program to predict the visual acuity (VA), best corrected VA (BCVA) and spherical equivalent (SE) of patients with retinopathy of prematurity (ROP) from 3 to 12 years old after intravitreal injection (IVI) of anti-vascular endothelial growth factor and/or laser photocoagulation treatment. METHODS: This retrospective study employed a feedforward artificial neural network with an error backpropagation learning algorithm to predict visual outcomes based on patient birth data, treatment received and age at follow-up. Patients were divided into two groups based on prior treatments. The main outcome measures were the difference between the predicted and actual values of visual outcomes. These were analysed using the normalised root mean square error (RMSE). Two-way repeated measures analysis of variance was used to compare the predictive accuracy by this algorithm. RESULTS: A total of 60 ROP infants with prior treatments were included. In the IVI group, the normalised average RMSE for VA, BCVA, and SE was 0.272, 0.185 and 0.131, respectively. In the laser group, the normalised average RMSE for VA, BCVA and SE was 0.190, 0.250 and 0.104, respectively. This result shows that better predictive power was obtained for SE than for VA or BCVA in both the IVI and laser groups (p<0.001). In addition, the algorithm performed slightly better in predicting visual outcomes in the laser group (p<0.001). CONCLUSIONS: This algorithm offers acceptable power for predicting visual outcomes in patients with ROP with prior treatment. Predictions of SE were more precise than predictions of for VA and BCVA in both groups.