Salvage percutaneous transluminal angioplasty of the superficial femoral artery in the diabetic foot with deteriorating limb ischemia.

INTRODUCTION: PAD frequently co-occurs with diabetes, often leading to chronic nonhealing wounds. Foot gangrene and amputation are common outcomes of untreated CLI. CASE REPORT: A 67-year-old male with diabetes and deteriorating limb ischemia following surgical stress underwent successful surgical repair after emergency PTA of the SFA for extensive heel necrosis. After surgical debridement of necrotic heel tissue, the ABI on the affected side suddenly reduced to 0.36, but it improved to 1.06 at 4 weeks following stenting angioplasty, allowing the subsequent flap surgery to repair the heel defect. At the 1-year follow-up visit, the patient exhibited durable heel coverage and the restoration of weightbearing function. No signs or symptoms indicative of restenosis were evident in the blood vessel treated with stent angioplasty. CONCLUSION: This case highlights the importance of proper evaluation of critical ischemic conditions and the need for prompt endovascular interventions in preserving the at-risk diabetic foot.

Early-Stage Pilomatricoma with Cystic Features: A Case Report and Literature Review.

A conventional pilomatricoma presents as an asymptomatic, firm, subcutaneous nodule, commonly in the head, neck, and extremities of the paediatric population. However, its variants show diverse clinical features, which often pose a diagnostic challenge to clinicians. We recently treated an unusual case of pilomatricoma with cystic features in the upper chest of a 9-year-old girl, which manifested as a single solid tumour floating in a serous-filled sac formed by thick fibrous tissue. Herein, we present novel clinicopathological features of an early-stage pilomatricoma that should be clinically differentiated from a cutaneous abscess.

Masson Tumor of the Heel Fat Pad.

ABSTRACT: Intravascular papillary endothelial hyperplasia (Masson tumor) is an uncommon benign vascular lesion characterized by a reactive proliferation of endothelial cells. This lesion commonly occurs in the head, neck, and upper extremities. Although it can be found anywhere in the body, the lesion has never affected the heel fat pad. This report presents a rare case of Masson tumor of the heel fat pad to facilitate the recognition of this uncommon lesion and also suggests other conditions to be considered when diagnosing heel lesions.

Double Primary Malignancies Involving Cutaneous Carcinoma.

ABSTRACT: Multiple primary malignancies (MPMs) refer to the presence of 2 or more histologically distinct malignant tumors in the same individual. The prevalence of MPMs has increased owing to earlier detection of tumors by screening tests and improved treatment modalities for primary tumors. Although any combination of malignant tumors is possible, reports of MPMs involving cutaneous carcinoma are uncommon in the literature. Herein, we present 2 uncommon cases of synchronous double primary malignancies involving basal cell carcinoma and primary cutaneous mucinous carcinoma as the index tumors, accompanied by a thyroid carcinoma and a thymoma as the second malignancy, respectively. The authors also describe the usefulness of positron emission tomography/computed tomography for detecting occult primary tumors in patients with cutaneous malignancies.

A Fully Automatic Postoperative Appearance Prediction System for Blepharoptosis Surgery with Image-based Deep Learning.

Purpose: To automatically predict the postoperative appearance of blepharoptosis surgeries and evaluate the generated images both objectively and subjectively in a clinical setting. Design: Cross-sectional study. Participants: This study involved 970 pairs of images of 450 eyes from 362 patients undergoing blepharoptosis surgeries at our oculoplastic clinic between June 2016 and April 2021. Methods: Preoperative and postoperative facial images were used to train and test the deep learning-based postoperative appearance prediction system (POAP) consisting of 4 modules, including the data processing module (P), ocular detection module (O), analyzing module (A), and prediction module (P). Main Outcome Measures: The overall and local performance of the system were automatically quantified by the overlap ratio of eyes and by lid contour analysis using midpupil lid distances (MPLDs). Four ophthalmologists and 6 patients were invited to complete a satisfaction scale and a similarity survey with the test set of 75 pairs of images on each scale. Results: The overall performance (mean overlap ratio) was 0.858 ± 0.082. The corresponding multiple radial MPLDs showed no significant differences between the predictive results and the real samples at any angle (P > 0.05). The absolute error between the predicted marginal reflex distance-1 (MRD1) and the actual postoperative MRD1 ranged from 0.013 mm to 1.900 mm (95% within 1 mm, 80% within 0.75 mm). The participating experts and patients were "satisfied" with 268 pairs (35.7%) and "highly satisfied" with most of the outcomes (420 pairs, 56.0%). The similarity score was 9.43 ± 0.79. Conclusions: The fully automatic deep learning-based method can predict postoperative appearance for blepharoptosis surgery with high accuracy and satisfaction, thus offering the patients with blepharoptosis an opportunity to understand the expected change more clearly and to relieve anxiety. In addition, this system could be used to assist patients in selecting surgeons and the recovery phase of daily living, which may offer guidance for inexperienced surgeons as well.

Ossifying pilomatricoma and a novel hypothesis for its pathogenesis: A case report and comprehensive literature review.

RATIONALE: Pilomatricoma is a benign skin appendageal tumor derived from hair follicle matrix cells that commonly affects the head, neck, and upper extremities of the pediatric population. Since the original tumor description, diverse variants have been reported in the literature. Pilomatricoma with florid osseous metaplasia is described as an ossifying pilomatricoma and is recognized as a distinct variant of this benign tumor. However, the pathogenesis of this variant remains unclear. In this study, we present an uncommon case of ossifying pilomatricoma and address the pathogenesis of metaplastic ossification through a comprehensive literature review. PATIENT CONCERNS: A 14-year-old boy presented with an asymptomatic protuberant mass in the preauricular region. DIAGNOSIS: Based on its clinicopathological features, we diagnosed the lesion as an ossifying pilomatricoma. INTERVENTIONS AND OUTCOMES: The lesion was surgically removed under local anesthesia. The postoperative course was uneventful during the 6-month postoperative follow-up. LESSONS: We suggest that metaplastic ossification in ossifying pilomatricoma represents another feature of foreign body reaction to keratinous materials containing shadow cells in old lesions and a walling-off phenomenon to prevent exposure of surrounding tissues to keratinous materials.

Salvaging a Totally Avulsed Nail Bed Using Free Grafting and Postoperative Ice Cooling: A Case Report.

Most nail bed injuries occur along with other fingertip injuries; however, isolated total avulsion injuries of the nail bed are uncommon. To obtain optimal results, reconstructive methods should be selected judiciously depending on the type of injury, the patient's needs for their economic status and postoperative aesthetics, and postoperative morbidities. Replantation with an avulsed nail bed, if feasible, can be a reasonable treatment option to avoid the morbidities of other donor sites. This report presents a rare case of a 26-year-old man who experienced an isolated total avulsion injury of the nail bed with exposure of the phalangeal bone while using machinery, which was treated successfully with free grafting and postoperative ice cooling.

Intravascular papillary endothelial hyperplasia of the finger: a case of Masson's tumor.

Intravascular papillary endothelial hyperplasia is an uncommon benign vascular lesion characterized by a reactive proliferation of endothelial cells. The lesion of the finger often presents diagnostic challenges to surgeons because of its rarity. We report a case of intravascular papillary endothelial hyperplasia to facilitate the recognition of this uncommon lesion.

Pseudocystic pilomatricoma: A new variant and review of the literature.

A classic pilomatricoma, which usually presents with an asymptomatic, solitary, firm, subcutaneous nodule in the head, neck, or extremities of the paediatric population, is easily diagnosed based on its characteristic clinical and histopathological features. However, its variants often pose particular diagnostic challenges to clinicians due to their rarity and diverse clinicopathological features. We present a new pseudocystic variant, manifesting as solid lesions floating in a fluid-filled sac.

Ruthenium Complexes as Anticancer Agents: A Brief History and Perspectives.

Platinum (Pt)-based anticancer drugs such as cisplatin have been used to treat various cancers. However, they have some limitations including poor selectivity and toxicity towards normal cells and increasing chemoresistance. Therefore, there is a need for novel metallo-anticancers, which has not been met for decades. Since the initial introduction of ruthenium (Ru) polypyridyl complex, a number of attempts at structural evolution have been conducted to improve efficacy. Among them, half-sandwich Ru-arene complexes have been the most prominent as an anticancer platform. Such complexes have clearly shown superior anticancer profiles such as increased selectivity toward cancer cells and ameliorating toxicity against normal cells compared to existing Pt-based anticancers. Currently, several Ru complexes are under human clinical trials. For improvement in selectivity and toxicity associated with chemotherapy, Ru complexes as photodynamic therapy (PDT), and photoactivated chemotherapy (PACT), which can selectively activate prodrug moieties in a specific region, have also been investigated. With all these studies on these interesting entities, new metallo-anticancer drugs to at least partially replace existing Pt-based anticancers are anticipated. This review covers a brief description of Ru-based anticancer complexes and perspectives.

An unusual presentation of acquired periungual fibrokeratoma: A mixed form of dome-shaped and branching type.

Acquired periungual fibrokeratoma is an uncommon benign fibrous tumour occurring in the periungual area, predominantly the proximal nail fold. We describe a case of acquired periungual fibrokeratoma with an unusual presentation of mixed features including dome-shaped and branching type in order to facilitate the recognition of this variant.

Giant Mixed Tumor of the Skin Affecting the Hemiface.

Mixed tumor of the skin (MTS) is a rare skin adnexal neoplasm occurring in sweat glands. It is usually benign, measures 0.5 to 3 cm, and presents as a slowly growing, painless, firm nodule commonly in the head and neck regions. Owing to its rarity and lack of distinctive clinical manifestations, confirmative diagnosis is made on the basis of its pathologic features. Malignant MTS also develops de novo or from preexisting benign MTS even though they occur rarely. It should be excised completely to exclude malignant potentials. Herein, we report a 35-year history of a giant MTS of eccrine type measuring approximately 10.5 × 6.5 cm on the right hemiface of a 91-year-old woman, which is the largest facial MTS reported in the literature so far, to the best of our knowledge.

Clinical and Demographic Characteristics of Blepharoptosis in Korea: A 24-year Experience including 2,328 Patients.

PURPOSE: To describe the demographics, relative incidence of subtypes, and clinical characteristics of blepharoptosis in Korean patients. METHODS: This is a retrospective, observational case series consisting of 2,328 patients who underwent ptosis surgery from 1991 to 2014 at a tertiary referral hospital in Korea. The patients were classified according to the type of ptosis and the evaluation of clinical characteristics including levator muscle function (LF) and degree of ptosis. RESULTS: Of the 2,328 patients, 1,815 (78%) had congenital ptosis and 513 (22%) had acquired ptosis. Simple congenital ptosis is the most common type overall (73.7%), and aponeurotic ptosis is the most common acquired type. More than three-quarters of eyes with congenital ptosis were affected in a moderate (34.4%) to severe degree (41.3%), and most of these eyes had fair (33.7%) to poor LF (60.1%). Among eyes with acquired ptosis, approximately three-quarters were affected in a mild (33.3%) to moderate degree (41.0%), with 63.3% of these eyes having good LF. The most widely used surgical technique was frontalis suspension (55.1%), followed by levator resection (29.0%) and aponeurosis repair (14.8%). At 3 years after the first surgery, 15.7% of patients with congenital ptosis and 10.4% of patients with acquired ptosis underwent reoperation. CONCLUSIONS: Although the prevalence has decreased from previous years, the proportion of cases with congenital ptosis was higher in this study than has been shown in research conducted in the West. The majority of eyes with congenital ptosis was affected to a severe degree and had poor LF, while those with acquired ptosis were affected to a moderate degree and had good LF. More cases with acquired ptosis presented with fair to poor LF, and frontalis suspension surgery was performed more commonly compared to previous studies. The reoperation rate was higher in congenital ptosis compared to acquired ptosis.

Determination of the Amount of Ptosis Correction in Levator Resection Surgery for Pediatric Congenital Ptosis.

BACKGROUND: It is difficult to determine the amount of eyelid lift in levator resection surgery for congenital ptosis, especially when the surgery is performed under general anesthesia. We aim to introduce an objective and steady method with which to adjust eyelid height, and to identify other factors to be considered during surgery. METHODS: This is a retrospective, observational study of 110 eyes from 78 patients who underwent levator resection surgery for congenital ptosis. Postoperative eyelid height was observed chronologically. The amount of eyelid lift during surgery was compared with the real postoperative change of palpebral fissure width (PF). The factors influencing the postoperative changes in eyelid height were investigated to predict outcome. RESULTS: Postoperative eyelid height stabilized 1 month after surgery. The real postoperative change in PF was slightly larger than the amount of intraoperative eyelid lift in cases with levator muscle function (LF) ≥ 7 mm, whereas it tended to be smaller in cases with LF < 5 mm. Statistically significant factors influencing the difference between the amount of intraoperative eyelid lift and the real postoperative change of eyelid height included preoperative PF, preoperative LF, and anesthesia-induced lagophthalmos. CONCLUSION: The preoperative PF, preoperative LF, and anesthesia-induced lagophthalmos should be considered when determining the amount of ptosis correction to perform in levator resection surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Analysis of the causes of recurrence after frontalis suspension using silicone rods for congenital ptosis.

BACKGROUND: Silicone rod is a commonly used synthetic suspension material in frontalis suspension surgery to correct blepharoptosis. The most challenging problem and a decisive drawback of the use of silicone rod is a considerable rate of ptosis recurrence after surgery. We examined patients with recurred ptosis and assessed the physical and micromorphological properties of implanted silicone rods to determine the causative mechanisms of recurred ptosis after frontalis suspension using silicone rod. METHODS: This is a prospective observational case series of 22 pediatric patients with recurred ptosis after frontalis suspension using silicone rods for congenital ptosis. Implanted silicone rods were observed and removed during the operation for correction of recurred ptosis. The removed silicone rods were physically and micromorphologically evaluated to determine the cause of recurrence. RESULTS: Pretarsal fixation positions migrated upward, whereas suprabrow fixation positions migrated downward during ptosis recurrence. The breaking strength of implanted silicone rods was reduced by approximately 50% during 3 years. Cracks, debris, and loss of homogenous structure with disintegration were observed on scanning electron micrographs of implanted silicone rods in patients with recurred ptosis. Preoperative severe degree of ptosis also contributed to recurred ptosis. CONCLUSIONS: Recurrence of ptosis after frontalis suspension using silicone rod was associated with physical changes of implanted silicone rods, including positional migration, weakened tensile strength, and micromorphological changes in combination with patients' characteristics.