Late spontaneous rupture of the extensor pollicis longus tendon after corticosteroid injection for flexor tenosynovitis.

INTRODUCTION: Spontaneous rupture of the extensor pollicis longus (EPL) tendon has been reported after trauma, rheumatoid arthritis and sports. Rupture may also occur as a consequence of the use of anabolic steroids for recreational purposes, or systemic steroids for the treatment of a variety of medical conditions. CASE REPORT: We present a case report of a woman affected with a spontaneous EPL tendon rupture resulted 14 months after a corticosteroid injection for flexor tenosynovitis, "trigger finger," of the thumb. The edges of the tendon were debrided and sutured using figure of eight stitch and a running locked stitch. In addition multiple specimens were sent to Pathology. DISCUSSION: Duplay in 1876 described spontaneous rupture as a problem of mechanical and pressure phenomena. Another cause of EPL rupture is related to the development and persistence of inflammatory processes seen in patients with medical illnesses such as rheumatoid arthritis. There have been no reports in the literature to date of spontaneous EPL tendon rupture in the late period after steroid injection. Tendon ruptures in the hand usually occur one or two weeks after a corticosteroid injection, and the affected tendons are usually in neighbouring areas.

A phylogeny for North American Mallocybe (Inocybaceae) and taxonomic revision of eastern North American taxa.

A multigene phylogenetic assessment of North American species of Mallocybe is presented based on analyses of rpb1, rpb2, ITS, and 28S rDNA nucleotide data. This framework enables a systematic revision of the genus for 16 eastern North American species and captures taxonomic and phylogenetic diversity in a global context. A grade of two unusual and poorly known North American species stems from the most recent common ancestor of the genus that gives rise to three core subgroups named here as clades Unicolores, Nothosperma, and Mallocybe. The grade of taxa includes the poorly known Lepista praevillosa from Florida and a new species from the southern Appalachians, M. montana, both of which appear to be narrow-range endemics. Clade Nothosperma is characterized by Australian and New Zealand species, whereas clade Unicolores is composed of six species from eastern North America and East Asia. Clade Mallocybe is dominated by numerous north temperate taxa and constitutes the sister group to clade Nothosperma. These major clades are distinguished by a combination of phylogeny, morphology, geographic distribution, and ecology. In addition, four North American species are described as new: M. leucothrix, M. luteobasis, M. montana, and M. tomentella. Several names originating in North America, long ignored or misunderstood in the literature, are revitalized and established by type comparisons and modern reference material collected from or near type localities. In addition, 11 species were subjected to mass spectrometry muscarine assays, none of which contained detectable amounts of muscarine except for two: M. sabulosa and M. praevillosa. This confirms a diffuse phylogenetic distribution of muscarine within the genus. Taxonomic descriptions are presented for 16 species, several synonymies proposed, and four new combinations made. A key to species of eastern North American Mallocybe is presented, along with illustrations of important diagnostic features. Citation: Matheny PB, Kudzma LV, Graddy MG, Mardini SM, Noffsinger CR, Swenie RA, Walker NC, Campagna SR, Halling R, Lebeuf R, Kuo M, Lewis DP, Smith ME, Tabassum M, Trudell SA, Vauras J (2023). A phylogeny for North American Mallocybe (Inocybaceae) and taxonomic revision of eastern North American taxa. Fungal Systematics and Evolution 12: 153-201. doi: 10.3114/fuse.2023.12.09.

Humanitarian rescue medical action for patient with advanced lower extremity lymphedema.

No clear data exists regarding the initiating process of medial care delivery in cases of humanitarian rescue for advanced and debilitating patient conditions. We report on the delivery of care from a hospital located in a rural area in Southern Taiwan to a desperate patient from a country across the world in Lima, Peru. The patient is a 45-year old woman with unilateral severe, progressive primary lymphedema of 26 years who was scheduled to undergo a high femoral amputation for infections, lymphatic leak, inability to ambulate, and symptomatic cardiomegaly. All arrangements for care, including dental restoration, were made by our hospital in collaboration with the government of Peru. Upon multi-departmental consultation, an 8-hour Charles procedure was performed removing 47 kg of lymphedematous thigh and leg tissue. Eleven months postoperatively the patient is healed and ambulating without assistance. Her weight dropped from 120 to 73 kg. This case of humanitarian action demonstrates intense collaboration and coordination between two governments with dialogue, diplomatic success, a lymphedema surgical feat, and ultimately a successful outcome for the patient.

Upper Gastrointestinal Bleed Embolization with Onyx®: The "Tattoo Effect".

Endoscopic intervention is well validated for the control of upper gastrointestinal bleeding (UGIB). In cases of refractory bleeding, transarterial embolization is a safe and effective alternative. Ethylene vinyl alcohol (EVOH) commonly known as Onyx® is an inherently black liquid embolic approved for use in cerebrovascular arteriovenous malformations and is increasingly used as an embolic agent in multiple peripheral and visceral territories. Onyx® has a uniquely undesirable property of causing black color discoloration when used in peripheral applications adjacent to the skin akin to a "tattoo effect." Knowledge of the agents used by the interventional radiologist, clinical correlation, and close follow-up can be of paramount importance to avoid unnecessary surgical intervention. Here, we report a case demonstrating this "tattoo effect" on the gastric mucosa following UGIB embolization.

An improved method of supercharged transposed latissimus dorsi flap with the skin paddle for the management of a complicated lumbosacral defect.

OBJECTIVE: Treatment of non-healing wounds of lower back often poses a powerful challenge. We present one of the first report of treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle. CASE REPORT: We report a case of a 59 year-old man with myeloma of the sacral spine who underwent radiotherapy and chemotherapy and subsequently, laminectomies and placement of hardware for ongoing paresis and spine instability. Then, he developed an open wound and osteomyelitis of the spine with culture positive tuberculous granulomas. After multiple surgical debridement, he presented to our service and was treated with a single stage debridement followed by the performance of a latissimus dorsi musculocutaneous flap based on paraspinal perforators and supercharged. RESULTS: This solution, allowed for augmentation of blood flow to the muscle with the inferior gluteal artery, provided coverage of the defect resistant to the pressure, and simplified post-operative management of the patient. CONCLUSIONS: Alternative treatment options, including free tissue transfer, posed difficulties in finding suitable recipient vessels near the defect, in inserting the flap so as to restore its original length without compromising blood flow, and in postoperative care of the patient. Treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle may represent a milestone procedure for complicated lower spine wounds.

Alternative filler materials and new implant designs: what's available and what's on the horizon?

Despite ample evidence that silicone gel-filled implants do not cause systemic illness, they are still not available in the United States for widespread use. At this point, saline-filled implants are widely available for use, and assuming favorable outcomes of the relevant silicone studies, some forms of silicone gel-filled implants could be approved by the FDA and be available as soon as 2003. Other products under preliminary consideration by the FDA for eventual studies include the 150 series and the cohesive silicone gel-filled 410 series by McGhan, and the NovaGold implant by NovaMed. Assuming favorable study results, one or more could be approved by the FDA by the year 2004. Any products not yet submitted to the FDA for review of study designs by this time are not likely to be available in the United States in the next 4 or 5 years.

Free microvascular transfer of the vermiform appendix for creation of a tracheo-oesophageal fistula: A new method of voice reconstruction.

BACKGROUND: Voice rehabilitation following laryngectomy can take many forms. As its basic premise, vibrating air must be transferred to the mouth where articulation takes place and speech can be produced. It requires a source of air, a conduit for transfer, and a mechanism for prevention of regurgitation and aspiration. Creating a tracheo-oesophageal fistula and maintaining it with a vascularised appendix has been the intention of this report. METHODS: Three patients with an average age of 53 years underwent the procedure of free transfer of the appendix for voice restoration during the months of September 2004 through December 2004. All patients had laryngectomies and one had total cervical oesophageal reconstruction with a pedicled pectoralis major flap. Voice evaluation, swallowing function, and presence of aspiration were evaluated. RESULTS: All flaps survived without complications. The results of swallowing function were unaltered from preoperative levels. All flaps remained patent at an average follow-up period of 8 months. All three patients could produce loud voice, which was intelligible at a reasonable distance. Maximal phonation time was 4s in two patients and 5s in one patient. Voice rehabilitation using the free appendix flap can achieve a phonation time which is low and words and short phrases that are intelligible but limited so far to this level. The donor site morbidity is low and aspiration was not present. The results of this study indicate that this method may have a potential role in voice reconstruction but requires more experience and refinement of this technique.

Treatment of auricular pseudocyst with aspiration and local pressure.

An auricular pseudocyst is a fluid filled cavity unlined by epithelium in the intracartilaginous space of the ear. Clinically, it presents as a painless outpouching on the upper anterior surface of the auricle with sterile straw coloured fluid found upon aspiration. If left untreated, permanent deformity of the pinna may result. Treatment of the pseudocysts has varied in the literature with techniques involving aspiration alone or incision and drainage; however, due to the high recurrence rates with these methods more aggressive therapies have been instituted. Although these techniques have achieved reasonable results with few recurrences, their invasive nature and chemotherapeutic and toxic agents used have caused significant morbidity. We present treatment of an auricular pseudocyst by simple aspiration and local pressure application using an auricular prosthesis formulated with the creation of a moulage fitted to the ear by our prosthetist. This minimally invasive and simplistic approach can avoid some of the complications related to other therapies, such as cartilage deformity, depigmentation of skin, and scarring and yields optimal cosmetic results.