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1.
J Hand Surg Am ; 2024 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-39115485

RESUMO

PURPOSE: Offering the benefits of rigid fixation while minimizing soft tissue dissection, intramedullary implants have become a popular choice among hand surgeons. Their placement often requires traversing or passing in proximity to joint surfaces. This study aimed to assess the damage to the articular cartilage of the base of the proximal phalanx resulting from antegrade placement of threaded headless intramedullary nails. METHODS: A cadaveric study comparing two techniques for antegrade placement of threaded headless intramedullary nails was conducted in 56 digits. The first entailed a single 2.1 mm intramedullary nail placed via the dorsal base of the proximal phalanx, whereas the second used two 1.8 mm intramedullary nails inserted via the collateral recesses of the phalangeal base. All specimens were analyzed for articular surface damage with the cartilage defect measured as a percentage of total joint surface area. Damage to the extensor tendons was also assessed in a subset of specimens. RESULTS: No significant difference in the percentage of articular surface damage was observed, with an average 3.21% ± 2.34% defect in the single 2.1 mm nail group and a 2.71% ± 3.42% mean defect in the two 1.8 mm nails group. There was no articular surface injury in 18% of digits in each group. Damage to extensor tendons was seen in three (9.4%) specimens and in all cases involved either the extensor indicis proprius or extensor digiti minimi. CONCLUSIONS: Hardware insertion using either the dorsal base of the proximal phalanx or the collateral recesses of the phalangeal base both demonstrated minimal articular cartilage damage and infrequent injury to the extensor tendons. CLINICAL RELEVANCE: With proper technique for antegrade insertion into the proximal phalanx, the cartilage defect observed often encompasses only a small percentage of the overall joint surface area.

2.
Am J Dermatopathol ; 45(9): e83-e85, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37462160

RESUMO

ABSTRACT: Nevus spilus, or speckled lentiginous nevus, is a relatively common lesion that presents at birth or in early childhood. It consists of a background tan patch, which appears similar to a café au lait macule or lentigo simplex on histology, studded with various types of nevi. Rarely, these nevi can undergo malignant transformation to melanoma. When melanoma develops within a heavily photodamaged nevus spilus, evaluating excision margins may be challenging because the combined histologic features of nevus spilus and severe dermatoheliosis can mimic melanoma in situ. We report a case of an elderly man with extensive sun damage who developed malignant melanoma within an occult nevus spilus, resulting in multiple excisions with false-positive margins.


Assuntos
Lentigo , Melanoma , Nevo , Neoplasias Cutâneas , Masculino , Recém-Nascido , Pré-Escolar , Humanos , Idoso , Margens de Excisão , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Melanoma/diagnóstico , Melanoma/cirurgia , Melanoma/patologia , Lentigo/patologia , Melanoma Maligno Cutâneo
6.
J Hand Surg Eur Vol ; : 17531934241277059, 2024 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-39275974

RESUMO

This case series describes the successful use of indocyanine green dye and near infrared fluorescence imaging in primary peripheral nerve repair.

7.
Injury ; 55(2): 111217, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38029683

RESUMO

BACKGROUND: An update on the epidemiology of distal radius fractures in the United States is necessary, particularly as the elderly population grows. Additionally, age and frailty have been associated with complications following surgical fixation of DRFs. Herein, we utilize the National Trauma Data Bank, a robust nationwide resource, to investigate the relationship between demographics, comorbidities, injury and fracture characteristics, and admission details. METHODS: Patients with isolated distal radius fractures were identified from the National Trauma Data Bank (2016-2019) according to ICD-10 codes. Univariate and multivariate regressions were conducted to determine independent risk factors for bilateral fractures, displaced fractures, open fractures, as well as length of hospital stay and adverse discharge disposition for patients undergoing inpatient surgical fixation. RESULTS: The incidence of DRFs was 3.6/1,000 trauma-related emergency department visits and 10.8/1,000 upper extremity traumas. Trauma mechanism was significantly associated with displaced and open fractures. Age (OR 1.01, 95% CI 1.01-1.01), BMI (OR 1.02, 95% CI 1.01-1.02), smoking (OR 1.34, 95% CI 1.15-1.57), and alcohol level (trace: OR 2.18, 95% CI 1.41-3.29; intoxicated: OR 2.20, 95% CI 1.63-2.95) were significantly associated with open fractures. Machinery (ß=2.04, 95% CI 1.00-3.08) and MVT (ß=0.39, 95% CI 0.08-0.69) mechanisms were independent risk factors for longer length of stay. mFI-5 was an independent risk factor, in a stepwise fashion, for both length of stay and adverse discharge disposition. CONCLUSIONS: High-energy mechanisms and risk factors for poor skin quality were significantly associated with open fractures. mFI-5 was an independent risk factor for longer length of stay and non-routine discharges in patients of all ages, despite controlling for other comorbidities, unrelated complications, and mechanism of injury. Trauma mechanism was an independent risk factor for prolonged length of stay only, particularly in patients younger than 65 years of age.


Assuntos
Fraturas Expostas , Fraturas do Rádio , Fraturas do Punho , Humanos , Idoso , Estados Unidos/epidemiologia , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/cirurgia , Comorbidade , Fatores de Risco , Estudos Retrospectivos
8.
Plast Reconstr Surg ; 150(2): 414-428, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35674521

RESUMO

BACKGROUND: Vascularized composite allotransplantation has redefined the frontiers of plastic and reconstructive surgery. At the cutting edge of this evolving paradigm, the authors present the first successful combined full face and bilateral hand transplant. METHODS: A 21-year-old man presented for evaluation with sequelae of an 80 percent total body surface area burn injury sustained after a motor vehicle accident. The injury included full face and bilateral upper extremity composite tissue defects, resulting in reduced quality of life and loss of independence. Multidisciplinary evaluation confirmed eligibility for combined face and bilateral hand transplantation. The operative approach was validated through 11 cadaveric rehearsals utilizing computerized surgical planning. Institutional review board and organ procurement organization approvals were obtained. The recipient, his caregiver, and the donor family consented to the procedure. RESULTS: Combined full face (i.e., eyelids, ears, nose, lips, and skeletal subunits) and bilateral hand transplantation (i.e., forearm level) was performed over 23 hours on August 12 to 13, 2020. Triple induction and maintenance immunosuppressive therapy and infection prophylaxis were administered. Plasmapheresis was necessary postoperatively. Minor revisions were performed over seven subsequent operations, including five left upper extremity, seven right upper extremity, and seven facial secondary procedures. At 8 months, the patient was approaching functional independence and remained free of acute rejection. He had significantly improved range of motion, motor power, and sensation of the face and hand allografts. CONCLUSIONS: Combined face and bilateral hand transplantation is feasible. This was the most comprehensive vascularized composite allotransplantation procedure successfully performed to date, marking a new milestone in plastic and reconstructive surgery for patients with otherwise irremediable injuries.


Assuntos
Transplante de Face , Transplante de Mão , Obtenção de Tecidos e Órgãos , Alotransplante de Tecidos Compostos Vascularizados , Adulto , Transplante de Face/métodos , Humanos , Masculino , Qualidade de Vida , Alotransplante de Tecidos Compostos Vascularizados/métodos , Adulto Jovem
10.
Inorg Chem ; 50(19): 9201-3, 2011 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-21863905

RESUMO

The subensemble kinetics of a platinum-sulfur covalent chemical reaction at the solution/surface interface of a model industrial catalyst support was examined using single-molecule fluorescence microscopy (SMFM) and was found to exhibit biexponential first-order kinetic behavior. The observed kinetics was a convolution of the observation probability and chemical reaction rate. These results suggest that deconvolution strategies may be broadly important for obtaining accurate chemical reaction kinetics with SMFM.

11.
J Am Chem Soc ; 132(43): 15167-9, 2010 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-20731349

RESUMO

Single-molecule fluorescence microscopy provided information about the real-time distribution of chemical reactivity on silicon oxide supports at the solution-surface interface, at a level of detail which would be unavailable from a traditional ensemble technique or from a technique that imaged the static physical properties of the surface. Chemical reactions on the surface were found to be uncorrelated; that is, the chemical reaction of one metal complex did not influence the location of a future chemical reaction of another metal complex.

12.
J Phys Chem A ; 114(7): 2438-46, 2010 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-20113000

RESUMO

A systematic study of the transition in silicate solutions from a solution containing a highly complex mixture of silicate species to one dominated by a single symmetric cubic octamer has been completed. Infrared and NMR results have been analyzed and compared with each other and literature values. The FT-IR band locations are dependent on many factors, particularly the dominant band near 1000 cm(-1). The analysis supports Dent Glasser's hypothesis that silica polymerization results from changes in distribution between the larger colloidal silica and intermediate sized anionic fraction rather than the continuous stepwise growth seen with organic polymerization. A constant value of silica monomer seen in all solutions independent of the complexity of the species or their distribution suggests equilibrium between the monomeric form and larger anions and polymers that is independent of their structure. No evidence is uncovered for specific silicate species dependent IR band assignments.


Assuntos
Silicatos/química , Espectroscopia de Ressonância Magnética/normas , Padrões de Referência , Solubilidade , Espectroscopia de Infravermelho com Transformada de Fourier , Água/química
13.
Bioorg Med Chem Lett ; 19(11): 2969-73, 2009 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-19410460

RESUMO

Starting from the known FXR agonist GW 4064 1a, a series of alternately 3,5-substituted isoxazoles was prepared. Several of these analogs were potent full FXR agonists. A subset of this series, with a tether between the isoxazole ring and the 3-position aryl substituent, were equipotent FXR agonists to GW 4064 1a, with the 2,6-dimethyl phenol analog 1t having greater FRET FXR potency than GW 4064 1a.


Assuntos
Isoxazóis/síntese química , Receptores Citoplasmáticos e Nucleares/agonistas , Animais , Cristalografia por Raios X , Transferência Ressonante de Energia de Fluorescência , Isoxazóis/química , Isoxazóis/farmacologia , Ratos , Receptores Citoplasmáticos e Nucleares/metabolismo , Relação Estrutura-Atividade
15.
J Am Acad Dermatol ; 60(6): 990-3, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19467370

RESUMO

BACKGROUND: Dermatopathologists often are asked by clinicians to report margins on punch excisions of melanocytic lesions. OBJECTIVE: We sought to determine the adequacy of surgical margins on melanocytic lesions submitted with intention of complete excision using punch removal technique. METHODS: We conducted prospective analysis of surgical margins on 266 consecutive patients who underwent attempted complete removal of 405 melanocytic nevi submitted as punch and fusiform excisions. RESULTS: Of 206 nonbisected punch excisions, 127 (62%) had final positive margins. Of 159 bisected punch excisions, 76 (48%) had final positive margins. Of 40 elliptical excisions, two (5%) had final positive margins. LIMITATIONS: Information on the perilesional rim of nonpigmented skin included in the excision was not available. CONCLUSIONS: Of punch excisions, 56% had positive margins. Importantly, 30% of these punch excised specimens were negative on initial levels but had positive margins after extensive sectioning, affirming that fusiform excisions are the preferred method to evaluate margins in melanocytic lesions.


Assuntos
Nevo Pigmentado/patologia , Nevo Pigmentado/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Pele/patologia , Humanos , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios/métodos
16.
Plast Reconstr Surg Glob Open ; 7(11): e2542, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31942317

RESUMO

Prompt, accurate diagnosis of breast implant infection is critical to minimizing patient morbidity. Bacterial culture false negative rate approaches 25%-30%, and better costeffective testing modalities are needed. Alpha defensin-1 (AD-1) is a neutrophil-mediated biomarker for microbial infection. With sensitivity/specificity of 97% and 96%, it has replaced culture as the preferred diagnostic modality for orthopedic periprosthetic infection, but has yet to be investigated in breast reconstruction. This pilot study compares the diagnostic performance of AD-1 to bacterial culture in suspected periprosthetic breast infection. METHODS: Patients with prosthetic breast reconstruction and suspected periprosthetic infection were prospectively studied. Implant pocket fluid was analyzed with gram stain and culture, AD-1 assay, and adjunctive markers. Demographics, operative history, prosthetic characteristics, and antibiotic exposure were collected, and diagnostic performance of each test was compared. RESULTS: Fifteen breasts with suspected periprosthetic breast infection were included, 10 (66.7%) of which were acutely infected. Gram stain correctly identified only 1 of 10 infections, whereas culture failed to identify 1 infection and reported equivocal/false-positives in 2 noninfected samples. AD-1, however, correctly classified all 15 samples. AD-1 exhibited 100% sensitivity and specificity, comparing favorably to culture (sensitivity: 90%, specificity: 60%), although this did not reach significance (P=0.22). Infected breasts also demonstrated significantly higher adjunctive marker levels compared to noninfected breasts. CONCLUSIONS: This study demonstrates the utility of AD-1 in diagnosing periprosthetic breast infection. Combining AD-1 with adjunctive inflammatory markers may allow more accurate, prompt detection of implant infection which may reduce morbidity and reconstructive failures.

17.
Bioorg Med Chem Lett ; 18(15): 4339-43, 2008 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-18621523
18.
Am J Dermatopathol ; 30(6): 600-3, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19033938

RESUMO

The occurrence of primary cutaneous ganglioneuroma is rare. We report 2 separate cases of primary cutaneous ganglioneuroma, both of which are associated with prominent overlying hyperkeratosis. The first case was in a 38-year-old woman with overlying verrucous keratosis. The second case was in a 93-year-old man with epidermal changes reminiscent of a seborrheic keratosis. Histologically, both lesions were composed of a proliferation of hyperplastic nerve fibers with spindled Schwann cells and axons with intermingled ganglion cells. Immunohistochemistry for neurofilament highlighted nerve fascicles; S100 protein displayed the associated Schwann cells, and neuron-specific enolase stained the interspersed ganglion cells. Variation in immunohistochemical staining was present between the 2 cases. A review of the literature demonstrates variable immunohistochemical staining of ganglion and Schwann cells in prior cases. Familiarity with these findings is important in establishing a diagnosis. The significance of the associated hyperkeratosis remains speculative.


Assuntos
Ganglioneuroma/complicações , Ganglioneuroma/diagnóstico , Ceratose/complicações , Ceratose/diagnóstico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Proliferação de Células , Feminino , Cistos Glanglionares/metabolismo , Cistos Glanglionares/patologia , Ganglioneuroma/patologia , Humanos , Ceratose/patologia , Masculino , Fosfopiruvato Hidratase/metabolismo , Proteínas S100/metabolismo , Células de Schwann/metabolismo , Células de Schwann/patologia , Neoplasias Cutâneas/patologia
19.
J Surg Case Rep ; 2017(9): rjx183, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29423165

RESUMO

Ichthyosis is a broad and loosely defined group of hereditary and acquired disorders characterized by filaggrin dysfunction and impaired epidermal homeostasis that results in dry, scaly and thickened skin. Individuals with truncation mutations in the profilaggrin gene coding for filaggrin are strongly predisposed to severe forms of ichthyosis. The phenotypical expression of ichthyosis caused by the same genotypical mutation can vary considerably in severity and in regards to how much constricting scar tissue develops. Here, we report a case of digital ichthyosis threatening the neurovascular integrity to the small finger to discuss the importance of early diagnosis and role of Z-plasty flaps in the surgical treatment of constriction band formation.

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