Benign or malign disturbances of the nail apparatus.

Disturbances of the nail apparatus are common and mainly benign. This review aims to investigate the aetiology of these disturbances, which range from more common benign causes to less common melanomas. Melanonychia may be the most prominent concern and is characterised by brown or black nail plate discoloration. Hence, understanding the most common nail changes, their epidemiology, pathophysiology, and clinical features are imperative to diagnosis and may prevent unnecessary surgical procedures in cases where it is not warranted.

[Benign skin tumours].

Benign skin tumours are commonly seen by general practitioners. They are important to differentiate from skin malignancies. Most benign skin lesions are diagnosed based on the history and clinical features. However, if the clinical diagnosis is uncertain, a skin biopsy, e.g. excisional or punch for histopathological examination is necessary to rule out malignancy. Seborrheic keratoses are the most common benign skin tumours with an increasing incidence with age. Other common benign skin lesions include melanocytic naevi, acrochordons and dermatofibromas, which may resemble malignant neoplasms.

[Immunosuppressive therapy and post-operative wound healing].

Patients in immunosuppressive treatment may have increased risk of post-operative infections and wound-healing complications. Perioperative management of immunosuppressive treatment is challenging due to the variety of medications and differences in surgical procedures across surgical specialities. This review examines the literature regarding the effect of immunosuppressive treatment on post-operative infections and wound-healing complications.

Prognostic implications of left ventricular hypertrophy diagnosed on electrocardiogram vs echocardiography.

It is unclear whether 12-lead ECG employing standard criteria for left ventricular hypertrophy (LVH) provides similar information with respect to long-term cardiovascular risk as echocardiography. The authors performed a retrospective cohort study of 1376 individuals without cardiovascular disease, who underwent ECG (LVH defined using the Sokolow-Lyon voltage combination (>35 mm) or the Cornell voltage-duration product (>2440 mm × ms)) and echocardiography (LVH defined as LV mass index (LVMI) >95 g/m2 for women and >115 g/m2 for men). The prognostic ability of LVH was assessed in Cox regression models adjusted for age, sex, smoking, systolic blood pressure, total cholesterol, antihypertensive medication, and fasting glucose. The primary end point was the composite of coronary events, heart failure, stroke, or death. The main secondary end point was heart failure or cardiovascular death. Median age was 67 (range 56-79) years, 68% were male. Eleven percent had ECG-defined LVH, 17% had echocardiographic LVH. Over median 8.5 years, 29% experienced a primary event. Event rates were 29%/35% for persons without/with ECG-defined LVH and 27%/39% for those without/with echocardiographic LVH. The Sokolow-Lyon combination, Cornell product, and ECG-defined LVH did not significantly predict the primary end point (P ≥ .05), but ECG-defined LVH predicted heart failure or cardiovascular death (adjusted hazard ratio (HR), 1.86, 95% confidence interval (CI), 1.13-3.08); P = .02). Conversely, LVMI was a significant, independent predictor of the primary end point (adjusted HR, 1.87, 95% CI, 1.13-3.10; P = .01), as was echocardiographic LVH (adjusted HR, 1.27, 95% CI, 1.01-1.61; P = .04). Echocardiographic LVH may be a better predictor of long-term cardiovascular risk than ECG-defined LVH in middle-aged and older individuals.

Quadruple synchronous primary cancers in a single patient.

Patients diagnosed with quadruple synchronous primary cancers are extremely rare and we present here, to the best of our knowledge, the first case report of this combination of primary cancers. A 70-year-old woman was diagnosed with cervical adenocarcinoma, melanoma on the right leg, invasive ductal cell carcinoma metastasis in the left axilla with no primary breast tumour detected and multiple basal cell carcinomas on the limbs, all within 2 months. The management was conducted in collaboration with six medical specialties. The cancers were surgically managed, with further adjuvant chemotherapy and ongoing hormone therapy for her breast cancer. Four years after the diagnosis, no signs of recurrence or further metastases from any of the cancers are present.

[Local anaesthetics].

Local anaesthetics are widely used in clinical practice. They comprise a group of weak organic bases, which selectively block sodium channels in the nerve cell membrane, thus blocking transmission of nociception by impeding depolarisation of the nerve. Local anaesthetics are generally safe and readily used and provide reduction of pain during biopsies, invasive procedures and surgery. This is an updated review of pharmacology and utilisation of local anaesthetics, as well as an overview of adjuvants, allergies, and adverse effects.

[Reconstruction of ritual female genital mutilation].

This review discusses female genital mutilation (FGM), which is a culturally founded ritual of unknown origin. The definition is intentional altering or injuring the female genitals for non-medical reasons. The WHO estimates, that more than 200 million women have sequelae from FGM. Acute compli-ca-tions range from haemorrhage and infection to death, while the most common chronic complications are vulvar pain, problems with micturition and childbirth, recurrent infec-tions, dysmenorrhoea, and dyspareunia. Favourable surgical techniques are available. Hitherto, these techniques are limited to certain types of FGM.

Conservatively managed saddle pulmonary embolism.

Massive, submassive, and nonmassive pulmonary embolism relate to the hemodynamic state, while saddle pulmonary embolus is a purely radiologic term. Patients with saddle embolus often present with hemodynamic compromise. However, treatment depends on the clinical presentation, and stable patients with a saddle pulmonary embolus can respond well to conventional anticoagulation.

Clear cell sarcoma-A review.

Clear cell sarcoma (CCS) previously known as malignant melanoma (MM) of the soft tissue, although, similar in morphology to MM, contemporary histopathologic and cytogenetic techniques have made this diagnosis obsolete, as it is now possible to distinguish between CCS and MM. CCS is often diagnosed in young adults with median age of 25 years. Overall mortality is generally poor, and the 5-year survival is between 40 and 60%. Hence, early diagnosis and radical surgery are key in the treatment of this extremely rare malignancy of the soft tissue comprising only about 1% of all sarcomas. This article present an overview of this rare malignancy.

[Reduced risk of diabetes and cardiovascular disease after bariatric surgery].

The worldwide incidence of obesity, defined as a BMI ≥ 30 kg/m2, has more than doubled during the past four decades. Bariatric/metabolic surgery provides the largest and most sustainable degree of weight loss. This review briefly summarises the emerging randomised evidence of the superiority of these procedures over conventional treatment, in achieving glycaemic control and inducing remission in patients with type 2 diabetes as well as the observational evidence suggesting improvements in the long-term risks of cardiovascular outcomes and mortality.

[Post-operative infections after cosmetic tourism].

Cosmetic tourism is defined as patient mobility across borders, typically constituted by patients seeking cosmetic surgery at lower costs abroad. The most common procedures are abdominoplasty, fat grafting and breast augmentation. Very little is known about the complication rates after cosmetic tourism, and there is a paucity of evidence in all aspects of cosmetic tourism. In this review, we focus on post-operative complications i.e. post-operative infections, in particular with rare microorganisms such as mycobacteria.

A pilot-study of hypnotherapy as complementary treatment for pain in chronic pancreatitis.

BackgroundChronic pain is the hallmark symptom of chronic pancreatitis (CP). Its treatment is complicated, and often the patients have side-effects notwithstanding that pain is not ameliorated in many cases. Hypnotherapy has been shown to improve symptoms of irritable bowel syndrome including abdominal pain and, as such, may serve as a remedy to relive pain. The aim of this open-label pilot-study was to test the effect of hypnotherapy for pain in patients with CP. MethodsFour patients with CP and chronic abdominal pain were included and followed for four consecutive weeks. The primary efficacy parameter was pain relief. After 1 week of baseline patients received a 1-h session of hypnotherapy. This was repeated at day 15 and day 23 and supplemented by self-administered hypnotherapy. ResultsThree of four participants completed the trial and experienced short lasting pain reduction during the trial. The reported pain relief was in the range of 20%-39% compared to baseline. Hypnotherapy improved self-reported sleep, vitality, and social life. ConclusionsThe results suggest that hypnotherapy may reduce pain related to CP. Furthermore, no adverse effects were reported and the majority of participants completed the trial. Further prospective controlled trials are warranted to examine the potential of hypnotherapy.

[Mycobacterium abscessus infection after cosmetic breast surgery in India].

A 36-year-old Danish woman underwent cosmetic breast surgery in India. Post-operatively, she presented with infection and ulcers under the breasts, and dicloxacillin was administered. The patient did not return for follow-up. Two years later the ulcer under the right breast had not healed, and the patient returned to hospital, where a wound culture was done. The result showed Mycobacterium abscessus. Hence, cephalexin administration was instituted, but the ulcer did not heal, and it was excised. The subsequent healing was rapid. Mycobacterial infections in Denmark are rare, serious, and often resistant to antibiotics.

Debut of Gastroesophageal Reflux Concomitant with Administration of Sublingual Immunotherapy.

Gastroesophageal reflux disease (GORD) is an often debilitating condition characterised by retrograde flow of content from stomach into the oesophagus, where the low pH of the stomach acid irritates the mucosa of the oesophagus. The most dominant symptoms in GORD are pyrosis, regurgitation, and dysphagia. Sublingual immunotherapy (SLIT) was first described in 1986. Following this description, the use has greatly increased in the treatment of allergic rhinitis, as an alternative to subcutaneously administered immunotherapy. Side effects are commonly of oropharyngeal and gastrointestinal nature, for example, swelling, itching, irritation, ulceration of the oropharynx and nausea, abdominal pain, vomiting, and diarrhoea. More serious side effects are dominated by respiratory tract and systemic manifestations. A 30-year-old male experienced refractory, relentless, and debilitation GORD subsequent to administration of sublingual immunotherapy for house dust mite in allergic rhinitis. The patient had to stop the SLIT after two weeks of administration due to GORD. The cessation resulted in rapid resolution of symptoms.

[Umbilical endometriosis and tumours in umbilicus].

Umbilical endometriosis is rare, representing only 0.5-1% of all cases of extragenital endometriosis. In infertile women, endometriosis may be as prevalent as 50%. Numerous differential diagnoses are present, hence the clinical diagnosis of umbilical tumours is intricate. In a 33-year-old woman, an umbilical tumour presented 12 months prior to referral. On referral, no cyclic bleeding was noticed, although intermittent bleeding and soreness of the element were present. Dysmenorrhoea, dyspareunia, intermittent pelvic pain, and three years of infertility were noted. A biopsy showed endometriosis.

[Atypical subcutaneous presentation of a basal cell carcinoma].

Basal cell carcinoma (BCC) have many treatment options either by dermatologist, with excision or radiotherapy. A 78-year-old woman had a BCC removed surgically, and 18 years after she had a subcutaneously located tumour extirpated at the same location. The result of pathological examination was BCC located atypically in the subcutis. Iatrogenic seeding from primary excision or non-radical primary excision may explain this presentation. This is only the second report of subcutaneously located BCC.