RESUMEN
The authors report a case of a unique reconstructive approach for an isolated macrodactyly of the lower extremity in an otherwise healthy African male. Surgical treatment included excision and local resection of the affected hypertrophied skin, soft tissue, and bone. A rectus abdominis free-tissue transfer and split-thickness skin graft were used for coverage of the defect. The foot healed without complication, and at 2-year follow-up, the patient had an aesthetically pleasing and fully functional result.
Asunto(s)
Deformidades Congénitas del Pie/cirugía , Recto del Abdomen/cirugía , Colgajos Quirúrgicos , Sindactilia/cirugía , Dedos del Pie/anomalías , Adulto , Humanos , Masculino , Microcirugia , Satisfacción del Paciente , Zapatos , Sindactilia/patologíaRESUMEN
Chronic heel pain syndrome (CHPS) is a common clinical entity. The etiology of CHPS has never been completely defined and there are no clear treatment regimens in the literature. Most authors agree that nonoperative treatment is effective in most patients. However, in 5%-10% of patients, operative intervention is required. Outcomes for these patients have been inconsistent. A series of 51 patients with intractable CHPS who were diagnosed with an entrapment of the posterior tibial nerve and its terminal branches is presented. Descriptive statistics were obtained for the demographic data and pre and postsurgical start-up and standing pain visual analog scale (VAS) scoring. Statistical testing of the VAS mean scores was performed using a paired t-test at the 0.01 level of significance. Pre- and postsurgical start-up and pre- and postsurgical standing pain VAS means were significantly different from each other (t = 19.6, p = .001 and t = 19.4, p = .001, respectively). Based on subjective and objective criteria, 96% of the patients experienced significant improvement and 90% reported completed resolution of heel pain. The presence of tarsal tunnel syndrome in all 51 patients strongly suggests entrapment neuropathy as the etiology of intractable CHPS.
Asunto(s)
Talón , Síndromes de Compresión Nerviosa/complicaciones , Dolor Intratable/etiología , Adulto , Anciano , Descompresión Quirúrgica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/cirugía , Dolor Intratable/cirugía , Síndrome , Síndrome del Túnel Tarsiano/complicaciones , Síndrome del Túnel Tarsiano/cirugía , Nervio Tibial/cirugíaRESUMEN
Previous studies have shown that type I diabetes (IDDM) increases the risk of developing periodontitis by 2-3-fold. IDDM patients exhibit destruction of the pancreatic beta cells, most probably caused by an autoimmune reaction. Evidence is accumulating to support the role of the autoimmune response in periodontal pathogenesis. A cytokine, interleukin (IL)-10, has been reported to selectively promote the expansion of a B lymphocyte lineage (CD5/LY1/B1) which has the propensity for secreting high levels of autoantibody. Therefore, the purpose of this project was to evaluate IL-10 production, percentage of CD5 B cells and the frequency of anti-collagen secreting cells in peripheral blood mononuclear cells of age, gender and race matched IDDM patients and controls. IL-10 production was evaluated by an ELISA using the supernatant of adherent peripheral blood cells cultured for 24 h in the presence of Porphyromonas gingivalis lipopolysaccharide (LPS). In 8 of 31 patients, IL-10 levels were significantly increased in IDDM compared to controls and a higher percentage of CD5 B cells was also observed by flow cytometry. In addition, these patients exhibited a higher frequency of anti-collagen secreting cells as elucidated by an ELISPOT. Moreover, treatment with a neutralizing anti-IL-10 antibody diminished the anti-collagen antibody response by 70%. These findings support the concept that a subset of IDDM patients possess an extremely robust IL-10 response following exposure to Gram-negative LPS, which could predispose them to the development of periodontitis through a heightened autoimmune mechanism.
Asunto(s)
Autoanticuerpos/biosíntesis , Linfocitos B/efectos de los fármacos , Diabetes Mellitus Tipo 1/inmunología , Interleucina-10/biosíntesis , Periodontitis/inmunología , Adolescente , Adulto , Antígenos CD19 , Linfocitos B/metabolismo , Antígenos CD5 , Estudios de Casos y Controles , Separación Celular , Niño , Colágeno/inmunología , Femenino , Citometría de Flujo , Humanos , Inmunofenotipificación , Leucocitos Mononucleares/metabolismo , Lipopolisacáridos/inmunología , Activación de Linfocitos , Masculino , Porphyromonas gingivalis/químicaRESUMEN
The authors present a case of congenital, bilateral, symmetrical, and purely transverse plane, abductus deformity of the second digit. The deformity appears to be familial in nature, although other possible etiologies remain including premature closure of the distal-lateral epiphysis of the middle phalanx, or a C-shaped epiphysis of the middle phalanx. The authors review a similar deformity described in orthopedic literature known as a delta phalanx.
Asunto(s)
Deformidades Congénitas del Pie/cirugía , Dedos del Pie/anomalías , Adulto , Artrodesis , Deformidades Congénitas del Pie/diagnóstico por imagen , Marcha/fisiología , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Radiografía , Articulación del Dedo del Pie/anomalías , Articulación del Dedo del Pie/diagnóstico por imagen , Articulación del Dedo del Pie/cirugía , Dedos del Pie/diagnóstico por imagen , Dedos del Pie/cirugíaRESUMEN
The authors present an alternative method of fixation for the Austin bunionectomy using the Richards self-tapping screw. A description of the screw and method of application is included. In more than 250 osteotomies fixated by this technique, no complications inherent to the self-tapping screw have been encountered.