Large Lobular Capillary Hemangioma Associated with Ingrown Toenail: Histopathological Features and Case Report.

Lobular capillary hemangioma (LCH-PG) is a type of pyogenic granuloma characterized by proliferating blood vessels that resemble conventional granulation tissue. Granulation tissue is very often seen in association with ingrown toenails. Despite the close relationship between both entities, LCH-PG shows clinically different behaviors, such as rapid growth and frequent recurrence. Currently, it is unknown exactly how the different etiological factors contribute to the formation of differences between entities. We present a case of a large LCH-PG associated with chronic onychocryptosis in a 26-year-old man. Histopathological features included extensive signs of ulceration, hyperkeratosis, and patchy epidermal acanthosis with the presence of fibrous septa with lobular areas beneath the ulcerative area. The presence of stroma with a marked proliferation of blood vessels with wall thickening and mixed-type inflammatory changes was also characteristic. In advanced stages of onychocryptosis, as presented here, conventional granulation tissue or pyogenic granuloma can be clinically difficult to distinguish from other benign or malignant neoplasms. Histological examination is mandatory, and excisional biopsy can provide a definitive diagnosis.

A Rare Paronychia with Superinfection with Prevotella bivia and Staphylococcus haemolyticus: The Importance of Early Microbiological Diagnosis.

Prevotella bivia is an anaerobic, gram-negative bacillus which naturally thrives in the human vagina, and is usually related to vaginal tract infections. However, this microorganism can also cause infections in other body locations. Infections with Prevotella bivia are frequently severe due to the risk of osteomyelitis and the lack of good protocols for adequate therapeutic management. Staphylococcus haemolyticus infection is one of the most frequent etiological factors of nosocomial infections, which hasthe ability to acquire multiple resistance against antimicrobial agents. We report a rare case of foot and hand paronychia with superinfection of Prevotella bivia and Staphylococcus haemolyticus. We highlight the importance of early microbiological diagnosis, and proper therapeutic management to avoid the risk of complications and the development of bacterial resistance to antibiotics.

La temperatura del pie como factor predictivo de aparición de úlceras en la Diabetes Mellitus / Foot temperature as a predictor of ulcers in Diabetes Mellitus

El Pie Diabético es una de las complicaciones más importantes de la Diabetes Mellitus debido a la posibilidad que existe de sufrir una úlcera plantar que aboque a una amputación. La neuropatía periférica diabética acontece en un 60-70 % de los sujetos con Diabetes Mellitus y se caracteriza por un trastorno de la sensibilidad táctil y dolorosa, la alteración del umbral de vibración y de la percepción térmica para los umbrales de temperatura al calor y al frío. La temperatura de los pies de los sujetos con Diabetes Mellitus sin neuropatía periférica diabética es menor que con presencia de neuropatía periférica diabética. Se produce una correlación entre el aumento de la temperatura y la aparición de lesiones en los pies, debido a que la temperatura aumenta en las zonas de riesgo de ulceración por la propia inflamación y a la a utolisis enzimática de los tejidos, previa a la aparición de una ulceración de la artropatía de Charcot. Resultados: Actualmente se emplean dos tipos de técnicas de medición de la temperatura: termografía y termometría. Las pruebas de termografía se clasifican en placas superpuestas de cristal líquido termosensible e infrarrojos, y las pruebas de termometría se dividen en infrarrojos y los sensores térmicos. La valoración térmica se debe incluir en los protocolos de exploración neurológica de los pies en la Diabetes Mellitus por ser una prueba eficaz, no invasiva y disminuye la tasa de aparición de úlceras. Conclusiones: Se considera que una diferencia de 2,2º C, en el mismo punto de ambos pues de un sujeto, indica la aparición de lesiones propias del Pie Diabético, bien una ulceración si hay lesión, o una artropatía de Charcot. La evidencia científica indica que el control de la temperatura de los pies disminuye la tasa de ulceraciones en la Diabetes Mellitus. Abogamos por la inclusión de la valoración térmica en el protocolo de exploración de los sujetos con Diabetes Mellitus, debido a su efectividad en la prevención de ulceraciones y por su escaso tiempo de cribado

The Diabetic Foot is one of the most important complications of Diabetes Mellitus due to the possibility of suffering a plantar ulcer that leads to an amputation. Diabetic peripheral neuropathy occurs in 60-70 % of subjects with Diabetes Mellitus and is characterized by a disturbance of tactile and painful sensitivity, the alteration of the threshold of vibration and thermal perception for temperature thresholds to heat and cold. The temperature of the feet of subjects with Diabetes Mellitus without diabetic peripheral neuropathy is lower than with the presence of diabetic peripheral neuropathy. There is a correlation between the increase in temperature and the appearance of lesions on the feet, because the temperature increases in the areas of risk of ulceration due to the inflammation itself and to the enzymatic autolysis of the tissues, prior to the appearance of a ulceration of Charcot arthropathy. Results: Currently, two types of temperature measurement techniques are used: thermography and thermometry. Thermography tests are classified into thermo sensitive infrared liquid crystal plates, and the thermometry tests are divided into infrared and thermal sensors. The thermal assessment should be included in the neurological examination protocols of the feet in Diabetes Mellitus because it is an effective, non-invasive test and decreases the rate of ulcer appearance. Conclusions: It is considered that a difference of 2.2º C, in the same point of both because of a subject, indicates the appearance of own injuries of the diabetic Foot, either an ulceration if there is an injury, or a Charcot arthropathy. Scientific evidence indicates that controlling the temperature of the feet decreases the rate of ulcerations in Diabetes Mellitus. We advocate the inclusion of thermal assessment in the protocol of exploration of subjects with Diabetes Mellitus, due to its effectiveness in the prevention of ulcerations and its short time of screening

Rotura en tendón de Aquiles: manejo postquirúrgico para acelerar el regreso a la actividad deportiva / Achilles Tendon rupture: Post-surgical management to accelerate the return to sport activity

La ruptura de tendón de Aquiles es una interrupción de tendón, se trata de una lesión comúnmente presente en la comunidad deportiva. Existen varios factores de riesgo, baja vascularización, infiltración de corticoides, fluoroquinolona, degeneración del tendón o recidivas. Tenemos dos vías de tratamiento conservador y quirúrgico. Encontramos menor proporción Re-interrupciones del tendón en tratamientos quirúrgicos. Los programas de tratamiento funcional han documentado resultados satisfactorios para la recuperación temprana de la lesión a través de ensayos controlados aleatorios y metaanálisis. Se comienza a evaluar el uso del Plasma Rico en Plaquetas (PRP) como tratamiento para lesiones de tejido musculo esquelético como la RTA en técnicas quirúrgicas abiertas. Esta revisión tiene como objetivo valorar la recuperación a través de técnicas funcionales e infiltraciones de PRP para la recuperación temprana del RTA. Las autoras declaran no tener intereses económicos

The rupture of the Achilles tendon is a disruption of the tendon, it is an injury present in the sports community. There are several risk factors, low vascularization, corticoid infiltration, fluoroquinolone, tendon degeneration or recurrence. We have two routes of conservative and surgical treatment. We found a lower proportion of tendon reinterruptions in surgical treatments. The functional treatment programs have documented satisfactory results for the early recovery of the lesion through randomized controlled trials and meta-analyzes. The use of Platelet Rich Plasma (PRP) as a treatment for musculoskeletal tissue injuries such as RTA in open surgical techniques is being evaluated. The purpose of this review is to assess the recovery through functional techniques and infiltrations of PRP for the early recovery of the RTA

Range of Ankle Dorsiflexion in a Group of Adults with Ligamentous Laxity.

BACKGROUND: Ligamentous or joint laxity is a clinical entity characterized by increased joint mobility beyond the range of motion regarded as normal, and joint mobility is an effective indicator of the degree of laxity. We examined the influence of ligamentous laxity on the range of ankle dorsiflexion with the knee flexed and extended, comparing lax adults with a control (nonlax) group. METHODS: The sample comprised 400 individuals: 200 in the control group (mean ± SD age, 32.49 ± 11.06 years) and 200 in the lax group (mean ± SD age, 29.82 ± 9.40 years). The Beighton criteria were applied to each participant to diagnose laxity or nonlaxity, and sex, age, and angle range of bilateral dorsiflexion with the knee extended and flexed were recorded. RESULTS: The mean ± SD dorsiflexion range with the knee straight was 16.14° ± 5.29° left ankle and 21.21° ± 4.93° right ankle in the lax group and 12.94° ± 4.17° left ankle and 17.08° ± 4.40° right ankle in the control group. The respective values with the knee flexed were 15.84° ± 5.31° and 21.21° ± 4.80° in the lax group and 12.95° ± 3.95 and 17.23° ± 4.25° in the control group. CONCLUSIONS: In this sample, ankle dorsiflexion range in the lax group was 4° bigger than that in the control group in both knee positions.

Clinical signs in the foot that are predictors of ligamentous laxity in the adult population.

OBJECTIVES: This study evaluates the influence of ligamentous laxity on the foot from observation of clinical signs and quantification of certain joint ranges. METHODS: The sample consisted of 400 subjects - 200 in the non-lax control group (ages 32.49 ± 11.06 years) and 200 in the lax group (ages 29.82 ± 9.41 years). The Beighton criteria were applied to each subject to diagnose laxity or non-laxity after noting their gender, age, and 2 joint ranges and 2 clinical signs for both feet. This was an observational analytical study of cases and controls, in which a multivariate binary logistic regression model was applied. RESULTS: Extension of the first metatarsophalangeal joint (MTPJ) ≥95°, extension of the 1st toe's interphalangeal joint (IPJ) ≥14°, and the signs 1st "in the plantar footprint, marked and narrowly confined support under metatarsal heads" and 2nd "in the plantar footprint, continuity of the 1st toe to the 1st metatarsal" presented significant differences between the lax and the non-lax groups. These are usable as parameters with which to detect laxity. The Beighton criteria were confirmed as being the most appropriate for diagnosis. CONCLUSIONS: We propose the use of 2 clinical signs that can be evaluated in plantar footprints ("1st" and "2nd") and 2 exploratory manoeuvres (extension of the first MTPJ ≥95° and extension of the 1st toe's IPJ ≥14°) as factors present in the foot which allow the detection of ligamentous laxity in the adult population, for subsequent confirmation by applying the Beighton criteria.