Salvage percutaneous transluminal angioplasty of the superficial femoral artery in the diabetic foot with deteriorating limb ischemia.

INTRODUCTION: PAD frequently co-occurs with diabetes, often leading to chronic nonhealing wounds. Foot gangrene and amputation are common outcomes of untreated CLI. CASE REPORT: A 67-year-old male with diabetes and deteriorating limb ischemia following surgical stress underwent successful surgical repair after emergency PTA of the SFA for extensive heel necrosis. After surgical debridement of necrotic heel tissue, the ABI on the affected side suddenly reduced to 0.36, but it improved to 1.06 at 4 weeks following stenting angioplasty, allowing the subsequent flap surgery to repair the heel defect. At the 1-year follow-up visit, the patient exhibited durable heel coverage and the restoration of weightbearing function. No signs or symptoms indicative of restenosis were evident in the blood vessel treated with stent angioplasty. CONCLUSION: This case highlights the importance of proper evaluation of critical ischemic conditions and the need for prompt endovascular interventions in preserving the at-risk diabetic foot.

Early-Stage Pilomatricoma with Cystic Features: A Case Report and Literature Review.

A conventional pilomatricoma presents as an asymptomatic, firm, subcutaneous nodule, commonly in the head, neck, and extremities of the paediatric population. However, its variants show diverse clinical features, which often pose a diagnostic challenge to clinicians. We recently treated an unusual case of pilomatricoma with cystic features in the upper chest of a 9-year-old girl, which manifested as a single solid tumour floating in a serous-filled sac formed by thick fibrous tissue. Herein, we present novel clinicopathological features of an early-stage pilomatricoma that should be clinically differentiated from a cutaneous abscess.

Masson Tumor of the Heel Fat Pad.

ABSTRACT: Intravascular papillary endothelial hyperplasia (Masson tumor) is an uncommon benign vascular lesion characterized by a reactive proliferation of endothelial cells. This lesion commonly occurs in the head, neck, and upper extremities. Although it can be found anywhere in the body, the lesion has never affected the heel fat pad. This report presents a rare case of Masson tumor of the heel fat pad to facilitate the recognition of this uncommon lesion and also suggests other conditions to be considered when diagnosing heel lesions.

Double Primary Malignancies Involving Cutaneous Carcinoma.

ABSTRACT: Multiple primary malignancies (MPMs) refer to the presence of 2 or more histologically distinct malignant tumors in the same individual. The prevalence of MPMs has increased owing to earlier detection of tumors by screening tests and improved treatment modalities for primary tumors. Although any combination of malignant tumors is possible, reports of MPMs involving cutaneous carcinoma are uncommon in the literature. Herein, we present 2 uncommon cases of synchronous double primary malignancies involving basal cell carcinoma and primary cutaneous mucinous carcinoma as the index tumors, accompanied by a thyroid carcinoma and a thymoma as the second malignancy, respectively. The authors also describe the usefulness of positron emission tomography/computed tomography for detecting occult primary tumors in patients with cutaneous malignancies.

A Fully Automatic Postoperative Appearance Prediction System for Blepharoptosis Surgery with Image-based Deep Learning.

Purpose: To automatically predict the postoperative appearance of blepharoptosis surgeries and evaluate the generated images both objectively and subjectively in a clinical setting. Design: Cross-sectional study. Participants: This study involved 970 pairs of images of 450 eyes from 362 patients undergoing blepharoptosis surgeries at our oculoplastic clinic between June 2016 and April 2021. Methods: Preoperative and postoperative facial images were used to train and test the deep learning-based postoperative appearance prediction system (POAP) consisting of 4 modules, including the data processing module (P), ocular detection module (O), analyzing module (A), and prediction module (P). Main Outcome Measures: The overall and local performance of the system were automatically quantified by the overlap ratio of eyes and by lid contour analysis using midpupil lid distances (MPLDs). Four ophthalmologists and 6 patients were invited to complete a satisfaction scale and a similarity survey with the test set of 75 pairs of images on each scale. Results: The overall performance (mean overlap ratio) was 0.858 ± 0.082. The corresponding multiple radial MPLDs showed no significant differences between the predictive results and the real samples at any angle (P > 0.05). The absolute error between the predicted marginal reflex distance-1 (MRD1) and the actual postoperative MRD1 ranged from 0.013 mm to 1.900 mm (95% within 1 mm, 80% within 0.75 mm). The participating experts and patients were "satisfied" with 268 pairs (35.7%) and "highly satisfied" with most of the outcomes (420 pairs, 56.0%). The similarity score was 9.43 ± 0.79. Conclusions: The fully automatic deep learning-based method can predict postoperative appearance for blepharoptosis surgery with high accuracy and satisfaction, thus offering the patients with blepharoptosis an opportunity to understand the expected change more clearly and to relieve anxiety. In addition, this system could be used to assist patients in selecting surgeons and the recovery phase of daily living, which may offer guidance for inexperienced surgeons as well.

Ossifying pilomatricoma and a novel hypothesis for its pathogenesis: A case report and comprehensive literature review.

RATIONALE: Pilomatricoma is a benign skin appendageal tumor derived from hair follicle matrix cells that commonly affects the head, neck, and upper extremities of the pediatric population. Since the original tumor description, diverse variants have been reported in the literature. Pilomatricoma with florid osseous metaplasia is described as an ossifying pilomatricoma and is recognized as a distinct variant of this benign tumor. However, the pathogenesis of this variant remains unclear. In this study, we present an uncommon case of ossifying pilomatricoma and address the pathogenesis of metaplastic ossification through a comprehensive literature review. PATIENT CONCERNS: A 14-year-old boy presented with an asymptomatic protuberant mass in the preauricular region. DIAGNOSIS: Based on its clinicopathological features, we diagnosed the lesion as an ossifying pilomatricoma. INTERVENTIONS AND OUTCOMES: The lesion was surgically removed under local anesthesia. The postoperative course was uneventful during the 6-month postoperative follow-up. LESSONS: We suggest that metaplastic ossification in ossifying pilomatricoma represents another feature of foreign body reaction to keratinous materials containing shadow cells in old lesions and a walling-off phenomenon to prevent exposure of surrounding tissues to keratinous materials.

ZW800-PEG: A Renal Clearable Zwitterionic Near-Infrared Fluorophore for Potential Clinical Translation.

Near-infrared (NIR) fluorescence imaging has advanced medical imaging and image-guided interventions during the past three decades. Despite tremendous advances in imaging devices, surprisingly only a few dyes are currently available in the clinic. Previous fluorophores, ZW800-1A and ZW800-1C, significantly improved the poor performance of the FDA-approved indocyanine green. However, ZW800-1A is not stable in serum and ZW800-1C induces severe stacking in aqueous media. To solve such dilemmas, ZW800-PEG was designed by introducing a flexible yet stable thiol PEG linker. ZW800-PEG shows high solubility in both aqueous and organic solvents, thus improving renal clearance with minimal binding to serum proteins during systemic circulation. The sulfide group on the meso position of the heptamethine core improves serum stability and physicochemical properties including the maximum emission wavelength shift to 800 nm, enabling the use of ZW800-PEG for image-guided interventions and augmenting photothermal therapy.

Salvaging a Totally Avulsed Nail Bed Using Free Grafting and Postoperative Ice Cooling: A Case Report.

Most nail bed injuries occur along with other fingertip injuries; however, isolated total avulsion injuries of the nail bed are uncommon. To obtain optimal results, reconstructive methods should be selected judiciously depending on the type of injury, the patient's needs for their economic status and postoperative aesthetics, and postoperative morbidities. Replantation with an avulsed nail bed, if feasible, can be a reasonable treatment option to avoid the morbidities of other donor sites. This report presents a rare case of a 26-year-old man who experienced an isolated total avulsion injury of the nail bed with exposure of the phalangeal bone while using machinery, which was treated successfully with free grafting and postoperative ice cooling.

Intravascular papillary endothelial hyperplasia of the finger: a case of Masson's tumor.

Intravascular papillary endothelial hyperplasia is an uncommon benign vascular lesion characterized by a reactive proliferation of endothelial cells. The lesion of the finger often presents diagnostic challenges to surgeons because of its rarity. We report a case of intravascular papillary endothelial hyperplasia to facilitate the recognition of this uncommon lesion.

Pseudocystic pilomatricoma: A new variant and review of the literature.

A classic pilomatricoma, which usually presents with an asymptomatic, solitary, firm, subcutaneous nodule in the head, neck, or extremities of the paediatric population, is easily diagnosed based on its characteristic clinical and histopathological features. However, its variants often pose particular diagnostic challenges to clinicians due to their rarity and diverse clinicopathological features. We present a new pseudocystic variant, manifesting as solid lesions floating in a fluid-filled sac.

Facile fabrication of elastic, macro-porous, and fast vascularized silicone orbital implant.

Orbital implants with interconnected porous architecture had gained prominence, as they were capable of being colonized by fibrovascular tissue and minimizing complications. However, mechanical properties of orbital implant had received little attention among existing design philosophy. Herein, a compliant porous silicone scaffold was developed by gelatin porogen-leaching method and used as the orbital implant in this study. The silicone scaffolds exhibited desired microstructure and simulated mechanical properties, including high porosity of ~90%, suitable pore size of 280-450 µm, reduced modulus of 50.1 ± 11.7 KPa, and excellent elasticity. in vitro results showed that the porous silicone scaffolds did not exhibit noticeable cytotoxicity and were favorable for both adhesion and proliferation of human vascular ECs. The porous silicone scaffold was easy to be manipulated when implanted into the anophthalmic sockets of rabbits. The implanted scaffolds provided satisfactory volume replacement and induced extensive fibro-vascularization, showing desirable orbital reconstruction effects. Therefore, our novel porous silicone scaffolds may be promising substitutes for current orbital implants.

Ruthenium Complexes as Anticancer Agents: A Brief History and Perspectives.

Platinum (Pt)-based anticancer drugs such as cisplatin have been used to treat various cancers. However, they have some limitations including poor selectivity and toxicity towards normal cells and increasing chemoresistance. Therefore, there is a need for novel metallo-anticancers, which has not been met for decades. Since the initial introduction of ruthenium (Ru) polypyridyl complex, a number of attempts at structural evolution have been conducted to improve efficacy. Among them, half-sandwich Ru-arene complexes have been the most prominent as an anticancer platform. Such complexes have clearly shown superior anticancer profiles such as increased selectivity toward cancer cells and ameliorating toxicity against normal cells compared to existing Pt-based anticancers. Currently, several Ru complexes are under human clinical trials. For improvement in selectivity and toxicity associated with chemotherapy, Ru complexes as photodynamic therapy (PDT), and photoactivated chemotherapy (PACT), which can selectively activate prodrug moieties in a specific region, have also been investigated. With all these studies on these interesting entities, new metallo-anticancer drugs to at least partially replace existing Pt-based anticancers are anticipated. This review covers a brief description of Ru-based anticancer complexes and perspectives.

An unusual presentation of acquired periungual fibrokeratoma: A mixed form of dome-shaped and branching type.

Acquired periungual fibrokeratoma is an uncommon benign fibrous tumour occurring in the periungual area, predominantly the proximal nail fold. We describe a case of acquired periungual fibrokeratoma with an unusual presentation of mixed features including dome-shaped and branching type in order to facilitate the recognition of this variant.

Giant Mixed Tumor of the Skin Affecting the Hemiface.

Mixed tumor of the skin (MTS) is a rare skin adnexal neoplasm occurring in sweat glands. It is usually benign, measures 0.5 to 3 cm, and presents as a slowly growing, painless, firm nodule commonly in the head and neck regions. Owing to its rarity and lack of distinctive clinical manifestations, confirmative diagnosis is made on the basis of its pathologic features. Malignant MTS also develops de novo or from preexisting benign MTS even though they occur rarely. It should be excised completely to exclude malignant potentials. Herein, we report a 35-year history of a giant MTS of eccrine type measuring approximately 10.5 × 6.5 cm on the right hemiface of a 91-year-old woman, which is the largest facial MTS reported in the literature so far, to the best of our knowledge.

The Efficacy of Negative Pressure Wound Therapy for Split-thickness Skin Grafts for Wounds on the Trunk or the Neck: A Randomized Controlled Trial.

INTRODUCTION: Skin failure may be both visually similar in appearance and can occur concomitant to a pressure injury, but it has a fundamentally different etiology. To date, no validated assessment tools or clinical indicators are available that can help definitively distinguish skin failure from a pressure injury. OBJECTIVE: The Skin Failure Clinical Indicator Scale (SFCIS), a proposed tool that uses readily available variables to assist in more definitively identifying skin failure, was developed and assessed. METHODS: A retrospective case-control study was conducted among acute care hospital patients who experienced acute skin breakdown before death. Data were extracted from the electronic medical records of deceased acute care patients who experienced acute skin breakdown prior to death between January 1, 2017, and March 1, 2019, in 2 US hospitals. Using ICD-10 coding, patients were separated into 2 groups depending on if the skin breakdown occurred at locations typical for pressure injury formation or atypical (non-pressure) locations. Patient diagnostic and clinical data were compared between the 2 groups. Univariate and multivariate data analyses were performed via backward stepwise logistic regression in order to identify significant predictors of skin failure; regression coefficients were converted into integers in order to create a tool that could assist in probable identification of skin failure. RESULTS: Of the 52 patients included in this study, 16 experienced skin breakdown at locations typical for pressure injury and 36 had skin breakdown in atypical locations, which was assumed to be indicative of skin failure. Factors found to help distinguish between skin failure and pressure injury included a serum albumin level less than 3.5 mg/dL (P = .07), impaired blood flow (P = .05), presence of sepsis/multiorgan dysfunction syndrome (P = .001), vasopressor/inotrope use (P ⟨ .001), and mechanical ventilation (P = .06), which ultimately correctly identified 83.7% as cases of probable skin failure. CONCLUSIONS: This scale may provide a means to correctly recognize and diagnose skin failure, initiate appropriate interventions, and decrease potential reimbursement penalties to facilities. Further testing will be necessary in order to validate the specificity and selectivity of this instrument.