Surgical management of a dermal lymphatic malformation of the lower extremity.

Dermal lymphatic malformations are rare congenital hamartomas of superficial lymphatics characterized by high recurrence rates after excision. The standard therapy for a single lesion is surgical excision with wide margins, which reduces recurrence but can have a potentially unacceptable aesthetic outcome. A case of a 24-year-old woman with a 6 cm x 5 cm dermal lymphatic malformation on her right thigh, diagnosed by clinical history, physical examination, magnetic resonance imaging and pathological findings, is reported. The patient underwent wide local excision with split-thickness skin grafting. After pathological examination revealed negative margins, the patient underwent tissue expander placement and excision of the skin graft with primary closure. The lesion did not recur, and the patient achieved a satisfactory aesthetic result. The present case represents the first report of the use of tissue expanders to treat dermal lymphatic malformations in the lower extremity and demonstrates a safe, staged approach to successful treatment.

Psychosocial risk factors for postherpetic neuralgia: a prospective study of patients with herpes zoster.

UNLABELLED: The results of previous studies using retrospective methods or small samples have suggested that there may be psychosocial risk factors for postherpetic neuralgia (PHN). We conducted a prospective study in which 110 patients with herpes zoster were assessed within the first month after rash onset with measures of acute pain and five broad domains of psychosocial functioning-physical, role, social, and emotional functioning, and stress and social support. Twenty of the 102 patients with follow-up data were diagnosed with PHN, defined as pain that had persisted for 4 months after rash onset. Measures of role functioning, personality disorder symptoms, and disease conviction during herpes zoster each made independent contributions to predicting either presence or intensity of PHN in logistic and linear regression analyses that controlled for relevant demographic and clinical variables, including age and acute pain intensity. These findings indicate that psychosocial variables are risk factors for the development of PHN. PERSPECTIVE: The results of this prospective study of patients with herpes zoster suggest that future research on the mechanisms and prevention of PHN should consider psychosocial as well as neurobiologic processes.

Acute pain in herpes zoster and its impact on health-related quality of life.

Although the effects of postherpetic neuralgia on physical and emotional functioning have been examined in a number of studies, the impact of acute pain in herpes zoster ("shingles") on health-related quality of life has been neglected. We describe the characteristics of herpes zoster pain and examine its relationship to physical, role, social, and emotional functioning in 110 patients with herpes zoster. When we controlled for relevant covariates, we found that greater pain burden, as assessed by the product of pain intensity and duration, was associated with poorer physical functioning, increased emotional distress, and decreased role and social functioning. The results demonstrate that herpes zoster pain has broad effects on the daily lives of patients and on their emotional health. The increasing incidence of herpes zoster that can be anticipated as the population ages requires that clinical trials that examine interventions to prevent or treat herpes zoster pain be given a high priority.

Squamous-cell carcinoma arising in a leprous neurotrophic ulcer: report of a case

Exophytic neoplasms arise rarely in neurotrophic ulcers of leprosy. When such a lesion does develop, it has clinical resemblance to an indolent and locally invasive epithelioma cuniculatum, may invade deeply, and may metastasize. The case described showed deep invasion and extensive involvement of bone. Exophytic neoplasms in neurotrophic ulcers of leprosy should be considered to be squamous-cell carcinomas, not epitheliomata cuniculata, because of their potential for rapid, deep invasion and metastases.