Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.434
Filtrar
1.
J Postgrad Med ; 67(1): 24-26, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33565473

RESUMO

Inclusion body fibromatosis (IBF) also called the "Reye tumor" is a rare spindle cell proliferation with distinct clinicopathological features. This is a report of four cases of IBF from a single institute. Typical location, age, size of the lesion, bland histology, and paranuclear inclusions are the distinguishing features of this entity. Medical literature search reveals very few series of cases of IBF, the remaining cases being in the form of case reports. The aim of this report is to highlight the typical features of this rare entity.


Assuntos
Fibroma/patologia , Corpos de Inclusão/patologia , Pré-Escolar , Feminino , Fibroma/cirurgia , Humanos , Masculino , Microscopia Eletrônica , Dedos do Pé/cirurgia , Resultado do Tratamento
2.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500295

RESUMO

A 42-year-old woman with a history of acute myeloid leukaemia status postallogeneic stem cell transplant presented with fevers, altered mental status, pulmonary infiltrates and septic shock that further progressed to thrombocytopenia and purpura fulminans. Laboratory studies were consistent with a diagnosis of thrombotic thrombocytopenic purpura (TTP). Blood cultures grew Streptococcus pneumoniae On chart review, our patient had a history of low immunoglobulin levels following stem cell transplant, which may have predisposed her to pneumococcal infection. The patient responded to therapy with ceftriaxone, plasma exchange, rituximab and caplacizumab. This is the fourth-documented case of pneumococcal induced TTP and, to the best of our knowledge, the first-describing pneumococcal induced TTP with purpura fulminans. We conclude that patients with TTP should be evaluated for infectious aetiologies and empiric antibiotics should be considered. Clinicians should be aware of the possibility for TTP to lead to purpura fulminans.


Assuntos
Bacteriemia/complicações , Infecções Pneumocócicas/complicações , Púrpura Trombocitopênica Trombótica/etiologia , Choque Séptico/complicações , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/sangue , Bacteriemia/terapia , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Feminino , Fibrinolíticos/uso terapêutico , Dedos/patologia , Dedos/cirurgia , Gangrena , Glucocorticoides/uso terapêutico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Fatores Imunológicos/uso terapêutico , Leucemia Mieloide Aguda/terapia , Nariz/patologia , Troca Plasmática , Infecções Pneumocócicas/sangue , Infecções Pneumocócicas/terapia , Púrpura Fulminante/sangue , Púrpura Fulminante/diagnóstico , Púrpura Trombocitopênica Trombótica/sangue , Púrpura Trombocitopênica Trombótica/terapia , Rituximab/uso terapêutico , Choque Séptico/sangue , Choque Séptico/terapia , Anticorpos de Domínio Único/uso terapêutico , Transplante de Células-Tronco , Dedos do Pé/patologia , Dedos do Pé/cirurgia
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(12): 1590-1593, 2020 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-33319541

RESUMO

Objective: To explore the application of the dorsal foot hexagonal flap for reconstruction of the web space in the fourth and fifth toe syndactyly combined with polydactyly. Methods: Between May 2016 and October 2019, 27 patients (34 feet) with the fourth and fifth toe syndactyly combined with polydactyly were treated, including 12 males and 15 females with an average age of 22.8 months (range, 10 months to 8 years). There were 7 bilateral feet and 20 unilateral foot. Twenty-four of which were incomplete and 10 were complete syndactyly of the fourth and fifth toes, and the fifth toes showed various degrees of fibular deflection. All the 34 feet were treated with one-stage reconstruction of the toe web with the dorsal foot hexagonal flap, and the correction of the fibular deviation of the fifth toe was made by removing the tibial polydactyly and using the articular surface dressing or wedge osteotomy. Results: All wounds healed by first intention without skin-frafting. All patients were followed up 6-36 months (mean, 18 months). There was no flexion contracture and obvious scar hyperplasia in all the patients, and the width and slope of the toe webs were normal. Three of the 34 webs developed web creep, and the rest of the toe webs were normal in depth. All 34 feet were corrected with peroneal fibular deviation, and the function of toe flexion was good. All parents of the children were satisfied with the outcome. Conclusion: The reconstruction of toe webs with dorsal foot hexagonal flaps for the treatment of the fourth and fifth toes syndactyly combined with polydactyly requires no skin graft. The operation is simple with high survival rate of the flap, the appearance and function of the toes are good, and the effectiveness is satisfactory.


Assuntos
Polidactilia , Procedimentos Cirúrgicos Reconstrutivos , Sindactilia , Criança , Feminino , Humanos , Lactente , Masculino , Polidactilia/cirurgia , Transplante de Pele , Retalhos Cirúrgicos , Sindactilia/cirurgia , Dedos do Pé/cirurgia , Resultado do Tratamento
5.
Am J Case Rep ; 21: e926886, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32999267

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, China, in late 2019 and has led to an ongoing pandemic. COVID-19 typically affects the respiratory tract and mucous membranes, leading to pathological involvement of various organ systems. Although patients usually present with fever, cough, and fatigue, less common manifestations have been reported including symptoms arising from thrombosis and thromboembolism. A spectrum of dermatologic changes is becoming recognized in patients with COVID-19 who initially present with respiratory symptoms. The mechanism behind these manifestations remains unclear. This report presents the case of a 47-year-old Hispanic man who developed cutaneous vasculitic lesions and gangrene of the toes following admission to hospital with COVID-19 pneumonia. CASE REPORT COVID-19 has been associated with cardiovascular disease entities including stroke, acute coronary syndrome, venous thromboembolism, and peripheral vascular disease. We present a case in which a 47-year-old Hispanic man arrived at the Emergency Department with COVID-19 and was admitted for respiratory failure. Despite anticoagulation initiated on admission in the presence of an elevated D-dimer, the patient developed gangrene of all his toes, which required bilateral transmetatarsal amputation. CONCLUSIONS This case shows that dermatologic manifestations may develop in patients who initially present with COVID-19 pneumonia. These symptoms may be due to venous thrombosis following SARS-CoV-2 vasculitis, leading to challenging decisions regarding anticoagulation therapy. Randomized controlled trials are needed to evaluate the efficacy of anticoagulation, to choose appropriate anticoagulants and dosing, and to assess bleeding risk.


Assuntos
Infecções por Coronavirus/complicações , Gangrena/etiologia , Gangrena/cirurgia , Pneumonia Viral/complicações , Síndrome Respiratória Aguda Grave/complicações , Dedos do Pé/cirurgia , Vasculite/etiologia , Amputação/métodos , Infecções por Coronavirus/diagnóstico , Serviço Hospitalar de Emergência , Seguimentos , Gangrena/fisiopatologia , Hispano-Americanos , Humanos , Masculino , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Multimorbidade , Pandemias , Admissão do Paciente , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etnologia , Insuficiência Respiratória/etiologia , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Dedos do Pé/irrigação sanguínea , Dedos do Pé/fisiopatologia , Resultado do Tratamento , Vasculite/fisiopatologia
6.
Diab Vasc Dis Res ; 17(3): 1479164120928868, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32538155

RESUMO

PURPOSE OF STUDY: To investigate toe systolic blood pressure and/or toe-brachial pressure index in predicting healing post minor diabetic foot amputations. KEY METHODS: A systematic search of EMBASE and PubMed (including Medline and The Cochrane Library) was conducted from database inception to 9 March 2020. Two authors independently reviewed and selected relevant studies. Quality was assessed with a modified Critical Appraisal Skill Programme checklist. MAIN RESULTS: Ten studies met the inclusion criteria. Nine studies investigating toe systolic blood pressure reported healing occurred at mean toe systolic blood pressure values ⩾30 mmHg, ranging between 30 and 83.6 mmHg. The meta-analysis (four studies) found toe systolic blood pressure <30 mmHg had 2.09 times the relative risk of non-healing post amputation, compared to toe systolic blood pressure ⩾30 mmHg (relative risk = 2.09, 95% confidence interval: 1.37-3.20, p = 0.001). Two studies investigating toe-brachial pressure index report successful healing where toe-brachial pressure index >0.2, with one study reporting a higher value of 0.8. MAIN CONCLUSIONS: Successful post-amputation healing outcomes were reported at mean toe systolic blood pressure ⩾30 mmHg, and the results varied considerably between the studies. Further research should identify whether variables, including amputation level, method of wound closure and length of post-operative follow-up periods, affect the values of toe systolic blood pressure and toe-brachial pressure index observed in this review.


Assuntos
Amputação , Índice Tornozelo-Braço , Pressão Sanguínea , Pé Diabético/cirurgia , Dedos do Pé/irrigação sanguínea , Dedos do Pé/cirurgia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Pé Diabético/diagnóstico , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Fatores de Risco , Resultado do Tratamento
7.
World Neurosurg ; 139: 12-19, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32251827

RESUMO

BACKGROUND: Ewing-like sarcoma with capicua transcriptional repressor (CIC) rearrangement is a unique class of undifferentiated round cell sarcomas characterized by CIC-double homeobox 4 gene fusion. Despite showing great histologic resemblance to Ewing sarcomas, they have proved to be a distinct pathological entity from the immunohistochemistry and genetic examinations and the response to treatment. We have presented a case of CIC-rearranged Ewing-like sarcoma with cerebral metastasis managed with operative resection and gamma knife radiosurgery. CASE DESCRIPTION: A 56-year-old woman had initially presented with an ulcerating lesion of the right fifth toe. The histological and immunohistochemical analysis revealed features consistent with CIC-rearranged Ewing-like sarcoma, which was confirmed with genetic analysis. Despite aggressive local control and a multidrug chemotherapy regimen, the patient developed multifocal metastases involving the lungs, femur, and cerebrum. The cerebral lesions were managed with surgery and gamma knife radiosurgery, with mixed results. CONCLUSION: CIC-rearranged Ewing-like sarcomas have recently been recognized as a distinct disease entity with a highly aggressive course. Treatment paradigms have yet to be defined to properly manage such an aggressive pathological process.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/terapia , Neoplasias Pulmonares/terapia , Metastasectomia , Radiocirurgia , Sarcoma/terapia , Neoplasias de Tecidos Moles/cirurgia , Dedos do Pé/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/secundário , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/genética , Neoplasias Femorais/secundário , Neoplasias Femorais/terapia , Rearranjo Gênico , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/secundário , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Proteínas Repressoras/genética , Sarcoma/diagnóstico por imagem , Sarcoma/genética , Sarcoma/secundário , Neoplasias de Tecidos Moles/genética , Neoplasias de Tecidos Moles/patologia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
8.
J Am Acad Orthop Surg ; 28(10): 410-418, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32073471

RESUMO

Hallux valgus deformity is a progressive forefoot deformity consisting of a prominence derived from a medially deviated first metatarsal and laterally displaced great toe, with or without pronation. Although there is agreement that the deformity is likely caused by multifactorial intrinsic and extrinsic factors, the best method of operative management is debated despite the creation of basic algorithms. Our understanding of the deformity and the development of newer techniques is continuously evolving. Here, we review the general orthopaedic principles of operative decision-making and management of hallux valgus deformity.


Assuntos
Hallux Valgus/cirurgia , Procedimentos Ortopédicos/métodos , Tomada de Decisões , Hallux Valgus/etiologia , Humanos , Ossos do Metatarso/cirurgia , Procedimentos Ortopédicos/tendências , Dedos do Pé/cirurgia
10.
J Pediatr Orthop ; 40(1): e30-e36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30950938

RESUMO

BACKGROUND: The phalanx bones in several cases of lateral polydactyly of foot revealed complicated alignment with radiographic findings revealing medial-protrusion and lateral deviation of the middle phalanx. We previously defined such cases as showing "mosaic-like alignment" and demonstrated favorable postoperative outcomes using our surgical procedure. The aim of this study was to evaluate the midterm and long-term postoperative outcomes in such cases. METHODS: The study included 17 feet from 16 patients; 5 male and 11 female, with one bilateral case. The radiographic findings in all cases revealed a mosaic-like alignment of phalanges. Average age of the patients at the initial surgery was 12 months and average duration of post-operative follow-up was 89 months (60 to 132 mo). The surgical procedures were focused on the alignment between the distal and proximal phalanges independent of the middle phalanx alignment. Ligamentous joint stability was restored using collateral ligament reconstruction. We retrospectively evaluated post-operative outcomes, and subjective evaluation by the patients and parents was carried out. RESULTS: No cases revealed either varus or valgus deformities, pigmentation of the grafted skin, or functional disturbance. As for postoperative complications, we observed visible thickening in 7 toes, 3 of which further underwent partial resection of the middle phalanx. Subjective evaluation of the postoperative results by the patients and parents was "very satisfied" or "satisfied" in 15 of 16 cases. CONCLUSION: On the basis of our midterm to long-term postoperative outcomes, we believe that our method of surgical reconstruction provides a new option for the treatment of lateral polydactyly of the foot with mosaic-like alignment of the phalanx bones. LEVEL OF EVIDENCE: Level IV-therapeutic studies.


Assuntos
Polidactilia/cirurgia , Dedos do Pé/anormalidades , Criança , Pré-Escolar , Ligamentos Colaterais/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Radiografia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Falanges dos Dedos do Pé/anormalidades , Falanges dos Dedos do Pé/diagnóstico por imagem , Falanges dos Dedos do Pé/cirurgia , Dedos do Pé/cirurgia , Resultado do Tratamento
11.
Foot Ankle Spec ; 13(2): 152-160, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31216881

RESUMO

Although they occur frequently, diabetic toe ulcers (DTUs) are poorly investigated. Long-term antibiotics or toe amputation are the usual indications for complicated DTU treatment. Some authors reported good to excellent results following conservative surgery (CS) for recalcitrant or infected wounds; yet no systematic review has been published. Seven studies, comprising 290 patients with 317 ulcers, met the inclusion criteria of this meta-analysis. Three types of CS were found: resection arthroplasty of the interphalangeal joint, toe-sparing bone excision (internal pedal amputation), and distal Symes amputation. The meta-analytical results were as follows: healing rate of 98.3%, healing time of 6.8 ± 3.9 weeks, recurrence rate of 2.3%, wound dehiscence/recurrent infection rate of 6.4%, skin necrosis rate of 2.8%, and revision surgery rate of 7.4%. Subgroup analyses showed no significant differences in outcomes between recalcitrant ulcers and infected ulcers nor between surgery types. Significance was found in relation to ulcer location; when compared with the hallux, DTU on the lesser toes demonstrated better outcomes. Compared with the reported overall results of standard of care associated with antibiotics or toe amputation of complicated DTUs in the literature, CS seems to be a better option for the treatment of recalcitrant or infected DTUs. Levels of Evidence: Level III.


Assuntos
Pé Diabético/cirurgia , Dedos do Pé/cirurgia , Tratamento Conservador , Humanos
12.
J Foot Ankle Surg ; 59(1): 125-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882135

RESUMO

Macrodactyly of the foot is an extremely rare congenital malformation characterized by an increase in the size of all the elements or structures of a digit or digits. Most sources indicate that macrodactyly affects the hand more often than the foot. This rare medical condition usually requires surgical intervention with a precise preoperative plan and postoperative rehabilitation. We present a case of macrodactyly of the right foot in which surgical reduction of the foot under assistance of 3-dimensional image technology was performed with satisfying cosmetic and functional outcomes.


Assuntos
Dedos/anormalidades , Deformidades Congênitas do Pé/cirurgia , Deformidades Congênitas dos Membros/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Amputação/métodos , Criança , Dedos/diagnóstico por imagem , Dedos/cirurgia , Deformidades Congênitas do Pé/diagnóstico por imagem , Humanos , Imageamento Tridimensional/métodos , Deformidades Congênitas dos Membros/diagnóstico por imagem , Deformidades Congênitas das Extremidades Inferiores/diagnóstico por imagem , Deformidades Congênitas das Extremidades Inferiores/cirurgia , Imagem por Ressonância Magnética , Masculino , Recuperação de Função Fisiológica , Cirurgia Assistida por Computador/métodos , Dedos do Pé/anormalidades , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/cirurgia , Tomografia Computadorizada por Raios X
13.
Intern Med ; 59(3): 439-443, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31588083

RESUMO

A 48-year-old woman with severe pain and numbness of her right leg and foot was admitted to our hospital. She had never smoked and had little exposure to passive smoking. Initially, polyarteritis nodosa with anti-phospholipid antibodies was considered. Combination therapy with methylprednisolone pulse therapy, intravenous cyclophosphamide pulse therapy, vasodilators, antiplatelet agents, and anticoagulants was not effective. Vasculopathy was progressive, and she presented with gangrene of the toes. She required amputation of her right leg. The pathological findings of the amputated leg revealed thromboangiitis obliterans (TAO). TAO should be considered even in non-smoking women. Non-response to immunosuppressant and anticoagulant therapies may be a clue to the diagnosis of TAO.


Assuntos
Amputação , Anticorpos Antifosfolipídeos/sangue , Pé/cirurgia , Tromboangiite Obliterante/tratamento farmacológico , Tromboangiite Obliterante/cirurgia , Dedos do Pé/cirurgia , Vasodilatadores/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Tromboangiite Obliterante/diagnóstico , Tromboangiite Obliterante/fisiopatologia , Resultado do Tratamento
14.
Adv Skin Wound Care ; 32(12): 1-4, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31764150

RESUMO

Thromboangiitis obliterans, or Buerger disease, is a rare nonatherosclerotic segmental inflammatory vasculitis that generally affects young tobacco smokers. Although no surgical treatment is available, the most effective way to halt the disease's progress is smoking cessation. In this case report, a 29-year-old smoker showed up to emergency department with gangrene of his fifth left toe and extensive plantar ulceration. After investigative angiography, he was diagnosed with Buerger disease. On November 2017, he underwent fifth left toe amputation and hyperbaric therapy. Five months after amputation, the patient was rehospitalized because of surgical wound dehiscence, wide ulceration, and pain. He was treated with lipofilling using the Coleman technique. Two weeks after the fat grafting procedure, the patient suspended pain control medication, and after 2 months, the surgical wound was almost healed. Fat grafting (lipofilling) is mostly used in plastic surgery; it offers regenerative effects, with minimal discomfort for the patient. This case report demonstrates a successful alternative use of lipofilling for this unique condition and opens up new options for use of this technique in other fields.


Assuntos
Tecido Adiposo/transplante , Amputação/métodos , Úlcera do Pé/cirurgia , Fumar/efeitos adversos , Tromboangiite Obliterante/cirurgia , Cicatrização/fisiologia , Adulto , Angiografia/métodos , Terapia Combinada/métodos , Serviço Hospitalar de Emergência , Seguimentos , Úlcera do Pé/etiologia , Úlcera do Pé/fisiopatologia , Sobrevivência de Enxerto , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Medição de Risco , Índice de Gravidade de Doença , Tromboangiite Obliterante/diagnóstico por imagem , Tromboangiite Obliterante/etiologia , Dedos do Pé/fisiopatologia , Dedos do Pé/cirurgia , Resultado do Tratamento
15.
J Am Podiatr Med Assoc ; 109(4): 322-326, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31762309

RESUMO

A schwannoma is a solitary benign tumor composed of Schwann cells occurring anywhere in the peripheral nervous system. The diagnosis of a schwannoma is often difficult to make by clinical presentation and advanced imaging modalities. We present a case report of a 61-year-old Hispanic woman with a left-foot, third-digit, soft-tissue mass. The diagnosis of a schwannoma of the proper digital nerve was made postsurgically by means of histopathologic and immunohistochemistry parameters. This is a rare location for a schwannoma, and neurogenic tumor should be included in the differential diagnosis of soft-tissue mass, as there have been prior case reports.


Assuntos
Doenças do Pé/patologia , Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Dedos do Pé/inervação , Feminino , Doenças do Pé/diagnóstico por imagem , Doenças do Pé/cirurgia , Humanos , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/cirurgia , Ultrassonografia
16.
Handchir Mikrochir Plast Chir ; 51(6): 434-439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698486

RESUMO

BACKGROUND: After loss of a thumb, the big toe is a possible donor site for reconstruction with wrap-around free flap and trimmed-toe transfer techniques. Early reconstructions seem to reduce the risk of post-operative infections, despite several studies that show different infection rates of the recipient site in immediate toe-to-hand transfer. The authors carried out a retrospective analysis of their experience in thumb reconstruction with big toe transfer and evaluated the results achieved with both immediate and delayed reconstructions in terms of infection occurrence. PATIENTS AND METHODS: From 2000 to 2017, patients who presented cut, crush and avulsion injuries in the thumb were selected and 33 toe-to-thumb transfers were performed. Patients were divided into two groups: in group A, patients underwent immediate reconstruction, while in group B delayed reconstructions were performed. The two groups received identical antimicrobial prophylaxis. Reliability of the immediate or delayed reconstruction was compared in terms of flap survival, requirement for a secondary intention healing and, in particular, rate of infection. RESULTS: 29 male and 4 female patients were treated. Toe-to-thumb transfers were performed in both groups: in group A, 8 wrap-around free flaps and 4 trimmed toe transfers; in group B, 11 wrap-around and 10 trimmed toe transfers. No flap loss occurred in either groups. No cases of infection were detected in the transferred toes. CONCLUSION: For toe-to-thumb transfer, there are published reports of a wide range of infection rates of the recipient sites. The authors compared their results in terms of infection rate between immediate reconstruction, group A, and delayed reconstruction, group B. Immediate toe-to-thumb transfer showed equal success rates to delayed transfer. No statistically significant difference in risk of infection between the two groups was found. Results showed that the immediate reconstruction was as safe and reliable as the delayed one.


Assuntos
Amputação Traumática , Infecções/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos , Polegar/cirurgia , Dedos do Pé/transplante , Amputação Traumática/cirurgia , Feminino , Traumatismos dos Dedos/cirurgia , Deformidades Adquiridas da Mão/cirurgia , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cirurgia Plástica/métodos , Dedos do Pé/cirurgia
17.
BMC Cancer ; 19(1): 1002, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653251

RESUMO

BACKGROUND: Amputation is the standard of care even for early-stage subungual melanomas (SUMs), known as nail apparatus melanoma, because the nail bed and nail matrix are close to the distal phalanx. However, a recent study demonstrated that not all patients with SUMs had histologic invasion of the underlying distal phalanx. As most SUMs occur in the thumb or big toe, amputation of either the thumb or big toe substantially interferes with activities of daily living, including poor cosmesis, loss of function, and phantom pain. Non-amputative digit preservation surgery can thus be applied in such cases without compromising patient prognosis. METHODS: We are conducting a multi-institutional single-arm trial to confirm the safety and efficacy of non-amputative digit preservation surgery. We will compare our results with those reported in the Japanese Melanoma Study, in which patients underwent amputation for SUMs as a traditional standard of care. Patients aged between 20 and 80 years with stage I, II, or III without evidence of tumor invasion to the underlying distal phalanx on preoperative radiograph are included in the study. The primary endpoint is major relapse-free survival (major RFS), which does not include local recurrence as an event; secondary endpoints include overall survival, digit-preservation survival, relapse-free survival, local relapse-free survival, partial relapse-free survival, and incidence of adverse events. A total of 85 patients from 21 Japanese institutions will be recruited within 5.5 years, and the follow-up period will last at least 5 years. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in August 2017, and patient enrollment began in November 2017. Ethical approval was obtained from each institution's Institutional Review Board prior to patient enrollment. DISCUSSION: This is the first prospective trial to confirm the safety and efficacy of non-amputative digit preservation surgery for SUM without distant metastasis or bony invasion. The results of this trial could provide evidence to support this less-invasive surgery as a new standard of care to preserve adequately functioning digits. TRIAL REGISTRATION: Registry number: UMIN000029997 . Date of Registration: 16/Nov/2017. Date of First Participant Enrollment: 12/Dec/2017.


Assuntos
Melanoma/epidemiologia , Melanoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças da Unha/epidemiologia , Doenças da Unha/cirurgia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Amputação/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Prospectivos , Polegar/patologia , Polegar/cirurgia , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Adulto Jovem
18.
BMJ Case Rep ; 12(10)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653621

RESUMO

Peripheral limb ischaemia and gangrene are devastating complications of pneumococcal sepsis. We report a 43-year-old professional pianist who presented with early sepsis and rapid development of this syndrome. No vasopressor medication was ever administered. We urgently reviewed the medical literature on a range of therapies recommended by consulting teams, to ensure he received optimal care. Based on our review and on feedback from the patient himself, we gained valuable insights into this illness and the merits of selected treatment options. His fingers ultimately recovered their function, intact, although several toes were later amputated. More recently published reviews postulate that imbalances in coagulation factors and natural anticoagulants occur as a result of disseminated intravascular coagulopathy and 'shock liver' in the sepsis syndrome, leading to microcirculatory thromboses. We submit this report as we believe it supports this hypothesis and adds further valuable information. We hope our observations will assist other critical care clinicians confronting this serious condition.


Assuntos
Dedos/patologia , Gangrena/etiologia , Isquemia/etiologia , Sepse/complicações , Dedos do Pé/patologia , Adulto , Amputação , Anticoagulantes/uso terapêutico , Diagnóstico Diferencial , Gangrena/tratamento farmacológico , Heparina/uso terapêutico , Humanos , Isquemia/tratamento farmacológico , Masculino , Milrinona/uso terapêutico , Música , Sepse/tratamento farmacológico , Dedos do Pé/cirurgia , Vasodilatadores/uso terapêutico
19.
J Am Podiatr Med Assoc ; 109(5): 401-406, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31599675

RESUMO

Onychocryptosis is a common pathology treated by podiatry medical services, and in a considerable percentage, surgical procedures are required to achieve a solution. There are multiple surgical approaches for ingrown toenails, both incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using carbon dioxide laser. This study presents a surgical procedure for onychocryptosis using a physical matrixectomy with a 1064-nm laser applied by means of a 400-µm optical fiber and surgical removal of the posterior cauterized tissue to achieve healing by primary intention. This technique was performed on 30 patients with onychocryptosis affecting the great toe (Mozena stages I and IIa), and all of the patients were followed up postoperatively for 12 months. The patients reported minimal postoperative pain, quicker surgical postoperative healing, rapid return to activities of daily living, and minor postoperative recurrence compared with previous studies using incisional procedures and chemical matrixectomies.


Assuntos
Terapia a Laser/métodos , Unhas Encravadas/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/cirurgia , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Dedos do Pé/cirurgia , Adulto Jovem
20.
Biomedica ; 39: 10-18, 2019 05 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31529845

RESUMO

Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected. There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases. We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.


Assuntos
Melioidose/epidemiologia , Amputação , Antibacterianos/uso terapêutico , Burkholderia pseudomallei/isolamento & purificação , Colômbia/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Doenças do Pé/cirurgia , Humanos , Hospedeiro Imunocomprometido , Falência Renal Crônica/complicações , Masculino , Melioidose/diagnóstico , Melioidose/tratamento farmacológico , Pessoa de Meia-Idade , Cooperação do Paciente , Recidiva , Ribotipagem , Dedos do Pé/microbiologia , Dedos do Pé/cirurgia , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...