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1.
Undersea Hyperb Med ; 46(5): 719-722, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683373

RESUMO

Introduction: Stingray spine injuries are among the most common marine animal injuries in humans. While most resolve with immersion in warm water, a few become infected and require antibiotics. We present a case report of a presumptive stingray injury that evolved to a major slough and which required prolonged healing in a patient with diabetes mellitus. Our literature review was unable to find a similarly reported case. Materials: A co-author was asked to evaluate and manage an ominous-appearing wound on the right foot of a diabetic. The problem developed after the individual had been wading in shallow ocean beach water. The patient's diabetic sensory neuropathy obscured the immediate association of the problem with a stingray injury, but this became the presumptive diagnosis when pain developed and necessitated that he seek medical care. Findings/Clinical Course: After an initial urgent care visit, increasing pain and worsening appearance of the patient's foot necessitated a visit to our emergency department. The patient was admitted the next day due to symptoms of systemic sepsis. On the fourth hospital day, a large bulla on the lateral side of the right foot was excised. This unroofed a full-thickness slough to the periosteum level of the underlying bones. Not until the 16th hospital day had enough improvement occurred to discharge the patient. Over the next 16 weeks, the wound improved, developed a vascular base and epithelialized. Conclusion: With a dearth of literature about stingray injuries in patients with diabetes mellitus reported, our case is unique: The patient's wound course more closely resembled a toxic inoculation than the typical puncture wound-cellulitis presentations associated with stingray injuries.


Assuntos
Mordeduras e Picadas/complicações , Traumatismos do Pé/terapia , Rajidae , Ferimentos Penetrantes/terapia , Adulto , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/terapia , Vesícula/etiologia , Vesícula/terapia , Complicações do Diabetes/terapia , Diabetes Mellitus , Traumatismos do Pé/etiologia , Humanos , Masculino , Necrose , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Cicatrização , Ferimentos Penetrantes/etiologia
3.
Wilderness Environ Med ; 30(3): 302-305, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229368

RESUMO

An experienced 24-y-old climber on Mount Everest presented to the Base Camp medical clinic with a friction blister on his right flank. The blister was filled with clear fluid and was located about 3 cm posterior and 3 cm superior to the highest point of the right iliac crest, the site where a climbing harness would support the climber while hanging. A diagnosis of friction blister caused by a climbing harness used while traversing between Camp 2 and Camp 3 of Mount Everest was made. The blister was managed with hydrocolloid dressing, and the patient resumed climbing after 1 wk. The lesion healed with scarring at 2 wk. Friction blisters of the feet are common in climbers wearing ill-fitting shoes, but friction blisters caused by climbing harnesses are unusual and have not been reported in the literature as far as the authors are aware. All existing guidelines for blister management pertain to blisters of the feet, and there are inconsistencies in recommendations made by various authors. This unusual case in an extreme environment provides a good learning opportunity.


Assuntos
Vesícula/terapia , Fricção , Montanhismo , Equipamentos Esportivos/efeitos adversos , Vesícula/etiologia , Humanos , Masculino , Nepal , Resultado do Tratamento , Adulto Jovem
4.
J Am Podiatr Med Assoc ; 109(2): 155-158, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31135195

RESUMO

Cutaneous adverse drug reactions make up 1% to 2% of all adverse drug reactions. From these adverse cutaneous drug reactions, 16% to 21% can be categorized as fixed drug reactions (FDR). Fixed drug reactions may show diverse morphology including but not limited to the following: dermatitis, Stevens-Johnson syndrome, urticaria, morbilliform exanthema, hypersensitivity syndrome, pigmentary changes, acute generalized exanthematous pustulosis, photosensitivity, and vasculitis. An FDR will occur at the same site because of repeated exposure to the offending agent, causing a corresponding immune reaction. There are many drugs that can cause an FDR, such as analgesics, antibiotics, muscle relaxants, and anticonvulsants. The antibiotic ciprofloxacin has been shown to be a cause of cutaneous adverse drug reactions; however, the fixed drug reaction bullous variant is rare. This case study was published to demonstrate a rare adverse side effect to a commonly used antibiotic in podiatric medicine.


Assuntos
Antibacterianos/efeitos adversos , Vesícula/induzido quimicamente , Ciprofloxacino/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , , Mãos , Vesícula/patologia , Vesícula/terapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Humanos , Masculino , Pessoa de Meia-Idade
5.
Chest ; 155(2): e25-e28, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30732698

RESUMO

A 46-year-old woman arrived at our ED for the worsening of a thoracic pain localized in the left interscapulo-vertebral region that she had been commenting on for the past few days. Anamnestic data were collected; vital parameters, blood tests, and ECG were normal.


Assuntos
Vesícula/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Vesícula/terapia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia
6.
Int J Oral Maxillofac Surg ; 48(1): 28-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30032974

RESUMO

The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened. Forty articles published between 1985 and 2016 describing 225 cases of ABH were finally selected. The mean age of the patients was 55.4 years; the male to female ratio was 0.7. The predominant localization was the palate (66%). A third of patients had no medical history. When specified, a triggering event or promoting factor was frequently found (82%). Biological tests were normal. A biopsy was performed on 35% of the patients. Treatment was symptomatic with a favourable outcome. Recurrences were frequent (62%). In conclusion, ABH is poorly documented and only by studies of low-level evidence. This review did not allow any aetiopathogenic association to be made with a general pathology or treatment. On the basis of this systematic review of the literature, diagnostic criteria aiming to improve the care of patients presenting with ABH are proposed.


Assuntos
Vesícula , Hemorragia Bucal , Biópsia , Vesícula/diagnóstico , Vesícula/epidemiologia , Vesícula/etiologia , Vesícula/terapia , Diagnóstico Diferencial , Humanos , Hemorragia Bucal/diagnóstico , Hemorragia Bucal/epidemiologia , Hemorragia Bucal/etiologia , Hemorragia Bucal/terapia , Recidiva , Fatores de Risco
8.
Gerokomos (Madr., Ed. impr.) ; 29(4): 210-212, dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-182267

RESUMO

Objetivo: Describir el proceso de cicatrización de dos úlceras por presión con el uso de apósitos con tecnología alveolar gelificante. Metodología: aplicación de las guías vigentes de tratamiento de las úlceras por presión. Resultados: Ambas úlceras evolucionaron progresivamente de manera favorable hasta conseguir su cicatrización a los 3 meses del inicio del tratamiento. Conclusiones: El uso de apósitos con tecnología alveolar gelificante, unido a la aplicación de las medidas preventivas, posturales e higiénico-dietéticas recomendadas en las guías de tratamiento de las úlceras por presión, fueron determinantes para el buen desarrollo del proceso de cicatrización de las lesiones


Aim: The aim was to describe the healing process of two pressure ulcers with the usage of dressings with gelifying alveolar technology. Methodology: Application of the current guidance about pressure ulcers treatment. Results: Both ulcers evolved progressively and favorably until reach their healing in three months from the beginning of the treatment. Conclusions: The usage of dressing with gelifying alveolar technology along with the application of preventive, postural and hygienicdietetic measures recommended by the guidance of pressure ulcers treatment, were essential for the good development of the healing process


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Lesão por Pressão/terapia , Cicatrização , Bandagens , Geleificantes , Atenção Primária à Saúde , Cuidados de Enfermagem , Vesícula/terapia , Apoio Nutricional , Desbridamento/enfermagem , Óxido de Zinco/uso terapêutico , Colagenases/uso terapêutico , Fibrina/uso terapêutico , Tecido de Granulação/efeitos dos fármacos
10.
Medicine (Baltimore) ; 97(17): e0563, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29703044

RESUMO

BACKGROUND: Health care providers commonly encounter blisters when treating burn patients. The question as to whether burn blisters should be drained or deroofed has long been debated. To our knowledge, there has been no controlled, randomized clinical trial to determine which treatment is the best management option. METHODS: Between March 2016, and September 2016; 40 patients with burn blisters greater than 6-mm were enrolled in our study. Patients were randomized into 2 groups: aspiration group and deroofing group. The number of days to complete re-epithelialization was noted. Patient and Observer Scar Assessment Scale data were recorded from subjects and investigators at 4 time points. Pain during dressing changes was evaluated using a visual pain scale. Bacterial cultures were also obtained. RESULTS: Average number of days to complete wound healing was 12 days in the aspiration group and 12.55 days in deroofing group. On the Patient and Observer Scar Assessment Scale, investigators found that the aspiration group scars demonstrated improvements in relief and thickness while subjects rated aspiration scars better in terms of pain. Patients with palm/sole blister in the deroofing group scored higher than aspiration group on the visual analogue pain score but it was also not statistically significant (2.66 vs 3.25). The overall incidence of colonization with microorganisms in each group was not significant (15% vs 40%). CONCLUSION: Neither aspiration nor deroofing is a superior treatment of burn blister. However, some objective indicators suggest that aspiration treatment might be more effective than deroofing treatment.


Assuntos
Vesícula/terapia , Queimaduras/complicações , Procedimentos Cirúrgicos Dermatológicos/métodos , Paracentese/métodos , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Bandagens , Vesícula/etiologia , Vesícula/cirurgia , Cicatriz/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Reepitelização , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Am J Case Rep ; 19: 52-56, 2018 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29332930

RESUMO

BACKGROUND Bullosis diabeticorum (BD) is a condition characterized by recurrent, spontaneous, and non-inflammatory blistering in patients with poorly controlled diabetes mellitus. While etiopathogenesis remains unclear, roles of neuropathy, vasculopathy and UV light are hypothesized. Most literature reports negative direct and indirect immunofluorescence findings in diabetics with bullous eruptions. Porphyria cutanea tarda, bullous pemphigoid, epidermolysis bullosa, and pseudoporphyria are other differential diagnoses of bullous lesions, and they must be excluded. CASE REPORT We present a 42-year-old African American male with long standing poorly controlled insulin dependent diabetes mellitus with blisters on his left hand and feet. The blisters were noticed three weeks prior to presentation and, thereafter, rapidly increased in size and spontaneously ruptured. Physical examination revealed a multitude of both roofed and unroofed bullous painless skin lesions. Hematoxylin and eosin (H&E) staining dramatized the dermal-epidermal blistering and re-epithelization process. Direct Immunofluorescence (DIF) was positive for 2 + IgG deposition in the already thickened basement membrane of the capillaries of the superficial vascular plexus. After debridement, his wounds greatly improved with over three months of aggressive wound care. CONCLUSIONS Primary immunologic abnormality likely plays no role in the onset of BD. To date, only one article has reported nonspecific capillary-associated immunoglobulin M and C3. This is the first case of BD with IgG deposition in the superficial capillary basement membrane. Positive findings on DIF suggest vasculopathy. Dermal microangiopathy, secondary to immunologic abnormality, is a possible underlying pathogenesis to bullae formation. Punch biopsy with DIF can be an additional diagnostic modality in the management of such cases.


Assuntos
Vesícula/diagnóstico , Vesícula/etiologia , Diabetes Mellitus Tipo 1/complicações , Imunoglobulina G/fisiologia , Adulto , Vesícula/terapia , Humanos , Masculino
15.
Indian J Pediatr ; 85(4): 257-260, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29076100

RESUMO

OBJECTIVES: To review the literature for justification of thoracoscopic management of blebs in children. METHODS: PubMed database was reviewed for articles in English, Portuguese and Spanish using the key words "thoracoscopy", "bleb" and "child". Data was collected for age, gender, type of surgery performed, operating time, conversions, complications, recurrences, follow-up and mortality. RESULTS: Eleven studies with total 266 patients were included (27 bilateral cases; n = 293 surgeries). Median age was 15.7 y (range 11-18 y), 225 were male (87.9%) and 31 were female (12.1%) patients. Endo GIA™ was used in 10 cases, Endoloop® in 11 surgeries, unspecified stapler devices in 150 procedures and, in 122 surgeries, instruments were not mentioned. Pleurodesis was performed in 213 (72.7%) cases. There were 5 (1.7%) conversions (adhesions n = 3, bleeding n = 1, camera failure n = 1). Complications were documented in 8 (2.7%): pneumothorax after chest tube removal 4 (drain reinsertion n = 3, reoperation n = 1); prolonged air leak 3, all submitted to che pleurodesis; bleeding requiring reoperation 1. Recurrence occurred in 25 (8.5%): 10 re-operation, 7 conservative management, 2 chemical pleurodesis, 2 chest tube reinsertions and in 4 the management was not specified. The median follow-up was 46.1 mo (range 3 mo-11 y). There were no lethal outcomes. CONCLUSIONS: Although data is scarce on specific instruments used, pleurodesis is performed in 70% of cases. Irrespective of this, thoracoscopic resection of blebs can be safely offered as it has a low complication and conversion rates and no mortality.


Assuntos
Vesícula/terapia , Pleurodese , Adolescente , Criança , Feminino , Humanos , Masculino , Pneumotórax , Recidiva , Toracoscopia
16.
Clin Rev Allergy Immunol ; 54(1): 26-51, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28779299

RESUMO

Autoimmune subepidermal blistering diseases of the skin and mucosae constitute a large group of sometimes devastating diseases, encompassing bullous pemphigoid, gestational pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, and anti-p200 pemphigoid. Their clinical presentation is polymorphic. These autoimmune blistering diseases are associated with autoantibodies that target distinct components of the basement membrane zone of stratified epithelia. These autoantigens represent structural proteins important for maintenance of dermo-epidermal integrity. Bullous pemphigoid (BP) is the most common subepidermal autoimmune blistering disease of the skin and mucosae. Although the disease typically presents with a generalized blistering eruption associated with itch, atypical variants with either localized bullous lesions or "non-bullous" presentations are observed in approximately 20% of patients. A peculiar form of BP typically associated with pregnancy is pemphigoid gestationis. In anti-p200 pemphigoid, patients present with tense blisters on erythematosus or normal skin resembling BP, with a predilection for acral surfaces. These patients have antibodies targeting the 200-kDa basement membrane protein. Epidermolysis bullosa is a rare autoimmune blistering disease associated with autoantibodies against type VII collagen that can have several phenotypes including a classical form mimicking dystrophic epidermolysis bullosa, an inflammatory presentation mimicking BP, or mucous membrane pemphigoid-like lesions. Mucous membrane pemphigoid (MMP) is the term agreed upon by international consensus for an autoimmune blistering disorder, which affects one or more mucous membrane and may involve the skin. The condition involves a number of different autoantigens in the basement membrane zone. It may result in severe complications from scarring, such as blindness and strictures. Diagnosis of these diseases relies on direct immunofluorescence microscopy studies and immunoserological assays. Management of affected patients is often challenging. We will here review the clinical and immunopathological features as well as the pathophysiology of this group of organ-specific autoimmune diseases. Finally, we will discuss the diagnostic approach and the principles of management in clinical practice.


Assuntos
Membrana Basal/imunologia , Vesícula/imunologia , Laminina/imunologia , Membrana Mucosa/imunologia , Penfigoide Bolhoso/imunologia , Complicações na Gravidez/imunologia , Pele/patologia , Autoanticorpos/metabolismo , Vesícula/terapia , Colágeno Tipo VII/imunologia , Feminino , Humanos , Penfigoide Bolhoso/terapia , Gravidez , Complicações na Gravidez/terapia
17.
Clin J Sport Med ; 28(1): 37-42, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28452830

RESUMO

OBJECTIVE: Blisters are common foot injuries during and after prolonged walking. However, the best treatment remains unclear. The aim of the study was to compare the effect of 2 different friction blister treatment regimens, wide area fixation dressing versus adhesive tape. DESIGN: A prospective observational cohort study. SETTING: The 2015 Nijmegen Four Days Marches in the Netherlands. PARTICIPANTS: A total of 2907 participants (45 ± 16 years, 52% men) were included and received 4131 blister treatments. INTERVENTIONS: Blisters were treated with either a wide area fixation dressing or adhesive tape. MAIN OUTCOME MEASURES: Time of treatment application was our primary outcome. In addition, effectiveness and satisfaction were evaluated in a subgroup (n = 254). During a 1-month follow-up period, blister healing, infection and the need for additional medical treatment were assessed in the subgroup. RESULTS: Time of treatment application was lower (41.5 minutes; SD = 21.6 minutes) in the wide area fixation dressing group compared with the adhesive tape group (43.4 minutes; SD = 25.5 minutes; P = 0.02). Furthermore, the wide area fixation dressing group demonstrated a significantly higher drop-out rate (11.7% vs 4.0%, P = 0.048), delayed blister healing (51.9% vs 35.3%, P = 0.02), and a trend toward lower satisfaction (P = 0.054) when compared with the adhesive tape group. CONCLUSIONS: Wide area fixation dressing decreased time of treatment application by 2 minutes (4.5%) when compared with adhesive tape. However, because of lower effectiveness and a trend toward lower satisfaction, we do not recommend the use of wide area fixation dressing over adhesive tape in routine first-aid treatment for friction blisters.


Assuntos
Fita Atlética , Bandagens , Vesícula/terapia , Traumatismos do Pé/terapia , Adulto , Feminino , Primeiros Socorros , Fricção , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos , Caminhada/lesões
19.
Zhonghua Yi Xue Za Zhi ; 97(40): 3171-3173, 2017 Oct 31.
Artigo em Chinês | MEDLINE | ID: mdl-29081165

RESUMO

Objective: To evaluate the effectiveness and safety of argon plasma coagulation (APC) via thoracoscopy on the treatment of spontaneous pneumothorax with subpleural blebs. Methods: Thirty patients with spontaneous pneumothorax with subpleural blebs were retrospectively analyzed during the period of Nov, 2012 to June, 2015 in Rizhao Hospital of Traditional Chinese Medicine. According to the classification of pulmonary bullae through medical thoracoscopy by Reid, type Ⅱand partial type Ⅲ pulmonary bullae (2 cm ≤ diameter <5 cm) were coagulated by argon, and pleural adhesions were mutilated by high frequency electrocision. Two years' follow-up was carried out to observe short-term and long term effect. Results: Thirty-nine pulmonary bullae were found in thirty patients, mainly in the upper lung (28 cases, 71.8%), including 28 type Ⅱ bullae (71.8%), 11 type Ⅲ bullae (28.2%) and most of them were single transparent bullae (24/39, 61.5%). Follow-up of short-term (72 h) effective rate was 70.0% and long-term effective rate was 89.3%. Conclusion: The application of APC via thoracoscopy in the treatment of subpleural bullae is safe and effective.


Assuntos
Coagulação com Plasma de Argônio , Vesícula/terapia , Pneumotórax/terapia , Toracoscopia , Humanos , Recidiva
20.
Neuroradiology ; 59(12): 1285-1290, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29046918

RESUMO

PURPOSE: Blood blister-like aneurysms (BBA) are small, friable, broad-based aneurysms that represent high risk for rerupture. Treatment of BBA is challenging, and may include surgical wrapping, clipping, multiple overlapping stents, and/or coiling. Flow diversion is a rapidly evolving treatment strategy for intracranial aneurysms, but the evidence for its use in cases of BBA is scarce. METHODS: A retrospective review of flow-diverter-treated, ruptured BBA cases at our tertiary care institution was undertaken. Clinical, imaging, procedural, and mid-term follow-up data on the patients were collected. RESULTS: Eight patients underwent flow-diverter stent treatment for ruptured BBA. Median age at time of treatment was 49 years (interquartile range [IQR] 42-57) with five females (62.5%). The most common location of the BBA was the supraclinoid segment of the internal carotid artery. The median Hunt-Hess score was 2 (IQR 1.7-3.2). All patients were treated with dual anti-platelet therapy. Good clinical outcomes (modified Rankin score 0-2) were seen in 6/7 (85.7%) patients with available follow-up at 1 year. Complete occlusion of the aneurysm on latest angiogram (7) or MRI (1) was seen in 6/8 (75%) patients (at a median of 8 months). No patient had rerupture, retreatment, or recurrence of the aneurysm. CONCLUSION: Flow-diverter stents may be a feasible treatment option for BBAs. They offer high occlusion and low retreatment rates with good mid-term outcomes, but the long-term efficacy remains unknown. Also, dual anti-platelet therapy in the acute ruptured setting can be challenging.


Assuntos
Aneurisma Roto/terapia , Vesícula/terapia , Aneurisma Intracraniano/terapia , Stents , Adulto , Aneurisma Roto/diagnóstico por imagem , Vesícula/diagnóstico por imagem , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
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