Xanthoma of Tendoachilles: Management and Follow-Up

Xanthoma is a rare pseudotumor of connective tissue, consisting of histiocytes with lipid deposits. Usually, it manifests as encapsulated lobular yellowish mass, often associated with familial hypercholesterolemia (FH). We present a case of xanthoma of tendoachilles just proximal to its insertion site, secondary to FH. The patient was a 28-year-old female presenting with a 2-year history of difficulty ambulating and complaints of swelling over the posterior aspect of her left lower leg just proximal to her heel. She had a deranged lipid profile level and was started on a lipid lowering agent for 3 weeks followed by total excision of the lesion with flexor hallucis longus tendon graft augmentation. The patient was able to bear full weight at 6 weeks and could stand on her toes by 4 months. No recurrences were noted at 1 year follow-up.

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Antiretroviral therapy and liver disorders in the OPERA® cohort

Therapeutic Advances in Drug Safety ◽

10.1177/2042098620976953 ◽

2020 ◽

Vol 11 ◽

pp. 204209862097695

Author(s):

Michael Wohlfeiler ◽

Karam Mounzer ◽

Laurence Brunet ◽

Jennifer Fusco ◽

Vani Vannappagari ◽

...

Keyword(s):

Hiv Treatment ◽

Lipid Lowering ◽

People Living With Hiv ◽

Severe Liver ◽

Cholesterol Lowering ◽

Liver Disorders ◽

History Of ◽

Lipid Lowering Agent ◽

New Treatment

Introduction: A comprehensive assessment of liver disorders was conducted among people living with HIV (PLWH) on a new antiretroviral regimen based on common core agents. Methods: Treatment-naïve and experienced PLWH first initiating dolutegravir (DTG), elvitegravir (EVG), raltegravir (RAL), or darunavir (DRV) in the OPERA® cohort were included if they had ⩾1 liver chemistry test performed both within 12 months before regimen start and over follow-up. Liver disorders were defined as a diagnosis of drug-induced liver injury (DILI) or moderate/severe liver chemistry elevations (LCE). History of liver disorders experienced within 12 months of initiation was summarized. Liver disorders occurring during follow-up were described as prevalent (all disorders) or incident (disorders occurring among PLWH without a history of liver disorders or advanced liver fibrosis). Results: Out of 16,024 PLWH, 38% initiated DTG, 43% EVG, 5% RAL, and 14% DRV. EVG users were younger and had a lower likelihood of comorbidities or lipid-lowering agent use than DTG users. EVG users were significantly less likely to have a history of moderate/severe LCE or to have prevalent moderate LCE. RAL users were older and had a higher likelihood of comorbidities or lipid-lowering agent use than DTG users. RAL users were significantly more likely to have a history of advanced liver fibrosis and prevalent moderate/severe LCE during follow-up. DRV users were older and had a lower likelihood of lipid-lowering agent use than DTG users. There was no difference in history of LCE, nor in prevalent or incident LCE between DRV and DTG users. No DILI diagnoses were recorded. Discontinuation following a liver disorder was rare (<1%) across all groups. Conclusion: While PLWH with comorbidities may have been channeled away from EVG and toward DTG and RAL, the incidence of moderate/severe LCE did not differ between DTG and EVG, RAL, and DRV. Plain language summary Liver disorders and HIV treatment A comprehensive assessment of liver disorders was conducted using data from the OPERA® cohort, which provides anonymous patient-level clinical data from electronic health records. People living with HIV (PLWH) who were starting a new HIV treatment regimen that included one of four common HIV drugs were included in this study. Liver disorders included drug-induced liver injury (DILI) and moderate or severe liver chemistry elevations. History of a disorder was defined as liver disorders that occurred before starting the new treatment. Prevalent disorders were those that occurred after starting the new treatment in the whole population. Incident disorders were those that occurred after starting the new treatment, but only among PLWH without any history of liver disorders. Out of 16,024 PLWH, 38% initiated dolutegravir (DTG), 43% elvitegravir (EVG), 5% raltegravir (RAL), and 14% darunavir (DRV). EVG users were younger and less likely to have other diseases or use cholesterol lowering drugs compared to DTG users. They were also less likely to have a history of moderate/severe liver chemistry elevations or to have prevalent moderate liver chemistry elevations. RAL users were older and more likely to have other diseases or use cholesterol lowering drugs compared to DTG users. They were also more likely to have prevalent moderate/severe liver chemistry elevations than DTG users. DRV users were older and less likely to use cholesterol lowering agents compared to DTG users. There was no difference in history of liver chemistry elevations, or in prevalent, or incident liver chemistry elevations between DRV and DTG users. There were no DILI diagnoses and discontinuation of treatment following liver disorders was rare across all groups. Overall, the incidence of liver disorders after starting a new HIV treatment regimen did not differ between four common antiretroviral drugs.

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Abstract 5108: Microalbuminuria is Associated with Progression of Coronary Atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽

10.1161/circ.118.suppl_18.s_1147-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Andrew P DeFilippis ◽

Holly J Kramer ◽

Ronit Katz ◽

Nathan Wong ◽

Alain Bertoni ◽

...

Keyword(s):

Lipid Lowering ◽

Albumin Creatinine Ratio ◽

Ethnic Study ◽

Median Increase ◽

Increased Risk ◽

History Of ◽

Relationship Of ◽

The Relationship ◽

Progression Of Atherosclerosis

Background: Microalbuminuria (MA) is associated with an increased risk of cardiovascular disease (CVD) but the mechanism by which microalbuminuria imparts this increased risk is not known. In this study we assessed the relationship between MA and the development and progression of atherosclerosis by measuring the incidence of new CAC and the progression of existing CAC in individuals free of clinical CVD. Methods : The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of 6,814 participants free of clinical CVD at entry who underwent assessment of coronary artery calcification (CAC) by computerized tomography at baseline. Overall, 6,775 individuals had data available on urinary albumin creatinine ratio (UACR); 1,109 individuals were excluded for missing data or macroalbuminuria (UACR≥300 mg/g). Incident CAC was defined as detectable CAC at follow-up among those with CAC=0 at baseline, and absolute CAC score change among those with CAC>0 at baseline. Relative risk (RR) regression adjusted for covariates; and multivariable adjusted median regression was employed to assess the independent relationship of MA with CAC incidence and progression. Results : Of the 5,666 subjects (mean age 62±10 years, 48% males), baseline MA was seen in 424 (7%) participants, who were more likely to have CAC compared to those with normal UACR (62% vs. 48%, p<0.0001). During a mean follow-up of 2.4±0.8 years, those with MA were more likely to develop CAC (28% vs. 15%, p<0.0001) and they had a higher absolute median increase in CAC (47 vs. 29 Agatston Units, p<0.0001). After adjustment for age, gender, ethnicity, site, follow-up duration, diabetes, hypertension, smoking, family history of heart attack, total cholesterol, lipid lowering medications and body mass index; MA was associated with incident CAC (RR 1.65; 95%CI 1.41–2.48) among those with CAC=0 at baseline. Among those with CAC>0 at baseline, MA was associated with a median increase in CAC of 7.93 (95%CI 0.38 –15.47) Agatston Units in multivariable adjusted analyses (variables noted above). Conclusion : MA is independently associated with development of incident CAC and progression of CAC in an asymptomatic multi-ethnic population, and may in part explain its associated increased risk of CVD.

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Complex lipid-lowering treatment options in patients with a history of acute coronary syndrome

Orvosi Hetilap ◽

10.1556/oh.2011.29036 ◽

2011 ◽

Vol 152 (8) ◽

pp. 296-302 ◽

Cited By ~ 1

Author(s):

Győző Dani ◽

László Márk ◽

András Katona

Keyword(s):

Acute Coronary Syndrome ◽

Serum Lipid ◽

Ldl Cholesterol ◽

Hdl Cholesterol ◽

Lipid Lowering ◽

Coronary Syndrome ◽

Target Values ◽

History Of ◽

Lipid Parameters

Authors aimed to assess how target values in serum lipid concentrations (LDL- and HDL-cholesterol, triglyceride) can be achieved in patients with a history of acute coronary syndrome during follow up in an outpatient cardiology clinic. Methods: 201 patients with a history of acute coronary syndrome were included and were followed up between January 1 and May 31, 2007.Authors analyzed serum lipid parameters of the patients and the lipid-lowering medications at the time of the first meeting and during follow up lasting two years. Results: During the enrollment visit only 26.4% of the patients had serum LDL cholesterol at target level, whereas high triglycerides and low HDL cholesterol levels were observed in 40.3% and 33.3% of the patients, respectively. Only 22 patients (10.9%) achieved the target levels in all three lipid parameters. Of the 201 patients, 179 patients participated in the follow up, and data obtained from these patients were analyzed. There was a positive trend toward better lipid parameters; 42.5% of the patients reached the desired LDL-cholesterol target value and 17.3% of the patients had HDL-cholesterol and triglycerides target values. Conclusions: These findings are consistent with those published in the literature. Beside the currently used therapeutic options for achieving optimal LDL-cholesterol, efforts should be made to reduce the so-called “residual cardiovascular risk” with the use of a widespread application of combination therapy. Orv. Hetil., 2011, 152, 296–302.

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Extraocular Myoplasty: Surgical Remedy For Intraocular Implant Exposure

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i2.27839 ◽

2020 ◽

Vol 11 (2) ◽

pp. 237-240

Author(s):

Anupam Singh ◽

M Vathulya ◽

Ajai Agrawal ◽

Rupal Verma ◽

S. K. Mittal ◽

...

Keyword(s):

Foreign Body ◽

Insertion Site ◽

Orbital Implant ◽

Buccal Mucosal Graft ◽

Implant Exposure ◽

Absorbable Sutures ◽

Body Sensation ◽

History Of ◽

Vicryl Suture

Background: Evisceration and nucleation are commonly performed ophthalmic surgeries for painful blind eye, disfiguring blind eye, endophthalmitis etc. After both these surgeries it is important to replace the lost volume in the orbit with implant. Implant is associated with many complications such as major discharge, exposure with discharge and implant exposure. The main surgical management of implant exposures basically primary revision or patch grafting with or without removal of the implant. Case: A 60 years old man presented to ophthalmic OPD with complaint of foreign body sensation and irritation in left eye. There was history of evisceration with silicon ball implant in left eye done one month back for painful blind eye at another hospital. On ophthalmic examination, there was a 3 × 4 mm of implant exposure most probably dueto tight closure. As per records the size of implant was 22mm. The patient was planned for extra-ocular myoplasty with buccal mucosal graft under general anesthesia. Observation: After sterile prepping and draping, 360˚ degrees peritomy was performed and care was taken to dissect between tenons and orbital implant. Medialand lateral recti were isolated and dissected upto 10-12mm from insertion site. Both the recti were secured with 6-0 vicryl suture and were detached from their respective insertions, advanced and approximated over the site of implant exposure. Thus the exposed implant was covered with a vascularized base which was reinforced with amucosal graft harvested from the buccal mucosa and secured with absorbable sutures. After 1 year of follow up patient was asymptomatic. Conclusion: Extraocular myoplasty with buccal mucosal graft is a good surgical remedy for orbital implant exposure implant.

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Posterior Ankle Arthroscopy for Osteochondromatosis of the Posterior Ankle Extra-Articular Space with a Longitudinal Tear of Flexor Hallucis Longus

Case Reports in Orthopedics ◽

10.1155/2020/6580472 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Ichiro Tonogai ◽

Koichi Sairyo

Keyword(s):

Ankle Arthroscopy ◽

Flexor Hallucis Longus ◽

Loose Bodies ◽

Arthroscopic Technique ◽

Posterior Ankle Arthroscopy ◽

History Of ◽

History Of Pain ◽

The Right ◽

Longitudinal Tear

We report a rare case of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of flexor hallucis longus (FHL). A 77-year-old woman was referred to our hospital with an approximately 4-year history of pain and swelling in the right posterior ankle joint without obvious trauma. The pain had worsened in the previous 2 years. On presentation, she had tenderness at the posteromedial and posterolateral ankle. Imaging revealed several ossified loose bodies in the posterior ankle extra-articular space. We removed the loose bodies, performed tenosynovectomy around the FHL, and released the FHL tendon using a posterior arthroscopic technique via standard posterolateral and posteromedial portals. A longitudinal tear and fibrillation were detected in the FHL. The patient was able to return to her daily activities approximately 3 weeks after surgery. At the 1-year follow-up visit, she continued to have minor discomfort and slight swelling on the posteromedial aspect of the right ankle but had no recurrence of the ossified loose bodies. To our knowledge, this is the first report of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of the FHL that was treated by removal of loose bodies, tenosynovectomy around the FHL, and release of the FHL tendon via posterior ankle arthroscopy.

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Metabolic syndrome in women with previous gestational diabetes

Scientific Reports ◽

10.1038/s41598-021-90832-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Karsten Kaiser ◽

Michael Festersen Nielsen ◽

Ervin Kallfa ◽

Greta Dubietyte ◽

Finn Friis Lauszus

Keyword(s):

Metabolic Syndrome ◽

Gestational Diabetes ◽

Glycosylated Hemoglobin ◽

Lipid Lowering ◽

Prior History ◽

Prescription Database ◽

History Of ◽

One Year ◽

Definition Of

AbstractTo evaluate the incidence and timing of the diagnosis of metabolic syndrome in a cohort of Danish women after a pregnancy with gestational diabetes (GDM) to estimate the optimum time for preventative actions in relation to metabolic syndrome (MetS). In this follow-up study, 435 women were included from a consecutive cohort with prior history of GDM. Data on dyslipidemia, hypertension and other cardiovascular disorders (CVD) were extracted from the electronic patient journal. Any antidiabetic, cardiovascular and cholesterol-lowering medicine was ascertained in the national prescription database. Similarly, any blood test taken was evaluated. We defined a patient having MetS if the criteria of the WHO based definition of diabetes or impaired glucose regulation were met. Further, we added as alternative for glucose intolerance, a glycosylated hemoglobin (HbA1c) > 44 mmol/mol or the former level ≥ 6.5%. Further, dyslipidemia, lipid lowering medications, BMI > 30 kg/m2 or antihypertensive treatment were used. For MetS outcome, diagnosis or medication for CVD was registered. All women were followed for median 5.7 years (range 0; 9). The incidence of MetS was 28%. Thirteen percent of these qualified already within one year after pregnancy for the diagnosis of MetS. Postpartum MetS was detected after a median of 3 years (range 0; 7 years); further, 36 (8%) had been diagnosed with manifest diabetes after pregnancy. The diagnosis of postpartum MetS was strongly associated with the prevalence of manifest diabetes. Six years after pregnancy the rate of metabolic syndrome was more than tripled (25 vs. 89%, no DM vs manifest DM, RR: 6.7; 95% CI 2.7–17, p < 0.001). At 40 years the MetS rate nearly tripled if manifest DM was diagnosed (26 vs. 78%, no DM vs. manifest DM, RR: 3.3, 95% CI 1.8–6, p < 0.001). We found that GDM and later on manifest DM in women increase the risk of metabolic syndrome. There seems to be a window of opportunity before the early thirties where it would be especially beneficial to begin preventive efforts in women with GDM.

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Operative Treatment of Fixed Flexion Deformity of Elbow by Anterior Release: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.5189 ◽

2020 ◽

Vol 58 (231) ◽

Author(s):

Abhishek Kumar Thakur ◽

Nabees Man Singh Pradhan ◽

Pramod Devkota ◽

Bidur Gyawali ◽

Prabhav Majgaiyan Pokhrel

Keyword(s):

Range Of Motion ◽

Plaster Cast ◽

Flexion Deformity ◽

Posterior Aspect ◽

Susceptibility Artifacts ◽

Post Operative Period ◽

History Of ◽

One Year ◽

Fixed Flexion Deformity

A 20-year-old male presented to our OPD with stiffness in his right elbow. He gave a history of sustaining a fracture around the same elbow when he was 4 years old. He was treated operatively for the same. In the post-operative period, he did not undergo any physiotherapy. On examination, he had a fixed flexion deformity in his right elbow with a range of motion between 90 and 110 degrees. X-ray did not show any bony abnormalities and MRI revealed susceptibility artifacts in posterior aspect. The elbow was approached anteriorly releasing all the soft tissue contractures. The elbow was immobilised in extension in a plaster cast for 4 weeks. The patient was under regular physiotherapy after plaster removal in the post-operative period. At one year follow up, he has an elbow range of motion between 20 and 120 degrees.

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Impaired endothelial glycocalyx predicts adverse outcome in subjects without overt cardiovascular disease: a 6-year follow-up study

European Heart Journal ◽

10.1093/eurheartj/ehab724.2503 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

I Ikonomidis ◽

J Thymis ◽

P Simitsis ◽

S Katsanos ◽

C Triantafyllou ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Cardiovascular Disease ◽

Family History ◽

Adverse Outcome ◽

Endothelial Glycocalyx ◽

Lipid Lowering ◽

C Statistic ◽

History Of

Abstract Aim Endothelial glycocalyx is involved in the clinical course of atherogenesis. The purpose of this study was to investigate whether disturbance of glycocalyx integrity is related with increased cardiovascular risk. Methods Perfused Boundary Region (PBR), a marker of glycocalyx integrity, was measured non-invasively in sublingual microvessels with a diameter ranging from 5–25 μm using a dedicated camera (Sideview, Darkfield Imaging). Increased PBR indicates reduced glycocalyx thickness. We measured baseline PBR in 400 apparently healthy subjects, without established cardiovascular disease. We prospectively monitored the occurrence of major cardiovascular events (MACE-death, myocardial infarction, stroke and heart failure hospitalization) during a 6-year follow-up period using electronic records and clinic visits. Results Forty-three MACE were documented during follow-up. Subjects with PBR at 5–9 μm microvessel diameter greater than 1.15 μm (mean value of the study cohort) had 2-fold higher risk for MACE than those with lower PBR in a model including sex, age, hyperlipidemia, diabetes, hypertension, current smoking, family history of coronary artery disease and treatment with ACEi/ARBs or lipid lowering agents (hazard ratio (HR): 2.49; 95% CI: 1.23–5.02, p=0.011, net reclassification improvement (NRI): 25%; C-statistic: 0.738). PBR5-9 ≥1.15 was an independent and additive predictor of outcome when added in a model including SCORE, risk factors not included in SCORE (diabetes, family history of CAD) and medication (HR: 2.48 NRI: 23.8%, C-statistic increase from 0.629 to 0.678, for all cardiac events and HR: 4.19, NRI: 33.1%, C-statistic increase from 0.654 to 0.734 for death myocardial infarction and stroke, p<0.01). Conclusion Endothelial glycocalyx integrity is an independent and additive predictor to atherosclerotic risk factors for adverse outcome at 6 years follow-up in individuals without diagnosed cardiovascular disease. FUNDunding Acknowledgement Type of funding sources: None.

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A 10-year experience using combined lipid-lowering pharmacotherapy in children and adolescents

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2016-0117 ◽

2016 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

María Beatriz Araujo ◽

María Sol Pacce

Keyword(s):

Risk Factor ◽

Analytical Study ◽

Pediatric Patients ◽

Combined Treatment ◽

Treatment Protocol ◽

Treatment Goal ◽

Lipid Lowering ◽

Treatment Goals ◽

History Of

AbstractBackground:Current pediatric guidelines for heterozygous familial hypercholesterolemia (HeFH) propose pharmacotherapy (PT) with statins from age 8 to 10 years; however, schemes with absorption inhibitors combined with statins, could be started earlier. The aim of the study was to show the 10-year results of a combined treatment protocol.Methods:Prospective, descriptive and analytical study. Pediatric patients (n=70; mean age at PT initiation 9.3 years [range, 2–17.5]) with HeFH who required PT between 2005 and 2015 were included. All patients ≥10 years, with LDL >190 mg/dL or >160 mg/dL with one cardiovascular risk factor (CVRF) or >130 mg/dL with two or more CVRF; and those patients 5–10 years and with LDL-C >240 mg/dL or a family history of a cardiovascular event before 40 years, were medicated. After a period on a lipid-lowering diet (LLD), all patients were started on ezetimibe. Patients who did not achieve the treatment goal were given statins. The variables were: age, age at PT initiation, duration of PT, initial LDL-C, mean LDL-C during ezetimibe monodrug therapy, mean LDL-C during combined PT, and percentage of LDL decrease.Results:LDL-C levels were: Baseline: 235 mg/dL±55; after 3 months on ezetimibe: 167 mg/dL±47 (decrease: −27.62%). In 18 patients who did not reach the treatment goal atorvastatin was added and their LDL-C decreased −41.5% (p: 0.02). Overall, mean final LDL-C was 155 mg/dL±30.4 (range, 98–257) and treatment goals were reached in 74% of the patients. No severe side effects were reported.Conclusions:Combined and sequential treatment starting at early ages was shown to be safe and effective over this follow-up period.

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Lipofibromatous Hamartoma of the Plantar Nerve

Journal of the American Podiatric Medical Association ◽

10.7547/16-168 ◽

2018 ◽

Vol 108 (2) ◽

pp. 182-185 ◽

Cited By ~ 2

Author(s):

Murat Mert ◽

Payam Hacısalihoglu

Keyword(s):

Soft Tissue ◽

Motor Deficits ◽

Flexor Hallucis Longus ◽

Tarsal Tunnel ◽

Morton’S Neuroma ◽

Rare Benign Tumor ◽

Lipofibromatous Hamartoma ◽

History Of ◽

Morton's Neuroma

Lipofibromatous hamartoma (LFH) is a rare, benign, tumor-like soft-tissue lesion that affects the peripheral nerves and forms a palpable neurogenic mass. Lipofibromatous hamartoma is associated with pain and sensory and/or motor deficits in the area of innervation of the affected nerve. This report describes a rare case of LFH of the plantar nerve. A 48-year-old woman presented to our outpatient orthopedic clinic with pain and a burning sensation on her left foot. The patient had a history of Morton's neuroma and had undergone a tarsal tunnel operation 2 years earlier at another center. None of her symptoms was alleviated by two previous operations. Magnetic resonance imaging with contrast revealed tenosynovitis of the flexor hallucis longus tendon and signal changes at deep tissue planes of the foot at the levels of the second and third toes, on the dorsal site and subcutaneous soft-tissue planes, suggesting edema and Morton's neuroma. The lesion was excised under spinal anesthesia, and histopathologic examination of the specimen revealed a diagnosis of LFH. The patient was discharged without any symptoms and her foot was normal at 8-month outpatient follow-up, with no indications of postoperative complications and/or recurrence.

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