scholarly journals Surgical management of extensive hypertrophic scarring of the halluces secondary to a decade of untreated onychocryptosis: An illustrative case report

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774051
Author(s):  
Dean J Samaras ◽  
Andrew C Kingsford
Keyword(s):  
Treatment Options ◽  
Rare Condition ◽  
Surgical Excision ◽  
Current Treatment ◽  
Illustrative Case ◽  
Hypertrophic Scarring ◽  
Psychosocial Effects ◽  
Term Outcome ◽  
Long Term Outcome

Extensive hypertrophic scarring of the halluces secondary to chronic onychocryptosis is a rare condition, which causes significant physical and psychosocial effects. In this case, a 31-year-old male developed large lesions on both great toes after he delayed treatment of chronic hallucal onychocryptosis for over a decade. Current treatment options for hypertrophic and keloid lesions in the foot and ankle vary considerably and differentiation is critical for appropriate treatment planning. In this case, surgical excision with total matrixectomy (modified Zadik–Syme) was considered optimal management. Histopathology testing confirmed the diagnosis of irritated hypertrophic scar secondary to onychocryptosis. The patient was monitored closely and at 3 months post-operatively, the incisional scars exhibited progressive maturation, and there was no recurrence of the lesions and no nail regrowth. Furthermore, the halluces were only marginally shorter providing good function and cosmesis. At the long-term follow-up consultation (5.5 years), the patient indicated complete satisfaction and had returned to regular footwear and social activities. Chronic onychocryptosis can trigger and facilitate proliferation of large benign keloid-like fibrous lesions; excision with total matrixectomy can provide an excellent long-term outcome.

The Natural History of Untreated Dorsal Wrist Ganglia and Patient Reported Outcome 6 Years after Intervention

2007 ◽  
Vol 32 (5) ◽  
pp. 502-508 ◽  
Author(s):  
J. J. DIAS ◽  
V. DHUKARAM ◽  
P. KUMAR
Keyword(s):  
Surgical Excision ◽  
Patient Reported Outcome ◽  
Postal Questionnaire ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Treatment Groups ◽  
Patient Reported ◽  
History Of ◽  
Term Benefit

We have evaluated the long-term outcome of excision, aspiration and no treatment of dorsal wrist ganglia prospectively in 236 (83%) of 283 patients who responded to a postal questionnaire at a mean of 70 months. The resolution of symptoms was similar between the treatment groups ( p>0.3). Pain and unsightliness improved in all three treatment groups. The prevalence of weakness and stiffness altered only slightly in all three treatment groups. More patients with a recurrent, or persistent ganglion complained of pain, stiffness and unsightliness ( p<0.0001). Patient satisfaction was higher after surgical excision ( p<0.0001), even if the ganglion recurred. Twenty-three of 55 (58%) untreated ganglia resolved spontaneously. The recurrence rate was 58% (45/78) and 39% (40/103) following aspiration and excision, respectively. Eight out of 103 patients had complications following surgery. In this study, neither excision nor aspiration provided significant long-term benefit over no treatment.

scholarly journals 4035 Astrocyte LDLR-Related Protein 1 Increases Cytokine Sensitivity – The Role of Glia in Recovery after Brain Damage

2020 ◽  
Vol 4 (s1) ◽  
pp. 3-3
Author(s):  
Sadiya Ahmad ◽  
Pamela Reed ◽  
Shane Sprauge ◽  
Naomi Sayre
Keyword(s):  
Plasma Membrane ◽  
Treatment Options ◽  
Significant Loss ◽  
Null Mouse ◽  
Dependent Manner ◽  
Related Protein ◽  
Stroke Patients ◽  
Term Outcome ◽  
Long Term Outcome

OBJECTIVES/GOALS: The limited treatment options for ischemic stroke patients have resulted in stroke being a leading cause of death and the primary cause of long-term disability in the U.S. Finding effective treatment options requires a better fundamental understanding of the ongoing processes that contribute to poor long-term outcome. METHODS/STUDY POPULATION: Expression of Apolipoprotein E4 predisposes stroke patients to poor long-term outcome. This study aims to test one possible mechanism by which ApoE4 contributes to cognitive decline after stroke. Here, we examine the effect of a major ApoE4 receptor, low-density lipoprotein receptor related protein 1 (LRP1) on sensitivity to stress in astrocytes. LRP1 binds and moves extracellular ligands and plasma membrane proteins into the endocytic system. Others have shown that LRP1 regulates cell-surface TNF receptor (TNFR1) in non-astrocytic cells. We propose That LRP1 similarly regulates TNFR1 in the central nervous system to attenuate inflammatory response after stroke. Studies have shown that ApoE4 slows the recycling of endocytic LDL receptors. We hypothesize that ApoE4 inhibits the ability of LRP1 to remove TNFR1 from the plasma membrane. This is expected to increase cytokine sensitivity, resulting in worse outcome after stroke. We investigated the effect of LRP1 on astrocyte TNFα signaling and response in immortalized ApoE null mouse astrocytes subjected to lentiviral-mediated knockdown of LRP1. The astrocyte response to TNFα stimulation was tested in a time dependent manner using Western blotting of NFkB pathway components, which are the downstream mediators of TNFα signaling. We also tested astrocyte viability after prolonged TNFα stimulation using Alamar Blue reagent. We found that LRP1 deficient cells have increased phosphorylation of NFkB upon TNFα stimulation, and that loss of LRP1 resulted in significant loss of astrocyte viability after prolonged stimulation. RESULTS/ANTICIPATED RESULTS: Altogether, our results indicate that loss of LRP1 renders astrocytes more sensitive to TNFα. Future experiments will focus on testing the influence of LRP1 on recovery after middle cerebral artery occlusion in mice. DISCUSSION/SIGNIFICANCE OF IMPACT: These studies will elucidate how astrocyte-LRP1 contributes to outcome after stroke, and helps us to understand one potential way that ApoE4 exerts pathological effects. A better understanding of the long-term processes after stroke will allow identification of therapies which improve the morbidity and mortality associated with stroke. CONFLICT OF INTEREST DESCRIPTION: NA.

scholarly journals Sex differences in traumatic brain injury: a multi-dimensional exploration in genes, hormones, cells, individuals, and society

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Cheng Ma ◽  
Xin Wu ◽  
Xiaotian Shen ◽  
Yanbo Yang ◽  
Zhouqing Chen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cognitive Impairment ◽  
Brain Injury ◽  
Treatment Options ◽  
Term Treatment ◽  
Neuroprotective Effects ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment

Abstract Traumatic brain injury (TBI) is exceptionally prevalent in society and often imposes a massive burden on patients’ families and poor prognosis. The evidence reviewed here suggests that gender can influence clinical outcomes of TBI in many aspects, ranges from patients’ mortality and short-term outcome to their long-term outcome, as well as the incidence of cognitive impairment. We mainly focused on the causes and mechanisms underlying the differences between male and female after TBI, from both biological and sociological views. As it turns out that multiple factors contribute to the gender differences after TBI, not merely the perspective of gender and sex hormones. Centered on this, we discussed how female steroid hormones exert neuroprotective effects through the anti-inflammatory and antioxidant mechanism, along with the cognitive impairment and the social integration problems it caused. As to the treatment, both instant and long-term treatment of TBI requires adjustments according to gender. A further study with more focus on this topic is therefore suggested to provide better treatment options for these patients.

Odontogenic myxoma invading the maxillary sinus – Case presentation

2016 ◽  
Vol 6 (21) ◽  
pp. 49-51
Author(s):  
Dan Cristian Gheorghe ◽  
Adina Zamfir-Chiru-Anton
Keyword(s):  
Maxillary Sinus ◽  
Surgical Excision ◽  
Surgical Removal ◽  
Odontogenic Myxoma ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Case Presentation ◽  
Complete Surgical Excision ◽  
Aggressive Tumor

Abstract Tumors of the maxillary sinus pose difficult challenges in a young patient. Our paper presents a very rare case of an odontogenic myxoma extended to the maxillary sinus, in a 14-year-old girl. The clinical picture suggested a malignancy or a local infection. The surgical removal was complete and the diagnosis was confirmed by immunohistochemistry. Discussions are made from the perspective of already published cases. A review of the disease is performed. CONCLUSION. Myxoma is a benign but aggressive tumor, needing complete surgical excision for a good long-term outcome.

scholarly journals A Five-Year Followup of Human Seminal Plasma Allergy in an 18-Year-Old Woman

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Ole D. Wolthers
Keyword(s):  
Seminal Plasma ◽  
Case Reports ◽  
Nasal Congestion ◽  
Rare Condition ◽  
Human Seminal Plasma ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Life Threatening ◽  
Low Prevalence

Case reports of women with the rare condition of human seminal plasma allergy have indicated that the condition may be associated with life-threatening anaphylactic reactions in relation to coitus. Few observations, if any, of long-term outcome of the condition are available. The aim of this paper was to present a case diagnosed in an 18-year-old girl who presented with generalized urticaria, nasal congestion and secretion, conjunctivitis, and periorbital and labial oedema 6–8 hours after coitus. During five years of followup the condition improved clinically significantly. Due to intimacy concerns and the low prevalence of the condition robust long term data on the natural course of the condition are difficult to obtain. The present case suggests that in some patients the condition may improve over time.

scholarly journals Prognostic Factors Affecting Long-Term Survival after Resection for Noncolorectal, Nonneuroendocrine, and Nonsarcoma Liver Metastases

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Fabio Uggeri ◽  
Enrico Pinotti ◽  
Marta Sandini ◽  
Luca Nespoli ◽  
Luca Gianotti ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Metastases ◽  
Treatment Options ◽  
Postoperative Outcome ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Factors Affecting ◽  
Pringle’S Maneuver

Aim. To evaluate feasibility and long-term outcome after hepatic resection for noncolorectal, nonneuroendocrine, and nonsarcoma (NCNNNS) liver metastases in a single center.Methods. We retrospectively reviewed our experience on patients who underwent surgery for NCNNNS liver metastases from 1995 to 2015. Patient baseline characteristics, tumor features, treatment options, and postoperative outcome were retrieved.Results. We included 47 patients. The overall 5-year survival (OS) rate after hepatectomy was 27.6%, with a median survival of 21 months. Overall survival was significantly longer for patients operated for nongastrointestinal liver metastases when compared with gastrointestinal (41 versus 10 months;p=0.027). OS was significantly worse in patients with synchronous metastases than in those with metachronous disease (10 versus 22 months;p=0.021). The occurrence of major postoperative complication negatively affected long-term prognosis (OS 23.5 versus 9.0 months;p=0.028). Preoperative tumor characteristics (number and size of the lesions), intraoperative features (extension of resection, need for transfusions, and Pringle’s maneuver), and R0 at pathology were not associated with differences in overall survival.Conclusion. Liver resection represents a possible curative option for patients with NCNNNS metastases. The origin of the primary tumor and the timing of metastases presentation may help clinicians to better select which patients could take advantages from surgical intervention.

X-linked thrombocytopenia (XLT) due to WAS mutations: clinical characteristics, long-term outcome, and treatment options

Blood ◽  
2010 ◽  
Vol 115 (16) ◽  
pp. 3231-3238 ◽  
Author(s):  
Michael H. Albert ◽  
Tanja C. Bittner ◽  
Shigeaki Nonoyama ◽  
Lucia Dora Notarangelo ◽  
Siobhan Burns ◽  
...  
Keyword(s):  
Severe Disease ◽  
Treatment Options ◽  
Gene Mutations ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Life Threatening ◽  
Severe Infections

Abstract A large proportion of patients with mutations in the Wiskott-Aldrich syndrome (WAS) protein gene exhibit the milder phenotype termed X-linked thrombocytopenia (XLT). Whereas stem cell transplantation at an early age is the treatment of choice for patients with WAS, therapeutic options for patients with XLT are controversial. In a retrospective multicenter study we defined the clinical phenotype of XLT and determined the probability of severe disease-related complications in patients older than 2 years with documented WAS gene mutations and mild-to-moderate eczema or mild, infrequent infections. Enrolled were 173 patients (median age, 11.5 years) from 12 countries spanning 2830 patient-years. Serious bleeding episodes occurred in 13.9%, life-threatening infections in 6.9%, autoimmunity in 12.1%, and malignancy in 5.2% of patients. Overall and event-free survival probabilities were not significantly influenced by the type of mutation or intravenous immunoglobulin or antibiotic prophylaxis. Splenectomy resulted in increased risk of severe infections. This analysis of the clinical outcome and molecular basis of patients with XLT shows excellent long-term survival but also a high probability of severe disease-related complications. These observations will allow better decision making when considering treatment options for individual patients with XLT.

Understanding and treating moyamoya disease in children

2009 ◽  
Vol 26 (4) ◽  
pp. E2 ◽  
Author(s):  
Jodi L. Smith
Keyword(s):  
Moyamoya Disease ◽  
Treatment Options ◽  
Unknown Etiology ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Indirect Revascularization ◽  
Collateral Vessels ◽  
Revascularization Procedures ◽  
Disease Present

Moyamoya disease, a known cause of pediatric stroke, is an unremitting cerebrovascular occlusive disorder of unknown etiology that can lead to devastating, permanent neurological disability if left untreated. It is characterized by progressive stenosis of the intracranial internal carotid arteries and their distal branches and the nearly simultaneous appearance of basal arterial collateral vessels that vascularize hypoperfused brain distal to the occluded vessels. Moyamoya disease may be idiopathic or may occur in association with other syndromes. Most children with moyamoya disease present with recurrent transient ischemic attacks or strokes. Although there is no definitive medical treatment, numerous direct and indirect revascularization procedures have been used to improve the compromised cerebral circulation, with outcomes varying according to procedure type. Such techniques improve the long-term outcome of patients with both idiopathic and syndrome-associated moyamoya disease. This review provides a comprehensive discussion of moyamoya disease in children, with an emphasis on the most effective surgical treatment options.

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