Pedal manifestations of Milroy's disease

1996 ◽  
Vol 86 (8) ◽  
pp. 400-402 ◽  
Author(s):  
SD Mehta ◽  
RJ Robinson ◽  
SA Bern
Keyword(s):  
Skin Flap ◽  
Recurrent Infections ◽  
Dorsal Aspect ◽  
Plantar Aspect ◽  
Vascular Compromise ◽  
History Of ◽  
Transmetatarsal Amputation

A pedal complication of Milroy's disease has been presented. With a history of multiple debridement procedures as in this case, there is the risk of recurrent infections and the possibility of permanent vascular compromise, particularly with respect to the thin pedal skin on the dorsal aspect. When the toes are recurrently involved with infection, a patient may be best served with a transmetatarsal amputation using a skin flap on the plantar aspect.

scholarly journals Mortality and Conversion Rate to Below Knee or Above Knee Amputation Following Transmetatarsal Amputation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0011
Author(s):  
D. Anthony Barcel ◽  
Susan M. Odum ◽  
Taylor Rowe ◽  
Jefferson B. Sabatini ◽  
Samuel E. Ford ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conversion Rate ◽  
Significant Risk ◽  
High Rate ◽  
Administrative Database ◽  
Categorical Variables ◽  
Diabetic Patients ◽  
Knee Amputation ◽  
History Of ◽  
Transmetatarsal Amputation

Category: Midfoot/Forefoot; Diabetes; Other Introduction/Purpose: Non-traumatic lower extremity amputations (LEA), especially those performed in dysvascular and diabetic patients, are known to have poor long-term prognosis. Perioperative mortality has been reported at between 4 and 10%, and the 1 and 5 year mortality rates range between 22-33% and 39-69%, respectively. While poor outcomes in these patients have been described, there is no consensus as to the predictors of mortality. The purpose of the study is to determine the percentage of patients who had a complication following transmetatarsal amputation (TMA) and identify associated risk factors for complications and mortality. Methods: We queried our institution’s administrative database to identify 247 TMA procedures performed in 229 patients between January, 2002 and December, 2016. Electronic health records were reviewed to document complications defined as reoperation, amputation and mortality. Mortality was also verified using the National Death Index. Additionally, we recorded risk factors including diabetes, A1c level, end stage renal disease (ESRD), cardiovascular disease (CVD), peripheral vascular disease (PVD), history of revascularization, contralateral amputation, and neuropathy. The majority of the study patients were males (157, 69%) and the average age was 57 years (range 24-91). The median BMI was 28 (range 16-58) and 29% of the study patients were obese with a BMI ≥ 30. Fishers Exact tests were used to compare categorical variables. Kruskal-Wallis and Independent T-tests were used to compare numeric data. All data were analyzed using SAS/STAT software version 9.4 (Carey, NC) and a 0.05 level of significance was defined apriori. Results: The conversion rate to below (BKA) or above knee amputation (AKA) was 26% (64 of 247). Males (p=.0274), diabetics (p=.0139), patients in ESRD (p=.019), and patients with a history of CVD (p=.0247) or perioperative revascularization (p=.022) were more likely to undergo further amputation following an index TMA. BMI was significantly higher in patients requiring BKA/AKA (p=.0305). There were no significant differences in age (p=.2723) or A1c levels (p=.4219). The overall mortality rate was 35% (84 of 229). Diabetes (p=.0272), ESRD (p=.0031), history of CVD (p<.0001) or PVD (p=.0179) were all significantly associated with mortality. Patients who died were significantly older (p=.0006) and had significantly higher A1c levels (p=.0373). BMI was not significantly associated with mortality. Twenty-two patients who had 23 further amputations subsequently died. Conclusion: In our series of patients undergoing TMA, 26% underwent further amputation and 35% of patients died. Conversion rate to BKA or AKA occurred at a high rate regardless of preoperative revascularization or the use of tendo-achilles or gastrocnemius lengthening procedures. Male sex, diabetes, ESRD, history of CVD or revascularization are significant risk factors for further amputation. ESRD, diabetes, history of CVD or PVD, older age and higher A1c levels are significant risk factors for mortality. These data provide useful insight into risk factors to be emphasized when counseling patients and their families to establish realistic postoperative expectations.

Self-Myofascial Release of the Superficial Back Line Improves Sit-and-Reach Distance

2020 ◽  
Vol 29 (4) ◽  
pp. 400-404 ◽  
Author(s):  
Whitney Williams ◽  
Noelle M. Selkow
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lower Extremity ◽  
Low Back ◽  
Myofascial Release ◽  
Plantar Surface ◽  
The Past ◽  
Plantar Aspect ◽  
History Of ◽  
Hamstring Flexibility

Context: Decreased hamstring flexibility can lead to a plethora of musculoskeletal injuries, including low back pain, hamstring strains, and patellofemoral pain. Lack of flexibility may be the result of myofascial adhesions. The fascia connected to the hamstrings is part of the superficial back line that runs from the cranium to the plantar aspect of the foot. Any disruption along this chain may limit the flexibility of the hamstring. Objective: To investigate if self-myofascial release (SMR) of the plantar surface of the foot in addition to the hamstring group was more effective at improving the flexibility of the hamstrings when compared with either intervention alone. Design: Cross-over study. Setting: Athletic training facility. Participants: Fifteen college students (5 males and 10 females; age: 20.9 [1.4] y, height: 173.1 [10.3] cm, mass: 80.0 [24.9] kg) who were not older than 30, with no history of low back pain or injury within the past 6 months, no history of leg pain or injury within the past 6 months, no current signs or symptoms of cervical or lumbar radicular pain, no current complaint of numbness or tingling in the lower-extremity, and no history of surgery in the lower-extremity or legs. Interventions: Each participant received each intervention separated by at least 96 hours in a randomized order: hamstring foam rolling, lacrosse ball on the plantar surface of the foot, and a combination of both. Main Outcome Measures: The sit-and-reach test evaluated hamstring flexibility of each participant before and immediately after each intervention. Results: There were no significant differences found among the SMR techniques on sit-and-reach distance (F2,41 = 2.7, P = .08, ). However, at least 20% of participants in each intervention improved sit-and-reach distance by 2.5 cm. Conclusions: SMR may improve sit-and-reach distance, but one technique of SMR does not seem to be superior to another.

scholarly journals Osteochondroma of the scapula associated with a subclavian artery pseudoaneurysm: Case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1882308
Author(s):  
Ana Oljaca ◽  
Daniela Hirzberger ◽  
Marko Bergovec ◽  
Kurt Tiesenhausen ◽  
Stephan H Koter ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Clinical Status ◽  
Previous History ◽  
Vascular Complications ◽  
Mechanical Compression ◽  
Vascular Surgeon ◽  
Artery Pseudoaneurysm ◽  
Dorsal Aspect ◽  
Multiple Exostoses ◽  
History Of

Osteochondromas rarely induce vascular complications by mechanical compression. We present the case of a subclavian artery pseudoaneursym caused by an osteochondroma of the scapula in a 67-year-old male. The diagnosis was based on a previous history of multiple exostoses, computed tomography and magnetic resonance imaging, as well as the local vascular clinical status of the lesion. Surgical treatment consisted of vascular and orthopaedic intervention. First, the vascular surgeon implanted a bypass of the subclavian artery from the ventral aspect, enabling the orthopaedic surgeon to resect the osteochondroma from the dorsal aspect. The patient recovered with full function. Vascular pseundoaneurysms should be taken into consideration in patients with osteochondromas, especially with a known history of multiple hereditary exostoses.

In Pursuit of the “Perforator” in the Perforator Skin Flap

2020 ◽  
Author(s):  
G. Ian Taylor ◽  
Geoffrey G. Hallock
Keyword(s):  
Skin Flap ◽  
Perforator Flap ◽  
The Novel ◽  
Full Circle ◽  
Reconstructive Microsurgery ◽  
Lower Extremity Reconstruction ◽  
History Of ◽  
Extremity Reconstruction ◽  
Surgical Manipulations ◽  
Do So

AbstractAnother congress of the World Society for Reconstructive Microsurgery (WSRM) this past year in Bologna was magnificent not just for the presentation of so many keynote lectures by the giants of our field nor the novel and innovative ideas shown by those who will someday follow in those footsteps, but by making all of us realize how many capable microsurgeons there are now practically everywhere in this world, doing incredibly important surgical management of challenges that previously were unmet and resulted in sheer devastation for so many of our patients. How much we are the same in our goals, aspirations, and abilities could not be overlooked, but it is amazing how much we also want to learn more together—each relying on the other. To do so, we must not forget our origins as we appropriately plan for the future. All this we philosophized in our WSRM panel on lower extremity reconstruction, while emphasizing on the surface the perforator flap that at the least today has caught everyone's attention. In this overview to follow, we once again tell two stories, starting with the beginnings of the concept of flaps in showing how the nomenclature has evolved over time according to our various surgical manipulations. Often overlooked, though, is a parallel timeline by the anatomists who have better elucidated the circulation to these flaps, where it will become obvious that often long ago the existence of perforators was recognized by them long before known by the surgeons. At least today, these two paths have at least temporarily intersected. Our pursuit of the “perforator” in the perforator skin flap has come full circle, following the course of the history of the flap itself—a pursuit of excellence.

scholarly journals Autoimmunity and immunodeficiency at the crossroad: autoimmune disorders as the presenting feature of selective IgM deficiency

2019 ◽  
Vol 12 (1) ◽  
pp. e223180
Author(s):  
Corrado Campochiaro ◽  
Sirin Atay ◽  
Kristina E N Clark ◽  
Voon Ong ◽  
Christopher P Denton
Keyword(s):  
T Cell ◽  
Literature Review ◽  
Autoimmune Diseases ◽  
European Society ◽  
Immunoglobulin M ◽  
External Factors ◽  
Recurrent Infections ◽  
Serum Iga ◽  
History Of ◽  
Igm Deficiency

Selective immunoglobulin M deficiency (sIgMD) is an immunodeficiency with undefined pathogenesis and commonly presenting with recurrent infections.1The European Society for Immunodeficiencies Registry defines sIgMD as a serum IgM level repeatedly below 2 SD of normal with normal levels of serum IgA, IgG and IgG subclasses, normal vaccination responses, absence of T-cell defects and absence of causative external factors. Rarely it can also be associated with autoimmune diseases.2–7Here we describe a patient with primary sIgMD; who presented with multiple autoimmune diseases without a history of recurrent infections and we provide a short literature review on sIgMD and autoimmune diseases.

scholarly journals Novel CD40LG Mutation in Two Cousins With Immunoglobulin Class Switch Recombinant Deficiency

2020 ◽  
Author(s):  
Shahnaz Armin ◽  
Keyvan Ramezani ◽  
Bibi Shahin Shamsian ◽  
Zahra Chavoshzadeh ◽  
Maryam Eghbali ◽  
...  
Keyword(s):  
Opportunistic Infections ◽  
Novel Mutation ◽  
Family Relationship ◽  
Cd40 Ligand ◽  
Immunoglobulin M ◽  
Recurrent Infections ◽  
Exon 2 ◽  
Class Switch ◽  
Inherited Immunodeficiency ◽  
History Of

The hyper-immunoglobulin M (HIGM) syndrome comprises a group of rare inherited immunodeficiency disorders characterized by normal or elevated levels of serum IgM with low or absent levels of serum IgG, IgA, and IgE. Patients with this syndrome usually present with a history of recurrent infections or opportunistic infections. Here, we report two male cousins from homozygote twin mothers. The first cousin presented with no signs or symptoms other than neutropenia, which was accidentally found in a routine blood test. Immunological workup in this patient showed undetectable IgG and IgA levels and normal IgM levels. The second cousin had a history of recurrent infections, and at the time of admission, he was diagnosed with Pneumocystis jirovecii infection. The immunologic workup of this patient showed undetectable IgG, decreased IgA, and increased IgM level. Due to their interesting family relationship, genetic analysis was performed, which detected a novel mutation in exon 2 (c.266 del G) of the CD40 ligand gene (CD40LG).

scholarly journals Early childhood infections, antistreptococcal and basal ganglia antibodies in adult ADHD: A preliminary study

2020 ◽  
Author(s):  
Francesco Oliva ◽  
Giulia di Girolamo ◽  
Francesca Malandrone ◽  
Noemi Iaia ◽  
Fiorella Biasi ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Adult Adhd ◽  
Enzyme Linked Immunosorbent Assay ◽  
Recurrent Infections ◽  
Hyperactivity Disorder ◽  
Childhood Infections ◽  
Streptolysin O ◽  
Increased Risk ◽  
History Of ◽  
The Relationship

Abstract Background: To explore the relationship between adult Attention Deficit/ Hyperactivity Disorder (ADHD), antistreptococcal titers, ABGA, and recurrent infections during early childhood.Method: Childhood history of recurrent infections and a blood sample were collected in a sample of DSM-IV adult outpatients with ADHD. The anti-streptolysin O (ASO), anti-deoxyribonuclease B (anti-DNase B), and anti-basal ganglia antibodies (ABGA) titers were determined in patient plasma by enzyme-linked immunosorbent assay (ELISA). Titers positivity was evaluated following manufacturer's specifications. Absolute titers were also collected as continuous variables.Results: Fourteen out of 22 (63.6%) have had recurrent infections in childhood (i.e., seven, 31.8%, have had tonsillitis or adenoiditis and seven, 31.8%, have had any other infections). Eighteen patients (81.9%) were positive for anti-DNase B, five (22.7%) for ASO, and 4 (18.2%) were positive for both of them. Five participants (22.7%) were ABGA positive, whereas only two (9.1%) were positive for all three antibodies.Conclusions: patients with ADHD might be more prone to infections during childhood and subclinical streptococcal infections during adulthood. Moreover, they seem to have an increased risk for basal ganglia autoimmunity in adulthood. Both infections and the ensuing acquired autoimmunity could influence the neurodevelopmental process, by contributing, at least in part, to the ADHD pathogenesis.

Prior tonsillectomy and subsequent risk of breast cancer in females: Systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10568-10568
Author(s):  
Salah Eddine Oussama Kacimi ◽  
Mounir Ould Setti ◽  
Amira Yasmine Benmelouka ◽  
Mohammad Aloulou ◽  
Hanane Zoubida Sekkal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Sensitivity Analysis ◽  
Effect Size ◽  
Recurrent Infections ◽  
Childhood Infections ◽  
Increased Risk ◽  
History Of ◽  
Leave One Out ◽  
Subsequent Risk

10568 Background: Exposure to recurrent infections in childhood was linked to an increased risk of cancer in adulthood. There is also evidence that a history of tonsillectomy, a procedure often performed in children with recurrent infections, is linked to an increased risk of leukemia, and Hodgkin lymphoma. Tonsillectomy could be directly associated with cancer risk or it could be a proxy for another risk factor such as recurrent infections and chronic inflammation. Nevertheless, the role of recurrent childhood infections and tonsillectomy on the one hand, and the risk of breast cancer (BC) in adulthood remain understudied. Our study aims to verify whether a history of tonsillectomy increases the risk of BC in women. Methods: A systematic review was conducted using PubMed, Google Scholar, Scopus, Embase and Web of Science databases from inception through November 2020 to identify the studies which explored the association between history of tonsillectomy and BC in females. The Newcastle Ottawa Scale was used to assess the quality of included studies. Odds ratio (OR) was used to measure effect size. The Random/Fixed effects model was applied to synthesize the associations between tonsillectomy and BC risk based on heterogeneity. Heterogeneity was assessed using the I-squared statistic. A forest plot was generated, and publication bias was assessed. The leave-one-out sensitivity analysis was performed to check if results were driven by a single study. Results: Seven studies with a total of 7259 patients were included in our analysis; out of them, 2200 patients were diagnosed with BC. Patients with a history of tonsillectomy (n = 2843) showed higher subsequent risk of developing BC (OR = 1.252; 95% CI = 1.115 - 1.406; P < 0.001; I2 = 9%) as compared to patients without a history of tonsillectomy (n = 4416). Using the leave-one-out sensitivity analysis to iteratively remove one study at a time, we confirmed that no single study had a substantial influence on the overall effect size. Conclusions: Our study supports and confirms the evidence that a history of tonsillectomy is associated with an increased risk of breast cancer. These findings are also an argument in support of the hypothesis that recurrent childhood infections are linked with adulthood breast cancer.

Survival Following Vascular Compromise in an Island Skin Flap

1981 ◽  
Vol 67 (2) ◽  
pp. 200-204 ◽  
Author(s):  
Nancy H. McKee ◽  
Howard M. Clarke ◽  
Ralph T. Manktelow
Keyword(s):  
Skin Flap ◽  
Vascular Compromise

Immunodeficiency

2020 ◽  
pp. 337-367
Author(s):  
Sophie Hambleton ◽  
Sara Marshall ◽  
Dinakantha S. Kumararatne
Keyword(s):  
Immune System ◽  
Family History ◽  
Viral Infections ◽  
Failure To Thrive ◽  
Normal Function ◽  
Recurrent Infections ◽  
Microbial Infection ◽  
History Of ◽  
Immunodeficiency Syndrome ◽  
Intrinsic Component

Immunodeficiency is caused by failure of a component of the immune system and results in increased susceptibility to infections. The possibility of an underlying immunodeficiency should be considered if a patient has: serious, persistent, unusual, or recurrent infections; failure to thrive in infancy; known family history of immunodeficiency; unexplained lymphopenia in infancy; or a combination of clinical features characteristic of a particular immunodeficiency syndrome. The nature of the microbial infection in a particular patient provides a clue to the likely cause of immunodeficiency. Primary immunodeficiency diseases are heritable disorders that result in defects in an intrinsic component of the immune system. Secondary immunodeficiencies are caused by conditions that impair the normal function of the immune system and include viral infections, myelomatosis, non-Hodgkin’s lymphoma, severe renal or liver failure, and use of therapeutic agents which impair immunity.

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