Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

Lupus vulgaris (LV) is a progressive, chronic form of cutaneous tuberculosis (CTB). The head and neck regions are the most commonly affected sites, followed by the arms and legs. Occurring in unusual sites may pose diagnostic difficulties. Herein, we report a case of LV present on the dorsal aspect of the right hand in a twenty-year-old Saudi male. It was misdiagnosed as leishmaniasis as the patient lived in an area in which it was endemic, and was treated accordingly with no benefit. A skin punch biopsy was taken and the diagnosis of LV was confirmed. The lesion responded well to anti-tubercular therapy (ATT), yet healed with atrophic scarring. Although rare, clinicians must be aware of the importance of considering CTB as an important differential, as misdiagnosis or delayed diagnosis of this entity may eventually cause prolonged morbidity.

Treatment of Navicular Stress Fracture Accompanied by Os Supranaviculare: A Case Report

Navicular stress fractures (NSFs) are relatively uncommon, and predominantly affect athletes. Patients complain of vague pain, bruising, and swelling in the dorsal aspect of the midfoot. Os supranaviculare (OSSN) is an accessory ossicle located above the dorsal aspect of the talonavicular joint. There have been few previous reports of NSFs accompanied by OSSN. Herein we report the case of a patient with OSSN who was successfully treated for an NSF. A 34-year-old Asian man presented with a 6-month history of insidious-onset dorsal foot pain that occasionally radiated medially toward the arch. The pain worsened while sprinting and kicking a soccer ball with the instep, whereas it was temporarily relieved by rest for a week and analgesics. Plain radiographs of the weight-bearing foot and ankle joints revealed a bilateral, well-corticated OSSN. Computed tomography (CT) revealed a sagittally oriented incomplete fracture that extended from the dorsoproximal cortex to the center of the body of the navicular. The OSSN was excised and the joint was immobilized with a non-weight-bearing cast for 6 weeks, followed by gradual weight bearing using a boot. The 5-month follow-up CT scan demonstrated definite fracture healing. At the 1-year follow-up, the patient’s symptoms had resolved, the American Orthopedic Foot and Ankle Society midfoot score had improved from 61 to 95 points, and the visual analog scale pain score had improved from 6 to 0. We describe a rare case of NSF accompanied by OSSN. Because of the fracture gap and biomechanical properties of OSSN, OSSN was excised and the joint was immobilized, leading to a successful outcome. Further research is required to evaluate the relationship between NSFs and OSSN, and determine the optimal management of NSFs in patients with OSSN.

Over 400 million years of cooperation: Untangling the chondrocranium-dermatocranium connection

The cranial endo- and dermal skeletons, which comprise the vertebrate skull, evolved independently and form separately during embryogenesis. In mammals, the mostly cartilaginous cranial endoskeleton forms prior to the bony dermatocranium. Many features of the chondrocranium are transient, undergoing endochondral ossification or disappearing, so its role in skull morphogenesis is not understood The fibroblast growth factor (FGF) and receptor (FGFR) signaling pathway contributes significantly to the regulation of osteochondroprogenitor cell function. Mutations in FGFR genes are associated with diseases that impact the skull including dwarfing chondrodyplasia and craniosynostosis syndromes. We investigate the developing chondrocranium and dermatocranium using a mouse model for craniosynostosis carrying a gain of function mutation in Fgfr2 to assess development of these cranial skeleton systems. Dermatocrania and chondrocrania of Fgfr2cC342Y/+ mice and their Fgfr2c+/+ littermates were quantified in 3D from microcomputed tomography images of mouse embryos. Chondrocrania of embryonic mice carrying the Fgfr2 mutation are larger than their Fgfr2c+/+ littermates and include novel extensions of cartilage over the lateral and dorsal aspect of the brain. Like the forming chondrocranium, the embryonic dermatocranium is larger in Fgfr2cC342Y/+ mice throughout embryogenesis but after disappearance of much of the chondrocranium, the dermatocranium becomes progressively smaller relative to Fgfr2c+/+ littermates during postnatal growth. Results reveal the direct effects of this Fgfr2c mutation on embryonic cranial cartilage, the impact of chondrocranial structure on developing dermatocranial elements, the importance of the chondrocranium in decoding the impact of specific genetic variants on head morphogenesis, and the potential for harnessing these effects as therapeutic targets.

Morphological ontogeny of Limnozetes schatzi sp. nov. (Acari: Oribatida: Limnozetidae) from Norway

The morphological ontogeny of Limnozetes schatzi sp. nov. from Norway is described and illustrated. The adult of this species is the most similar to that of L. rugosus (Sellnick, 1925), but differs from it mainly by the body shape (it is stockier in dorsal aspect and less convex in lateral aspect than L. rugosus), longer prodorsal seta in and notogastral setae, lack of seta c3, which in some individuals of L. rugosus is present, and sculpture of notogaster. Moreover, in L. schatzi seta l' on femur III is absent, but in L. rugosus it is present. Seta d on femora I–III and seta l' on femora I and II have relatively long barbs, covered often with debris. The juveniles of L. schatzi have all gastronotal setae short, whereas the latter species has some setae longer (lm and lp in larva, lp in nymphs).

Wnt1 Role in the Development of the Habenula and the Fasciculus Retroflexus

Wnt1 is one of the morphogenes that controls the specification and differentiation of neuronal populations in the developing central nervous system. The habenula is a diencephalic neuronal complex located in the most dorsal aspect of the thalamic prosomere. This diencephalic neuronal population is involved in the limbic system and its malfunction is related with several psychiatric disorders. Our aim is to elucidate the Wnt1 role in the habenula and its main efferent tract, the fasciculus retroflexus, development. In order to achieve these objectives, we analyzed these structures development in a Wnt1 lack of function mouse model. The habenula was generated in our model, but it presented an enlarged volume. This alteration was due to an increment in habenular neuroblasts proliferation rate. The fasciculus retroflexus also presented a wider and disorganized distribution and a disturbed final trajectory toward its target. The mid-hindbrain territories that the tract must cross were miss-differentiated in our model. The specification of the habenula is Wnt1 independent. Nevertheless, it controls its precursors proliferation rate. Wnt1 expressed in the isthmic organizer is vital to induce the midbrain and rostral hindbrain territories. The alteration of these areas is responsible for the fasciculus retroflexus axons misroute.

Eccrine Nevus in the Forearm of a 16-Year-Old Presenting as Unilateral Hyperhidrosis: A Clinicopathological Correlation Paradigm

A case of a purely eccrine nevus in an adolescent patient presenting with focal hyperhidrosis on an area comprising the left forearm and the dorsal aspect of the left hand is described. No clinically evident lesions were identifiable. Dermatopathologic findings were subtle, showing only a slight increase in the number of eccrine glands. Clinicopathological correlation was paramount to achieve the diagnosis.

Composite Flap - Serratus Anterior with Rib Component – a Foot Salvage Solution after a Severe Crush Injury

Severe work accidents are one of the most frequent causes for physical disability in adults, alongside car accidents and war/gunshot injuries. In this article we present the case of a severe crush injury of the left foot that occurred in a 31 year-old patient who was involved in a work accident. After an unsuccessful tissue coverage using local flaps, the salvage solution was that of a composite free flap, aiming not only to cover, but also to restore stability to the foot. The treatment of choice was the serratus anterior muscle harvested together with osseous component (8th rib). The healing was difficult, due to wound dehiscence with bone exposure over a small area, but the problem was addressed using FGF (fibroblast growth factor) sponges, which enabled granulation and complete wound closure. The outcome of the case was favourable, gait being possible without any deficiency. For the cosmetic and functional reasons, the patient suffered one last surgical procedure to debulk the dorsal aspect of the foot. The final result was more than satisfactory, the patient being totally rehabilitated and socially and professionally reintegrated.

Cutaneous reaction to sea urchin spines

A 35-year-old male returned from vacation in Hawaii where he went scuba diving and snorkeling. While snorkeling, he stepped on a sea urchin and sustained injuries to the dorsal aspect of his right foot. He began to swim back to shore when he felt significant pain and began removing visible spines when he reached shore. He saw a physician in Hawaii who removed remaining spines and started a treatment regimen of cephalexin 500 mg QID. Patient followed up 2 weeks later with his home dermatologist for persistent granuloma and was given 15-day course of oral doxycycline 50 mg BID with near full recovery within 2 weeks. Even physicians practicing inland need to be aware of coastal injuries and reactions as they can mimic other common skin tumors such as keratoacanthomas.

Accessory medial cuneiform bone in a child: unreported site and review of literature

<p>Accessory ossicles of the foot are not uncommon finding in foot radiographs which has confused radiologists and orthopedic surgeons from time immemorial. Occasionally these bones are symptomatic, hindering daily activities of patients. We present a case report of an eleven years old girl with a symptomatic accessory medial cuneiform on the dorsal aspect of left foot. The child was evaluated radiologically and after a trial of failed conservative treatment, she was operated upon. Intraoperatively a superficial nerve on dorsum of this accessory ossicle was found, and the extra bone was excised. This accessory bone was found to be related to medial cuneiform bone at its dorsal and distal surface making to suggest its name as "Os cuneo-I metatarsale-I dorsale". Detailed radiological evaluation is mandatory for identification and exact anatomical localization of the extra bone before proceeding to excision, when non operative treatment fails to relieve the symptoms.</p><p><strong> </strong></p>