1/13. Protean manifestations of lipoid proteinosis in a 16-year-old boy.We report a 16-year-old Japanese male with lipoid proteinosis showing various skin manifestations. The patient was born to nonconsanguineous parents and none of his relatives was similarly affected. The patient suffered from a hoarse voice and refractory temporal epilepsy from early childhood. Computed tomography scanning of the brain showed bilateral calcification in the temporal lobes, a characteristic feature of lipoid proteinosis. On physical examination, various skin manifestations, including papules and haemorrhagic blisters, acne-like scars at sites of minor trauma or friction, and beads of small papules along the free margins of the eyelids were noted. A skin biopsy showed deposits of homogeneous hyaline-like material, positive on periodic acid-Schiff staining, throughout the dermis, particularly around small blood vessels. It is noteworthy that a range of characteristic skin lesions can be present in a patient with lipoid proteinosis even with mild systemic involvement.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/13. Cryopreserved cultured epidermal allografts achieved early closure of wounds and reduced scar formation in deep partial-thickness burn wounds (DDB) and split-thickness skin donor sites of pediatric patients.Burn treatment in children is associated with several difficulties, e.g. available skin replacement is small, donor area could expand, and subsequent hypertrophic scar and contracture could become larger along with their physical growth. In order to have better clinical results, the authors prepared cryopreserved cultured epidermal allografts from excess epidermal cells of other patients, and applied the epidermal allografts to 55 children, i.e. 43 cases of deep partial-thickness burn wounds (DDB) due to scald burn and 12 cases with split-thickness skin donor sites. In the 43 DDB patients, epithelialization was confirmed 9.1 /-3.6 days (mean /-S.D.) after treatment. In 10 of the 43 patients, epithelialization was comparable between the area which received the epidermal allografts (grafted area) and the area which did not receive the epidermal allografts but was covered with usual wound dressing (non-grafted area). As a result, epithelialization day was 7.9 /-1.7 in grafted areas and 20.5 /-2.3 in non-grafted areas. In the 12 patients with split-thickness skin donor sites, epithelialization was confirmed 6.3 /-0.9 days after treatment. Epithelialization of the grafted and non-grafted areas was comparable in 8 of the 12 patients, and it was 6.5 /-1.1 days and 14.1 /-1.6 days, respectively. In these 10 DDB patients and 8 split-thickness skin donor site patients, redness and scar formation were also milder in the grafted area. The 55 patients have been followed up for 1-8 years (mean, 4.75 years), and scar formation was suppressed in both DDB and split-thickness skin donor sites. These findings showed that cryopreserved cultured epidermal allografts achieve early closure of the wounds and good functional outcomes.- - - - - - - - - - ranking = 0.23837176454142keywords = physical (Clic here for more details about this article) |
3/13. Telangiectatic erythematous cutaneous reaction to an implantable cardioverter defibrillator.A 76-year-old man developed progressive blanchable reticulate erythema at the implantation site of his third implantable cardioverter defibrillator (ICD). Despite reports of allergic contact dermatitis to implantable devices, extensive routine patch testing in our patient failed to identify a responsible allergen. The clinical presentation and pathologic evidence were consistent with reticular telangiectatic erythema that has been reported overlying pacemakers and, in the English literature recently, overlying ICDs in two patients. Reticular telangiectatic erythema is a benign reactive condition that is possibly due to a combination of aberrant local circulatory and physical forces such as heat, electric fields, or magnetic fields.- - - - - - - - - - ranking = 0.23837176454142keywords = physical (Clic here for more details about this article) |
4/13. Functional reconstruction for severe postburn microstomia.A man with severe burn microstomia refractory to traditional management (Z release, skin grafting, splinting, bilateral commissuroplasty, and extensive physical therapy) is presented. Successful functional microstomia reconstruction was achieved with a three-stage approach consisting of the following: (1) lip, commissure, and cheek reconstruction with bilateral temporalis muscle transfers; (2) free flap neck and lower lip contracture release; and (3) vestibuloplasty with a stented full-thickness skin graft.- - - - - - - - - - ranking = 0.23837176454142keywords = physical (Clic here for more details about this article) |
5/13. Surgical treatment of hypopharyngeal stenosis in children.Five cases are presented of severe scarring, in the hypopharynx in children, which did not respond to conservative measures. These patients were treated by excision of the scar tissue and reconstitution of the area by Z-plasty, local mucosal flaps, regional chest flaps and colon transfer depending upon the severity of the problem. All had rehabilitation undertaken of the structural integrity of deglutive, respiratory, and vocal mechanisms. It is recommended that in this type of problem early rehabilitation is warranted rather than subjecting the child to prolonged gastrostomy and tracheotomy into puberty. When extended, the morbidity has a physical and psychological affect on these children.- - - - - - - - - - ranking = 0.23837176454142keywords = physical (Clic here for more details about this article) |
6/13. Intraoperatively fabricated bite block in the management of scar contracture hypomobility.Intraoral surgical procedures produce scar tissue formation that may limit mandibular opening. Many procedures have been developed to release these scar contractures, but most lead to further scar formation and greater limitation in opening. The purpose of this article to describe a technique with the use of an intraoperatively fabricated self-curing acrylic bite block combined with aggressive physical therapy in the management of this difficult clinical problem.- - - - - - - - - - ranking = 0.23837176454142keywords = physical (Clic here for more details about this article) |
7/13. leuprolide acetate in the management of cesarean scar endometriosis.BACKGROUND: Progestin or estrogen-progestin combination therapy has not proven useful in the treatment of endometriosis of the abdominal scar after cesarean delivery. We report our experience in managing this condition with a gonadotropin agonist. CASE: A 22-year-old black woman with a history of two previous cesareans developed endometriosis of the abdominal scar. The extent of the lesion was estimated by computed tomographic (CT) scan, and a 6-month preoperative course of leuprolide acetate was administered. The patient exhibited prompt symptomatic response to the gonadotropin agonist, but the physical examination and CT scan findings were unchanged. Pathologic examination after surgical removal of the lesion confirmed the clinical diagnosis. CONCLUSION: leuprolide acetate administered to a patient with cesarean scar endometriosis was associated with an improvement in symptoms, but there was no change in lesion size.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/13. Assessment of cosmetic and functional results of conservative versus surgical management of facial burns.This study was undertaken to determine whether tangential excision and thick split-thickness skin grafting (STSG) of deep facial burns give a better cosmetic and functional result than conservative management. Forty patients (28 adults, 12 children) treated for facial burns between July 1989 and July 1991 were evaluated in follow-up (mean 18.3 /- 8.3 months). The patients were categorized into the following groups according to depth and management of their facial burns: (A) healed without surgery in less than 21 days (n = 13), (B) healed without surgery in 21 days or more (n = 11), (C) early debridement and thick STSG in 18 days or less after the burn (n = 6), and (D) delayed debridement and thick STSG in more than 18 days after the burn (n = 10). Facial esthetics were evaluated by use of a modified scar assessment scale [range 0 (normal) to 16 (multiple abnormalities)], and functional problems of the face and neck were evaluated by use of physical examination. Group A patients had a significantly better overall rating on the scar assessment scale (2.1 /- 2.9) than the patients in the other groups that required more than 21 days to heal, B (8.0 /- 2.7), C (7.3 /- 2.9), and D (5.7 /- 2.5) (p < 0.01, analysis of variance). Also, skin-grafted areas in the surgically treated groups C and D had a significantly better scar rating than wounds that healed spontaneously in group B (5.7 /- 4.0 vs 8.0 /- 2.7, p < 0.05; and 5.1 /- 2.6 vs 8.0 /- 2.7, p < 0.05). There was no significant difference among groups B, C, and D when the total number of persistent functional problems after treatment were compared. The most common functional problems for these patients were microstomia (17/27) and eyelid ectropion (17/27). patients with superficial facial burns that heal in less than 21 days appear to heal with generally very acceptable cosmetic and functional results. However, in those patients with deep facial burns that require prolonged periods for spontaneous wound healing, tangential excision of the wound and resurfacing with thick STSG appear to give better cosmetic results than conservative management, with no greater incidence of functional complications.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/13. Arthroscopic subscapularis tenolysis: a technique for treating refractory glenohumeral stiffness following open reduction and internal fixation of a displaced three-part proximal humerus fracture.This case illustrates the treatment of a stiff shoulder following open reduction and internal fixation of a three-part fracture of the proximal humerus. motion could not be improved with physical therapy or with manipulation under general anesthesia. Arthroscopic subscapularis tenolysis provided a dramatic increase in range of motion. The unique pathological findings may render such cases refractory to manipulation because of thick unyielding scar tissue. In such cases, arthroscopic subscapularis tenolysis may provide the only means of improving the final range of motion.- - - - - - - - - - ranking = 0.23837176454142keywords = physical (Clic here for more details about this article) |
10/13. Scarring folliculitis in the ectrodactyly-ectodermal dysplasia-clefting syndrome. Histologic, scanning electron-microscopic and biophysical studies of hair.Several clinical syndromes are characterized by ectodermal dysplasia (ED) in association with clefting of the lip and/or palate. In these syndromes, alopecia is primarily due to abnormalities of the hair shaft associated with increased hair fragility. scalp dermatitis is yet another peculiar finding, primarily seen in the ankyloblepharon-ED-clefting (AEC) syndrome. We report on a 16-year-old patient with ectrodactyly-ED-clefting (EEC) syndrome, who exhibited a scarring alopecia due to deep folliculitis. On scanning electron microscopy, irregular torsion and longitudinal grooving of the hair shaft (pili torti et canaliculi) were observed. Quantitative determinations of the elastic and viscous parameters of hair demonstrated a normal viscosity but a significantly reduced hair elasticity, indicating either an abnormal composition or a disordered arrangement of microfibrils within the apparently normal keratin matrix. In contrast to the erosive scalp dermatitis of early onset in the AEC syndrome, alopecia in this case of EEC syndrome demonstrated follicular scarring with onset during puberty. We question a possible role of the anatomical hair abnormality in the pathogenesis of chronic deep folliculitis in this and clinically related syndromes.- - - - - - - - - - ranking = 0.95348705816569keywords = physical (Clic here for more details about this article) |
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