Sihler's Staining of the Thoracic Cutaneous Nerve and its Significance / Tinción de Sihler del Nervio Cutáneo Torácico y su Relevancia

SUMMARY: Our team has modified Sihler's intramuscular nerve staining method to allow for calculation of nerve density. Therefore, this study aimed to show the overall distribution pattern of the thoracic cutaneous nerves to provide a morphological basis for selecting and matching sensory reconstruction during skin flap transplantation. Twelve Chinese adult cadavers were dissected; the thoracic skin was removed, and the modified Sihler's staining method was performed. Centered around the nipple, the chest skin was divided into four regions: medial-superior, lateral-superior, lateral-inferior, and medial-inferior. The thoracic skin was not only innervated by the branches of the 1st to 7th intercostal and supraclavicular nerves, but also by a small number of nerves that directly reached the skin and passed through the pectoralis major muscle. There is a phenomenon of cross overlap between the branches of adjacent intercostal nerves. The branches of the 2nd to 7th intercostal nerves were distributed in the breast, and the branches of the lateral and anterior cutaneous branches were densely distributed around the nipple, forming a grid-like anastomosis. There was no cross-overlapping innervation between the anterior cutaneous branches on both sides. The density of nerve distribution in the four regions of the chest was in the order of the medial-superior, lateral-superior, lateral-inferior and medial-inferior region, respectively. These results may be used to map sensory regions when designing thoracic skin flaps for reconstruction surgery to obtain improved sensory recovery.

Nuestro equipo ha modificado el método de tinción nerviosa intramuscular de Sihler para permitir el cálculo de la densidad nerviosa. Por lo tanto, este estudio tuvo como objetivo mostrar el patrón de distribución general de los nervios cutáneos torácicos proporcionando una base morfológica para seleccionar y combinar la reconstrucción sensorial durante el trasplante de colgajo de piel. Se diseccionaron 12 cadáveres de individuos adultos chinos. Se eliminó la piel torácica y se realizó el método de tinción de Sihler modificado, centrada alrededor del pezón, la piel del pecho se dividió en cuatro regiones: medial- superior, lateral-superior, lateral-inferior y medial-inferior. La piel torácica no solo estaba inervada por los ramos de los nervios intercostal y supraclavicular 1º a 7º, sino también por un pequeño número de nervios que llegaban directamente a la piel y pasaban a través del músculo pectoral mayor. Existe un fenómeno de superposición cruzada entre los ramos de los nervios intercostales adyacentes. Los ramos de los nervios intercostales 2º a 7º se distribuyeron en la mama, y los ramos de los ramos cutáneos lateral y anterior se distribuyeron densamente alrededor del pezón, formando una anastomosis en forma de rejilla. No hubo inervación cruzada entre los ramos cutáneos anteriores en ambos lados. La densidad de la distribución nerviosa en las cuatro regiones del tórax estaba en el orden de región medial-superior, lateral-superior, lateral-inferior y medial-inferior, respectivamente. Estos resultados pueden ser útiles para mapear regiones sensoriales al diseñar colgajos de piel torácicos para utilizarlos en cirugía de reconstrucción y obtener así una mejor recuperación sensorial.

Ethambutol induced subacute cutaneous lupus erythematosus in an elderly female with co-morbidities

Papulosquamous lesions in an elderly female with multiple co-morbidities often pose diagnostic challenge. We present an interesting case of anti-tubercular treatment (ATT) induced sub-acute cutaneous lupus erythematosus. The patient presented with papulosquamous lesions in generalised distribution, which showed interface dermatitis on histopathology. The serology for anti-nuclear antibodies, anti-Ro and anti-La was positive. The rash resolved spontaneously after stopping all the suspected drugs. Oral provocation was performed with first line anti-tubercular drugs and ethambutol was found to be the culprit drug, which was later confirmed by reappearance of skin rash by inadvertent ingestion of one dose of ethambutol by the patient.

Rare case of immune mediated cutaneous leucoclastic vasculitis with pancytopenia in a rheumatoid arthritis patient with chronic cytomegalovirus infection

Acute febrile illnesses with systemic involvement can present significant diagnostic and therapeutic challenges, particularly in patients with multiple comorbidities. This case report highlights a complex presentation of acute febrile illness with pancytopenia and immune-mediated cutaneous vasculitis in a patient with type II diabetes mellitus. A 52-year-old male with a known history of type II diabetes mellitus presented with fever, decreased oral intake, loose stools, oral ulcers, dysphagia, and rashes over the trunk and abdomen for four days. Upon admission to the ICU, extensive diagnostic evaluations were performed, revealing significant hematological, biochemical, and serological abnormalities. Imaging studies and histopathological examinations were conducted to further investigate the underlying etiology. Laboratory findings indicated pancytopenia, acute kidney injury, and hyperkalemia. Infectious disease workup was largely negative, except for a positive CMV IgG. Imaging studies revealed medical renal disease, and a skin punch biopsy confirmed cutaneous leukocytoclastic vasculitis. Bone marrow biopsy suggested bone marrow suppression. Multidisciplinary management, including dialysis, IV fluids, antibiotics, blood transfusions, steroids, and Ganciclovir, led to the patient抯 gradual improvement and stabilization. The comprehensive diagnostic and therapeutic approach in this case underscores the importance of considering immune-mediated etiologies in patients with atypical presentations. Multidisciplinary collaboration was crucial in managing the multifaceted clinical condition of the patient. Early recognition and prompt multidisciplinary management are essential in similar cases. Extensive diagnostic evaluations should be performed to identify the underlying causes, and immune-mediated etiologies should be considered in complex presentations. Further research is recommended to explore optimal management strategies for such multifaceted conditions.

Cutaneous findings in neonates and their socio-demographic profile: a prospective observational study

Background: A wide range of disorders can manifest as skin lesions due to the great difficulty the skin encounters while transitioning from an aqueous to a dry environment in a neonate. Among the skin conditions commonly seen in neonates are temporary benign lesions, atopic dermatitis (and associated disorders), bullous dermatoses. Aim was to study the various patterns of skin lesions in neonates and to estimate the prevalence of physiological and pathological skin lesions.Methods: This prospective observational study was conducted in the department of pediatrics at Acharya Shri Chander College of Medical Sciences and Hospital (ASCOMS) a tertiary care hospital in Jammu. A total of 300 neonates (day 1 to day 28 of life) and having any skin lesions or manifestations born at the hospital or visiting out patient抯 department were included in the study. The data collected was compiled on excel sheet and was analyzed statistically by using statistical package for the social sciences (SPSS) software version 21.0.Results: It was found that the most of the skin manifestations were observed in neonates born to multiparous mothers at term gestation and having average weight. The male to female ratio was 1.3:1. The frequency of the cutaneous manifestations were seen more in neonates born via the caesarean section.Conclusions: It is concluded that the most common skin lesion was erythema toxicum followed by icterus neonatorum.

A study of cutaneous adverse drug reactions in the dermatology department of a tertiary care teaching hospital in Gujarat

Background: Various drugs are responsible for different cutaneous adverse drug reactions (CADRs). Considering variation in drug responses and the day-to-day increasing burden of ADRs, this study was done with emphasis on the need for effective evaluation and the reporting of the ADR reporting programme. Methods: This was an observational cross-sectional study conducted for the duration of six months in the dermatology department to evaluate various clinical patterns of CADRs. Results: A total of 60 CADRs were reported. Among them, 51.67% were present in males and 48.33% were present in females. The most common CADR was FDE (35%), followed by macula-papular rash (25%). Antimicrobials were most commonly responsible for CADRs, followed by NSAIDs, antiepileptic, anti-gout, and anti-hypertensive medications. Conclusions: For better patient care, drug safety, and rational use of medicines, knowledge of various drugs responsible for CADRs can be useful for health care professionals to reduce mortality and morbidity by monitoring, reporting, and assessment of CADRs whenever detected.

The anatomical relationship of the superficial branches of radial nerve: a cadaveric study

Background: The major superficial branches of the radial nerve like inferior lateral cutaneous nerve of arm (ILCNA) and posterior cutaneous nerve of forearm (PCNF) are susceptible to get injured during surgical procedure done in distal half of humerus. Methods: In this study 25 voluntary donated cadavers were dissected to define the course and position ILCNA and PCNF of the radial nerve and their ramifications in relation to anatomical landmarks such as the lateral inter muscular septum or bony landmarks such as lateral epicondyle. Results: The inferior lateral cutaneous nerve of the arm arose from the radial nerve at the lower part of the spiral groove, at a mean of 14.8 cm proximal to the lateral epicondyle and 4.2 cm proximal to the uppermost fibres of the brachioradialis muscle. The posterior cutaneous nerve of the forearm arose from the inferior lateral cutaneous nerve at a mean of 6.7 cm proximal to the lateral epicondyle. Conclusions: The described lateral approach permits assessment of any part of the radial nerve and reduces the risk of iatrogenic injury.

Recurrence factors in patients with cutaneous melanoma and positive sentinel lymph node treated in a single reference unit in Buenos Aires / Factores de recurrencia en pacientes con melanoma cu táneo y ganglio centinela positivo

Abstract Introduction : Although therapeutic advances have improved results of cutaneous melanoma (CM), senti nel node-positive patients still have substantial risk to develop recurrent disease. We aim to investigate prog nostic indicators associated with disease recurrence in positive-sentinel lymph node biopsy (SLNB) patients in a Latin-American population. Methods : Retrospective analysis of CM patients and positive-SLNB (2010-2020). Patients were divided into two groups: Group A (completion lymph node dissection, CLND), Group B (active surveillance, AS). Association of demographics, tumor data and SLN features with recurrence-free (RFS), distant metastases-free (DMFS) and melanoma specific (MSS) survival was analyzed. Results : Of 205 patients, 45 had a positive SLNB; 27(60%) belonged to Group A and 18(40%) to Group B. With a median follow-up of 36 months, 16 patients (12 in Group A and 4 in Group B) developed recurrent dis ease and estimated 5-yr RFS at any site was 60% (CI95%, 0.39 - 0.77) (44.5% in CLND group vs. 22% in AS group; P = 0.20). Estimated 5-yr DMFS and MSS: 65% (CI 95%, 0.44 - 0.81) and 73% (CI 95%, 0.59 - 0.89) with no differ ences between groups (p = 0.41 and 0.37, respectively). Independent predictors of poorer MSS were extranodal extension (ENE) and MaxSize > 2 mm of melanoma deposit in SLN. Factors independently associated with DMFS: Breslow depth > 2 mm, ENE, number (≥ 2) of posi tive SN and CLND status. Conclusion : Primary tumor and SN features in mela noma provide important prognostic information that help optimize prognosis and clinical management. AS is now the preferred approach for most positive-SLNB CM patients.

Resumen Introducción : Si bien los avances terapéuticos han permitido mejorar los resultados del melanoma cutáneo (MC), los pacientes con ganglio centinela positivo (BGCP) aún tienen riesgo elevado de desarrollar recurrencia de la enfermedad. Nuestro objetivo fue investigar in dicadores pronósticos asociados a dicho evento en una población latinoamericana. Métodos : Análisis retrospectivo de pacientes con MC y BGCP entre 2010-2020. Los pacientes se dividieron en 2 grupos: Grupo A (linfadenectomía terapéutica) y Grupo B (Vigilancia activa, VA). Se analizaron datos demográficos, tumorales y características del GC junto con sobrevida-libre de recurrencia (SLR), libre de metástasis a distancia (SLMD) y específica de melanoma (SEM). Resultados : De 205 pacientes, 45 presentaron BGCP; 27 (60%) perteneció al Grupo A y 18 (40%) al Grupo B. Con una mediana de seguimiento de 36 meses, 16 pa cientes (12 en Grupo A y 4 en Grupo B) desarrollaron enfermedad recurrente con una SLR a 5 años de 60% (IC95%: 0.39-0.77) (44.5% en Grupo B vs. 22% en Grupo A; P = 0.20). Las SLMD y SEM estimadas a 5 años fueron de 65% (CI 95%, 0.44 - 0.81) y 73% (CI 95%, 0.59 - 0.89) sin diferencias entre ambos grupos (p = 0.41 y 0.37, respec tivamente). Los predictores independientes de peor SEM fueron: extensión extranodal (ENE) y MaxSize > 2mm de depósito tumoral en GC. Los factores asociados de forma independiente con SLMD fueron Breslow >2mm, ENE, número (≥ 2) de GC positivos y el status (positividad) de la linfadenectomía. Conclusión : Características del tumor primario y del GC brindan información importante que ayuda a optimi zar el pronóstico y manejo clínico de los pacientes con MC. La VA es actualmente el abordaje de elección para la mayoría de los pacientes con BGCP.

Miltefosina comparada con Glucantime para el tratamiento de la leishmaniasis cutánea en niños: una revisión sistemática y metaanálisis / Miltefosine compared to Glucantime for the treatment of cutaneous leishmaniasis in children: a systematic review and meta-analysis / Miltefosina comparada ao Glucantime para o tratamento da leishmaniose cutânea em crianças: uma revisão sistemática e meta-análise

Objetivo: este estudio pretende realizar una comparación de la eficacia y los posibles efectos adversos asociados al uso de Miltefosina y Glucantime para el tratamiento de la leishmaniasis cutánea (LC) en niños. Método: se realizó una revisión sistemática de ensayos clínicos y estudios de cohortes, que evaluaran tratamientos de la LC en niños (≤12 años). Se efectuaron búsquedas estructuradas en PubMed, EMBASE, Cochrane, LILACS, Web of Science y SciELO. No se aplicaron restricciones en cuanto a etnia, país, sexo o año de publicación. Los idiomas se limitaron a inglés, español y portugués. Dos revisores independientes revisaron los artículos, extrajeron los datos y evaluaron el riesgo de sesgo. Se realizó un resumen cuantitativo de los estudios incluidos. Resultados: encontramos un total de 747 registros, que incluían 3 ensayos clínicos aleatorizados (ECA) y 1 estudio no aleatorizado. La mayoría de los artículos excluidos en la revisión de texto completo no informaban de los resultados por separado para los niños. En la LC americana (LCA), 4 estudios evaluaron la Miltefosina y el Glucantime. Su eficacia varió del 55,8 al 82,7 % y del 55 al 68,9 %, respectivamente. Conclusiones: en esta revisión sistémica y metaanálisis encontramos que la Miltefosina es mejor opción de tratamiento sistémico para CL en términos de curación clínica y menor efecto adverso al Glucantime administrado de forma sistémica, sin embargo, estas diferencias no fueron significativas.

Objective: this study aims to perform a comparison of the efficacy and potential adverse effects associated with the use of Miltefosine and Glucantime for the treatment of cutaneous leishmaniasis (CL) in children. Method: a systematic review of clinical trials and cohort studies evaluating treatments for CL in children (≤12 years) was conducted. Structured searches were performed in PubMed, EMBASE, Cochrane, LILACS, Web of Science, and SciELO. No restrictions were applied regarding ethnicity, country, gender, or year of publication. Languages were limited to English, Spanish, and Portuguese. Two independent reviewers screened articles, extracted data, and assessed the risk of bias. A quantitative summary of included studies was performed. Results: a total of 747 records were found, including 3 randomized clinical trials (RCTs) and 1 non-randomized study. Most articles excluded in the full-text review did not report results separately for children. In American CL (ACL), 4 studies evaluated Miltefosine and Glucantime. Their efficacy ranged from 55.8 to 82.7 % and from 55 to 68.9 %, respectively. Conclusions: in this systematic review and meta-analysis, we found that Miltefosine is a better systemic treatment option for CL in terms of clinical cure and fewer adverse effects compared to Glucantime administered systemically; however, these differences were not significant.

Objetivo: este estudo tem como objetivo realizar uma comparação da eficácia e dos possíveis efeitos adversos associados ao uso de Miltefosina e Glucantime para o tratamento da leishmaniose cutânea (LC) em crianças. Método: foi realizado uma revisão sistemática de ensaios clínicos e estudos de coorte que avaliaram tratamentos para LC em crianças (≤12 anos). Foram realizadas buscas estruturadas no PubMed, EMBASE, Cochrane, LILACS, Web of Science e SciELO. Não houve restrições quanto à etnia, país, sexo ou ano de publicação. Os idiomas foram limitados a inglês, espanhol e português. Dois revisores independentes revisaram os artigos, extraíram os dados e avaliaram o risco de viés. Foi feito um resumo quantitativo dos estudos incluídos. Resultados: encontramos um total de 747 registros, incluindo 3 ensaios clínicos randomizados (ECR) e 1 estudo não randomizado. A maioria dos artigos excluídos na revisão em texto completo não relatava resultados separados para crianças. Na LC americana (LCA), 4 estudos avaliaram Miltefosina e Glucantime. Sua eficácia variou de 55,8% a 82,7% e de 55% a 68,9%, respectivamente. Conclusões: nesta revisão sistemática e meta-análise, encontramos que a Miltefosina é uma melhor opção de tratamento sistêmico para LC em termos de cura clínica e menos efeitos adversos em comparação com o Glucantime administrado de forma sistêmica; no entanto, essas diferenças não foram significativas.

Dual cutaneous lymphoid dyscrasias in a pediatric patient, with progression to mycosis fungoides: case report

This case report explores the progression of cutaneous lymphoid dyscrasia to a lymphoma in a 13-year-old boy with pityriasis lichenoides chronica and lichenoid pigmented purpuric dermatitis, the latter evolving into mycosis fungoides. We highlight some of the crucial clinical and histological characteristics to differentiate between these entities. Early identification of this progression is critical not only for preventing further lymphoma development but also for initiating prompt therapy.

Sporotrichoid cutaneous leishmaniasis: atypical form

Leishmaniasis comprises a heterogeneous and extensive group of infectious and non-contagious diseases caused by protozoa of the genus Leishmania spp. It is a disease considered endemic in 92 countries, with at least 1 million new cases of integumentary forms annually. Cutaneous leishmaniasis is endemic in the tropics and neotropics. It is often referred to as a group of diseases because of the varied spectrum of clinical manifestations, which range from small cutaneous nodules to gross mucosal tissue destruction. Cutaneous leishmaniasis can be caused by several Leishmania spp. and is transmitted to human beings and animals by sandflies. Despite its increasing worldwide incidence, because it is rarely fatal, cutaneous leishmaniasis has become one of the so-called neglected diseases, In endemic countries, diagnosis is often made clinically and, if possible, by microscopic examination of lesion biopsy smears to visually confirm leishmania parasites as the cause. Cutaneous leishmaniasis often presents as an ulcerated lesion, with raised, infiltrated edges, classically described as frame-like edges at the site of the mosquito bite. We report an uncommon case of a patient who presented with a lesion on the face, sporotrichoid in appearance, and thigh, which appeared simultaneously, of clinical lesions of cutaneous leishmaniasis, laboratory-confirmed and which showed excellent clinical evolution with the use of liposomal amphotericin B.

Características de la población residente en áreas de trasmisión de leishmaniasis en el Perú, 2010 - 2022 / Characteristics of the population residing in areas of leishmaniasis transmission in Peru, 2010 - 2022

RESUMEN Introducción. La leishmaniasis es una enfermedad zoonótica endémica con amplia distribución en Perú. Objetivo. Identificar los escenarios de transmisión de leishmaniasis y la población que reside en estos, e identificar las características de las poblaciones afectadas durante el periodo 2010 a 2022. Métodos. Estudio descriptivo, transversal, ecológico con unidad de análisis el nivel distrital. Se utilizó datos de fuentes secundarias de acceso público. Resultados. En el periodo de estudio se reportaron 85 117 casos, 7 374 007(22,08%) habitantes residían en 543 distritos con transmisión continua, 11 467 420 (34,33%) habitantes que residían en 454 distritos con reporte esporádico de casos y 14 558 983(43,59%) residían en 893 distritos libres de trasmisión. El 98,16% de los casos ocurrieron en distritos con trasmisión continua, el 1,84%, en distritos con reporte esporádico de casos. La incidencia acumulada media anual fue 3,48 casos/10 000 habitantes. 18 departamentos reportaban trasmisión continua, Madre de Dios (42,45 casos/10 000 habitantes) y Cusco (15,78 casos/10 000 habitantes) tuvieron las tasas más altas. Las poblaciones de mayor riesgo son: hombres, adolescentes y jóvenes; residentes de distritos: de selva, del quintil de mayor pobreza monetaria, del quintil con mayor porcentaje con al menos 1 NBI, y del quintil de menor índice de desarrollo humano. Conclusión. La leishmaniasis tiene amplia distribución en Perú, 56,41% de la población habita en distritos que reportan casos. Existen grupos poblacionales con mayor riesgo absoluto, los cuales pueden ser blanco de intervenciones diferenciadas de prevención y control.

ABSTRACT Introduction. Leishmaniasis is an endemic zoonotic disease widely distributed in Peru. Objectives. Identify transmission scenarios and the population residing in them and identify the characteristics of the affected populations during the period 2010-2022. Methods. Descriptive, cross-sectional, ecological study with district as analysis units. Publicly accessible secondary data sources were used. Results. During the study period, 85,117 cases were reported; 7,374,007 (22.08%) inhabitants live in 543 districts with continuous transmission; 1,146,7420 (34.33%) inhabitants reside in 454 districts with sporadic reports of cases; and 1,455,8983 (43.59%) reside in 893 transmission-free districts. 98.16% of the cases occurred in districts with continuous transmission; 1.84% occurred in districts with sporadic case reports. The mean annual incidence rate was 3.48 cases/10,000 inhabitants. 18 departments report continuous transmission; Madre de Dios (42.45 cases/10,000 inhabitants) and Cusco (15.78 cases/10,000 inhabitants) report the highest rates. The populations with higher absolute risk are men, adolescents, and young people; residents: from jungle districts; from the quintile with the highest monetary poverty; from the quintile with the highest percentage with at least 1 NBI; and from the quintile with the lowest human development index. Conclusion. Leishmaniasis is widely distributed in Peru, with 56.41% of the population living in districts reporting cases. There are population groups with a higher absolute risk, which can be the target of differentiated prevention and control interventions.

Expresión transcripcional de receptores tipo Toll y citoquinas proinflamatorias en macrófagos infectados con Leishmania braziliensis nativa / Transcriptional expression of Toll-like receptors and proinflammatory cytokines in macrophages infected with native Leishmania braziliensis

RESUMEN Introducción. El receptor de tipo Toll (TLR) que interactúe con el promastigote de Leishmania spp. determina la vía de activación celular. Objetivo. Identificar la expresión transcripcional de TLR-3, TLR-4, TLR-9, IL-12 y TNF-α en macrófagos infectados con una cepa nativa de L. braziliensis (Lbn). Métodos. La identificación de Lbn se hizo empleando qPCR para secuencias del DNA del cinetoplasto. Los macrófagos peritoneales de ratones fueron infectados con promastigotes y se midieron la producción de óxido nítrico (ON). Se cuantificaron los niveles transcripcionales para TLRs y citoquinas empleando qRT-PCR. Resultados. Lbn presentó 96% de homología con L. braziliensis. En los infectados con promastigotes se observó elevada producción de ON a las 2 h; significativa expresión transcripcional especialmente de TLR-3 y TLR-9 que se correspondió con la expresión para citoquinas. Conclusión. Lbn activó fuertemente a los macrófagos mediante los TLRs endosomales lo cual puede ser aplicado en el diseño de agonistas para tratar la enfermedad.

ABSTRACT Introduction. The Toll-like receptor (TLR) interacting with the promastigote of Leishmania spp. determines the cellular activation pathway. Objective. To determine the transcriptional expression of TLR-3, TLR-4, TLR-9, IL-12 and TNF-α in macrophages infected with a native strain of L. braziliensis (Lbn). Materials and Methods. Identification of Lbn was performed by qPCR for kinetoplast DNA sequences. Mouse peritoneal macrophages were infected with promastigotes (MI) and nitric oxide (NO) production was measured; transcript levels for TLRs and cytokines were quantified by qRT-PCR. Results. Lbn showed 96% homology to L. braziliensis. High ON production was observed in IMs at 2 h; significant transcriptional expression especially of TLR-3 and TLR-9, which corresponded with expression for cytokines. Conclusions. Lbn strongly activated macrophages via endosomal TLRs, which can be applied in the design of agonists to treat the disease.

Fístula enterocutánea: un enfoque desde las generalidades y el estado nutricional / Enterocutaneous fistula: An approach based on generalities and nutritional status

Introducción. Una fístula es una conexión anormal entre dos superficies epitelizadas. Cerca del 80 % de las fístulas entero-cutáneas son de origen iatrogénico secundarias a cirugía, y un menor porcentaje se relacionan con traumatismos, malignidad, enfermedad inflamatoria intestinal o isquemia. La morbilidad y las complicaciones asociadas pueden ser significativas, como la desnutrición, en la que intervienen múltiples factores. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Google Scholar y SciELO, utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes de los últimos años. Resultados. La clasificación de las fístulas se basa en su anatomía, su gasto o secreción diaria y su localización. Existe una tríada clásica de las complicaciones: sepsis, desnutrición y anomalías electrolíticas. El control del gasto de la fístula, el drenaje adecuado de las colecciones y la terapia antibiótica son claves en el manejo precoz de estos pacientes. Los estudios recientes hacen hincapié en que la sepsis asociada con la desnutrición son las principales causas de mortalidad. Conclusiones. Esta condición representa una de las complicaciones de más difícil y prolongado tratamiento en cirugía abdominal y colorrectal, y se relaciona con importantes tasas de morbilidad, mortalidad y altos costos para el sistema de salud. Es necesario un tratamiento multidisciplinario basado en la reanimación con líquidos, el control de la sepsis, el soporte nutricional y el cuidado de la herida, entre otros factores.

Introduction. A fistula is an abnormal connection between two epithelialized surfaces. About 80% of enterocutaneous fistulas are of iatrogenic origin secondary to surgery, and a smaller percentage are related to trauma, malignancy, inflammatory bowel disease or ischemia. The associated morbidity and complications can be significant, such as malnutrition, in which multiple factors intervene. Methods. A literature search was carried out in the PubMed, Google Scholar and SciELO databases using the keywords described and the most relevant articles from recent years were selected. Results. The classification of fistulas is based on their anatomy, their daily secretion output, and their location. There is a classic triad of complications: sepsis, malnutrition and electrolyte abnormalities. Control of fistula output, adequate drainage of the collections and antibiotic therapy are key to the early management of these patients. Recent studies emphasize that sepsis associated with malnutrition are the main causes of mortality. Conclusions. This condition represents one of the most difficult and prolonged complications to treat in abdominal and colorectal surgery, and is related to significant rates of morbidity, mortality and high costs for the health system. Multidisciplinary treatment based on fluid resuscitation, sepsis control, nutritional support, and wound care, among other factors, is necessary.

Clinical insights into dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous soft tissue sarcoma, it is the second most common skin sarcoma after Kaposi's sarcoma. The cause of DFSP remains unknown. The case of a 54-year-old female patient with a diagnosis of Dermatofibrosarcoma protuberans is presented, displaying a typical clinical presentation. It is characterized by an initial lesion in the form of a reddish spot on the anterior region of the chest, which showed slow growth until the development of a multinodular and irregular lesion with multiple recurrences. The lesion is resected, confined to the superficial layers of the skin, with 3 cm margins, confirming the histopathological diagnosis of dermatofibrosarcoma protuberans with clear margins. DFSP is an uncommon cutaneous sarcoma that is typically low- to intermediate-grade, and while it has a limited likelihood of metastasis, it exhibits a notable tendency for local recurrence. The risk of recurrence is closely linked to the extent of surgical resection.

Enfermedad de Rosai-Dorfman cutánea, reporte de un caso / Cutaneous Rosai-Dorfman disease, a case report

RESUMEN La enfermedad de Rosai-Dorfman cutánea (ERDC) es una rara proliferación reactiva de histiocitos, que cursa con lesiones cutáneas sin compromiso generalizado. Las manifestaciones clínicas cutáneas son diversas y la variante clínica "tipo tumoración" es la forma más infrecuente. Se describe el caso de un paciente con ERDC que se presentó con esta forma inusual.

ABSTRACT Cutaneous Rosai-Dorfman disease (CRDD) is a rare reactive histiocytic proliferation, which presents with skin lesions without systemic involvement. The clinical cutaneous manifestations are diverse and the "tumor-like" clinical variant is the most infrequent. We describe the case of a patient with CRDD who presented with this unusual form.

IL-1β and IL-17 in cutaneous lupus erythematous skin biopsies: could immunohistochemicals indicate a tendency towards systemic involvement?

Abstract Background: Only a fraction of patients with cutaneous lupus erythematosus (CLE) will eventually progress toward systemic disease (SLE). Objective: To find inflammatory biomarkers which could predict the progression of cutaneous lupus erythematosus (CLE) into systemic lupus erythematosus (SLE) using immunohistochemical (IHC) assays. Methods: Immunohistochemical markers for cytotoxic, inflammatory, and anti-inflammatory responses and morphometric methods were applied to routine paraffin sections of skin biopsies, taken from lesions of 59 patients with discoid lupus, subacute lupus, and lupus tumidus. For the diagnosis of SLE, patients were classified by both the American College of Rheumatology (ACR-82) and the Systemic Lupus International Collaborating Clinics (SLICC-12) systems. Results: Skin samples from CLE/SLE +patients presented higher expression of IL-1β (ARC-82: p = 0.024; SLICC-12: p = 0.0143) and a significantly higher number of cells marked with granzyme B and perforin (ARC: p = 0.0097; SLICC-12: p = 0.0148). Biopsies from CLE/SLE- individuals had higher expression of IL-17 (ARC-82: p = 0.0003; SLICC-12: p = 0.0351) and presented a positive correlation between the density of granzyme A+and FoxP3+ cells (ARC-82: p = 0.0257; SLICC-12: p = 0.0285) and CD8+ cells (ARC-82: p = 0.0075; SLICC-12: p = 0.0102), as well as between granulysin-positive and CD8+ cells (ARC-82: p = 0.0024; SLICC-12: p = 0.0116). Study limitations: Patients were evaluated at a specific point in their evolution and according to the presence or not of systemic disease. The authors cannot predict how many more, from each group, would have evolved towards SLE in the following years. Conclusions: In this cohort, immunohistochemical findings suggested that patients with a tendency to systemic disease will show strong reactivity for IL-1β, while those with purely cutaneous involvement will tend to express IL-17 more intensely.

Decrease of 5-hydroxymethylcytosine in primary cutaneous CD4+ small/medium sized pleomorphic T-cell lymphoproliferative disorder

Abstract Background: Primary cutaneous CD4+ small/medium-sized pleomorphic T-Cell lymphoproliferative disorder (PC-SMTLD) has been considered as a controversial dermatological disease that has been included in cutaneous T-cell lymphoma group, presenting most commonly as a solitary nodule and/or plaque with a specific and characteristic head and neck predilection. Due to the considerable overlap between PC-SMTLD and pseudolymphoma (PL), the differential diagnosis is often challenging. Methylation of DNA at position 5 of cytosine, and the subsequent reduction in intracellular 5-hydroxymethylcytosine (5-hmC) levels, is a key epigenetic event in several cancers, including systemic lymphomas. However, it has rarely been studied in cutaneous lymphomas. Objectives: The authors aimed to explore the role of differential 5-hmC immunostaining as a useful marker to distinguish PC-SMTLD from PL. Methods: Retrospective case series study with immunohistochemical and immunofluorescence analysis of 5-hmC was performed in PL and PC-SMTLD. Results: Significant decrease of 5-hmC nuclear staining was observed in PC-SMTLD when compared with PL (p<0.0001). By semi-quantitative grade integration, there were statistical differences in the final 5-hmC scores in the two study groups. The IF co-staining of 5-hmC with CD4 revealed a decrease of 5-hmC in CD4+ lymphocytes of PC-SMTLD. Study limitations: The small clinical sample size of the study. Conclusions: The immunorreactivity of 5-hmC in CD4+ lymphocytes was highly suggestive of a benign process as PL. Furthermore, the decrease of 5-hmC nuclear staining in PC-SMTLD indicated its lymphoproliferative status and helped to make the differential diagnosis with PL. © 2023 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

Effects of ultrasound guided pericapsular nerve group combined with lateral femoral cutaneous nerve block on analgesia,stress response and postoperative cognitive function in patients undergoing hip replacement / 临床外科杂志

Objective To investigate the effect of ultrasound guided block of pericapsular nerve(PENG)combined with lateral femoral cutaneous nerve(LFCN)on analgesia,stress response and postoperative cognitive function in patients undergoing hip replacement.Methods 102 patients who underwent hip Joint replacement in our hospital from September 2020 to September 2022 were selected and randomly divided into control group(51 cases)and study group(51 cases).The control group was given ultrasound guided iliac fascia space block(FICB),and the study group was given ultrasound guided PENG combined with LFCN block.The perioperative related indicators,postoperative analgesia effect,stress response indicators and postoperative cognitive function of the two groups were compared.Results There was no statistically significant difference in the comparison of surgical time between the two groups(P＞0.05).The amount of sufentanil used and the number of analgesic pump used within 48 hours after surgery in the study group were significantly lower than those in the control group(P＜0.05).The first postoperative time of getting out of bed and hospitalization in the study group were significantly shorter than those in the control group(P＜0.05).There was no statistically significant difference in VAS scores between the two groups at 6 h,12 h,24 h,and 48 h after surgery(P＞0.05).The VAS scores of the study group were significantly lower than those of the control group at 6 h,12 h,and 24 h after surgery(P＜0.05).The heart rate(HR)and Mean arterial pressure(MAP)of the control group were higher at the time of block(T1),30 min of block(T1)(T2),and the end of block(T3)than at the time of entry(T0)(P＜0.05).HR and MAP of the study group were significantly lower than those of the control group(P＜0.05).The MMSE scores of the two groups at 6 h,12 h,24 h,and 48 h after surgery were lower than those before surgery(P＜0.05),but the MMSE scores of the study group were significantly higher than those of the control group(P＜0.05).Conclusion Using ultrasound guided PENG combined with LFCN block for patients undergoing hip Joint replacement can more effectively reduce the amount of opioids and the number of use of analgesia pump,reduce postoperative pain in the exercise state,reduce stress reaction,and have less impact on cognitive function,so as to promote faster recovery of patients.

Decompression of lateral femoral cutaneous nerve in treatment of meralgia paraesthetica caused by pelvic fracture / 中华显微外科杂志

Objective:To evaluate the efficacy in decompression of lateral femoral cutaneous nerve (LFCN) through a small incision, following precise localisation with auxiliary examinations, in the treatment of meralgia paraesthetica (MP) caused by pelvic fractures.Methods:A retrospective study was conducted on 6 patients with MP caused by pelvic fractures at the Department of Hand Surgery, Huashan Hospital, Fudan University between June 2019 and June 2022. Among the 6 patients with MP caused by pelvic fractures, 4 were treated conservatively, 1 received an internal fixation with a steel plate, and the other received an internal fixation with screws. The average time after the injury to surgery was 5.33 (range: 3-7) months. Preoperative ultrasound and CT scans were performed to identify the sites of compression on LFCN. After the decompression of LFCN, Visual analog scale (VAS) scores were employed to compare the therapeutic effectiveness with what that before surgery, at 3 months and within 1 year (7-11 months) after surgery. SPSS 26.0 data statistical was used analysis software for data analysis and processing, the data was represented as (Mean ± SD). Friedman test was used to compare the differences in VAS scores among 6 patients before surgery, at first postoperative follow-up, and second postoperative follow-up. If the differences were statistically significant, pairwise comparisons were further conducted, and the Bonferroni correction method was used to adjust the significance level. P<0.05 indicated a statistically significant difference. Results:After the LFCN decompression, all patients showed a decrease in VAS scores with significantly reduced area of skin paraesthesia at the first postoperative follow-up review. At the second review, all patients scored VAS zero, except 1 who was scored 2. There was a statistically significant difference compared to preoperative VAS scores (Friedman test: χ2=12.0, P=0.002; paired t-test: P=0.002). Conclusion:For the meralgia paraesthetica caused by pelvic fractures, compression points on LFCN can be easily identified through auxiliary examinations. Precise release of the LFCN from compression through a small incision, after an accurate localisation, provides a rapid and complete relief of pain and sensory abnormalities.

Comparison of two types of pedicled homodigital flap in reconstruction of thumb-tip or thumb-pulp defects / 中华显微外科杂志

Objective:To compare the clinical effects between the homodigital radial flap of the dorsal cutaneous branch of radial palmar proper digital artery (PPDA) and the homodigital reverse island flap of the ulnar dorsal digital artery (DDA) on reconstruction of defects in thumb-tip or thumb-pulp.Methods:The retrospective case-control study method was used. From January 2016 to August 2022, a total of 65 thumb-tip or thumb-pulp defects were treated in the Department of Hand Surgery of the Second Hospital of Tangshan. Thirty-five defects of thumbs were reconstructed with the homodigital radial flap pedicled with dorsal cutaneous branch of radial PPDA (PPDA group) and the other 30 thumbs were treated by the homodigital ulnar reverse island flap pedicled with ulnar DDA (DDA group). Sizes of the wounds and flaps in PPDA group were 1.9 cm×1.5 cm to 2.9 cm×2.4 cm and 2.1 cm× 1.7 cm to 3.1 cm×2.6 cm, respectively, and the dimensions of the wounds and flaps in DDA group were 2.0 cm× 1.7 cm to 2.9 cm×2.5 cm and 2.2 cm×1.9 cm to 3.2 cm×2.8 cm, respectively. The wounds of donor site in both groups were all directly closed. Survival of the flaps and wound healing of donor sites were observed in both groups. The time of surgery and duration of follow-up of the 2 groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone reviews and WeChat video-clips. At the final follow-up, record of total active motion (TAM) of the injured thumbs, angle of first web of the affected hands, static TPD of the flaps, patient satisfaction of the appearance of flaps and donor sites were taken. According to the Michigan Hand Function Questionnaire (MHQ) evaluation criteria, the patient satisfaction of the appearance of flaps and donor sites were evaluated. The measurement and count data acquired from both groups were compared by independent sample t-test and χ2 tests or Fisher's exact test, respectively. P<0.05 was considered statistically significant. Results:All 35 flaps in PPDA group and 26 flaps in DDA group survived primarily, except 4 flaps in the DDA group that showed blisters and healed with dressing changes. The primary survival rate of flap in PPDA group (100%) was higher than that of DDA group (87%), and the difference was statistically significant ( P<0.05). Donor sites of both groups healed primary. The time of surgery and duration of follow-up in PPDA and DDA groups were 59.11 minutes±5.42 minutes and 15.37 months±3.32 months, and 61.27 minutes±5.96 minutes and 16.17 months±3.60 months, respectively. There was no statistically significant difference between the 2 groups ( P>0.05). At the final follow-up, the thumb TAM and angle of thumb web in PPDA and DDA groups were 135.14°±10.04° and 90.29°±4.36° and 132.17°±11.04° and 89.00°±4.81°, respectively. There was no statistically significant differences between the 2 groups ( P>0.05). The static TPD, patient satisfaction of the appearance of flaps and donor sites in PPDA group were 7.11 mm±1.21 mm, 4.69 point±0.47 point and 4.43 point±0.50 point, which were better than DDA group [8.20 mm±1.47 mm, 4.40 point±0.50 point and 4.13 point±0.57 point, respectively] with a statistically significant difference ( P<0.05). Conclusion:The homodigital radial flap of the dorsal cutaneous branch of radial PPDA and the homodigital ulnar reverse island flap of the ulnar DDA are both suitable for reconstruction of defects in thumb-tip or thumb-pulp. Compared with the homodigital reverse island flap with the DDA, a homodigital radial flap with the dorsal cutaneous branch of PPDA has advantages in higher primary survival rate, better flap sensation and appearance at both of recipient and donor sites.