Early Diagnosis and Treatment of Pyoderma Gangrenosum: Reviewing Mobile Phone Photos Saved a Patient From Unnecessary Surgeries.

Pyoderma gangrenosum of the breast following surgery is a rare aseptic inflammatory cutaneous condition that causes very rapid progressing and expanding painful ulceration of the surgical site and the adjacent skin. The greatest issue concerning pyoderma gangrenosum is its diagnosis. Almost invariably, it is misdiagnosed as a wound infection, which results in delayed identification, lengthy antibiotic regimens, and ineffective detrimental surgical debridements, causing significant patient disfigurement. We present a rare case report of pyoderma gangrenosum complicating the surgical site of the breast reduction procedure two months after simultaneous performance of operations including breast reduction, abdominoplasty, and lumbar liposuction. The diagnosis was established within four hours from the initial lesion and symptom presentation due to the accurate evaluation of photographs sent from the patient's mobile phone to the surgeon every half hour. Immediate appropriate treatment with oral corticosteroids within this time interval was initiated, resulting in favorable healing for the patient within four months.

Carotid Body Tumor in a 26-Year-Old Male Patient Managed With Preoperative Embolization.

Carotid body tumors are rare, highly vascularized neuroendocrine tumors that arise near the bifurcation of the common carotid artery (CCA). Controversy exists in the management of those tumors about whether preoperative embolization facilitates surgical excision and decreases perioperative complication risk. We present the case of a 26-year-old patient with a carotid body tumor manifesting as a painless pulsatile mass in the anterior triangle over the left side of the neck and provide details of the preoperative diagnostic steps. Treatment included preoperative embolization of the tumor followed by surgical excision after 48 hours to safely address this rare pathology, resulting in a favorable outcome for the patient.

Mathematical Modelling and Simulation of Atherosclerosis Formation and Progress: A Review.

Cardiovascular disease (CVD) is a major threat to human health since it is the leading cause of death in western countries. Atherosclerosis is a type of CVD related to hypertension, diabetes, high levels of cholesterol, smoking, oxidative stress, and age. Atherosclerosis primarily occurs in medium and large arteries, such as coronary and the carotid artery and, in particular, at bifurcations and curvatures. Atherosclerosis is compared to an inflammatory disease where a thick, porous material comprising cholesterol fat, saturated sterols, proteins, fatty acids, calcium etc., is covered by an endothelial membrane and a fragile fibrous tissue which makes atheromatic plaque prone to rupture that could lead to the blockage of the artery due to the released plaque material. Despite the great progress achieved, the nature of the disease is not fully understood. This paper reviews the current state of modelling of all levels of atherosclerosis formation and progress and discusses further challenges in atherosclerosis modelling. The objective is to pave a way towards more precise computational tools to predict and eventually reengineer the fate of atherosclerosis.

Right or left thoracotomy for esophageal atresia and right aortic arch? Systematic review and surgicoanatomic justification.

INTRODUCTION: The optimal thoracotomy approach for the management of esophageal atresia and tracheoesophageal fistula (EA/TEF) with a right aortic arch (RAA) remains controversial. METHODS: Systematic review of complications and death rates between right- and left-sided repairs, including all studies on EA/TEF and RAA, apart from studies focusing on long-gap EA and thoracoscopic repairs. Review of right- and left-sided surgical anatomy in relation to reported complications. RESULTS: Although no significant differences were elicited between right- and left-sided repairs in complications (9/29 vs. 1/6, p = 0.64) and death rates (2/29 vs. 0/6, p = 0.57), unique anatomic complications - such as injury to the RAA covering the esophagus and intractable bleeding - associated with mortality were revealed in the right thoracotomy group. Left-sided repairs following failed repair through the right showed higher complications rate (3/3) than straightforward right- (9/29) or left-sided repairs (1/6) (p = 0.024). Right thoracotomies converted to left thoracotomies led to staged repairs more frequently (4/9) than straightforward right (5/38) or left thoracotomies (0/6) (p = 0.03). CONCLUSIONS: There is not enough evidence to support that right thoracotomy, characterized by unique surgicoanatomic difficulties, is equivalent to left thoracotomy for EA/TEF with RAA. Both approaches might be required, and, therefore, surgeons should be familiarized with surgical anatomy of mediastinum approached from right and left. Systematic review, Level of Evidence III.