Benign tumours leading to total penile denudation treated with Manuka honey dressings: A case report and review of literature.

INTRODUCTION: Penile denudation is a devastating condition often reconstructed with a split-thickness skin graft(STSG). As this kind of reconstruction is challenging, we present an non-invasive treatment using Manuka honey dressings with a satisfying result. This was performed as a salvage procedure after failed STSG. CASE: A 55-year-old non-smoking male was admitted from his general practitioner with a newly onset of phimosis and lower urinary tract symptoms. Benign tumours complicated with infection were found on all segments of the penis causing dehiscence of the skin. After surgical removal of tumours and an unsuccessful STSG, Manuka honey dressings was used. Full sexual function was regained, and the patient was satisfied with the result. DISCUSSION: Alternatives to STSG are full-thickness skin graft using the inguinal or scrotal borrowing method, or using a dermal matrix before a STSG. A rediscovered method is using Manuka honey, with its unique combination of bactericidal, anti-inflammatory and healing-promoting properties. A wide range of wound types may benefit from Manuka honey dressings. A recent Danish in vitro study on honey derived from various Danish floras even shows high antibacterial effect superior to commercial medical grade honey. Considering a growing resistance to antibiotics, medical honey may contribute as a alternative to extensive wound care. CONCLUSION: We successfully treated a penile denudation with Manuka honey following a failed STSG. Wounds, ulcers, and burns may be infected, and can be challenging, time consuming, and expensive to treat. Manuka honey may be a good alternative to reconstructive surgery and can be managed on an out-patient basis.

Case Report: Breast Seroma Mimicking Breast Implants.

Introduction Breast seroma may be caused by a variety of factors including lymphatic disruption, continuous inflammation and foreign bodies such as breast implants. In cases of breast implants associated seroma the diagnosis of Anaplastic Large Cell Lymphoma (ALCL) should be investigated. Presentation of Case A 45-year-old Caucasian woman was referred with bilateral swelling of the breasts causing tension and pain. MRI showed accumulations compatible with bilateral silicone implants. Ultrasound-guided aspiration showed no malignancy or silicone. The patient had a history of both soy- and silicone implants. Three years prior her breast implants was removed due to capsule formation. To treat the pain and rule out potential malignancy we performed capsulectomy of only the right breast, on the wish of the patient. We found brown fluid, no breast implants and histology of fluid and tissue showed no malignancy. DISCUSSION: Breast seroma usually develops weeks after surgery such as mastectomy or axillary lymph node dissection. This patient developed a seroma through months and years after her last surgery. In cases of late seroma malignancy should be ruled out. Diagnostic statements should not solely be based on radiology, but in conjunction with clinical findings. CONCLUSION: We performed capsulectomy on a patient with breast seroma mimicking breast implants. We excluded the diagnosis of breast implant-associated ALCL. Radiology has limitations and should be considered in conjunction with the patient's statement and the clinical findings.

Cerebral water and ion balance remains stable when humans are exposed to acute hypoxic exercise.

BACKGROUND: Intense physical activity increases the prevalence of acute mountain sickness (AMS) that can occur within 10 h after ascent to altitudes above 1500 m and is likely related to development of cerebral edema. This study evaluated whether disturbed cerebral water and ion homeostasis can be detected when intense exercise is carried out in hypoxia and monitored the influence of muscle metabolism for changes in arterial variables. METHODS: On two separate days, in random order, 30 min cycling exercise was performed in either hypoxia (10% O2) or normoxia at an intensity that was exhaustive in the hypoxic trial (∼120 W; n=9). RESULTS: Exercise in hypoxia affected muscle metabolism, as evidenced by higher (p<0.05) leg lactate release at 7.5 min and a continuous decline in arterial pH (p<0.001) that was not observed in normoxia. Middle cerebral artery flow velocity increased (p<0.01) with exercise under both circumstances. No cerebral net exchange of Na(+) or K(+) was evident. Likewise, no significant net-exchange of water over the brain was demonstrated and the arterial and jugular venous hemoglobin concentrations were similar. CONCLUSION: Challenging exercise in hypoxia for 30 min affected muscle metabolism and increased an index of cerebral blood flow, but cerebral net water and ion homeostasis remained stable. Thus, although AMS develops within hours and may be related to exercise-induced disturbance of cerebral ion and water balance, such changes are not detectable when subjects are exposed to acute 30 min maximal exercise in hypoxia.