A case series of verrucae vulgares mimicking hyperkeratosis in individuals with diabetic foot ulcers.

BACKGROUND: Diabetic foot ulcers are a common complication in the advanced stages of diabetes mellitus. Certain lesions may be refractory to usual treatments with prolonged healing. In these cases, differential diagnoses to classical ulcers should be considered. Although plantar warts are a common and easy-to-diagnose finding in the general population, diagnosis can be challenging in people with diabetic foot ulcers, as they mimic hyperkeratosis in these people. CASE REPORT: We report seven cases of people with diabetic foot ulcers and verrucae vulgares mimicking treatment-refractory hyperkeratosis, presenting to our centre between 2014 and 2016. Diagnosis was aided by the clinical presentation, followed by dermoscopy and punch biopsy. Treatment included topical application of 5-fluoruracil and salicylic acid (four people), cryotherapy (three people) and surgical excision (three people), all in combination with local pressure offloading. In five people, the verrucae were completely removed after a mean treatment period of 9.4 months; two individuals were lost to follow-up. CONCLUSION: Verrucae may be more common in people with diabetic foot lesions and polyneuropathy than generally assumed. Typical findings include small, pinhead-sized bleedings within and surrounding hyperkeratous lesions. These findings should alert the clinician for the potential presence of a verruca. In such cases, biopsy should be performed to enable specific diagnosis and treatment.

Relation of endometriosis and neuromuscular disease of the gastrointestinal tract: new insights.

OBJECTIVE: To investigate the neuromuscular activity of the gastrointestinal tract by antroduodenal manometry in women with endometriosis documented by laparoscopy, to assess the effects of diet and drug therapy on symptoms, and to assess the bacterial overgrowth that is commonly associated with these nerve diseases. DESIGN: Prospective, open-label study. SETTING: A clinical center for the care of women's health. PATIENT(S): Fifty women with endometriosis documented by laparoscopy and gastrointestinal tract symptoms characterized by chronic abdominal pain, nausea, vomiting, early satiety, bloating and distention, and altered bowel habits. INTERVENTION(S): Motility of the gastrointestinal tract was recorded and bacterial overgrowth was assessed. Treatment consisted of dietary changes, including reduction of glycemic carbohydrates, balancing with omega 9 oils, elimination of foods with caffeine and tyramine, and addition of omega 3 fatty acids, as well as drug therapy with clonazepam (0.25 mg 3 times per day). RESULT(S): All 50 women showed a characteristic motility change (ampulla of Vater-duodenal wall spasm, a seizure equivalent of the enteric nervous system). Forty of the women showed bacterial overgrowth. There was a significant reduction in the total symptom score after 8 weeks of treatment. CONCLUSION(S): This study suggests that endometriosis and gastrointestinal tract symptoms are a result of the dysfunction of hollow organs. Correction of the biochemical imbalance of the eicosanoid system and the hypersecretion of insulin that results from excessive intake of glycemic carbohydrates and lack of essential fatty acids significantly decreases symptoms in patients with endometriosis and associated neuromuscular disease of the gastrointestinal tract.

[The oculocardiac reflex during vitrectomy under neuroleptanalgesia]. / Untersuchungen des okulokardialen Reflexes bei Vitrektomien in Neuroleptanalgesie.

Oculocardiac reflex (OCR) is a frequently occurring complication in eye operations. It is a trigemino-vagal reflex characterised by the clinical occurrence of bradycardia and other cardiac rhythm disturbances following manipulations on the eye and its surroundings especially after traction of the external eye muscles. In this paper based on an analysis of 402 anaesthesia records, a bradycardia frequency (f = less than 60/min) of 31.8% was noted while other rhythm disturbances occurred in 5.7%. Predisposition facts were identified as age over 50, hypertension and cardiac diseases requiring medication with cardiac drugs. The frequency of OCR is considerably lowered by diabetes mellitus. Examination of 159 traction measurements made at the lateral rectus muscle revealed that the first manipulation made at the rectus bulbi superior muscle resulted in a statistically significantly stronger reflex activity than at the other muscles. In a further series of investigations in which rectus bulbi superior muscle was tested last, this muscle again showed the biggest frequency deviation. Only determination of the percentage heart rate decrease is suitable for characterising reflex activity. The frequency of the reflex occurring in our study was 71.7%, the result being reduced by the high proportion of diabetics, who are relatively reflex insensitive.

The short-term and long-term soft-tissue profile changes accompanying mandibular advancement surgery.

To provide an improved data base for predicting the soft-tissue changes that accompany mandibular advancement surgery, short- and long-term serial cephalograms from the records of eighteen patients were analyzed. Hard- and soft-tissue landmarks were located on serial tracings and later were reduced to rectangular X-Y coordinates for computer-generated measurement data and statistical analyses. The interpretation of mean value, ratio, and regression equation data showed that the lower lip, inferior labial sulcus, and chin tissues moved forward and downward. The mandibular short-term (mean = 3.7 months postsurgery) horizontal change means were greater than the long-term (mean = 18 months postsurgery) horizontal change means. The posteriorly directed long-term means may result from functional adaptations that follow the short-term surgery-related spatial changes. These data also show the need for long-term prediction data to supplement the short-term data base.

Distally based sartorius muscle flap in the treatment of infected femoral arterial prostheses.

Although less frequent, arterial prosthetic infections are still a disaster for patient and surgeon since they can lead to multiple complications. The inguinal area is the site of more than three-quarters of the graft infections because of anatomical and technical factors. Of all the proposed forms of treatment none has proven to be totally effective and applicable to all cases. We have employed a technique in which the infected portion of the graft is removed, replaced by a new graft and covered with a distally based sartorius muscle flap. Two illustrative cases are presented in which the procedure proved to be successful for two and for eleven years, and the question is raised as to the benefits of this maneuver in the prevention of infection in those cases that require re-operation.

Progress in Palmito (Heart-of-Palm) Processing Research.

Palmito is a gourmet product obtained from the young and tender leaves of certain palm trees. Brazil is the main producer and exporter of canned, acidified palmito. In this paper the main aspects of raw material procurement, processing and packaging are reviewed. Most of the original work was done at the Instituto de Tecnologia de Alimentos (ITAL) in Campinas, Brazil. The palmito is mainly produced from two species of naturally growing palms. There are two main technical problems in palmito processing: discoloration of the naturally white product and safe acidification to inhibit Clostridium botulinum growth. Both problems have been solved adequately in laboratory and pilot plant work. Acceptance and implementation of these technological developments by the small palmito canneries is essential to obtain products acceptable to the international market.