scholarly journals Thoracic osteomyelitis secondary to a complicated digital mucous cyst infection: a case report

2019 ◽  
Vol 2 (1) ◽  
pp. 103-105
Author(s):  
Jake L Nowicki ◽  
Andrew Raymond ◽  
Phillip A Griffin
Keyword(s):  
Treatment Options ◽  
Joint Stiffness ◽  
Subsequent Development ◽  
Surgical Infection ◽  
Thoracic Spinal ◽  
Cyst Infection ◽  
Spinal Osteomyelitis ◽  
Distal Interphalangeal ◽  
Mucous Cyst ◽  
Cyst Recurrence

Since the first description by Hyde in 1883,1 the pathogenesis and clinical features of digital mucous (DM) cysts, as well as treatment options, have been well described in the literature.2 Complications associated with surgical treatment include cyst recurrence, loss of range of motion of the distal interphalangeal (DIP) joint, joint stiffness, post-surgical infection and nail dystrophies.3 Digital mucous cyst infection prior to treatment is not well documented. This report describes a complicated case of a DM cyst infection upon presentation with subsequent development of DIP joint septic arthritis, bacteremia and thoracic spinal osteomyelitis.

scholarly journals The Bipedicle Advancement Flap on Skin Coverage After Mucous Cyst Excision:A Retrospective Study of 18 Cases.

2020 ◽  
Author(s):  
Yanming Ma ◽  
Xiangjun Meng ◽  
Yun Su ◽  
Zuofa Yan ◽  
Quansheng Shao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Analogue Scale ◽  
Advancement Flap ◽  
Effective Technique ◽  
Patients Satisfaction ◽  
Skin Defects ◽  
Distal Interphalangeal ◽  
Mucous Cyst ◽  
Cyst Recurrence ◽  
Skin Coverage

Abstract Background : Many patients have skin defects after digital mucous cyst (DMC) excision, and this study aimed to assess the clinical outcomes of using a bipedicle advancement flap to cover such defects. Methods : From January 2016 to January 2018, DMCs on 18 fingers of 15 patients (4 males and 11 females, with a mean age of 64 years) were treated with cyst and osteophyte excision and a bipedicle advancement flap to cover the resultant defect in this retrospective study. Postoperative flap survival, healing and infection were evaluated. The pre- and postoperative ranges of motion (ROMs) of the distal interphalangeal (DIP) or thumb interphalangeal (IP) joints were recorded. Postoperative patients’ satisfaction was assessed by the visual analogue scale (VAS; 0～10). Results : The patients were followed up for 12-36 months (mean, 20 months). All the flaps survived, the incisions healed well without infection, and no cyst recurrence occurred. The postoperative ROM of the affected fingers was restored to the preoperative ROM by two months after surgery. No difference was found between the preoperative and postoperative ROMs. The score of patients’ satisfaction for surgery by means of VAS was 8.5±1.0. Conclusions : The bipedicle advancement flap is a simple and effective technique for covering skin defects following DMC excision.

scholarly journals The Bipedicle Advancement Flap on Skin Coverage After Mucous Cyst Excision: A Retrospective Study of 18 Cases.

2020 ◽  
Author(s):  
Yanming Ma ◽  
Xiangjun Meng ◽  
Yun Su ◽  
Zuofa Yan ◽  
Quansheng Shao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Advancement Flap ◽  
Effective Technique ◽  
Flap Survival ◽  
Cyst Excision ◽  
Skin Defects ◽  
Distal Interphalangeal ◽  
Mucous Cyst ◽  
Cyst Recurrence ◽  
Skin Coverage

Abstract Background Many patients have skin defects after digital mucous cyst (DMC) excision, and this study aimed to assess the clinical outcomes of using a bipedicle advancement flap to cover such defects.Methods From January 2016 to January 2018, DMCs on 18 fingers of 15 patients (4 males and 11 females, with a mean age of 64 years) were treated with cyst and osteophyte excision and a bipedicle advancement flap to cover the resultant defect in this retrospective study. Postoperative flap survival, healing and infection were evaluated. The pre- and postoperative ranges of motion (ROMs) of the distal interphalangeal (DIP) or thumb interphalangeal (IP) joints were recorded. The patients were followed up for 12-36 months (mean, 20 months).Results All the flaps survived, the incisions healed well without infection, and no cyst recurrence occurred. The postoperative ROM of the affected fingers was restored to the preoperative ROM by two months after surgery. No difference was found between the preoperative and postoperative ROMs.Conclusions The bipedicle advancement flap is a simple and effective technique for covering skin defects following DMC excision.

scholarly journals EP22 A manifestation of severe sarcoid arthropathy in the distal interphalangeal joint

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Rajiv Ark
Keyword(s):  
Case Report ◽  
Lymph Nodes ◽  
Cardiac Sarcoidosis ◽  
Treatment Options ◽  
Nasal Discharge ◽  
Pulmonary Manifestations ◽  
Distal Interphalangeal ◽  
The Right ◽  
Little Finger

Abstract Case report - Introduction In 2011 a gentleman in his 50s presented with nasal blockage and bloody discharge. He was diagnosed with sarcoidosis and after 9 years of failed strategies to control his disease, he developed dactylitis. X-ray of the hands showed severe arthropathy in the distal interphalangeal joints. This case demonstrates an uncommon extrapulmonary manifestation of sarcoidosis. Although most of his follow up was with a respiratory clinic, his main symptoms were not due to interstitial lung disease, highlighting the importance of a multidisciplinary approach. To reduce the need for steroids, several DMARDs were tried illustrating that there are limited treatment options. Case report - Case description This gentleman presented in June 2011 with left epiphora, bloody nasal discharge and fatigue. He had no family history of sarcoidosis and was of Caucasian ethnicity. He was referred by his GP to Ophthalmology and ENT. Septoplasty showed a 95% blockage at the lacrimal sac. A biopsy was performed, and histology showed a nasal sarcoid granuloma. He was referred to the respiratory team who requested a high-resolution CT scan showing sizeable lymph nodes. One inguinal node was biopsied confirming sarcoid granulomas before starting treatment. Calcium was briefly raised, and serum ACE was initially 123. He was started on 40mg of prednisolone for 6 weeks, which was tapered to 20/25mg on alternating days. There was a recurrence of his nasal discharge; steroids were increased again but he developed symptoms of muscle weakness from long term steroid use. He was referred to an interstitial lung disease clinic at a tertiary centre where he was investigated for cardiac sarcoidosis with MRI due to ventricular ectopics. Hydroxychloroquine was started to reduce the steroid use however he developed symptoms of tinnitus, so it was stopped. Methotrexate, Azathioprine and Leflunomide were all trialled to however they did not have any impact on controlling his disease. His Prednisolone was slowly reduced by 1mg a month. When he had recurrence of his symptoms, he was given IV methylprednisolone. Nine years after his first presentation he presented with stiffness of the right thumb base. This progressed to dactylitis and slight fixed flexion deformity of right index finger and left little finger. An x-ray of his hands showed disease in the distal interphalangeal joints bilaterally with severe changes in the left little finger. The effects of long-term steroids led him to request a letter to support early retirement. Case report - Discussion The main rationale for changing treatment options was to reduce the prednisolone dose. Steroids were the only treatment option that showed evidence of controlling his disease when the dose was between 25mg and 40mg a day. Each of the DMARDs that were trialled had a different side effect profile and did not show any evidence of suppressing disease as symptoms recurred. Dose changes later in treatment fluctuated, reflecting a balancing act between disease recurrence and side effects of long-term steroids. There are many extra pulmonary manifestations of sarcoidosis that were investigated in this case. The first being the nasal granuloma, which can occur in sarcoid patients with symptoms of epistaxis, crusting, congestion, and pain. There were granulomatous changes seen in the hila as well as other lymph nodes such as the inguinal region; inguinal lymphadenopathy can lead to pain in the groin area. In addition to this it was important to exclude uveitis with ophthalmology review as he had symptoms of epiphora. Uveitis can be diagnosed in ophthalmological assessment of sarcoid patients in the absence of ocular complaints. Cardiac sarcoidosis was excluded with an MRI at a specialist heart and lung centre due to ventricular ectopics. Cardiac sarcoidosis can lead to heart block, arrhythmias, and congestive cardiac failure. Finally, he developed sarcoid arthropathy, review of his radiological images over time showed extensive damage to the joints of the hand. This gentleman had poor outcomes due to limited treatment options for his disease. Being restricted to long term steroid as the mainstay of treatment led to early retirement due to fatigue and muscle weakness. Conversely, under dosing steroids led to recurrence in symptoms. His disease is still not controlled as shown by an evolving sarcoid arthropathy. Case report - Key learning points An illustration of sarcoid arthropathy is also shown in this case. Sarcoid arthropathy is an uncommon manifestation of the disease primarily affecting joints in the hands and feet. In this case the distal interphalangeal joints and proximal interphalangeal joints were affected. The first symptom of arthropathy was stiffness of the base of the right thumb in 2017, this could fit with an osteoarthritic picture and could be mistaken for it in undiagnosed sarcoidosis. The most severe disease was in the DIP of the left little finger, which is not commonly affected. An oligoarthritic pattern with involvement of the ankle is seen more often. This is also an unusual case of sarcoidosis as there was no family history of the disease and his ethnicity did not predispose him to the condition. He also had a few uncommon extra pulmonary manifestations of sarcoidosis. The importance of a multidisciplinary approach in managing sarcoidosis was demonstrated in this case. Most of his follow up was with a respiratory clinic. However, respiratory symptoms were not the main issue during the patient journey; early ENT and rheumatology input was significant in managing his disease. Although pulmonary lymph nodes were enlarged, they did not affect his lung function.

scholarly journals Diagnosis and initial management in psoriatic arthritis: a qualitative study with patients

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Emma Dures ◽  
Clive Bowen ◽  
Mel Brooke ◽  
Jane Lord ◽  
William Tillett ◽  
...  
Keyword(s):  
Functional Limitations ◽  
Treatment Options ◽  
Joint Stiffness ◽  
Self Management ◽  
Easy Access ◽  
Specialist Care ◽  
Structured Interviews ◽  
Psychosocial Burden ◽  
Initial Management ◽  
Presenting Symptoms

Abstract Objectives PsA is an inflammatory condition that can cause pain, fatigue, swelling and joint stiffness. The consequences include impaired physical function, a high psychosocial burden, reduced quality of life and work disability. The presenting symptoms can be non-specific and varied, leading to delays in diagnosis or referral to specialist teams. The aim of this study was to explore patients' experiences of being diagnosed and the initial management of PsA. Methods The study used a qualitative design, with data collected in one-to-one, face-to-face semi-structured interviews. Results Fifteen newly diagnosed patients (<24 months) from three hospital sites in the southwest of England participated. Interviews were transcribed, anonymized and analysed using inductive thematic analysis. The following two main themes with sub-themes represent the data: symptom onset to specialist care: ‘it was the blind leading the blind’ (making sense of symptoms; mis-diagnosis and missed opportunities; and fast and easy access to expertise); and diagnosis as a turning point: ‘having somebody say you've got something wrong with you, I was euphoric’ (validation and reassurance; weighing up treatment options; taking on self-management; and acknowledging loss and change). Conclusion Participants were already dealing with functional limitations and were highly distressed and anxious by the time they received their diagnosis. Physical and mental outcomes could be improved by the implementation of existing psoriasis management guidelines and strategies for earlier referral from primary care to rheumatology and by the development of guidelines on educational, self-management and psychological support provision soon after diagnosis.

scholarly journals Drug Resistance and the Role of Combination Chemotherapy in Improving Patient Outcomes

2013 ◽  
Vol 2013 ◽  
pp. 1-15 ◽  
Author(s):  
Denise A. Yardley
Keyword(s):  
Drug Resistance ◽  
Treatment Options ◽  
Metastatic Breast ◽  
Subsequent Development ◽  
Patient Treatment ◽  
Prior Therapy ◽  
Concurrent Use ◽  
Heavily Pretreated ◽  
Chemotherapy Agents ◽  
The Impact

Resistance to cancer chemotherapy is a common phenomenon especially in metastatic breast cancer (MBC), a setting in which patients typically have had exposure to multiple lines of prior therapy. The subsequent development of drug resistance can result in rapid disease progression during or shortly after completion of treatment. Moreover, cross-class multidrug resistance limits patient treatment choices, particularly in a setting where treatments options are few. One attempt to minimize the impact of drug resistance has been the concurrent use of two or more chemotherapy agents with unrelated mechanisms of action and differing modes of drug resistance, with the intent of blocking the development of multiple intracellular escape pathways essential for tumor survival. Within the past decade, an array of mechanistically diverse agents has augmented the list of combination regimens that may be both synergistic and efficacious in pretreated MBC. The aim of this paper is to review mechanisms of resistance to common chemotherapy agents and to consider current combination treatment options for heavily pretreated and/or drug-resistant patients with MBC.

Multifocal meningeal melanocytoma: a new pathological entity or the result of leptomeningeal seeding?

2009 ◽  
Vol 111 (3) ◽  
pp. 488-491 ◽  
Author(s):  
Youssef Ali ◽  
Ralph Rahme ◽  
Ronald Moussa ◽  
Gerard Abadjian ◽  
Lina Menassa-Moussa ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Malignant Transformation ◽  
Treatment Options ◽  
Pathological Features ◽  
Unique Case ◽  
Thoracic Spinal Cord ◽  
Meningeal Melanocytoma ◽  
Leptomeningeal Seeding ◽  
Thoracic Spinal ◽  
The Brain

Meningeal melanocytoma is a rare benign CNS tumor derived from the leptomeningeal melanocytes. Although unusual, malignant transformation with leptomeningeal seeding into the brain or spinal cord may occur years after the initial diagnosis. The authors report a unique case of multifocal benign meningeal melanocytoma involving both cerebellopontine angles and the thoracic spinal cord, with associated diffuse leptomeningeal hyperpigmentation. They review the literature relevant to this topic and discuss the radiological and pathological features of this disease as well as its treatment options.

Osteophyte excision without cyst excision for a mucous cyst of the finger

2013 ◽  
Vol 39 (3) ◽  
pp. 258-261 ◽  
Author(s):  
H.-J. Lee ◽  
P.-T. Kim ◽  
I.-H. Jeon ◽  
H.-S. Kyung ◽  
I.-H. Ra ◽  
...  
Keyword(s):  
Medical Records ◽  
Lateral Collateral Ligament ◽  
Extensor Tendon ◽  
Skin Incision ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Cyst Excision ◽  
Post Operative Pain ◽  
Distal Interphalangeal ◽  
Mucous Cyst

Osteophyte excision is a mainstay of treatment for mucous cyst combined with Heberden’s node in a distal interphalangeal joint or in an interphalangeal joint of the thumb. The aim of this study was to evaluate the results of osteophyte excision without cyst excision for the treatment of a mucous cyst combined with Heberden’s node. The medical records of 37 patients (42 cases) with a mucous cyst with Heberden’s node were retrospectively reviewed. Thirty-eight of 40 cases with available pre-operative simple radiographs showed evidence of joint arthrosis. A T-shaped skin incision of the joint capsule between the extensor tendon and lateral collateral ligament was used. Osteophyte excision without cyst excision was performed. All cysts, except one, regressed without recurrence or a skin complication after osteophyte excision, but eight cases showed post-operative pain and loss of range of motion. Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger.

scholarly journals Acute MRSA Sinusitis with Intracranial Extension and Marginal Vancomycin Susceptibility

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Parvathi S. Kumar ◽  
Kenji M. Cunnion
Keyword(s):  
Staphylococcus Aureus ◽  
High Risk ◽  
Inhibitory Concentration ◽  
Treatment Options ◽  
Subsequent Development ◽  
Intracranial Extension ◽  
Surgical Drainage ◽  
Intracranial Abscess ◽  
Acute Bacterial Sinusitis ◽  
Rifampin Resistance

Methicillin resistantStaphylococcus aureus(MRSA) is increasingly being described as a cause of acute sinusitis. We present a patient with acute MRSA sinusitis complicated by rapid intracranial extension, marginal vancomycin susceptibility (MIC = 2 mg/L), delayed drainage of intracranial abscess, and subsequent development of rifampin resistance. Given the relatively high risk of intracranial extension of severe acute bacterial sinusitis and high mortality associated with invasive MRSA infections, we suggest early surgical drainage of intracranial abscesses in these circumstances. We believe this is important given the limited intracranial penetration of currently available treatment options for MRSA, especially those with a vancomycin minimal inhibitory concentration (MIC) of ≥2 mg/L.

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