Demodicosis is the term applied to a variety of skin diseases caused by demodex mites. Although t... more Demodicosis is the term applied to a variety of skin diseases caused by demodex mites. Although they are felt to be commensal organisms of the pilosebaceous units of the face, scalp, and chest, Demodex folliculorum and D brevis have been implicated in papulopustular rosacea, perioral dermatitis, and other papulopustular eruptions. Often overlooked in the differential diagnosis of chronic, pruritic eruptions of sebaceous skin, the increasing use of dermatoscopy in regular clinical examination offers a potential new option for rapid diagnosis of this infestation. Herein we describe a case of facial demodicosis and its response to treatment, and newly describe the dermatoscopic features of demodicosis. A 28 year-old Iranian man with a several-year history of a pruritic, progressive rash involving the bearded face and temporal scalp presented for evaluation. He stated the eruption began as a single red spot in his beard for which he sought evaluation from numerous dermatologists. Previous unsuccessful therapies included courses of prednisone, antifungal creams, topical corticosteroids, and selenium-containing shampoo. Previous patch testing revealed sensitivity to thimerosal #23, which he subsequently avoided with no improvement. Physical examination revealed poorly marginated red patches surmounted by fine white scale on the bilateral cheeks and temples and diffusely throughout the beard. Greasy, yellowish scale was noted throughout the scalp. Dermatoscopic examination revealed blotchy milky red erythema, white scale and innumerable perifollicular and non-follicle based tapered yellowish filaments. At follicular ostia numerous filaments were identified protruding from a single opening. Potassium hydroxide preparation of skin scrapings from the cheek revealed multiple viable demodex mites. The patient was instructed to perform 3 12-hour applications of permethrin 5% cream to the entire face 7 days apart. Within 6 weeks of this treatment, the patient reported significant improvement in erythema and scale. Demodicosis should be considered in the differential diagnosis of recurrent or recalcitrant dermatitic or rosacea-like eruptions in a seborrheic distribution. Detection of numerous tapered yellowish filaments within a field of erythema, pruritus, or scale should prompt clinicians to investigate further for demodicosis. This case is reported for its novel dermatoscopic description of a common infestation. Commercial support: None identified.
Background: Arachnoiditis af ter epidural blood patch (EBP) has been described and associated to ... more Background: Arachnoiditis af ter epidural blood patch (EBP) has been described and associated to the presence of intrathecal blood. Typical symptoms are: lower back pain, foot burn, peripheral sensory and motor deficits and rigor nucalis. Its genesis is to date controversial but it can give serious and long-term clinical complications. Materials and Methods: EBP for intracranial hypotension syndrome not responsive to conservative treatment was carried out in 94 patients from the year 2003 to 2011. The procedure was performed by an experienced anaesthetist using 20 to 35 ml of autologous blood. The last 40 cases were performed on prone position under fluoroscopy guidance with 5 ml Iopamidol to localize the epidural space and confirm the correct site of injection. A lumbar CT scan was carried out in all patients 30 minutes af ter the procedure. Results: 89/94 cases had resolution of symptoms af ter one EBP while 5 patients required a second treatment. We had a single case of accidental dural puncture. All patients reported lower back pain that resolved in all cases in 1-3 days sometimes requiring acetaminophen treatment. In 9/94 cases (including the patient with dural puncture) traces of blood could be seen in the liquoral space in the post-procedural CT scan. We report no cases of arachnoiditis as confirmed clinically and instrumentally. The follow up at 6 month and 2 years reported no recurrence of symptoms. Discussion: Our data confirm the ef ficacy of lumbar autologous EBP in the SIH. The only side ef fect reported was lower back pain most probably related to direct puncture trauma. Intrathecal blood was present in 9 patients but none reported signs nor symptoms of arachnoiditis. Presence of blood in the liquoral space in the absence of dural puncture could be explained by the high pressure gradient created by insuf flation and seems not to have negative consequences and resolve spontaneously. Arachnoiditis in our casistic cannot be correlated to the presence of intrathecal autologous blood.
Epidural anestezi ve analjeziye bağlı çeşitli komplikasyonlar gelişebilir. Pnömosefali'de epidura... more Epidural anestezi ve analjeziye bağlı çeşitli komplikasyonlar gelişebilir. Pnömosefali'de epidural kateter takılması sırasında gelişen ve ender görülen bir komplikasyonudur. Bu olgu sunumunda 65 yaşında akciğer kanser tedavisi gören hastanın sol bacaktaki ağrısı için epidural kateter takılması sırasında ani gelişen ve daha sonra kaybolan baş ağrısı ile kateter takılmasından 3 gün sonra künt, sürekli, hareketle artan, yatınca geçmeyen frontal baş ağrısına eşlik eden konfüzyon, oryantasyon bozukluğu bulguları saptanan bir pnömosefali olgusunu sunmayı amaçladık.
Women who undergo mastectomy and breast reconstruction are shown to express more pain than those ... more Women who undergo mastectomy and breast reconstruction are shown to express more pain than those who undergo mastectomy alone. The authors evaluated postoperative pain outcomes following breast reconstruction. Patients undergoing primary implant-based (n = 1038) or flap-based (n = 837) reconstructions from 2004 to 2012 at the University of California, Los Angeles, were evaluated. Postoperative pain was measured using the visual analogue scale, total narcotic use, and number of patient-controlled analgesia attempts. Narcotic dosage was standardized to morphine equivalents per kilogram. The authors modeled postoperative narcotic use, patient-controlled analgesia attempts, and visual analogue scale scores over time using spline graphs for comparison between the two reconstruction methods. Both total narcotic use and patient-controlled analgesia attempts were higher in the implant-based group throughout the immediate postoperative period. Implant-based reconstruction patients had signif...
Demodicosis is the term applied to a variety of skin diseases caused by demodex mites. Although t... more Demodicosis is the term applied to a variety of skin diseases caused by demodex mites. Although they are felt to be commensal organisms of the pilosebaceous units of the face, scalp, and chest, Demodex folliculorum and D brevis have been implicated in papulopustular rosacea, perioral dermatitis, and other papulopustular eruptions. Often overlooked in the differential diagnosis of chronic, pruritic eruptions of sebaceous skin, the increasing use of dermatoscopy in regular clinical examination offers a potential new option for rapid diagnosis of this infestation. Herein we describe a case of facial demodicosis and its response to treatment, and newly describe the dermatoscopic features of demodicosis. A 28 year-old Iranian man with a several-year history of a pruritic, progressive rash involving the bearded face and temporal scalp presented for evaluation. He stated the eruption began as a single red spot in his beard for which he sought evaluation from numerous dermatologists. Previous unsuccessful therapies included courses of prednisone, antifungal creams, topical corticosteroids, and selenium-containing shampoo. Previous patch testing revealed sensitivity to thimerosal #23, which he subsequently avoided with no improvement. Physical examination revealed poorly marginated red patches surmounted by fine white scale on the bilateral cheeks and temples and diffusely throughout the beard. Greasy, yellowish scale was noted throughout the scalp. Dermatoscopic examination revealed blotchy milky red erythema, white scale and innumerable perifollicular and non-follicle based tapered yellowish filaments. At follicular ostia numerous filaments were identified protruding from a single opening. Potassium hydroxide preparation of skin scrapings from the cheek revealed multiple viable demodex mites. The patient was instructed to perform 3 12-hour applications of permethrin 5% cream to the entire face 7 days apart. Within 6 weeks of this treatment, the patient reported significant improvement in erythema and scale. Demodicosis should be considered in the differential diagnosis of recurrent or recalcitrant dermatitic or rosacea-like eruptions in a seborrheic distribution. Detection of numerous tapered yellowish filaments within a field of erythema, pruritus, or scale should prompt clinicians to investigate further for demodicosis. This case is reported for its novel dermatoscopic description of a common infestation. Commercial support: None identified.
Background: Arachnoiditis af ter epidural blood patch (EBP) has been described and associated to ... more Background: Arachnoiditis af ter epidural blood patch (EBP) has been described and associated to the presence of intrathecal blood. Typical symptoms are: lower back pain, foot burn, peripheral sensory and motor deficits and rigor nucalis. Its genesis is to date controversial but it can give serious and long-term clinical complications. Materials and Methods: EBP for intracranial hypotension syndrome not responsive to conservative treatment was carried out in 94 patients from the year 2003 to 2011. The procedure was performed by an experienced anaesthetist using 20 to 35 ml of autologous blood. The last 40 cases were performed on prone position under fluoroscopy guidance with 5 ml Iopamidol to localize the epidural space and confirm the correct site of injection. A lumbar CT scan was carried out in all patients 30 minutes af ter the procedure. Results: 89/94 cases had resolution of symptoms af ter one EBP while 5 patients required a second treatment. We had a single case of accidental dural puncture. All patients reported lower back pain that resolved in all cases in 1-3 days sometimes requiring acetaminophen treatment. In 9/94 cases (including the patient with dural puncture) traces of blood could be seen in the liquoral space in the post-procedural CT scan. We report no cases of arachnoiditis as confirmed clinically and instrumentally. The follow up at 6 month and 2 years reported no recurrence of symptoms. Discussion: Our data confirm the ef ficacy of lumbar autologous EBP in the SIH. The only side ef fect reported was lower back pain most probably related to direct puncture trauma. Intrathecal blood was present in 9 patients but none reported signs nor symptoms of arachnoiditis. Presence of blood in the liquoral space in the absence of dural puncture could be explained by the high pressure gradient created by insuf flation and seems not to have negative consequences and resolve spontaneously. Arachnoiditis in our casistic cannot be correlated to the presence of intrathecal autologous blood.
Epidural anestezi ve analjeziye bağlı çeşitli komplikasyonlar gelişebilir. Pnömosefali'de epidura... more Epidural anestezi ve analjeziye bağlı çeşitli komplikasyonlar gelişebilir. Pnömosefali'de epidural kateter takılması sırasında gelişen ve ender görülen bir komplikasyonudur. Bu olgu sunumunda 65 yaşında akciğer kanser tedavisi gören hastanın sol bacaktaki ağrısı için epidural kateter takılması sırasında ani gelişen ve daha sonra kaybolan baş ağrısı ile kateter takılmasından 3 gün sonra künt, sürekli, hareketle artan, yatınca geçmeyen frontal baş ağrısına eşlik eden konfüzyon, oryantasyon bozukluğu bulguları saptanan bir pnömosefali olgusunu sunmayı amaçladık.
Women who undergo mastectomy and breast reconstruction are shown to express more pain than those ... more Women who undergo mastectomy and breast reconstruction are shown to express more pain than those who undergo mastectomy alone. The authors evaluated postoperative pain outcomes following breast reconstruction. Patients undergoing primary implant-based (n = 1038) or flap-based (n = 837) reconstructions from 2004 to 2012 at the University of California, Los Angeles, were evaluated. Postoperative pain was measured using the visual analogue scale, total narcotic use, and number of patient-controlled analgesia attempts. Narcotic dosage was standardized to morphine equivalents per kilogram. The authors modeled postoperative narcotic use, patient-controlled analgesia attempts, and visual analogue scale scores over time using spline graphs for comparison between the two reconstruction methods. Both total narcotic use and patient-controlled analgesia attempts were higher in the implant-based group throughout the immediate postoperative period. Implant-based reconstruction patients had signif...
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