Exercise-induced anaphylaxis in an elderly patient

A 75-year-old Japanese woman presented with acute flushing pruritus and a feeling of diffuse warmth followed by collapse while dancing. After resting for 30 min and receiving a rapid infusion of 0.9% sodium chloride, her condition stabilised. She admitted that she had a similar experience 2 years earlier while dancing. Based on her history, her symptoms were attributed to exercise-induced anaphylaxis. None of the episodes was associated with any other suspicious cotriggers of anaphylaxis. She was successfully discharged from the clinic without any complications after receiving careful guidance on how to prevent this condition.

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Dysphagia management in bilateral frontal opercular syndrome (Foix-Chavany-Marie syndrome)

An 80-year-old woman was admitted to hospital with acute anarthria and severe dysphagia, characterised by loss of voluntary control of the muscles of facial expression, mastication, bolus manipulation (tongue) and pharyngeal constriction, with relative preservation of involuntary movements. Brain imaging revealed an acute infarct in the left frontal operculum and an area of gliosis consistent with an old infarct in the right frontal operculum. A clinical and radiological diagnosis of bilateral anterior frontal opercular syndrome (Foix-Chavany-Marie-syndrome) was made.

Deglutition consists of a voluntary oral stage and an involuntary pharyngeal and oesophageal phase. As involuntary movements were relatively preserved and no sensory loss was suspected, it was hypothesised that, once initiated or triggered, pharyngeal swallowing could be adequate. This was trialled at the bedside without adverse effects and subsequently videofluoroscopy demonstrated timely laryngeal elevation and closure, adequate opening of the upper oesophageal sphincter and smooth transit of the bolus from mouth to oesophagus. Oral intake was restored within days of admission and a percutaneous endoscopic gastrostomy was avoided. This is the first time to the authors' knowledge that this management approach has been described for this condition.

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Spontaneous painful subungual thumb haematoma

We present the case of a 56-year-old man who presented to our accident and emergency department 15 years after a work-based injury to his left thumb.

In January 2017, the patient was woken up acutely with excruciating pain in his left thumb with no preceding trauma. On clinical examination, only a subungual haematoma was noted. Radiographs of the effected thumb demonstrated a round, lytic lesion with an accompanying hairline fracture on the distal phalanx of the left thumb. The radiologist suggested a differential diagnosis of enchondroma should be considered.

The patient was referred for a routine plastic surgery outpatient appointment. Curettage sampling of the lesion was performed and a cement filler was used to prevent further pathological fractures.

The biopsy report stated that the sample contained normal bone tissue with no evidence of enchondroma or other malignancy and the patient was discharged without any further complications.

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Sentinel lymph node biopsy status is not the most powerful predictor of prognosis in cutaneous melanoma

Abstract

Sentinel lymph node (SLN) status has been advocated in several recently published articles as the single most valuable prognostic marker for melanoma, and of greater prognostic importance than more established parameters such as Breslow thickness. A careful examination of the evidence for these claims, however, indicates that they are not substantiated by the available data, are somewhat misleading and suggest misinterpretation of the statistical analysis of the papers to which they refer. We will examine the basis for these claims and show why they are invalid.

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Chemical peels: A review of current practice

Abstract

Chemical peels belong to a group of cutaneous resurfacing procedures that are used in the treatment of photoageing, inflammatory dermatoses, epidermal proliferations, pigmentary disorders and scarring. This review describes best current practice, highlights recent advances in chemical peel technology and discusses the recommended uses for different peel types. It also presents the results of a survey of the chemical peeling practices of 30 Australian dermatologists.

http://ift.tt/2y1ol2q

High-risk squamous cell carcinoma masquerading as dense inflammation on Mohs frozen sections

Abstract

High-risk squamous cell carcinoma (SCC) can present a unique challenge in Mohs surgery. This case report describes how high-risk SCC may masquerade as only a dense inflammation on frozen sections. This feature should raise the index of suspicion for hidden SCC and be a routine indication for further processing by paraffin sections and immunohistochemistry.

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UK multicentre audit of the management of eczema in children

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