Head and Neck Medicine by Alexandros G.Sfakianakis

Lipedema is a painful disease of subcutaneous adipose tissue leading to bilateral increase of leg and/ or arm volume, but sparing hands and feet. Although conservative treatment with complex decongestive therapy has been considered as the fundamental treatment, micro‐cannular liposuction in tumescent anesthesia has become a surgical option.

We report on 111 patients mostly with advanced lipedema treated by this technique in our center between 2007 and 2018. The median age of the patients was 44 years. Eighty percent of patients had at least one comorbidity. There was an association of longstanding and advanced disease to obesity and diseases of the metabolic syndrome‐spectrum. The median total amount of lipoaspirate was 4700 mL, with a range of 950 mL to 14 250 mL. The median reduction of limb circumference was 6 cm. The median pain level before treatment was 7.8 and 2.2 at the end of the treatment. An improvement of mobility could be achieved in all patients. Bruising was also reduced. Serious adverse events were observed in 1.2% of procedures, the infection rate was 0% and the bleeding rate was 0.3%. Liposuction is an effective treatment for painful lipedema. The procedure should be performed in specialized centers.

http://bit.ly/2DappBP

Post‐erysipela panniculitis ossificans of the lower leg treated with pentoxifylline

Abstract

We report the case of a female patient who developed a firm, wooden‐like, non‐pitting oedema of the left lower leg after a dermo‐hypodermitis. The clinical picture was accompanied by intense pain, strongly impacting the patient's quality of life. A soft‐tissue ultrasound demonstrated several millimetric hyperechoic linear lesions whose histopathological examination was conclusive for panniculitis ossificans.

A conservative medical management with compression stockings associated with pentoxifylline 800 mg/day was prescribed with improvement of the oedema and, in particular, a good pain control. To date, after a two‐year therapy with pentoxifylline, the leg wooden‐like oedema has substantially improved, despite the persistence of the well‐known foci of ossification, and the pain has resolved, conditioning a substantial improvement of the patient's quality of life. No side effect has been observed during the routine follow‐up.

Although there is no unanimous opinion in the Literature about the effect of pentoxifylline on bone formation and osteogenic differentiation, pentoxifylline treatment proved to be beneficial in our patient both for the heterotopic ossification process and the pain control. We collected some of the data in literature about pentoxifylline effects and advanced some hypotheses to explain our results. Finally, we suggest that an anti‐inflammatory and vasodilators drug such as pentoxifylline could be a possible alternative in heterotopic ossification disorders.

http://bit.ly/2TQx6ma

Treatment of fibro-osseous lesions at the pediatric skull base

Publication date: Available online 14 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Jeffrey C. Rastatter, Jeffrey Leonard, Patrick C. Walz

Fibro-osseous lesions of the pediatric skull base are loosely associated group of bony lesions that are all uncommonly occurring clinical entities. Management differs significantly amongst the fibro-osseous lesions but clinical and radiographic presentation can overlap significantly. Fibro-osseous lesions include fibrous dysplasia, ossifying fibroma, osteoma, and aneurysmal bone cyst in addition to even less common lesions such as giant cell tumor of bone and osteosarcoma. In this chapter, the fibro-osseous lesions affecting the pediatric skull base will be reviewed with an emphasis on the clinical, radiographic, and management differences between diagnoses.

http://bit.ly/2AOWh1o

The role of a sequencing-based clinical intestinal screening test in patients at high-risk for Clostridium difficile and other pathogens: a case report

Hospitalization and antibiotic treatment can put patients at high risk for Clostridium difficile infection, where a disturbance of the gut microbiome allows for Clostridium difficile proliferation and associated ...

http://bit.ly/2T2vAxe