Marjolin's Ulcer of the Leg Secondary to Nonhealing Chronic Venous Stasis Ulcer

We report on a 79-year-old man with a chronic venous stasis ulceration of >20 years' duration in the left medial leg presenting to our clinic after admission for bleeding and suspected infection of his ulceration. This lesion had been biopsied in 1999 and was found to be a benign, chronic venous insufficiency ulceration. Plain film radiographs as well as a bone scan did not identify osteomyelitis. Because of the hypertrophic, nodular appearance of this ulceration, it was the clinicians' discretion to perform a repeat biopsy of the lesion. Biopsy revealed invasive, well-differentiated squamous cell carcinoma. A computed tomography scan subsequently identified a suspicious inguinal lymph node, and an ultrasound-guided needle aspiration revealed metastatic squamous cell carcinoma of the biopsied lymph node. Above-knee amputation was indicated at this time and was performed in conjunction with local superficial inguinal lymph node resection, after which the patient was discharged from our service.     

2008下肢慢性静脉疾病指南简介

<正>1下肢慢性静脉疾病(chronic venous disease,CVD)的病理生理静脉曲张是CVD最常见的表现,继发性静脉曲张是下肢深静脉血栓形成(deep vein thrombosis,DVT)的结果,DVT再通可能增加相对梗阻和深浅和交通静脉的反流。静脉曲张也可能是盆腔静脉反流造成。卵巢、盆腔、外阴、外生殖器和臀肌的反流可能与盆腔充血和症状和体征有关。     

Training Grip Control with a Fitts' Paradigm: A Pilot Study in Chronic Stroke

Study DesignA clinical measurement study.PurposeTo test the applicability of Fitts' paradigm to grasping tasks in individuals with chronic stroke.IntroductionFitts' Law relates the time of target achievement to task difficulty in repetitive motor tasks.MethodsSix male chronic stroke patients performed repetitive actuation of a grip force dynamometer with their affected hands for 12 sessions over four to six weeks.ResultsMovement times followed Fitts' behavior with correlations of R² > 0.8 for all subjects. Grasp control improved during training, as indicated by an average decrease in Fitts' slope of 26% at high difficulty levels (p < 0.05), and decreases in the number of force corrections and in jerkiness, both at p < 0.001 level.ConclusionsThe Fitts' grip force targeting protocol provides an objective standardized instrument for grasp proficiency quantification and a potentially efficacious platform for hand training for persons with stroke.Level of EvidenceN/A.     

bFGF-Induced Alterations in Cellular Markers of Senescence in Growth-rescued Fibroblasts from Chronic Venous Ulcer and Venous Reflux Patients

Fibroblasts cultured from the distal lower extremity of chronic venous insufficiency (CVI) patients exhibit characteristics of cellular senescence. Basic fibroblast growth factor (bFGF) has been shown to improve growth rates in these fibroblasts. In bFGF-treated fibroblasts, levels of fibronectin and matrix metaloproteinase-2 (MMP-2), known to be up-regulated in senescence, were examined to determine whether bFGF induces changes in these markers of senescence with rescue of cellular proliferation. Fibroblasts were isolated from the distal leg of patients with CVI with and without ulcers (fb-D). In all patients, a control was obtained from the proximal ipsilateral thigh (fb-P). Cells were plated at 3000 cells/plate and treated with bFGF (20 ng/mL) on days 1, 5, 8, and 11. Total cell number was obtained on days 5 and 12 using the Coulter particle counter, and concurrently cells were plated at 10,000 cells/plate and treated with bFGF on the same schedule; cell lysate was harvested on day 12 for immunoblot analysis for MMP-2 and fibronectin. In all patients (n = 7), fb-P grew faster than fb-D (p = 0.039). fb-D showed a mean 3.3-fold increase in growth in response to bFGF, and immunoblot analysis demonstrated an up-regulation of fibronectin and MMP-2 in response to bFGF. This represents the possibility that by stimulating growth, bFGF may drive cells toward senescence. This suggests clinical implication for the use of bFGF and other growth factors in general.     

Malignant Transformation of a Chronic Venous Stasis Ulcer to Basal Cell Carcinoma in a Diabetic Patient: Case Study and Review of the Pathophysiology

The degeneration of chronic wounds into basal cell carcinoma is rare. We present an atypical case of basal cell carcinoma diagnosed by soft tissue biopsy in a long-standing wound that had been treated for 3 years as a chronic venous stasis ulcer. In addition to the case report, we review the biomedical literature describing malignant transformation of long-standing wounds. Foot and ankle specialists should be on the lookout for changes that signal malignant transformation in long-standing ulcers.     

Patient-perceived barriers to surgical treatment of cleft lip and palate in Brazil: A multi-region study

IntroductionMany patients worldwide are unable to access timely primary repair of cleft lip and palate. The aim of this study was to assess patient-perceived barriers to accessing timely cleft lip and palate repair across Brazil.MethodsA 29-item questionnaire was applied to patients undergoing surgery for cleft lip and/or palate across five contrasting sites in Brazil from February 2016 to November 2017. Differences in patient timelines, demographics, and patient-reported barriers were compared by region. A multivariate logistic regression was used to determine predictors of delayed care.ResultsOf 181 patients, 42% of patients received timely primary surgical repair. The age of the patient at the interview was 82 months (standard deviation [SD] 107) and 52% were male. The majority of delays occurred between diagnosis and primary surgical repair. The mean number of barriers to accessing timely surgical care cited by each patient was 3.77. The most common barrier was perceived “lack of hospitals that provided the surgery in my area” (48% (n = 86)). Univariate logistic regression showed increased odds of receiving late care in the state of Amazonas (odds ratio [OR] 2.91; 95% confidence interval [CI] 1.07–7.96; P = 0.037) or Para (OR 4.46; 95% CI 1.09–19.70; P = 0.037). Multivariate logistic regression determined predictors of delayed care to be female sex (OR = 2.05; 95% CI 1.05–3.99; P = 0.035) and perceived poor availability of care (OR = 0.045; 95% CI 1.02–4.37; P = 0.045).ConclusionThe majority of patients in Brazil are not receiving timely primary repair of their clefts. Improvements in the coordination of care, patient education and patient empowerment are required.