Patterns of venous reflux and obstruction in patients with skin damage due to chronic venous disease

Identified were characteristics of individuals with skin damage related to chronic venous disease. Patients with chronic venous disease (n = 164) were evaluated with duplex ultrasound imaging and were placed in classes 4, 5, and 6 according to the CEAP classification. Their findings were compared with 100 class 2 controls. The prevalence of deep venous thrombosis was higher in the study group (23.7%) versus controls (5.1%; P < .0001), as was the prevalence of deep, perforator, and combined patterns of disease (P < .0001, P < .0007, and P < .0001). The mean duration of disease in controls 2 was shorter compared with the study group (P = .0019). The prevalence of reflux and obstruction within the study group was higher than in controls (P = .0021). Skin changes accurately reflect severity of chronic venous disease. Superficial and perforator vein reflux is the major cause of disease.     

The ulnar digital artery perforator flap: A new flap for little finger reconstruction - A preliminary report

An ulnar digital artery perforator flap was used for little finger reconstruction. The flap has a reliable blood supply, being perfused by a constant sizeable perforator. This paper describes a study of a cadaveric dissection with methylene blue dye that was conducted to prove the rationality and reliability of the blood supply. The position of the perforator is confirmed intraoperatively by an exploratory incision before committing to the distal incision. The flap used to cover the flexor aspect of the little finger in three cases yielded positive results. To our knowledge, a digital artery perforator flap of this nature is unprecedented. We propose to call this flap the B.J. Flap after our institute.     

Enabling Task-Specific Volitional Motor Functions via Spinal Cord Neuromodulation in a Human With Paraplegia

We report a case of chronic traumatic paraplegia in which epidural electrical stimulation (EES) of the lumbosacral spinal cord enabled (1) volitional control of task-specific muscle activity, (2) volitional control of rhythmic muscle activity to produce steplike movements while side-lying, (3) independent standing, and (4) while in a vertical position with body weight partially supported, voluntary control of steplike movements and rhythmic muscle activity. This is the first time that the application of EES enabled all of these tasks in the same patient within the first 2 weeks (8 stimulation sessions total) of EES therapy.     

Five Simultaneous Primary Tumors in a Single Patient: A Case Report and Review of the Literature

Multiple primary malignancies (MPMs) are present when a patient is diagnosed with more than one primary malignancy and when each tumor is histologically unrelated to the others. MPMs are considered synchronous when they present within 6 months of one another. Here, we report the case of a 57-year-old woman with a past medical history significant for melanoma in 1988, who presented in 2014 with 5 distinct tumors within 4 months: malignant melanoma of the right popliteal fossa, invasive lobular breast carcinoma, diffuse large B cell lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, and a giant cell tumor of tendon sheath/pigmented villonodular synovitis. We discuss her treatment and also present a brief review of the literature. The incidence of MPMs appears to be on the rise, which demands an interdisciplinary, multimodal, and personalized approach to care.Key Words: Multiple malignancies, Melanoma, Breast cancer, Lymphoma, Giant cell tumor     

Four-decade maintenance of analgesia with percutaneous cordotomy

The management of severe, medically intractable pain is a significant challenge for neurosurgeons and pain management physicians. An existing technique that can effectively alleviate contralateral chronic pain is cordotomy, interruption of the lateral spinothalamic tract of the spinal cord. Since 1912, cordotomy has evolved from a relatively morbid open surgical procedure to a percutaneous radiofrequency procedure with low morbidity. However, since cordotomy is utilized primarily in cancer pain patients, long-term patient follow-up is rare, and the potential duration of analgesia following cordotomy is not known. Here we describe a case with a 41-year follow-up of percutaneous cordotomy for noncancer pain that resulted in over 35 years of complete analgesia, the longest recorded in the literature to date. This case demonstrates that percutaneous cordotomy can provide long-lasting, complete analgesia in some patients and merits continuation as a part of the neurosurgical arsenal of pain therapies.