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Elevated foot pressure and high temperatures have been proposed as predictive factors for diabetic foot ulceration; however, on their own, their predictive value is still questionable. This pilot study hypothesized that combining these two measurements in a thermo-pressure model could result in a more reliable risk assessment tool for providing risk categorization aimed to determine whether there is a correlation between foot plantar pressure and temperature in patients living with diabetes mellitus (DM) when compared with healthy individuals following a 15 min walk. Foot pressure and thermographic images were taken from 48 participants who were categorised into four groups following clinical evaluation into healthy individuals (Group A), living with DM with no complications (Group B), DM with peripheral arterial disease (Group C) and DM patients with neuropathy (Group D). This study demonstrated a positive correlation between pressure and temperature; as pressure increases, so does temperature. This was more pronounced in the groups with DM when compared to the healthy group. More research is warranted to further develop this innovative thermo-pressure model, which could hopefully be more sensitive in categorizing and identifying patients living with DM who are at risk of developing foot ulceration to initiate prompt care.

Abstract Background The Aboriginal and Torres Strait Islander community has an increased risk of developing chronic illnesses including diabetes. Among people with diabetes, foot complications are common and make a significant contribution to the morbidity and mortality associated with this disease. The aim of this review was to systematically evaluate the literature comparing the rates of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians to non-Indigenous Australians. Methods MEDLINE, EMBASE, The Cochrane Library; PUBMED and CINAHL were searched from inception until August 2016. Inclusion criteria were: published cross-sectional or longitudinal studies reporting the prevalence of diabetes related foot complications in both a cohort of Aboriginal and Torres Strait Islander Australians and a cohort of one other Australian population of any age with diabetes. Risk of bias was assessed using the STROBE tool. Results Eleven studies including a total of 157,892 participants were included. Studies were set in Queensland, the Northern Territory and Western Australia, primarily in rural and remote areas. Aboriginal and Torres Strait Islander Australians experienced substantially more diabetes related foot complications with the mean age up to 14 years younger than non-Indigenous Australians. Aboriginality was associated with increased risk of peripheral neuropathy, foot ulceration and amputation. In several studies, Aboriginal and Torres Strait Islander Australians accounted for the vast majority of diabetes related foot complications (up to 91%) while comprising only a small proportion of the regional population. Reporting quality as assessed with the STROBE tool showed underreporting of: methods, sample description and potential sources of bias. There are no data available for some Australian states and for specific types of diabetes related foot complications. Conclusions Aboriginal and Torres Strait Islander Australians have a 3–6 fold increased likelihood of experiencing a diabetes related foot complication compared to non-Indigenous Australians. Evidence-based, culturally appropriate screening and intervention programs and improved access to effective health care services are required to prevent a widening of the gap in diabetes related foot complications between Aboriginal and Torres Strait Islander and non-Indigenous Australians.

The incidence rates of thin melanomas (≤1 mm Breslow thickness) have increased in many fair-skinned populations, prompting a need to better identify patients with thin melanomas who will eventually die from the disease. This study aimed to describe the clinicopathological characteristics of lethal melanomas in Western Sweden, with a focus on thin lesions. Population-based data on invasive melanomas diagnosed during the years 1990 to 2014 were extracted from the Swedish Melanoma Registry, and linked to the Swedish Cause of Death Registry. The age-standardized incidence (US population 2000) of thin melanomas increased from 9.1×10–5 (95% confidence interval (95% CI) 8.5–9.8) to 21.3×10–5 (95% CI 20.4–22.1) during the study period. Thin melanomas comprised 55.2% of the total and contributed to 13.5% of all melanoma deaths. Non-ulcerated melanomas 0.76–1 mm and ulcerated melanomas 0.26–1.0 mm showed a poorer survival compared with other thin melanomas.

Abstract Background The peripheral complications of diabetes mellitus remain a significant risk to lower-limb morbidity. In New Zealand, risk of diabetes, comorbidity and lower-limb amputation are highly-differential between demographic groups, particularly ethnicity. There is growing and convincing evidence that the use of pedobarography – or plantar pressure measurement – can usefully inform diabetic foot care, particularly with respect to the prevention of re-ulceration among high-risk patients. Methods For the current feasibility study, we embedded pedobarographic measurements into three unique diabetic foot clinic settings in the New Zealand context, and collected pedobarographic data from n = 38 patients with diabetes using a platform-based (Novel Emed) and/or in-shoe-based system (Novel Pedar). Our aim was to assess the feasibility of incorporating pedobarographic testing into the clinical care of diabetic feet in New Zealand. Results and Conclusions We observed a high response rate and positive self-reported experience from participants. As part of our engagement with participants, we observed a high degree of lower-limb morbidity, including current ulceration and chronic foot deformities. The median time for pedobarographic testing (including study introduction and consenting) was 25 min. Despite working with a high-risk population, there were no adverse events in this study. In terms of application of pedobarography as a clinical tool in the New Zealand context, the current feasibility study leads us to believe that there are two avenues that deserve further investigation: a) the use of pedobarography to inform the design and effectiveness of offloading devices among high-risk diabetic patients; and b) the use of pedobarography as a means to increase offloading footwear and/or orthoses compliance among high-risk diabetic patients. Both of these objectives deserve further examination in New Zealand via clinical trial.

Introduction. Prognosis of patients with localized primary cutaneous melanoma depends on various clinical and pathomorphological aspects. The latest ones are the Breslow depth, Clark invasion, ulceration and mitoses in primary tumor. All of this prognostic features have been studied and discussed during last 30 years. The analyses of the prognostic value of this factors is being continued till nowadays, and that is the main idea of our current study.The aim of our study is to determine the influence of pathomorphological factors on long-term treatment results in patients with primary head and neck cutaneous melanoma.Materials and methods. 174 patients with localized primary head and neck cutaneous melanoma were included (were considered for the analysis) (1995–2014). All the patients were considered for Breslow depth (T), Clark invasion, and ulceration using archived pathomorphological tissue samples. The proliferative tumor activity (mitotic rate) was determined in 24 cases with tumor with tumor thickness less than 1.0 mm.Results. Recurrence-free survival according to ulceration and N0 correlated with long-term treatment results. So, 5-year survival was worse in group with ulceration – 51,8 ± 5,9 % rather than group without ulceration – 69,5 ± 6,4% (р = 0,046). Recurrence-free survival according to Clark invasion and N0 correlated with long-term treatment results and worsened with growth of invasion level. So, 5-year survival in I level group was 100 % versus 27,8 ± 9,4 % in V level group (р = 0,00014). Recurrence-free survival according to mitotic rate did not correlate with long-term treatment results. So, 5-year survival was 79,5 ± 13,0 % and 81,8 ± 11,6 % respectively.Conclusions. Ulceration of the primary tumor is a factor affecting the rate of regional metastases, which subsequently leads to decrease in relapse-free survival. Also, a direct relation exists between increased rate of regional and distant metastases and increased Clark level of invasion. Mitotic index has a certain effect on the rate of regional metastases, but it doesn’t manifest in analysis of long-term results. Supposedly, this factor is not “strong” enough.

Background: In developing countries, oral squamous cell carcinoma is a leading cause of mortality due to late diagnosis. Hence, the aim of the study was to analyze the clinical and pathological presentation of buccal mucosa carcinoma patients. Materials and Methods: A case series study was conducted in regional cancer centre, Tamil Nadu. Demographic and clinical details were collected from medical registries between 2013 and 2015. Results: The present study consists of 198 cases which comprised 125 (63.1%) male and 73 (36.9%) female. The mean age of the cases was 54.16 ± 17.25 years. Histopathology reports showed most frequency of well-differentiated buccal squamous cell carcinoma 98 (49.5%) and followed moderate 98 (34.3%) and poorly differentiated 32 (16.2%). Clinical tumor nodal metastasis reports revealed 168 (85%) of advanced clinical stage (III and IV) of buccal mucosa carcinoma, whereas only 30 (15%) was presented at early stage (I and II) of disease. Based on the clinical and histopathological analysis, 86 (43.4%) cases were fit for surgery and followed by adjuvant chemo- - and radio-therapy. Of 198 cases, the most common clinical complaints were identified with 73 (38%) pain and followed by 47 (28%) bleeding, may be due to unawareness or ignorance of disease. Conclusion: The study concluded that most of the cases had diagnosed in advanced stage of tumor with severe pain and bleeding. Hence, further studies warrant on awareness of clinical symptoms and also to analyze the risk factors for delay diagnosis in Tamil Nadu population, which might reduce morbidity and mortality.

Introduction: We report an unusual case of osteomyelitis of the left foot due to syphilitic bone involvement. Case presentation: A 73-year-old man came to our attention with a four-month history of fever and a hypertrophic ulceration of the fifth metatarsal of the left foot. He had a history of syphilis treated years before. The CT scan showed an evident osteolytic area of the metatarsal phalangeal joint of the fifth left toe. The serological tests demonstrated a syphilitic reinfection. On suspicion of a bone localization of syphilis, an US-guided bone biopsy was performed. The histological examination with silver impregnation confirmed the diagnosis. The patient was treated with the traditional treatment of syphilis using penicillin, obtaining the complete resolution of the radiological and cutaneous alterations. Conclusions: The aim of this work is to sensitize clinicians to suspect syphilis in case of osteolytic lesions in patients with a history of this disease.

Before the era of immune checkpoint blockade, a meta-analysis encompassing fifteen trials reported that adjuvant IFN-α significantly reduces the risk of relapse and improves survival of ulcerated melanoma (UM) with no benefit for higher doses compared to lower doses. IFNa2b affects many cell intrinsic features of tumor cells and modulates the host innate and cognate immune responses. To better understand the biological traits associated with ulceration that could explain the efficacy of prophylactic type 1 IFN, we performed immunohistochemical analysis of various molecules (major histocompatibility complex class I and class II, MX Dynamin Like GTPase 1 (MX1), inducible Nitric-Oxide Synthase (iNOS) or CD47) in two retrospective cohorts of melanoma patients, one diagnosed with a primary cutaneous melanoma (1995–2013, N = 172, among whom 49% were ulcerated melanoma (UM)) and a second one diagnosed with metastatic melanoma amenable to lymph node resection (EORTC 18952 and 18991 trials, N = 98, among whom 44% were UM). We found that primary and metastatic UM exhibit higher basal expression of MHC class I molecules, independently of Breslow thickness, histology and lymphocytic infiltration compared with NUM and that primary UM harbored higher constitutive levels of the antiviral protein Mx1 at the border of tumor beds than NUM. These findings suggest that UM expand in a tumor microenvironment where chronic exposure to type 1 IFN could favor a response to exogenous IFNs.

Notre travail vise à rapporter un cas de carcinome urothelial vésical qui est une tumeur rare chez les sujets de moins de 40 ans, et apporter notre expérience thérapeutique, cela à travers l'observation d'un patient âgé de 37 ans, avec antécédent d'infection urinaire et un séjour dans une région riveraine (bilharziose) ayant consulté pour hypogastralgie et hématurie totale macroscopique. Le bilan clinique et paraclinique, mettait en évidence une volumineuse masse tumorale vésicale d'allure infiltrante, sans envahissement ganglionnaire ou organique local ou à distance. Sa prise en charge chirurgicale a consisté en une exérèse biopsique tumorale vésicale suivie d'une cystectomie totale, avec enterocystoplastie iléale de substitution. Les suites opératoires ont été simples. Il avait bénéficié egalement d'une chimiothérapie adjuvante et une vitaminothérapie B12. Les contrôles cliniques et paracliniques effectués 6 et 12 mois ne montraient aucune récidive.

Before the era of immune checkpoint blockade, a meta-analysis encompassing fifteen trials reported that adjuvant IFN-α significantly reduces the risk of relapse and improves survival of ulcerated melanoma (UM) with no benefit for higher doses compared to lower doses. IFNa2b affects many cell intrinsic features of tumor cells and modulates the host innate and cognate immune responses. To better understand the biological traits associated with ulceration that could explain the efficacy of prophylactic type 1 IFN, we performed immunohistochemical analysis of various molecules (major histocompatibility complex class I and class II, MX Dynamin Like GTPase 1 (MX1), inducible Nitric-Oxide Synthase (iNOS) or CD47) in two retrospective cohorts of melanoma patients, one diagnosed with a primary cutaneous melanoma (1995–2013, N = 172, among whom 49% were ulcerated melanoma (UM)) and a second one diagnosed with metastatic melanoma amenable to lymph node resection (EORTC 18952 and 18991 trials, N = 98, among whom 44% were UM). We found that primary and metastatic UM exhibit higher basal expression of MHC class I molecules, independently of Breslow thickness, histology and lymphocytic infiltration compared with NUM and that primary UM harbored higher constitutive levels of the antiviral protein Mx1 at the border of tumor beds than NUM. These findings suggest that UM expand in a tumor microenvironment where chronic exposure to type 1 IFN could favor a response to exogenous IFNs. [ABSTRACT FROM AUTHOR]

Background: Massive hemoptysis refers to bleeding from the sputum exceeding 100 ml/day. This condition is known to have a poor prognosis. Although foreign body aspiration is not as common as other risk factors, it may result in massive hemoptysis. In the current study, we presented a case of massive hemoptysis due to the aspiration of a toothpick. Case Presentation: The patient was a 49-year-old woman who was primarily suspected of having tuberculosis. After observing blood in the sputum, interventions, including chest computed tomography (CT) scan and conservative management, were performed. The CT scan showed no malignancy, and paraclinical investigations were negative. However, hemoptysis was progressing into an acute phase; therefore, a surgical intervention was performed for the patient. After the surgery, the cause of the lesion was found to be a toothpick. The patient was under intensive care after surgery and was discharged from the hospital in a good general condition. The morphological evaluation of the lesion showed a bronchial wall with ulceration, besides granulation tissue formation, hematoma, and fibrinoid necrosis due to foreign body aspiration into the lung, resulting in inflammatory reactions. Conclusion: In this case report, foreign body aspiration resulted in massive hemoptysis. Our primary attempts to diagnose the cause of lesion were unsuccessful, and surgery was performed due to the life-threatening condition of the patient. Overall, unexplained hemoptysis may occur following a serious accident due to foreign body aspiration. [ABSTRACT FROM AUTHOR]

The present study was designed to investigated the effect of aqueous extract of pomegranate peels in treatment of gastric ulceration that induced experimentally in laboratory rats . Forty adult female rats were divided randomly into five groups each group included eight rats . The first group control group which received distilled water, the second group experimentally gastric ulceration by indomethacin while the third, fourth and fifth groups were gave aqueous extract of pomegranate peels at concentrations (25, 50 and 100 mg/kg body weight) respectively after induction of gastric ulceration. The current results showed a significant decreasing (Pd”0.05) in body weight, weight of (heart, liver, kidney, spleen and ovary) and LH level in experimentally gastric ulceration group compared with control group while non -significant decreasing was observed in other hormones (FSH, estrogen and progesterone). Significant increasing (Pd”0.05) was noticed in body weight and increasing in weight of organs in all groups which treated with aqueous extract of pomegranate peels at all concentrations compared with experimentally gastric ulceration group, while the level of hormones for groups which treated with aqueous extract of pomegranate peels was decreased compared with hormones of gastric ulceration group. Also, the results showed that the indomethacin caused gastric ulcer and many histopathological changes included affected of muscularis layer, fibrosis, infiltration of inflammatory cells with change in epithelium layer and congestion of blood vessels, while using of aqueous extract of pomegranate peels at concentrations (25, 50 and 100 mg/kg body weight) led to reconstitution of stomach by normal mucosa layer, epithelial tissue in addition to no signs of gastric ulcer. [ABSTRACT FROM AUTHOR]

Background: Anastomotic complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) including leaks, ulceration, and stenosis remain a significant cause of post-operative morbidity and mortality. Our objective was to compare two different surgical techniques regarding short-term anastomotic complications.Methods: A retrospective analysis of all patients operated with a primary LRYGB from 2006 to June 2015 in one institution, where prospectively collected data from an internal quality registry and medical journals were analyzed.Results: In total, 2420 patients were included in the analysis. 1016 were operated with a technique where the mesentery was divided during the creation of the Roux-limb (DM-LRYGB) and 1404 were operated with a method where the mesentery was left intact (IM-LRYGB). Leakage in the first 30 days [2.6% vs. 1.1% (p < 0.05)], and ulceration or stenosis occurring during the first 6 months after surgery [5.6% vs. 0.1% (p < 0.05)] was significantly higher in the DM-LRYGB group. Adjusted odds ratio for anastomotic leak was 0.46 (95% CI 0.24-0.87) and for stenosis/ulceration 0.01 (95% CI 0.002-0.09).Conclusion: IM-LRYGB seems to reduce the risk of complications at the anastomosis. A plausible explanation for this is that the blood supply to the anastomosis is compromised when the mesentery is divided. [ABSTRACT FROM AUTHOR]

• Numerous studies have been conducted on phenytoin to promote the healing of ulcers. • Phenytoin is commercially available as a topical spray with high percentage of organic solvents that causes skin dryness, redness, irritation, burning and allergic contact dermatitis. • Hence, there is a need for new organic solvent-free topical formulations that can improve phenytoin wound healing ability with minimal or no adverse effects. • Nanostructured lipid carriers are advantageous in comparison to other topical carriers in several aspects with high percutaneous absorption due to their high surface area and negligible skin irritability. • Our aim is to develop a novel topical NLC for enhancing the entrapment efficiency and sustained release of phenytoin and study its impact on the healing of DFU in patients with no clinical evidence of ischaemia or infection. • PHT-NLC-dressing is more effective than PHT-hydrogel at the same concentration in healing of DFU. The aim of this study is to develop, and characterize nanostructured lipid carriers (NLCs) of phenytoin (PHT) in order to improve its entrapment efficiency and sustained release to improve the healing process. Twenty-seven patients with neuropathic diabetic foot ulceration (DFU) were enrolled in this study. Patients were comparable regarding size, grading of ulcer and control of diabetes with no major deformity. All patients were managed by weekly sharp debridement if indicated and offloaded with cast shoes. They were equally divided into three groups: PHT-NLC-hydrogel (0.5%w/v), phenytoin hydrogel (0.5%w/v) and blank hydrogel groups. Changes in wound area were monitored over 2 months. Baseline wound area of PHT-NLC, PHT and blank hydrogels were 5.50 ± 3.66, 3.94 ± 1.86 and 5.36 ± 2.14 cm2, respectively. Ulcers treated with PHT-NLC hydrogel showed smaller wound area compared to control groups (ρ < 0.05). The overall reduction in ulcer size were 95.82 ± 2.22% for PHT-NLC-hydrogel in comparison to 47.10 ± 4.23% and –34.91 ± 28.33% for PHT and blank-hydrogel (ρ < 0.001), respectively. PHT-NLC hydrogel speeds up the healing process of the DFU without adverse effects when compared to the positive and negative control hydrogels. Moreover, the study can open a window for topical application of NLCs loaded with PHT in the treatment of numerous dermatological disorders that resist conventional treatment. The delivery of drug molecules and their localization into the skin is the main purpose of the topical dosage forms. In this manuscript, the impact of topical phenytoin loaded nanostructured lipid carrier in improving wound healing in patients with neuropathic diabetic foot ulceration was investigated. Phenytoin loaded nanostructured lipid carrier dressing was found to be more effective than phenytoin hydrogel at the same concentration in healing of neuropathic diabetic foot ulcer. [ABSTRACT FROM AUTHOR]

Aims: Incorrectly fitting shoes are implicated in callus formation and a significant proportion of diabetic foot ulcers, yet remain surprisingly prevalent. We review the current shoe fit guidelines for consistency and discuss ways in which technology may assist us in standardising methods of footwear assessment.Methods: Narrative review.Results: Incorrectly fitted shoes are implicated in the development of some diabetic foot ulcers yet surprisingly there's no consensus on shoe fit, despite substantial spending on prescription footwear. Suggested toe gaps vary from 6 to 20 mm and measurement methods also vary from Brannock Devices and callipers to manual measurement.Conclusions: To prevent fit-related foot ulceration, we need to standardise our biomechanical definition of fit. Future research should (1) evaluate the potential use of 3D scanning technology to provide a standardised means of capturing foot morphology; (2) develop a working biomechanical definition of fit, including toe gap through the identification of key physiological markers that capture and predict dynamic foot shape changes during different physical activities and body weight loading conditions; and (3) determine whether changes in dynamic foot shape of those with diabetes differs from those without, impacting on their shoe fitting needs, potentially necessitating specialist footwear at an earlier stage to avoid ulceration. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyse the characteristics of patients, including demographics, medical history and treatment, with a diabetic foot ulcer (DFU) during their first follow-up visit to a general practitioner (GP). Methods: A two-part quantitative online questionnaire was distributed among GPs in France, UK, Germany and Spain. Part one entailed a survey of GPs' perceptions of referrals for DFU. Part two collected data on recently managed DFU cases. The percentage of responses was compared for each question and across the four countries for significant differences. Results: In part one of the study, 600 questionnaires were collected (150 per country) and 1188 patients managed for a DFU were included in the second part. About 88% of patients had type 2 diabetes, with a significant proportion of suboptimal control (average HbA1c: 10.64mmol/l). A patient complaint led to diagnosis in 60% of the cases. Wounds were found to be more frequently located in the toes and midfoot, and were superficial (according to the Texas Wound Classification system) in 80% of the cases. More than two-thirds of patients developed small wounds (<5cm2); more than half of them had infected wounds. Approximately 50% of wounds were ischaemic, which triggered the onset of a DFU. Follow-up wound examinations before and after hospitalisation were performed by nurses, except in Germany where GPs undertook this role, including prescribing offloading devices and in the UK where follow-up was managed by podiatrists. Ischaemia, wound necrosis, suspected osteomyelitis and absence of wound healing were the primary reasons for hospital admission during the first month after diagnosis. Conclusion: Delay in specialised foot care is a recurring topic in the treatment of DFUs, even with different health-care structures across Europe. Knowledge and education on DFUs should be reinforced among GPs and nurses to establish a global DFU care network between primary and specialised care, avoid hospitalisation and adequately manage high-risk patients. [ABSTRACT FROM AUTHOR]

Effective footwear and offloading interventions were recommended in the official guidance for diabetic foot (DF) management, where unfortunately the detail of shoes' definition was still unclear; meanwhile, in China, 0.1 billion population has been diagnosed with diabetes mellitus, but what kind of shoes worn by Chinese diabetic patients was unknown. Therefore, the aim of this study was to establish a system to quantify the comfortability of shoes among DF patients, and based on this method conduct a random survey of shoe wearing situation in diabetes population in Sichuan province. 472 participants joined in this study and their shoes were defined as structure of shoes, upper materials, status of welt, heel height and thickness of sole. Each part of shoes was first quantified into scores; and then aggregated scores were calculated as the final assessment result for the shoes. Three levels reflecting the recognition of shoes from patients were classified into: discomfort; moderate comfort; comfort. Finally, a univariate analysis with least significant difference (LSD) was exerted in shoe wearing comfort for variables of age, gender, BMI, occupation, history of diabetes mellitus and Michigan score. Results show that numbers of elder and male patients wear comfort shoes were more than that of female and younger ones; meanwhile, those findings were recorded to be significant. Overall, comfortability quantification system was established and both gender and age factors determined the consciousness and knowledge in shoe wearing; thereby, our system was valid and shoes wearing education for female and younger diabetic patients are urgent. [ABSTRACT FROM AUTHOR]

Gastrointestinal complications, including hemorrhage, can occur with intracranial lesions and after craniotomy. As early as the 19th century, surgeons were aware that brain tumors could cause gastric ulcers and acute perforations. Investigators used animal experiments both to reproduce these clinical observations and to seek ways to block the effects. Gastrointestinal lesions were seen as a result of the stress of acute brain injury or as a direct consequence of brain surgery. The thinking at the time was markedly influenced by the presumed stress and psychic factors proposed by Cannon. This historical vignette summarizes the major experimental works linking the brain with the stomach. [ABSTRACT FROM AUTHOR]

Abstract Background Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous cancer worldwide. Several tumour characteristics are considered to pose an elevated risk for systemic spread of carcinoma cells ('high-risk' features). Early detection of subclinical metastases could permit early treatment and improve overall survival. To detect occult metastases and evaluate risk of future distant metastases, diagnostic extirpation of the sentinel lymph node (SLNE) is routinely performed in cutaneous melanoma and can be offered in high-risk cutaneous squamous cell carcinoma (hrcSCC). However, the clinical utility of SLNE in patients with hrcSCC remains unknown. Material and methods An ambidirectional cohort study with prospective patient recruitment was performed. Between July 2008 and April 2017, of 139 eligible patients, SLNE was performed in 114 cases (25 patients refused). Median follow-up was 23.7 months. Results We analysed the characteristics of 114 patients with hrcSCC who underwent SLNE. Eighty-nine patients (78.1%) were men, and 25 patients (21.9%) were women (median age 72.2 years). In multivariable analyses, histopathological detection of ulceration (hazard ratio, HR 2.9 [95% confidence interval, CI 0.7–12.2]), perineural growth (HR 3.0 [95% CI 0.6–14.6]) and clinically occult SLN metastases (HR 10.7 [95% CI 1.9–60.6]) were strongly associated with future occurrence of distant metastases. A positive predictive value of 50% was noted for patients where SLN metastasis was detected to develop distant metastases. However, distant metastases also occurred in seven patients when histopathological SLN evaluation had shown no evidence of metastases. Conclusions Our data suggest SLNE is not a reliable diagnostic approach to evaluate the risk of future systemic carcinoma spread and development of distant metastases in patients with hrcSCC. Highlights • Cutaneous squamous cell cacrinoma (cSCC) is the second most common skin cancer after basal cell carcinoma. • The risk to metastasise is markedly elevated for cSCCs with a tumor depth > 4 mm, undifferentiated or perineural growth. • The value of sentinel lymph node ex in hrcSCCs is highly controversial. [ABSTRACT FROM AUTHOR]

Wound debridement is an integral part of wound management. A clinician's ability to assess the wound and select the proper debridement technique is as critical as addressing all aspects of wound management, including vascular assessment, offloading, infection control and selecting the appropriate wound dressing regimen. In this article, the authors aim to review the literature and evaluate outcomes of debridement methods for diabetic foot ulcers (DFUs). The authors hope this summary will serve as useful clinical practice review for clinicians managing DFUs and highlight conditions of the wound, patient and/or the modality that should be considered when selecting wound debridement techniques that could increase healing rates and improve outcomes. [ABSTRACT FROM AUTHOR]

Recent advances in technology have given us 3D printed footwear for marathon runners, along with insoles capable of measuring in-shoe temperature and pressure. Custom 3D printed biometric footwear for those with diabetes and neuropathy therefore seems a natural development but has yet to emerge. The authors discuss both the feasibility of developing a 3D printed shoe incorporating sensors to provide real-time microclimate data and some of the practical problems that remain, including a brief outline of recent advances in this field. [ABSTRACT FROM AUTHOR]

Objective: Oral ulceration with bone sequestration (OUBS) describes a site‐specific intraoral ulcer that covers exposed, non‐vital bone in patients lacking any etiological factor known to induce osteonecrosis. We aimed to conduct a retrospective study of eight new cases of OUBS and review the literature. Subjects and Methods: This is a retrospective study of OUBS cases, diagnosed and managed during 2007–2017. Inclusion criteria were the presence of oral ulcer with exposed non‐vital bone at sites of bone prominence and the absence of any factor known to cause osteonecrosis. The English literature was reviewed on original OUBS cases. Results: Eight patients (5 males and 3 females, aged 27–75 years) were diagnosed with OUBS during years 2007–2017. Four cases involved the mandibular mylohyoid ridge, one a mandibular anterior exostosis and three the maxillary buccal/palatal exostoses. Exposed bone was removed under local anesthesia, resulting in complete healing in all cases. The literature review yielded 32 OUBS cases in the mandible. Conclusion: Oral ulceration with bone sequestration is a distinct, probably under‐reported rather than rare clinical entity that should be regarded the provisional diagnosis in case of an oral ulcer covering exposed, non‐vital bone at sites of bone prominence in patients lacking any etiological factor known to induce osteonecrosis. [ABSTRACT FROM AUTHOR]

Behçet's disease is a chronic, relapsing, systemic infiammatory disease affecting the orogenital mucosa, eyes, joints, blood vessels, nervous system and intestines. The prevalence of neurological involvement varies geographically and can include psychiatric manifestations. Current evidence for a causal association between Behçet's disease and bipolar disorder is limited to a small number of case reports. We report a case of a patient with a recent diagnosis of bipolar disorder who was subsequently diagnosed with Behçet's disease. The 38-year-old male presented with a 6-month history of right eye visual blurring, 5-month history of mouth ulcers and 3 months of genital ulceration. His infiammatory markers were raised. An MRI of the brain was conducted in the absence of any focal neurological signs or symptoms owing to his past psychiatric history. The MRI showed changes in the medial aspect of the right temporal lobe highly suspicious of neuro-Behçet's disease. His inpatient care was coordinated with neurology, rheumatology, ophthalmology and psychiatry teams, and he was later discharged with outpatient follow up owing to a clinical improvement on high-dose steroids. This case shows that, although widely unrecognised, neuro-Behçet's can occur in the absence of focal neurology. Additionally, neuro-Behçet's should be considered in patients with bipolar disorder presenting with symptoms suggestive of Behçet's disease. The case emphasises how patients presenting with ulceration, mood disorder and visual changes should not have these symptoms considered in isolation and multisystem disease should be considered. Furthermore, the coordinated multidisciplinary approach required for the care of patients with Behçet's disease is demonstrated. [ABSTRACT FROM AUTHOR]

Periodontitis is a general term for diseases characterised by inflammatory destruction of tooth-supporting tissues, gradual destruction of the marginal periodontal ligament and resorption of alveolar bone. Early-onset periodontitis is due to disturbed neutrophil extracellular trap (NET) formation and clearance. Indeed, mutations that inactivate the cysteine proteases cathepsin C result in the massive periodontal damage seen in patients with deficient NET formation. In contrast, exaggerated NET formation due to polymorphonuclear neutrophil (PMN) hyper-responsiveness drives the pathology of late-onset periodontitis by damaging and ulcerating the gingival epithelium and retarding epithelial healing. Despite the gingival regeneration, periodontitis progression ends with almost complete loss of the periodontal ligament and subsequent tooth loss. Thus, NETs help to maintain periodontal health, and their dysregulation, either insufficiency or surplus, causes heavy periodontal pathology and edentulism.

Plantar ulceration is a serious complication of diabetes. However, the mechanism of injury initiating ulceration remains unclear. The unique structure of the plantar soft tissue includes superficial and deep layers of adipocytes contained in septal chambers, however, the size of these chambers has not been quantified in diabetic or non-diabetic tissue. Computer-aided methods can be leveraged to guide microstructural measurements and differences with disease status. Adipose chambers in whole slide images of diabetic and non-diabetic plantar soft tissue were segmented with a pre-trained U-Net and area, perimeter, and minimum and maximum diameter of adipose chambers were measured. Whole slide images were classified as diabetic or non-diabetic using the Axial-DeepLab network, and the attention layer was overlaid on the input image for interpretation. Non-diabetic deep chambers were 90 %, 41 %, 34 %, and 39 % larger in area (26,954 ± 2428 µm2 vs 14,157 ± 1153 µm2), maximum (277 ± 13 µm vs 197 ± 8 µm) and minimum (140 ± 6 µm vs 104 ± 4 µm) diameter, and perimeter (405 ± 19 µm vs 291 ± 12 µm), respectively, than the superficial (p < 0.001). However, there was no significant difference in these parameters in diabetic specimens (area 18,695 ± 2576 µm2 vs 16627 ± 130 µm2, maximum diameter 221 ± 16 µm vs 210 ± 14 µm, minimum diameter 121 ± 8 µm vs 114 ± 7 µm, perimeter 341 ± 24 µm vs 320 ± 21 µm). Between diabetic and non-diabetic chambers, only the maximum diameter of the deep chambers differed (221 ± 16 µm vs 277 ± 13 µm). The attention network achieved 82 % accuracy on validation, but the attention resolution was too coarse to identify meaningful additional measurements. Adipose chamber size differences may provide a basis for plantar soft tissue mechanical changes with diabetes. Attention networks are promising tools for classification, but additional care is required when designing networks for identifying novel features. All images, analysis code, data, and/or other resources required to replicate this work are available from the corresponding author upon reasonable request. • Septal chambers were 26–66 % larger in non-diabetic deep adipose compared to superficial. • Septal chambers were smaller in diabetic deep adipose than non-diabetic. • Axial-DeepLab attention was too coarse to direct research measurements. [ABSTRACT FROM AUTHOR]

Potassium channels and transporters maintain potassium homeostasis and play significant roles in several different biological actions via potassium ion regulation. In previous decades, the key revelations that potassium channels and transporters are involved in the production of gastric acid and the regulation of secretion in the stomach have been recognized. Drugs used to treat peptic ulceration are often potassium transporter inhibitors. It has also been reported that potassium channels are involved in ulcerative colitis. Direct toxicity to the intestines from nonsteroidal anti-inflammatory drugs has been associated with altered potassium channel activities. Several reports have indicated that the long-term use of the antianginal drug Nicorandil, an adenosine triphosphate-sensitive potassium channel opener, increases the chances of ulceration and perforation from the oral to anal regions throughout the gastrointestinal (GI) tract. Several of these drug features provide further insights into the role of potassium channels in the occurrence of ulceration in the GI tract. The purpose of this review is to investigate whether potassium channelopathies are involved in the mechanisms responsible for ulceration that occurs throughout the GI tract.

Methotrexate (MTX) is an antifolic drug used in the treatment of immune-mediated and neoplastic diseases. Initiation or dosage changes in MTX therapy can cause mucositis and bone marrow suppression. Skin lesions due to acute MTX toxicity are rare, but they serve as a herald for later-onset pancytopenia. Therefore, identification of those cutaneous lesions might help to initiate rescue strategies at an early stage. Here we describe a case with mucocutaneous ulcerations and pancytopenia due to overdosed MTX.

Mucosal and cutaneous ulceration as a result of nicorandil use is well described in the literature. Nicorandil induced penile ulceration is a rare clinical manifestation. Six cases arising from either the dorsal or lateral prepuce have been reported in current literature. We present a case of nicorandil induced penile ulceration affecting the dorsolateral prepuce and give an overview of the penile cutaneous circulation.

Lower GI bleeding is a common cause for hospitalization in adults. Medication-associated mucosal injury is an important clinical entity that can result in significant morbidity and mortality. We present the case of a 45-year-old woman with a 3-month history of intermittent abdominal cramping and rectal bleeding. Her medical history was extensive and included end-stage renal disease and a remote history of endometrial carcinoma that was treated with radiation. Initial workup was concerning for ischemic and radiation colitis, however, histology was most consistent with acute inflammation and ulceration associated with crystal fragments. Sevelamer and cholestyramine are commonly used ion-exchange resins that have been associated with mucosal damage. Both medications were discontinued and her symptoms resolved. Our case highlights an underrecognized but important cause of hematochezia.

Malignant syphilis is considered a rare disease, more commonly affecting individuals with poor immunity. We report a case of acquired immune deficiency syndrome (AIDS) with repeated crusted ulcerations. Our report shows the typical skin lesions of malignant syphilis and a reinfection with the same rashes. A 22-year-old homosexual male was admitted to hospital for fever and ulcerations with overlying brown–black rupioid crusts. Then he was confirmed human immunodeficiency virus infection. Malignant syphilis was diagnosed by positive markers and biopsy pathology. After application of benzathine penicillin for 3 weeks, the symptoms improved and rapid plasma regain (RPR) decreased from 1:64 to 1:4 in 8 months. But the patient appeared with rashes that was accurately the same with rashes before 13 months later, and RPR rose to 1:128, which was likely to be reinfection after frequent sexual activity. And he responded well to doxycycline treatment. Although the clinical manifestations of malignant syphilis are severe, the response to the therapy of penicillin and doxycycline are excellent, even with repeated infection. [ABSTRACT FROM AUTHOR]

Background: Oral ulceration can be experienced by anyone, including those who are elderly. Various trigger factors can occur in elderly patient, but the main thing to consider is the degenerative factors that affect the occurrence of some medical problems. Handling oral ulceration in elderly patients should be done carefully and holistically otherwise the improvement is only temporary and can reappear or even be worse. Purpose: In this paper we will discuss two different case reports of elderly female patients and both having some oral ulceration. Cases: First case of recurrent oral ulceration experienced by 58 years old patient, and second case is concerning a 77 years old patient with chronic oral ulceration and also having some medical problems. Aphthous like ulcers (ALU) is a diagnosis for recurrent oral ulceration associated with systemic condition, and usually started after adolescent age. Elderly or geriatric condition itself is a special condition that contribute to the degree of a disease. Cases management: Both patients given non pharmacology and pharmacology therapies. The non pharmacology therapy includes communication, information, and education, also oral hygiene instruction. Steroid as anti-inflammatory drugs had an important role in healing process, beside other medication. Conclusion: Oral ulceration in elderly patients with or without a medical problems becomes a challenging thing to handle due to the complexity of their condition. As a dentist we have more careful to arrange the treatment plans for elderly patients when combine with some therapy related systemic disease.

Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum. Rare in Europe but endemic in some regions of Brazil, United States, Africa and Asia. Most of the cases are asymptomatic. Disseminated form is defined by the presence of an extra-pulmonary focus, particularly associated with immunosuppression. We report a case of an unilateral persisted tonsillar ulceration, in an immunocompetent Portuguese host, as manifestation of disseminated African histoplasmosis 45 years later after living 3 years in Africa.

Nicorandil is a medication used for treatment and prevention of angina pectoris. Its mode of action involves both arterial and venous vasodilation. Although there are numerous known side effects, one of the more unusual, adverse reactions is ulceration of the external genitalia. This case reports the finding of penile preputial ulceration secondary to the use of Nicorandil. The authors make some recommendations for management.

L'hydrocèle est une accumulation de liquide entre les deux feuillets de la vaginale testiculaire. Elle peut être de très grande abondance. Elle demeure une pathologie fréquemment retrouvée en région tropicale. Nous rapportons un cas d'hydrocèle de très grande abondance avec épaississement de la vaginale chez un sujet âgé de 56 ans en zone sahélienne avec ulcération de la bourse. Il s'agit de Monsieur YM âgé de 56 ans ayant consulté pour grosse bourse avec une sensation de pesanteur, gênante à la marche, évoluant depuis un an environ avec une augmentation progressive du volume. À l'inspection, on retrouve une volumineuse bourse gauche avec une plaie de 3cm (A,B). Nous avions évoqué deux hypothèses diagnostiques, une hydrocèle volumineuse et une tumeur scrotale ulcérée. Une échographie des bourses réalisée a montré un épanchement de grande abondance dans la vaginale estimée à 3000ml avec un épaississement de la tunique vaginale dont le diamètre mesure 7mm. Le diagnostic d'hydrocèle unilatérale de très grande abondance fut retenu avec pachy-vaginalite. L'intervention chirurgicale a extrait 2,8L de liquide teinte (C) avec une suite opératoire favorable (D) sous triple antibiothérapie.

Koch’s bacillus infection is a rare cause of gastric ulcer. Gastric perforation associated with tuberculosis is extremely rarely presented as generalised peritonitis. A 39-year-old patient presented with epigastralgia with fever for one week. The physical examination found a generalised abdominal defense. Computed tomography evoked the diagnosis of perforated duodenal ulcer. The patient was operated and a suture excision of a perforated gastric ulcer was performed. The mesentery contained multiple lymph nodes. The small intestine was uniformly carded. The histopathological examination showed a gastric tuberculous ulcer. Acute peritonititis complicating tuberculous duodenal ulcer should be evoked especially in endemic area. Clinical history, abdominal CT scan results, and intraoperative exploration should suggest this diagnosis with therapeutic implications.

The nasopharyngeal bursa is an invaginated space that links the remnants of the notochord with the pharyngeal epithelium. Nasopharyngeal bursitis can occur in the midline of the upper portion of the nasopharynx if the notochord remnants and midline recess continue to persist. Nasopharyngeal bursitis, also known as Tornwaldt cyst, can be divided into cystic and crusting types. Crust types are relatively rare. Electrocauterization of the ulcerative lesion of the crust type is an effective and minimally invasive method. This report presents a case of crust-type nasopharyngeal bursitis that heals spontaneously without electrocauterization therapy. [ABSTRACT FROM AUTHOR]