Medicine
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Cutaneous presentation preceding acute myeloid leukemia (AML) is rare, and the prognosis is poor. ⋯ These findings suggest that skin infiltration of AML may precede any systemic evidence, and typical cutaneous lesions in elderly individuals may be indicative for AML.
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Livedoid vasculopathy (atrophie blanche) is a form of thrombotic vasculopathy. It is characterized by small ulcers that become crusted, and heal after several months to produce white atrophic scars. The most commonly affected sites are the lower legs, in particular the dorsum of the feet and ankles. ⋯ On histopathological examination, the central ivory white areas correlated with dermal fibrosis, the reticular pigmentation corresponded to epidermal basal layer hyperpigmentation or melanin within melanophages in the dermal papillae, and the vascular structures correlated with dilatation and proliferation of capillaries in the upper dermis. In summary, the most common dermoscopic features of livedoid vasculopathy identified in this study were central crusted ulcers or ivory white scar-like areas associated with peripheral reticular pigmentation and increased vascular structures. The characterization of dermoscopic criteria for livedoid vasculopathy may improve the accuracy in the clinical diagnosis and follow-up of this disease.
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Case Reports
A new method for selective reduction in TRAP sequence with a contraindication to fetoscopic surgery: A case report.
The preferred method for multifetal pregnancy reduction (MFPR) is a transabdominal intrathoracic or intracranial injection of potassium chloride (KCl). However, in monochorionic multiple pregnancies (MMPs), especially in monoamnionic multifetal pregnancies, selective feticide by this method is often associated with miscarriage of the remaining fetuses. Selective fetal reduction in MMPs by blood flow ablation using radiofrequency ablation or fetoscopic laser surgery may improve survival of the remaining fetus. Although often successful, MFPR by these methods is contraindicated in cases of twin reversed arterial perfusion (TRAP) sequence in triplet pregnancies complicated by polyhydramnios or anterior placenta, as it is difficult to locate the ablation target. ⋯ The new approach provided a safer, more accessible, and more cost-effective method for MFPR in MMPs with a contraindication to fetoscopic surgery compared to radiofrequency ablation and fetoscopic laser surgery.
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Observational Study
An independent evaluation on the interobserver reliability and intraobserver reproducibility of Toyama classification system for cervical dumbbell tumors.
Dumbbell tumors can not only cause the compression of cervical cord and nerve root, but also invade the important structures and the surrounding organs, causing great harm to the patient. Toyama classification that is commonly used has not been evaluated and still requires independent validation. The objectives of this study were to evaluate and analyze the interobserver reliability and intraobserver reproducibility of Toyama classification system, explore the differences, discover the shortages, and evaluate the clinical value for diagnosis. ⋯ This study shows that it has low reliability and reproducibility. Accordingly, surgical management of the resection of dumbbell cervical tumors raises several problems, including preservation of the cervical nerve root, control of the vertebral artery, and maintenance of spine. There is a need to optimize the classification in the future.
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Case Reports
Successful percutaneous stent implantation for isolated dismal transverse aortic arch kinking.
Isolated dismal transverse aortic arch kinking in adults is rare, and there is no recommended therapy at present. Percutaneous stent implantation may be an effective method to correct it and could be considered. ⋯ This case indicates that transverse aortic arch kinking in isolation can be well treated by percutaneous stent implantation in adult patients. Unlike pure aortic coarctation, elongation and bucking give the rise to the occurrence rate of stent sliding and migration and sometimes a second stent is needed.