Linear morphea presenting as acquired unilateral edema.

Linear morphea presenting as acquired unilateral edema.

Pediatr Dermatol. 2007 Mar-Apr

Fiala KH,
Wells MJ,
Mullinax KA,
Stetson CL,
Paulger BR.
Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.

We describe a 2-year-old African-American boy with a 4-month history of gradually worsening unilateral edema that was initially noted on his left hand and then approximately 2 weeks later on his left lower extremity. In addition, linear hypopigmented patches were noted along the left forearm and leg, with no appreciable scarring or induration. The edema on the left-hand side of his body progressed so that he developed tense bullae on his left hand.

Two months later, the hypopigmented patches were indurated and bound-down, especially over the left groin and thigh. A biopsy specimen from this area showed features characteristic of morphea. In this patient, dilated lymphatic channels secondary to the sclerosis of the morphea caused the bullae. Bullous morphea is a rare condition.

We were unable to find any reports its occurrence in children under 18 with associated lymphedema. This entity should be included in the differential for acquired unilateral edema in children.

PMID: 17461812 [PubMed - in process]

Two-year results of intravitreal triamcinolone acetonide injection for the treatment of diabetic macular edema.

Two-year results of intravitreal triamcinolone acetonide injection for the treatment of diabetic macular edema.

Batioglu F,
Ozmert E,
Parmak N,
Celik S.
Department of Ophthalmology, Faculty of Medicine, Ankara University, Mamak Street, Ankara, 06100, Turkey.

PURPOSE: To investigate 2-year results of intravitreal triamcinolone acetonide injection for the treatment of diffuse diabetic macular edema unresponsive to previous laser photocoagulation.

METHOD: The study included 75 eyes of 75 diabetic patients with clinically significant diffuse macular edema that had failed to respond to previous laser photocoagulation. An intravitreal injection of triamcinolone acetonide at the dose of 4 mg/0.1 ml was administered. Best-corrected visual acuity was measured as the logarithm of the minimum angle of resolution (logMAR), and central macular thickness was obtained by optical coherence tomography at each visit. Intraocular pressure and lenticular status were also evaluated. Differences among measurements were evaluated by Friedman two-way analysis of variance by ranks. Mean follow-up period was 24.7 +/- 5.9 months.

RESULTS: The mean central macular thickness, which was obtained 3 days, 1 month, 3 months, 6 months, 9 months, 12 months, 18 months and 24 months postoperatively, was significantly different from the baseline measurement (P <> 0.05). During the follow-up, 29 (38.7%) eyes received re-injection of intravitreal triamcinolone. Twenty-one (28%) eyes developed intraocular pressure values higher than 21 mmHg, and 18 (24%) eyes developed cataract. Thirteen (17.3%) eyes required cataract and/or glaucoma surgery.

CONCLUSIONS: In refractory diabetic macular edema, intravitreal triamcinolone effectively reduces foveal thickness and improves visual acuity in the short term, but with the extended follow-up, the number of recurrences and steroid-related complications were shown to increase. Nevertheless, it may be a therapeutic option in some patients that do not respond to previous laser photocoagulation.

PMID: 17453151 [PubMed - as supplied by publisher]

Breast cancer presenting as unilateral arm edema.

Breast cancer presenting as unilateral arm edema.
J Gen Intern Med. 2007 May

Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.

CONTEXT: Symptomatic arm lymphedema as the presenting symptom of invasive breast carcinoma is a rare occurrence.

DESIGN: We report a case of invasive breast cancer presenting with unilateral arm swelling. The patient was initially thought to have venous thrombosis. A thorough physical examination and a mammogram revealed the presence of breast cancer and associated subclinical axillary lymphadenopathy.

CONCLUSION: Failure to recognize this presentation can lead to misdiagnosis or a significant delay in diagnosis and treatment.

PMID: 17443377 [PubMed - in process]

Sudden Death in Toddlers with Viral Meningitis, Cerebral Edema, Lund Edema

Sudden Death in Toddlers with Viral Meningitis, Massive Cerebral Edema, and Neurogenic Pulmonary Edema and Hemorrhage: Report of Two Cases.
Pediatr Dev Pathol. 2007 Mar

Krous H,
Chadwick A,
Miller D,
Crandall L,
Kinney H.

Viral (lymphocytic) meningitis typically does not cause sudden death, especially in the absence of severe inflammation in the brain or other organs. We report two toddlers with clinical evidence of a viral infection who died unexpectedly and were found at autopsy to have lymphocytic meningitis associated with severe brain edema, transtentorial herniation, neurogenic pulmonary edema and hemorrhage, and cardiomegaly. Influenza A, demonstrated in tracheal epithelium by immunocytochemistry, is the presumed cause of the mild meningitis in one case; adenovirus was cultured from swabs of the brain and anus in the second case.

Current concepts of neurogenic pulmonary edema and acute cardiac dysfunction associated with intracranial disease are discussed in considering the mechanism of sudden death in these toddlers. These cases emphasize the possibility that mild intracranial viral infections may be a rare cause of sudden death via lethal cardiopulmonary complications. They also underscore the importance of a comprehensive autopsy, including detailed neuropathologic examination and viral testing, in determining of the cause of unexpected death in toddlers.

PMID: 17378656 [PubMed - as supplied by publisher]

Edema in the lower limb of patients operated on for proximal femoral fractures

Edema in the lower limb of patients operated on for proximal femoral fractures

J Trauma. 2007 Mar

Kazmi SS,
Stranden E,
Kroese AJ,
Slagsvold CE,
Diep LM,
Stromsoe K,
Jorgensen JJ.

BACKGROUND: Patients with proximal femoral fracture (PFF) often develop postoperative edema in the operated limb. This may lead to reduced mobilization, increasing the length of hospitalization. It is therefore relevant to gain information about the extent and pathogenesis of this edema formation.

METHODS: Forty-one patients with PFF (30 women and 11 men) were studied pre- and postoperatively. Patients were grouped into pertrochanteric fractures and femoral cervical fractures, according to the AO/ASIF classification of PFF. Thigh and calf volumes were calculated in both fractured and contralateral limbs preoperatively and on postoperative days 3, 5, 7, and 30.

RESULTS: All patients with PFF developed edema in the operated limb. The greatest volume increase occurred on postoperative day 7 (p <>

CONCLUSIONS: Postoperative edema in the thigh and leg of the operated limb was considerable. The magnitude of edema formation was related to the severity of primary trauma and the type of osteosynthesis. Therefore, the operation performed for PFF should be minimally traumatic.

PMID: 17414351 [PubMed - in process]

Dosimetric predictors of laryngeal edema.

Dosimetric predictors of laryngeal edema.

Int J Radiat Oncol Biol Phys. 2007 Mar 28

Sanguineti G,
Adapala P,
Endres EJ,
Brack C,
Fiorino C,
Sormani MP,
Parker B.
Department ofRadiation Oncology, University of Texas Medical Branch, Galveston, TX.

PURPOSE: To investigate dosimetric predictors of laryngeal edema after radiotherapy (RT).

METHODS AND MATERIALS: A total of 66 patients were selected who had squamous cell carcinoma of the head and neck with grossly uninvolved larynx at the time of RT, no prior major surgical operation except for neck dissection and tonsillectomy, treatment planning data available for analysis, and at least one fiberoptic examination of the larynx within 2 years from RT performed by a single observer. Both the biologically equivalent mean dose at 2 Gy per fraction and the cumulative biologic dose-volume histogram of the larynx were extracted for each patient. Laryngeal edema was prospectively scored after treatment. Time to endpoint, moderate or worse laryngeal edema (Radiation Therapy Oncology Group Grade 2+), was calculated with log rank test from the date of treatment end.

RESULTS: At a median follow-up of 17.1 months (range, 0.4- 50.0 months), the risk of Grade 2+ edema was 58.9% +/- 7%. Mean dose to the larynx, V30, V40, V50, V60, and V70 were significantly correlated with Grade 2+ edema at univariate analysis. At multivariate analysis, mean laryngeal dose (continuum, hazard ratio, 1.11; 95% confidence interval, 1.06-1.15; p < p =" 0.008)">

CONCLUSION: Laryngeal edema is strictly correlated with various dosimetric parameters; mean dose to the larynx should be kept

PMID: 17398024 [PubMed - as supplied by publisher]