Skin Discoloration Research Articles

Validity of Kramer Scale in Neonatal Hyperbilirubinemia

Introduction: Jaundice refers to the yellow discoloration of sclera, skin and mucous membranes. It is a common problem that is faced during the first week of life by nearly every neonate. It is important to determine whether the clinical examination can be used reliably as a clinical screening tool for the diagnosis of neonatal jaundice. The diagnostic accuracy of Kramer’s rule was compared to venous method in this study in order to provide less invasive, time consuming and less painful method of measuring neonatal hyperbilirubinemia. Objective: To determine the diagnostic accuracy of Kramer’s rule of assessing neonatal hyperbilirubinemia taking serum bilirubin as “Gold standard”. Setting: New-born nursery at Paediatric Unit, Liaquat University Hospital, Hyderabad, Sindh. Design: Cross sectional validation study. Subject and Methods: A total of 317 neonates coming under inclusion criteria presenting at new-born nursery were examined. First, baby is undressed and clinical assessment of jaundice done. Then the venous blood sample was collected for serum bilirubin level and sent to diagnostic lab. Data was collected on predetermined pro-forma. Results: The average age of the neonate was 3.51±1.55 days. Sensitivity, specificity, positive predicted value, negative predicted value and accuracy of Kramer’s Rule in detection of neonatal hyperbilirubinemia was 90.7%, 80.5%, 88%, 84.6% and 86.75% respectively. Conclusion: Our study demonstrated that the Kramer’s scale could be better choice for detection and screening of neonatal hyperbilirubinemia. It is a non-invasive and quick method that can avoid babies from getting a skin infection or other complications related to blood sampling.

Toxicity Responses of the Fish Behaviour and Morphological Changes at Chromium Chloride in Hetropneustes fossilis

The current aquatic studies of toxicity of chromium chloride depond on biotic or abiotic factors i.e. temperature, concentration of Metal Salt Oxidation, PH, values, alkalinity, salinity and hardness of water. The experimental fish caused external behaviour responses observed were rest lessens, jumping, erratic swimming, gulping of air at the surface, loss of equilibrium sluggishness, opercular movements and fishes lied on the water surface before death and morphological changes like, discoloration of skin pigmented patches on body, shedding of scales sedimentation of chemical on body, mucous secretion and ballooning were observed in exposed animals the observed data shown the H. fossilis can be used as a good bio-indicator for heavy metal contamination in fresh water bodies.

Evaluation of the Reduction of Skin Hyperpigmentation Changes under the Influence of a Preparation Containing Kojic Acid Using Hyperspectral Imaging-Preliminary Study.

Aim: The aim of this study was to demonstrate the effects of using a preparation containing kojic acid on skin hyperpigmentation using hyperspectral imaging, which enables a quantitative assessment of the effect of the preparation used on the reduction of skin discoloration. Materials and methods: Preliminary studies were carried out on 12 patients with post-acne skin. A hyperspectral camera with a spectral range of 400-1000 nm was used to image skin hyperpigmentation before and after the application of 3% kojic acid. Hyperspectral profiles were analyzed, and image analysis and processing methods were applied. Results: Studies performed using a hyperspectral camera have shown that kojic acid reduces skin discoloration by increasing skin brightness in 75% of patients tested, reducing skin contrast in approximately 83% and increasing skin homogeneity in approximately 67% of patients.

MP36-06 COMPARISON OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM TO SURGERY FOR THE MANAGEMENT OF PEYRONIE’S DISEASE: A RANDOMIZED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP36-06 COMPARISON OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM TO SURGERY FOR THE MANAGEMENT OF PEYRONIE’S DISEASE: A RANDOMIZED TRIAL Jacob Warner, Benjamin Green, Joshua Savage, Klint Brearton, Matthew Ziegelmann, Sevann Helo, Tobias Kohler, and Landon Trost Jacob WarnerJacob Warner More articles by this author , Benjamin GreenBenjamin Green More articles by this author , Joshua SavageJoshua Savage More articles by this author , Klint BreartonKlint Brearton More articles by this author , Matthew ZiegelmannMatthew Ziegelmann More articles by this author , Sevann HeloSevann Helo More articles by this author , Tobias KohlerTobias Kohler More articles by this author , and Landon TrostLandon Trost More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since the FDA approval of Collagenase Clostridium Histolyticum (CCH) for the treatment of Peyronie’s Disease (PD), there has been significant debate as to its role and comparable efficacy in relation to surgical therapies. Specifically, investigators have compared relative utilization, costs, and outcomes with varying conclusions. The objective of the current study was to compare various objective and subjective outcome measures between men undergoing CCH or surgery for PD. METHODS: A randomized, controlled trial (NCT04786106) is ongoing. Participants are randomized 1:1 to receive either CCH + traction (RestoreX) + sildenafil or penile surgery (plication and/or incision and grafting) + traction + sildenafil for PD. Objective, standardized (International Index of Erectile Function [IIEF] and Peyronie’s Disease Questionnaire [PDQ]), and non-standardized assessments are obtained at baseline, and post-treatment at 3, 6, 12, 24, 36, 48, and 60 months. Key outcomes include differences in standardized questionnaires, penile curvature, penile length, subsequent interventions, and non-standardized questionnaire responses. Curvature is measured in two planes and summed to provide a composite curvature. Penile length is measured from pubic symphysis to corona. All therapies were stopped prior to the 3-month time point (i.e. traction and sildenafil). RESULTS: A total of 40 men have been randomized, with 3-month data available on 38 men (CCH=19, surgery=19). Mean age at enrollment was 54.9 years, PD duration 36.6 months (mo), composite curvature 72.3 degrees (deg), and penile length 12.7 cm. All baseline variables were statistically similar between cohorts. Regarding the primary outcome, post-treatment, CCH men reported higher overall satisfaction (3-months: 93.8% vs 84.3% surgery, p=0.16. For secondary outcomes at 3 months, the mean curve improvement was 83.7% vs 53.9% and length change -4.1% vs +6.3% for surgery versus CCH, respectively. The majority of adverse events were higher in the surgery cohort (p<0.01): pain 63% vs 6%, length loss 69% vs 20%, palpable lumps 42% vs 19%, sensation loss 58% vs 19%, and other 16% vs 6%. Skin discoloration was higher in the CCH cohort (6.3% vs 0%). CONCLUSIONS: Preliminary data suggests that when compared to surgery, CCH results in higher overall satisfaction (not statistically significant), decreased curve improvement, improved penile length, and fewer impacts on erectile function and sensation. Source of Funding: Endo Pharmaceuticals Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e481 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacob Warner More articles by this author Benjamin Green More articles by this author Joshua Savage More articles by this author Klint Brearton More articles by this author Matthew Ziegelmann More articles by this author Sevann Helo More articles by this author Tobias Kohler More articles by this author Landon Trost More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparative efficacy of ayurveda interventions Shwitrahara Lepa and Avalgujabeejadi Lepa in the Management of Shwitra (Vitiligo)

INTRODUCTION: Vitiligo is one of the major skin diseases affecting the normal pigmentation of the skin. It is an auto-immune disorder resulting in skin hypopigmentation due to reduced melanin production. In Ayurveda classical texts, the external application of Shwitrahara Lepa (SHL) and Avalgujabeejadi Lepa (AGL) is indicated for managing vitiligo. Hence, given literary indication, the present study was undertaken to evaluate the efficacy of SHL and AGL in managing vitiligo. MATERIALS AND METHODS: An open-label, parallel-group, randomized, controlled clinical study was conducted among 40 participants aged between 21 and 60 diagnosed with vitiligo. The participants were randomly assigned into two equal groups. Group A was treated by using an external application of SHL with water. Group B received AGL external application with cow urine. The external application of the interventions was done over the lesion once a day following early morning (7:00 a.m.) sunlight exposure for 15 min daily for 45 days. The effect of therapy was assessed through clinical parameters such as Vitiligo Area Scoring Index (VASI), pigmentation, margin, and the number of lesions along with classical symptoms of vitiligo, such as discoloration of the skin, reddish or coppery discoloration, skin dryness, burning sensation, itching, and thickening of the skin. RESULTS: The results of the study indicate that both SHL and AGL are significant in improving the score of VASI (P &lt; 0.001) and pigmentation and reducing the margin of the lesions compared to baseline. Significant reduction in skin dryness and itching was noted in both SHL (P = 0.004, P = 0.023) and AGL (P = 0.034, P = 0.009) groups. SHL also significantly reduced whitish skin discoloration and burning sensation (P &lt; 0.05). On comparing the effect of SHL and AGL, statistically nonsignificant results (P &gt; 0.05) were obtained for all the assessment parameters, indicating that both interventions are equally effective. No adverse drug reactions were noted. CONCLUSION: Both the formulations are equally effective.

Aesthetic Dermatology, The Rising Trend

Aesthetic Dermatology, also known as cosmetic dermatology provides treatment for skin, hair or body that emphasizes on improving an individual’s appearance. It is widely conducted to treat conditions such as moles, wrinkles, scars, excess fat, skin discoloration, skin laxity, and cellulite. Benefits such as minimally invasive or non-invasive and relatively less time-consumption with better outcomes has foster the patients to seek these treatments. With soaring demand for these treatments, numerous myths and misconceptions regarding the field of aesthetic dermatology have arisen which need to addressed. Also, this constantly evolving field with new devices and tools requires extra vigilance, continue medical education and a governing body to have check upon negligent professional activity, if occurs any

KRAMERS RULE AS A SCREENING TEST TO ASSESS NEONATAL HYPERBILIRUBINEMIA

Background: neonatal jaundice is a frequently encountered condition in the postnatal ward. If not treated properly, it can lead to permanent neurological sequelae. The gold standard investigation for diagnosis is total serum bilirubin (TSB)level. Transcutaneous bilirubinometers and visual assessment of cephalo-caudal progression of yellowish discoloration of neonatal skin by Kramers rule are commonly used non-invasive methods to predict jaundice. If correctly applied, these methods can help in minimising the number of blood samples to be drawn for TSB testing. Aims/Objectives:1. To assess the reliability of Kramers rule in predicting TSB in healthy neonates admitted in postnatal ward. 2. To assess theusefulness of Kramers rule in deciding which neonates require testing of TSB levels. Methods: This is a cross sectional study conducted on 100 healthy neonates admitted in the post-natal ward of a tertiary care hospital. Data was collected in pre-designed case record sheets. Sensitivity and specificity of Kramers rule in correct prediction of serum bilirubin was identified by using true and false outcomes. Results:The mean age at which neonates were examined was at 72 hours of life. 41% of the neonates were male and 59% were female.79% of the total babies were born via normal vaginal delivery and 21% via caesarean section.The sensitivity of Kramers rule in predicting serum bilirubin levels was 83.33% with a specificity of 54.55% (P value 0.015). Conclusion: Kramers rule is a fairly reliable method for predicting serum bilirubin levels and can help in avoiding unnecessary blood testing in neonates, especially in resource limited settings where such facilities might not be available.

Design and Characterization of Nanoflowers-based Biosensor for Estimation of Bilirubin in Jaundice.

Nanoflowers (NFs) are flower-shaped nanoparticulate systems with a higher surface-to-volume ratio and good surface adsorption. Jaundice indicates yellow discoloration of skin, sclera, and mucus membrane and is a clinical indication of bilirubin accumulation in the blood which occurs as a consequence of the incapability of the liver to excrete bilirubin in the biliary tree or conjugate bilirubin and higher production of bilirubin in the body. Several methods have been developed so far for bilirubin estimation in jaundice like the spectrophotometric method, chemiluminescence method, etc., but biosensing methods provide advantages over traditional methods concerning the surface area, adsorption, particle size, and functional characteristics. The primary objective of the present research project was to formulate and examine the adsorbent nanoflowers-based biosensor for accurate, precise, and sensitive detection of bilirubin in jaundice. The particle size of adsorbent nanoflowers was found to be in the range of 300-600nm with the surface charge (zeta potential) in the range of -1.12 to -15.42 mV. Transmission electron microscopy and scanning electron microscopy images confirmed the flower-like morphological structure of adsorbent NFs. The adsorption efficiency of NFs for bilirubin adsorption was maximum at 94.13%. Comparative studies of bilirubin estimation in the pathological sample with adsorbent NFs and diagnostic kit displayed bilirubin concentration to be 1.0 mg/dL in adsorbent nanoflowers and 1.1 mg/dL with diagnostic kit indicating effective detection of bilirubin with adsorbent NFs. The nanoflower-based biosensor acts as a smart approach to elevate adsorption efficiency on the surface of nanoflower due to a higher surface-to-volume (SV) ratio. Graphical Abstract.

Skin discoloration and softening are the primary factors impacting postharvest quality of hot water-treated mango (Mangifera indica L.)

About 85 to 90% of mangos imported to the United States from Mexico are hot water-treated (HWT). Mango chilling injury (CI) disorder limits prolonged low-temperature storage and affects the ability of shippers to transport mangos over long distances. Imported mangos display various CI symptoms that influence fruit postharvest quality, such as grayish, scald-like skin discoloration, lenticel spotting, skin pitting, loss of flesh color and flesh browning. There is limited information available on the interaction between harvest maturity, temperature and duration of exposure and their effects on postharvest life. We examined the relationship between cultivar, maturity stage at harvest, shipping temperature, and shipping duration of HWT mangos; the onset and severity of CI incidence, along with impact on consumer quality, and used the data to predict shipping-distribution postharvest life. Among the tested cultivars, ‘Tommy Atkins’ showed high incidence of skin damage (41%) after 10 days of cold storage, among all temperatures and maturity stages. Skin damage was the main barrier affecting postharvest quality. Within 24 days of simulated shipment, ‘Tommy Atkins’ showed a minimum of 11% incidence of flesh damage among temperatures and maturity stages. The onset of flesh damage occurred much later than skin damage and its incidence was low and manageable by selecting cultivar, harvest maturity and temperature during shipment to prolong postharvest life.To avoid CI during transportation and assure high consumer quality, HWT mangos should be transported at ≥ 10.0 to 12.5 °C. However, softening and decay incidence may become a problem during distribution at the destination. Therefore, improved packaging to protect soft mangos during handling at the receiving end and consumer educational programs are critical.

Frequency of common bile duct strictures in patients presenting with obstructive jaundice in Ayub teaching hospital

Background; Obstructive jaundice in simple terms means the outflow of bile has been obstructed anywhere from the liver to the duodenum. It is caused by obstruction, blockage and/or compression of common bile duct (CBD) and/or biliary tract that leads to incomplete excretion of bile into the intestine. Patients with obstructive jaundice usually present with Complains of abdominal pain, yellow discoloration of skin and/or eyes, pale stools, dark colored urine, nausea, vomiting and pruritus. Objective: To determine frequency of common bile duct strictures in patients presenting with obstructive jaundice in Ayub teaching hospital. Material and Method. This Cross Sectional Study was conducted in the department of Gastroenterology, ATH, Abbottabad from 15th September 2020 to 15th March 2021. A total of 135 patients of both gender presenting with jaundice and having serum bilirubin ≥1.1 mg/dl, alkaline phosphatase ≥140 IU/L along with evidence of obstruction of common bile duct were included in the study. Presence of CBD stricture was confirmed through Ultrasonography or CT abdomen. Results: Age range in this study was from 20 to 80 years with mean age of 44.651±12.90 years. Female gender was dominant with 61.5% patients. Common bile duct strictures was seen in 9.6% patients.

Sulfaquinoxaline Toxicosis in a Juvenile Broiler Breeder Flock.

A flock of 50,000 28-day-old broiler breeder chickens experienced an elevated mortality event. Chickens from that flock, five pullets and six cockerels, were submitted for diagnostic investigation. Necropsy revealed bacterial septicemia with fibrinous polyserositis in the majority of the birds while two cockerels had coccidial typhlitis. Because sulfadimethoxine was not available at the time, sulfaquinoxaline (SQ) was prescribed at label dosage with water treatment for 2 days, followed by 3 days of no medication, followed by 2 days of medication. The mortality rose dramatically 9 days after the last treatment. Lesions at that time consisted of skin discoloration, subcutaneous petechiation, and enlarged pale kidneys. Mortality remained elevated for 14 days. Analysis of blood, kidney, and liver revealed elevated levels of SQ. Recalculation of dosage, water consumption, amount of drug administered, remaining drug stock, and concentration of supplied SQ were analyzed and determined to be as predicted.

Anionic competition on arsenate removal by modified granular ferric hydroxide adsorbent

The presence of inorganic forms of arsenic in water causing a serious threat to human health. Exposure of arsenic can cause serious diseases such as skin discoloration, cancer of skin, kidney and lung, blood vessel diseases, high blood pressure, and reproductive disorders. Removal of arsenic to provide safe drinking water was conducted to investigate the effects of individual and combined anions (sulphate, nitrate, phosphate, and chloride ions) on the arsenate adsorption capacity of modified granular ferric hydroxide adsorbent in batch experiments. The observed adsorption data fit the Langmuir model well. The presence of sulphate (400 mg/l), nitrate (15 mg/l), and chloride (250 mg/l) ions did not significantly affect the arsenate adsorption and the maximum adsorption capacity of arsenic was reduced by less than 5%. In contrary, phosphate ions showed strong competition for the adsorption process as the maximum adsorption capacity of the material was reduced by 59.8 and 73% at concentrations of 0.2 and 0.5 mg/l, respectively. The results also showed that phosphate anions were slightly preferable than arsenate in their competitive adsorption by the adsorbent.

Gangrene as a rare manifestation of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic, multifaceted autoimmune inflammatory disease that can affect any part of the body. Peripheral gangrene is a rare manifestation of SLE. We describe a case of 26-year-old female who presented with complaints of bilateral lower limb rash, blackish discoloration of skin over right little finger and right third toe for past 2 months. On evaluation her anti RNP, anti SM and anti dsDNA antibodies were strongly positive. She was treated with IV unfractionated heparin, IV corticosteroids, IV antibiotics and other supportive measures.

Early Skin Temperature Characteristics of the Kennedy Lesion (Kennedy Terminal Ulcer)

BACKGROUND: Pressure injuries are associated with skin temperature changes, but little is known about skin temperature characteristics of the Kennedy Lesion (KL). PURPOSE: The purpose of this study was to describe early skin temperature changes in KLs using long-wave infrared thermography. METHODS: KLs were identified from chart review in 10 ICU patients. Skin assessments were performed within 24 hours of new skin discoloration. Temperature measurements were performed using a long-wave infrared thermography imaging system. Relative Temperature Differential (RTD) between the discolored area and a selected control point was calculated. RTDs of &gt; +1.2 °C and &lt; -1.2 °C were considered abnormal. Demographic data and observable characteristics of the KL were collected when available. Descriptive statistics (Mean +/- SD; %) were used. RESULTS: The major finding of this study was that there were no early skin temperature differences between the KLs and surrounding skin. CONCLUSION: The early stage of the KL may be limited to microvascular injury which results in a normal skin temperature. More studies are needed to verify this finding and to ascertain whether KL skin temperature changes over time. The study also supports the bedside use of thermography in skin temperature assessment.

Examining Violaceous Skin Discoloration during the COVID-19 Pandemic: Conducting Research in Resource Scarcity.

To describe the observed patterns and presentations of violaceous discoloration that appeared to be related to the COVID-19 disease process. This retrospective observational cohort study included adults who were COVID-19 positive with purpuric/violaceous lesions in pressure-adjacent areas of the gluteus without preexisting pressure injury. Patients were admitted to an ICU at a single quaternary academic medical center between April 1 and May 15, 2020. Data were compiled by review of the electronic health record. The wounds were described by location, tissue type (violaceous, granulation, slough, eschar), wound margin (irregular, diffuse, nonlocalized), and periwound condition (intact). A total of 26 patients were included in the study. Purpuric/violaceous wounds were found predominantly on White (92.3%) men (88.0%) aged 60 to 89 years (76.9%) with a body mass index 30 kg/m2 or higher (46.1%). The majority of wounds were located on the sacrococcygeal (42.3%) and fleshy gluteal regions (46.1%). Wounds were heterogeneous in appearance (poorly defined violaceous skin discoloration of acute onset), and the patient population had clinical characteristics similar to acute skin failure (eg, concomitant organ failures and hemodynamic instability). Additional larger population-based studies with biopsies may assist in finding patterns related to these dermatologic changes.

Successful management of severe hypertriglyceridemia in a neonate with apolipoprotein A deficiency; a case report with literature review

Introduction: Reports regarding severe neonatal hypertriglyceridemia are scarce, and there is no consensus regarding its management. This report describes the successful management of a neonatal case of hypertriglyceridemia managed successfully. Case report: A 2-day-old male neonate born to consanguineous parents presented with yellow skin discoloration. The mother had moderate hypertriglyceridemia. While testing for jaundice, the neonate’s blood was noticed to be milky. Blood lipid profile test showed highly elevated triglyceride (1,000-10,000 mg/dl), very-low-density lipoprotein level (1,800 mg/dl), and low-density lipoprotein (206 mg/dl) levels, and a low level of high-density lipoprotein (12 mg/dl). Further laboratory diagnosis revealed apolipoprotein A1 deficiency (39 mg/dl). The patient was put on a statin tablet of 0.25 mg twice daily and a formula diet (Monogen – Nutricia) low in triglycerides and rich in medium-chain triglycerides, and was given 1 ml Omega-3 syrup twice daily. After a dramatic decline in serum level, he was put on a 50% medium-chain-triglyceride formula and Gemfibrozil triglyceride-lowering agent. Conclusion: Early diagnosis of severe hypertriglyceridemia in the neonatal period aids in the early initiation of treatment and prevention of severe complications. Conservative treatment via dietary modifications and supplementation can be associated with satisfactory outcomes.

Type 1 Hemochromatosis: A Review of the History, Inheritance and Treatment of Iron Overload Disorder

Hereditary hemochromatosis (also known as type 1 hemochromatosis, iron overload disorder, or the Celtic Curse) is a genetic disorder characterized by an autosomal recessive inheritance pattern. This review project focused on gathering comprehensive data about the history, causes, inheritance, diagnosis, and treatment of iron overload disorder. Through such research, it was discovered that type 1 hemochromatosis may occur due to one of two nucleotide sequence changes (either the C282Y mutation or the H63D mutation) in the HFE gene, which codes for the construction of the homeostatic iron regulator protein and regulates production of the hormone hepcidin. As a result of these mutations, individuals affected by hemochromatosis have elevated iron levels and excess deposits of iron in tissues and organs. Such deposits may cause a variety of symptoms and complications, including fatigue, skin discoloration, heart failure, cirrhosis, liver cancer, and diabetes. Hemochromatosis is one of the most common genetic disorders in the world, affecting one in every three hundred individuals. The majority of hemochromatosis patients are of northern European descent. Currently, there is no cure for type 1 hemochromatosis; however, the primary treatment method for this disorder is phlebotomy. Due to the widespread prevalence of the disorder, researchers continue to explore experimental treatment methods, including gene therapy and iron chelation therapy.

Our Experience at Tertiary Medical College: Comparative Study Between Surgical Deroofing with Buttoning Technique and Posterior Cartilage Window with Pressure Gauze Dressing Technique in Patients with Pseudocyst of Pinna.

Our Experience at Tertiary Medical College: Comparative Study Between Surgical Deroofing with Buttoning Technique and Posterior Cartilage Window with Pressure Gauze Dressing Technique in Patients with Pseudocyst of Pinna.

Transoral Thyroidectomy: Initial Results of the European TOETVA Study Group

BackgroundThe aim of this study was to evaluate a new surgical technique by the European Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Study Group.MethodsThis study included 391 patients (47 [(12%]) male and 344 [(88%)] female) who had undergone endoscopic thyroid or parathyroid surgery via the vestibular approach between February 2016 and May 2022 at nine centers. The data were analyzed with regard to complications, surgery time and specimen retrieval.ResultsOverall, 376 (96.2%) TOETVA and 15 (3.8%) transoral endoscopic parathyroidectomy vestibular approach interventions were performed with an average surgery time of 145 (± 61.2) minutes and 509 nerves at risk. The specimens were retrieved via a transoral vestibular and retroauricular approach in 66 (16.9%) patients and via a transaxillary approach in 8 (2%). Benign histology including Grave’s disease was identified in 272 (69.6%) patients, 1 (0.3%) presented noninvasive follicular thyroid neoplasms with papillary-like nuclear features, and 103 (26.3%) showed differentiated thyroid carcinoma. Solitary parathyroid adenoma were removed in 15 (3.8%) patients. Conversion to open surgery was necessary in 13 (3.3%) and revision had to be performed in 2 (0.5%) patients. Transient recurrent laryngeal nerve palsy (RLNP) was present in 18 (4.6%) and permanent RLNP in 2 (0.5%) patients. Fifteen (3.8%) patients experienced transient hypoparathyroidism after thyroidectomy. No case of permanent hypoparathyroidism was observed. Postoperative surgical site infection occurred in 1 (0.3%) patient. Despite a higher rate of sensory and motor disorders and skin discoloration at discharge, permanent disorders were present in only 3 (0.8%) and 16 (4.1%) patients, respectively.ConclusionOur results show that transoral endoscopic surgery, performed by experienced endocrine surgeons, is a safe alternative to conventional thyroid surgery.

Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management.

Stasis dermatitis is a chronic inflammatory skin disease of the lower extremities. It typically occurs in older individuals and is the cutaneous manifestation of venous hypertension caused by venous reflux. Such retrograde venous blood flow is the result of incompetent venous valves, valve destruction, or venous obstruction. Stasis dermatitis is eczematous. The associated impairment of venous valves may cause swelling of the legs, leading to serious conditions including venous ulcerations. Diagnosis can be challenging because of its clinical resemblance to other skin conditions and poor clinical recognition by physicians. The cornerstones of stasis dermatitis treatment are compression therapy to ameliorate pain and swelling, topical treatments to alleviate secondary skin changes, and interventional treatment options to correct the underlying causes of venous reflux. Given the central role of inflammation of the lower extremities in driving the cutaneous changes characteristic of stasis dermatitis, new therapeutic approaches that target the inflammation are under clinical evaluation in patients with stasis dermatitis.