Notes

[Introduction to forensic gerontology].
We describe a laparoscopic surgical technique using indocyanine green (ICG) fluorescence to identify and preserve rare arterial branching associated with pediatric congenital biliary dilatation. Congenital biliary dilatation with pancreaticobiliary maljunction was diagnosed in a 9-year-old girl, who presented with upper abdominal pain. Abdominal enhanced computed tomography (CT) showed that the accessory right hepatic artery (aRHA) branched from the posterior superior pancreaticoduodenal artery (PSPDA) and flowed through the right aspect of the dilated common bile duct (CBD) directly into the right lobe of the liver. We performed laparoscopic dilated biliary duct resection and hepaticojejunostomy, administering ICG intravenously, at a dose of 0.6 mg/kg. The ICG fluorescence overlay mode showed an aRHA running along the right side of the dilated CBD. The aRHA was dissected from the CBD without injury. After finishing the anastomosis, the beating of the aRHA was preserved, confirming that blood flow had been maintained.
To compare two prostaglandin analogs and two application intervals between mifepristone and the prostaglandin analog administration on the time to abortion in second trimester termination of pregnancy. Other endpoints were live birth rate and fetal lifetime after expulsion.

Retrospective data of 373 abortions performed were evaluated. Four medical induction subgroups and two feticide subgroups were considered. The definition criteria of the subgroups were the choice of administered prostaglandin analog (misoprostol vs. sulprostone) and the time interval between mifepristone and prostaglandin analog administration (48 vs. 24h). The outcome parameters were the time to complete uterine evacuation (TCUE), the live birth rate and duration of fetal life.

In the misoprostol subgroups, the median TCUE was 1.6h longer in the 24-h group than in the 48-h group (p=0.950). In the sulprostone subgroups, the median TCUE was 1.9h shorter in the 24-h group than in the 48-h group (p=0.950). The median TCUE was shorter for sulprostone than for misoprostol in all six subgroups (p<0.001). The rate of fetal live births ranged between 13.6and 15.9% within the medical induction subgroups (p=0.969). The median fetal lifetime was slightly shorter in the sulprostone groups than in the misoprostol groups (p=0.563).

Both application intervals and prostaglandin analogs are similarly effective. The therapy regime should be adapted to the personal preferences of the woman, the situational and clinical conditions.
Both application intervals and prostaglandin analogs are similarly effective. The therapy regime should be adapted to the personal preferences of the woman, the situational and clinical conditions.Purely prepontine arachnoid cysts not extending into the suprasellar region in neonates are rare. Herein, we report a purely prepontine arachnoid cyst in a neonate which caused central apnea and was successfully treated with microscopic cyst fenestration and C1 laminectomy.
In the paediatric age group, the overall degree of evidence regarding decompressive craniectomy (DC) and cranioplasty is low, whereas in adults, randomised controlled trials and prospective multicentre registries are available. To improve the evidence-based treatment of children, a consensus was reached to establish a prospective registry under the auspices of the European Society for Pediatric Neurosurgery (ESPN).

This international multicentre prospective registry is aimed at collecting information on the indication, timing, technique and outcome of DC and cranioplasty in children. The registry will enrol patients ≤ 16years of age at the time of surgery, irrespective of the underlying medical condition. The study design comprises four obligatory entry points as a core dataset, with an unlimited number of further follow-up entry points to allow documentation until adolescence or adulthood. Study centres should commit to complete data entry and long-term follow-up.

Data collection will be performed via a web-based portal (homepage www.pedccr.com ) in a central anonymised database after local ethics board approval. An ESPN steering committee will monitor the project's progress, coordinate analyses of data and presentation of results at conferences and in publications on behalf of the study group.

The registry aims to define predictors for optimal medical care and patient-centred treatment outcomes. The ultimate goal of the registry is to generate results that are so relevant to be directly transferred into clinical practice to enhance treatment protocols.
The registry aims to define predictors for optimal medical care and patient-centred treatment outcomes. The ultimate goal of the registry is to generate results that are so relevant to be directly transferred into clinical practice to enhance treatment protocols.A 42-year-old woman presented with multiple, discrete, symmetric hyperkeratotic papules and comedo-like lesions over the cheek and upper part of the back. These lesions first began to appear at the age of 20 years. Since then, new lesions have periodically appeared with spontaneous regression. Keratinous material could be extruded, leaving behind pock-like scars. The scalp, palms, soles, and mucous membranes were spared. Because the lesions were asymptomatic, the patient did not seek any treatment (Figure 1 and 2). (SKINmed. 2022;20152-153).Case 1 An 89-year-old obese Caucasian man with a history of coronary artery disease, hypothyroidism, and hyperlipidemia presented with herpes zoster on the lower back, and postherpetic neuralgia. The patient complained of significant pain and reported that he had been spending most of his day over the past few weeks in a seated position. (SKINmed. 2022;20149-151).A French (Caucasian) woman with a history of nonobstructive hypertrophic cardiopathy, type 1 diabetes mellitus, cataract, and ante-hypophysary insufficiency had undergone multiple magnetic resonance imaging (MRI) studies. She had developed end-stage renal disease (ESRD) and had undergone hemodialysis for 10 years before receiving a kidney-pancreas allotransplantation at the age of 48 years. She received antithymocyte globulins as induction immunosuppression and steroids (5 mg/d), mycophenolate mofetil (2 g/d), and tacrolimus (5 mg/d) as maintenance immunosuppression. Following transplantation, she underwent a cerebral MRI with injection of a gadolinium-based contrast agent (GBCA) in the work-up for Schwartz-Bartter syndrome. Shortly thereafter, she progressively developed cutaneous infiltration, sclerosis, and hyperpigmentation on her extremities and back (Figure 1), firm nodules on the thighs and the right hand, and confluent papules on the back, all of which were asymptomatic. She had no facial involvement,INmed. 2022;20145-148).A 40-year-old male, wrestler since 15 years of age presented with asymptomatic hyperpigmentation over both his both upper extremities for 10 years. There was no history of preceding itching or redness; of using a nylon brush, scrubbers, or sponges during bathing; or of excessive towel rubbing after bathing and applying cosmetics; however, he had been rubbing sand over both arms for 15 years. He had no personal or family history of atopy, diabetes, or thyroid disease. Cutaneous examination revealed the presence of symmetrical sharply defined reticulate brownish hyperpigmentation over both arms and favoring the left (Figure 1). Dermatoscopy revealed multiple uniform small brown fine streaks radiating from the center becoming reticulated (Figure 2). Hematologic and biochemical studies, in particular thyroid studies, were normal. Histopathologic examination revealed an amorphous eosinophilic deposit in the papillary dermis suggestive of macular amyloidosis (MA) (Figure 3). Methyl violet stain revealed amyloid positive areas (Figure 4), and a diagnosis of MA was made. With the cessation of the sand rubbing and the application of tacrolimus ointment (0.1%), the lesions slowly diminished. (SKINmed. 2022;20141-143).A 52-year-old woman with a 10-pack-year smoking history presented with serious hair loss. She had a 10-year history of Crohn's disease associated with arthritis, for which she had been taking adalimumab. After 2 months of this treatment, she developed pustular lesions on her palms, soles, and scalp. Her gastroenterologist discontinued adalimumab injections, ordered skin biopsy, and switched her to ustekinumab 90-mg subcutaneous injections every 8 weeks. She then presented to our dermatology clinic, 2 months following the initiation of anti-IL12/23 medications, for her alopecia. She had no personal or family history of psoriasis. (SKINmed. 2022;20136-138).Adverse reactions to drugs are a major concern in health, and children seem to be particularly vulnerable to these reactions. Cutaneous reactions account for 35% of the drug-related adverse effects in children. We conducted a retrospective study to characterize the pediatric population having a diagnosis of cutaneous adverse drug reactions (CADRs) in children admitted in a tertiary hospital during 6 years. (SKINmed. 2022;20126-129).Dermatology residents have 3 years to master core competencies related to the delivery of patient care, preservation of medical professionalism, and responsible use of health care; however, it is crucial for residents to recognize other things outside of their formal curriculum that are equally vital to their training. Over the years, we have observed residents and now offer our own perspectives. We have collectively observed five extracurricular aspects commonly overlooked by dermatology residents that are important to their education and future practice. (SKINmed. 2022;20123-125).The incidence rate of melanoma have risen constantly since the 1970s, mainly due to increased sun exposure and sun-tanning. Primary prevention remains the most effective manner of reducing the incidence rate of melanoma, but it is confronted with campaigns conveying a message that may cause concern during leisure and recreational activities. Other forms of primary prevention approaches need to be created. In this paper, an exploratory study of 20 Caucasian patients of a private dermatology practice tested the following hypothesis "How can scientific-driven art be used in the primary prevention of melanoma?" We attempted to raise patient awareness using PEAUrigami® educational-artistic compositions based on skin pattern paper, origami artwork. Two frames illustrating the pigmentary system and a melanoma were exhibited in the office of dermatologist. IKK16 The spontaneous reactions of the 20 patients collected by the dermatologist resulted in the co-creation of a final educational- artistic triptych for primary prevention of melanoma, with the dermatologist offering guidance to the artist. This triptych is now systematically used by the dermatologist with new patients at a private practice as an original and effective manner of primary prevention, as this instinctively produces emotions and feelings of danger through the limbic system. It reinforces the educational aspect of sun prevention and accentuates the contrast between "good" and "evil." Scientific-driven art such as PEAUrigami® can produce this type of conscious and subconscious emotions, especially when the vision of an artist is combined with that of a dermatologist. In the future, we trust that all forms of scientific-driven art forms could be a complementary method for the primary prevention of melanoma in private dermatology practice. We recommend dermatologists to try out these educational-artistic compositions by replacing decorative frames at their practices. (SKINmed. 2022;20115-120).
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