Jeremy Tamir

Hard to heal pressure ulcers (stage III-IV): efficacy of injected activated macrophage suspension (AMS) as compared with standard of care (SOC) treatment controlled trial.

The objective of this study was to compare local injections of AMS with SOC treatments for stage III and IV pressure ulcers in elderly patients. It was designed as historically prospective 2-arms non-parallel open controlled trial, and conducted in a department of geriatric medicine and rehabilitation of a university affiliated tertiary hospital. We studied 100 consecutive elderly patients with a total of 216 stage III or IV pressure ulcers, 66 patients were assigned to the AMS group and had their wounds injected, while 38 patients were assigned to the SOC group. Primary outcome was rate of complete wound closure. Time to complete wound closure and 1-year mortality served as secondary outcomes. Statistical analyses were performed at both patient and wound levels. Percentage of completely closed wounds (wound level and patient level) were significantly better (p<0.001/p<0.001, respectively) in all patients in favor of AMS, as well as in the subset of diabetic patients (p<0.001/p<0.001). Similarly, AMS proved significantly better for the subset of those with leg ulcers and with baseline wounds ≤15 cm(2), compared with SOC. There were no statistically significant differences with regard to time to complete closure or 1-year mortality rates in the two groups. It is concluded that there is a significant difference in favor of stage III and IV wound closure rates by AMS, as compared with SOC treatments.

Myiasis with Lund's Fly (Cordylobia rodhaini) in Travelers

Myiasis is an infestation of human tissue by the larvae of certain flies. There are many forms of myiasis, including localized furuncular myiasis, creeping dermal myiasis and wound and body cavity myiasis.1 Cordylobia anthropophaga (the Tumbu fly) and Dermatobia hominis (the human botfly) are the most common causes of myiasis in Africa and tropical America respectively. The genus Cordylobia also contains two less common species, C. ruandae and C. rodhaini. The usual hosts of C. rodhaini are various mammals (particularly rodents), and and humans are accidentally infested. Figure 1 shows the life cycle of C. rodhaini, which occurs over 55 to -67 days.3 The female fly deposits her eggs on dry sand polluted with the excrement of animals or on human clothing. In about 3 days, the larva is activated by the warm body of the host, hatches and invades the skin. As the larva matures, it induces a furuncular swelling. In 12 to -15 days, the larva reaches a length of about 23 mm, exits the skin and falls to the ground to pupate. The adult fly emerges in 23 to -26 days, and the life cycle resumes. In humans, the skin lesion starts as a red papule that gradually enlarges and develops into a furuncle. In the center of the lesion an opening forms, through which the larva breaths and discharges its serosanguinous feces. The lesion is associated with increasing pain until the larva exits the skin. The disease is usually uncomplicated and self-limiting.

Breast augmentation with fresh-frozen homologous fat grafts.

Abstract. The purpose of this report is to present a patient who underwent breast augmentation with fresh-frozen fat homografts in Russia 10 years ago, despite the publication of major complications following this procedure.

A comparison between CO2 laser surgery with and without lateral fold vaporization for ingrowing toenails

Background: An ingrowing toenail is an excessive lateral nail growth into the nail fold. It acts as a foreign body and exerts a local pressure sore‐like effect, which may result in inflammation and granulation. Several treatment modalities exist, including chemical ablation and different surgical procedures. Here we describe and compare a simple and effective method of partial matricectomy using the CO2 laser (group A) versus a similar method with the addition of lateral nail fold vaporization (group B). Objective: Outcome evaluation of a modified laser treatment modality for ingrowing toenails and determination of the role of lateral fold vaporization in reducing the recurrence of symptoms. Methods: Forty patients (mean age 32.45 years) were treated with CO2 laser ablation of toenails between 1999 and 2005 by four physicians. One physician implemented a method that includes lateral nail fold vaporization and resection of the nail segment with its nail bed from 1999 to 2005. Three physicians implemented a similar technique but without lateral fold vaporization between 1999 and 2003, and added lateral fold vaporization to the performed procedure starting in 2004. Results: The recurrence rate was 37.5% in group A and 6.2% in group B. The overall average disease‐free follow‐up period was 42.2 months. Conclusion: The use of CO2 laser in the treatment of ingrowing toenails offers an effective modality. We demonstrate the importance of lateral fold vaporization with the CO2 laser both in improving efficacy and in decreasing recurrence rates over a long follow‐up period.

Galactorrhea complicating wound healing following reduction mammaplasty.

Galactorrhea complicating wound healing following reduction mammaplasty occurs rarely; only isolated cases have been reported in recent years. We report the case of a 25-year-old woman who presented with delayed healing and dehiscence of surgical wounds 3 weeks following vertical scar reduction mammaplasty. During surgical debridement, spontaneous discharge of milk in the wound was noted. Serum prolactin levels were high, and she was treated with carbegoline, a dopamine agonist, which suppressed the prolactin secretion and led to rapid cessation of lactation. A second debridement and delayed primary closure were performed to achieve a satisfactory postoperative result.

Necrotizing periorbital cellulitis following aesthetic rhinoplasty

Rhinoplasty is rarely complicated with infection. We present a case of necrotizing periorbital cellulitis that developed in an 18-year-old woman following aesthetic rhinoplasty. The clinical manifestations consisted of swelling of the eyelids and necrosis of the lower eyelid regions, accompanied by high fever. Streptococcus pyogenes was isolated from the wound. The patient responded well to administration of intravenous amoxycillin/clavulanate and conservative local treatment. The infection resolved uneventfully. At 2-year follow-up, the cosmetic result was excellent.