Nails, distorted [keywords]
- Lower limbs deformities in patients with McCune-Albright syndrome: Tomography and treatment. [Journal Article]
- Afr J Paediatr Surg 2016 Jul-Sep; 13(3):125-30.
The skeletal changes in McCune-Albright disease are usually severe because of the polyostotic form of the disease. Trendelenberg gait and limited mobility are the most common presenting features. The constellation of Café-au lait spots and polyostotic bone involvement is commonly referred to as McCune-Albright's syndrome (MAS).One boy and 4 girls (7-16 years) were sought in our departments from 1998 to 2012. Limb length discrepancy was the main clinical presentation. Repetitive micro-fractures caused the development of 'Shepherd crook' deformity with pain were the main burden.Because of the repetitive micro-fractures and the significant deformity that distorted the integrity of the long bones which were associated with pain. We referred to re-alignment valgus osteotomy with internal fixation to preserve proper alignment. Moreover, guided growth technique with 8-plates was performed in 1 case.Tendency to progressive unilateral lower limb deformity in patients with MAS is usually associated with thinning and expansion of the cortex and distortion of the normal lower limb integrity secondary to repetitive micro-fractures. The latter is a situation which warrants surgical treatment to re-align the deformity and to preserve function. Prophylactic intramedullary nailing via the application of locking nails to ensure stabilisation of the femoral neck was found to be effective. However, nevertheless, the mosaic nature of MAS means any cell, tissue and organ in any site of the body could be affected to varying degrees. The clinical manifestations are a diversity of the disorder ranging from mild clinical signs to severe life-threatening disease.
- Laser therapy for onychomycosis in patients with diabetes at risk for foot complications: study protocol for a randomized, double-blind, controlled trial (LASER-1). [Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't]
- Trials 2015.:108.
In a sham-controlled double-blind trial, we aim to establish the efficacy and safety of the local application of laser therapy in patients with diabetes, onychomycosis and risk factors for diabetes-related foot complications. Onychomycosis leads to thickened and distorted nails, which in turn lead to increased local pressure. The combination of onychomycosis and neuropathy or peripheral arterial disease (PAD) increases the risk of developing diabetes-related foot complications. Usual care for high-risk patients with diabetes and onychomycosis is completely symptomatic with frequent shaving and clipping of the nails. No effective curative local therapies exist, and systemic agents are often withheld due to concerns for side effects and interactions.The primary aim is to evaluate the efficacy of four sessions of Nd:YAG 1064 nM laser application on the one-year clinical and microbiological cure rate in a randomized, double-blind, sham-controlled design with blinded outcome assessment. Mandatory inclusion criteria are diagnosis of diabetes, risk factors for developing foot ulcers defined as a modified Simm's classification score 1 or 2 and either neuropathy or PAD. A total of 64 patients are randomized to intervention or sham treatment performed by a podiatrist.This study will be the first double-blind study that investigates the effects of local laser therapy on onychomycosis, specifically performed in patients with diabetes with additional risk factors for foot complications.Clinical trials.gov as NCT01996995 , first received 22 November 2013.
- The use of immunohistochemistry in the evaluation of the nail matrix in biopsies of ingrown toenails. [Journal Article]
- Rom J Morphol Embryol 2013; 54(2):253-9.
The success of surgical approaches to ingrown toenails depends on the extraction (either partial or total) of the nail matrix. The identification of the nail matrix in specimens taken from ingrown toenails is not always easy because of the fragmentation of the biopsies, difficulties in matrix orientations and the heavy inflammatory infiltrate. In biopsies taken from polydactyly surgeries, the matrix shows a peculiar pattern of expression of the CD10 and CD34 markers that differs from the one shown by the lateral nail fold. We investigated whether such a pattern was also found in biopsies from ingrown toenails, which can be greatly distorted through inflammation and fibrosis. We examined 15 biopsies from cases of ingrown toenails at different clinical stages. We performed routine Hematoxylin-Eosin studies, as well as immunohistochemical studies with CD10, CD34, HMB-45 and Melan-A. The morphologic changes in all cases were typical of those found in ingrown toenails and their intensities correlated with the clinical stages. Matrical keratinization was identified in all of the biopsies. Morphologic features that are compatible with the lateral nail fold were also seen in seven of the 15 biopsies. In five cases, an intermediate area of transition between matrix and lateral nail folds was heavily distorted by inflammatory changes. Melanocytic markers showed scattered intra-epidermal cells in all but one case. HMB-45 and Melan-A were equally good in demonstrating the melanocytic population. We concluded that the expression of CD10 and CD34 in cases of ingrown toenails is preserved and it follows the pattern described in nails from polydactyly. Therefore, both markers can be useful in fragmented specimens taken from surgeries for ingrown toenails, in order to confirm the removal of the nail matrix.
- Extended Neviaser portal approach to antegrade humeral nailing. [Case Reports, Journal Article]
- Orthopedics 2013 Feb; 36(2):e244-8.
Certain arthropathies can distort the normal acromiohumeral relationship and make traditional anterolateral access to the proximal humerus for nailing difficult or impossible. This article presents a case of bilateral antegrade humeral nailing in which the Neviaser portal approach was used for humeral shaft fractures in a patient with distorted shoulder anatomy secondary to severe cuff tear arthropathy and rheumatoid arthritis. Based on a literature review, extending the traditional superomedial (Neviaser) portal to the shoulder to perform humeral nailing has never been described clinically. An 85-year-old woman with rheumatoid arthritis and bilateral cuff tear arthropathy presented after a mechanical fall from standing height with bilateral acute humeral shaft fractures. Preoperative fluoroscopy confirmed the inability to access the traditional starting point with an anterolateral approach due to a shield acromion resulting from cuff tear arthropathy and rheumatoid arthritis. Bilateral locked antegrade humeral nails were successfully placed through a 3-cm incision just off the medial border of the acromion and directly posterior to the acromioclavicular joint (the extended Neviaser portal approach). Postoperatively, the patient demonstrated early evidence of clinical and radiographic union. She was able to return to her preinjury function level, with an active range of motion comparable with her baseline. The Neviaser portal approach to antegrade humeral nailing is an effective solution to diaphyseal humeral fractures when access to the traditional anterolateral proximal humeral starting port is not possible due to distorted shoulder anatomy.
- Cobblestone lissencephaly in Schinzel-Giedion syndrome. [Case Reports, Journal Article]
- J Child Neurol 2013 Feb; 28(2):259-63.
The brain of a 5-year-old boy with Schinzel-Giedion syndrome displayed a cobblestone appearance of orbital and lateral aspects of frontal lobes due to widespread glioneuronal meningeal heterotopia. Meningeal heterotopia consisted of scattered neurons, neurofilament positive axons, and myelinated fibers accompanied by striking astrocytic gliosis. The underlying cortex showed gaps in the pial basal lamina, distorted neuronal layering, and focal polymicrogyria. The number of capillaries appeared increased throughout the brain. Mild hydrocephalus was associated with a slight atrophy of corpus callosum as well as villous hyperplasia and marked stromal degeneration of the choroid plexus. Our findings suggest that Schinzel-Giedion syndrome may represent One more entity within enlarging spectrum of lissencephalic cortical dysplasia syndromes.
- Correction of pincer-nail deformities with autograft or homograft dermis: modified surgical technique. [Comparative Study, Journal Article]
- J Hand Surg Am 2005 Mar; 30(2):400-3.
The pincer-nail deformity is characterized by an excessively curved and distorted nail across the transverse dimension. Forty-nine sides (paronychial folds) were dissected off the distal phalanx periosteum with scissors and/or a small elevator. The dermis was placed between the paronychial fold and the plalanx to flatten the germinal and sterile matrix. Direct comparison of autograft dermis to homograft dermis did not show any significant differences in postcorrection appearance of the nail or relief of symptoms. Surgical time averaged 22 minutes less in those patients having reconstruction on both sides of one nail with homograft dermis.
- Superficial fungal infections in adolescence. [Journal Article, Review]
- Adolesc Med 2001 Jun; 12(2):v-vi, 213-27.
Cutaneous fungal infections occur frequently in the adolescent population, and are second only to acne in generating skin-related adolescent anguish. Though superficial fungal infections of the skin are rarely life-threatening, they can cause significant worrisome cutaneous findings (e.g., white spots from pityriasis versicolor, distorted nails from onychomycosis). Such changes are particularly threatening to an adolescent who wants to be just like everybody else. This article focuses on several of the more common cutaneous fungal infections in adolescence, including pityrosporum (tinea) versicolor and dermatophyte infections of the feet, groin, skin, and nails. The prevalence of each disease is discussed, along with its clinical presentation, differential diagnosis, and methods of treatment.
- Inhibitory effect of terbinafine on the invasion of nails by Trichophyton mentagrophytes. [Journal Article, Research Support, Non-U.S. Gov't]
- J Am Acad Dermatol 1995 Nov; 33(5 Pt 1):718-23.
Terbinafine has a broad spectrum of action in vitro and primary fungicidal action against many pathogenic fungi. Its mode of action against dermatophyte fungi in nail keratin is little understood.Our purpose was to determine the bioavailability of terbinafine in a nail fragment model.The effect of terbinafine on adherence and germination of arthroconidia of Trichophyton mentagrophytes on nail fragments was assessed by gross examination and light and electron microscopy.Preexposure of nail fragments to terbinafine concentrations (0.001 to 10 mg/L) inhibited fungal growth and acted as a barrier to dermatophyte invasion. Damaged arthroconidia and distorted hyphae on the surface of nail fragments were observed.This in vitro model provides an alternative system for studying the activity of antifungal agents in nail and demonstrates the morphologic changes in dermatophyte fungi after exposure to terbinafine.
- [Nail fold formation using a thenar flap in complete syndactylia]. [English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 1982 Dec; 14(4):199-203.
In complete syndactyly fingers are fused along their whole length and the nail is continuous over a narrow osseous bridge between the nail processes of the distal phalanges. When the fingers are separated there is no adjacent skin to form a lateral nail fold and, therefore, the finger end will become distorted. By using a thenar flap to the dorsal aspect of the syndactylic finger tips material is transferred to create normal lateral nail folds when the fingers are separated some months later.
- Management of painful toes from distorted toentails. [Journal Article]
- J Dermatol Surg Oncol 1979 Jul; 5(7):554-6.