1/12. Postoperative pressure-induced alopecia: report of a case and discussion of the role of apoptosis in non-scarring alopecia.We report a case of postoperative pressure induced alopecia in a 21-year-old black female after multiple intraoperative procedures. The histopathology is distinctive and demonstrated features in common with trichotillomania and alopecia areata, including the presence of pigment casts, catagen follicles, melanophages and apoptotic bodies. External hair manipulation is considered the primary event in the etiology of pigment casts, however, our present case demonstrated numerous pigment casts despite a complete lack of evidence of external hair manipulation. We performed pattern analysis and in situ end-labeling in 19 cases of non-scarring alopecia. Pigment casts were seen in postoperative alopecia (1 case), alopecia areata (1 case) and trichotillomania (5 cases). These forms of alopecia have in common the sudden termination of the anagen phase of the hair cycle. When the anagen portion of the hair cycle is prematurely disrupted hairs enter into catagen. Pigment casts may represent a non-specific reaction pattern of follicles that are suddenly transformed from anagen to catagen. We therefore propose that hair manipulation is not uniquely responsible for the formation of pigment casts. The primary pathophysiology resulting in the formation of pigment casts more correctly reflects the sudden termination of the anagen phase of the hair cycle.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
2/12. Asymptomatic chronic intestinal ischemia caused by idiopathic phlebosclerosis of mesenteric vein.Phlebosclerosis of the mesenteric vein is a rare condition causing chronic intestinal ischemia, it has only been reported in japan. A 56-year-old man with liver cirrhosis and hepatic tumor presented with phlebosclerosis of mesenteric vein without any abdominal symptoms. He was admitted for examination of suspected hepatic tumor. Abdominal plain x-ray films and computed tomography revealed calcification of the mesenteric vein. barium enema revealed narrowing and thumbprinting from the cecum to transverse colon. On colonoscopic examination, blue-black vessels were visible in the terminal ileum, and hyperemic nodular mucosa with small irregular ulcers surrounded by dark purple mucosa was found from the cecum to transverse colon. The etiology of mesenteric vein phlebosclerosis is unknown, although a physical mechanism rather than inflammatory changes appear to be involved in this rare and usually progressive condition of chronic intestinal ischemia.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
3/12. necrosis of the eyelids and sclera after retrobulbar anesthesia.A 52-year-old man had loss of vision and black discoloration of the lids of the right eye after a retrobulbar injection of 3 mL lidocaine hydrochloride 2% (Xylocaine). Examination of the right eye revealed no light perception with extensive necrosis of the lids. Anterior segment examination revealed conjunctival pallor, corneal edema, and necrosis of the sclera. This is a previously unreported complication of retrobulbar anesthesia comprising ophthalmic artery occlusion with scleral melt, ocular ischemia, and eyelid necrosis.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
4/12. Severe ischemia of the glans penis following circumcision: a successful treatment via pentoxifylline.Severe ischemia or necrosis of glans penis is rare. We report the case of an 11-year-old boy with severe glanular ischemia occurring 24 h after circumcision. This was successfully treated with pentoxifylline injection for 5 days, and while the black color of the glans penis changed to brownish at 48 h, appearances were close to normal at 5 days. The patient did not require any surgical intervention, and was discharged without sequelae. We suggest that pentoxifylline might be considered as a treatment of choice for severe ischemia of glans penis.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
5/12. Mononeuropathy in sickle cell anemia: anatomical and pathophysiological basis for its rarity.Peripheral neuropathy is a rare complication of sickle cell disease. We report a young black woman with sickle cell anemia who developed a proximal median mononeuropathy in the setting of sickle cell crisis. The clinical and electrodiagnostic features are consistent with an ischemic mechanism from the sickling process. The pathophysiological basis for the rarity of this complication may be related to the rich anastomotic microvasculature of peripheral nerve and the unique large size of the capillaries of this vascular network.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
6/12. Anterior segment ischemia: a complication of retinal detachment repair in a patient with sickle cell trait.Anterior segment ischemia (ASI) is a dreaded complication of retinal detachment surgery particularly in patients with predisposing factors such as sickle cell disease. We report a case of ASI after scleral buckling in an otherwise healthy black patient with sickle cell trait. Conditions of relative hypoxia intraoperatively from either anesthesia or surgical manipulation may precipitate vasoocclusive phenomena in these normally asymptomatic patients. Since the incidence of sickle cell trait in the black population in the united states is 8.5%, we recommend these patients have a preoperative sickle test followed by hemoglobin electrophoresis with quantification if positive. The presence of sickle cell trait should alert the surgeon to the risk of ASI, and factors predisposing to hypoxia should be minimized when possible.- - - - - - - - - - ranking = 2keywords = black (Clic here for more details about this article) |
7/12. Embolic anterior ischemic optic neuropathy.The presumed cause of anterior ischemic optic neuropathy is atherosclerotic vascular changes. Small-vessel occlusive vascular disease most likely causes occlusion of one or more posterior ciliary arteries, compromising blood flow to the optic nerve head and choroid. We present the case of a 59-year-old black man with cholesterol emboli within the retinal vasculature combined with a clinical picture of anterior ischemic optic neuropathy and choroidal nonperfusion demonstrated by i.v. fluorescein angiography. We believe this is evidence that, in a rare case, embolic phenomena may be the cause of anterior ischemic optic neuropathy.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
8/12. Dissecting hematoma presents as acute lower limb ischemia: diagnostic patient profile and management.Three unusual cases with dissecting hematoma of the thoracic aorta, presenting solely with unilateral ischemia of the right lower extremity, are described. The world literature is reviewed. We present the following patient profile to facilitate the diagnosis: (1) hypertensive middle aged black male, or (2) young white male with stigmata of Marfan's syndrome, both complaining of sudden unilateral ischemia of the right lower extremity. Common causes of acute arterial occlusion are absent. The diagnosis, once suspected, must be confirmed by immediate angiography before planning the treatment for the limb ischemia. We advocate femoro-femoral bypass to relieve acute limb-threatening when definitive management involves delay in scheduling or requires transfer to another institution.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
9/12. Reversal of retinal and optic disc ischemia in a patient with sickle cell trait and glaucoma secondary to traumatic hyphema.A 14-year-old black boy with sickle cell trait, who sustained a traumatic hyphema, developed moderately elevated intraocular pressure that failed to respond to carbonic anhydrase inhibitors and osmotic agents. On the tenth postinjury day, a sudden increased cupping of the optic disc and partial central retinal artery obstruction caused painless loss of vision. Reversal of the cupping, the retinal ischemia, and the intraocular pressure was documented following anterior chamber paracentesis, and visual acuity returned to 6/6. Pathophysiology of the posterior ischemia is discussed. This case documents the potentially debilitating course of traumatic hyphema in "benign" sickle cell trait and its avoidance with proper management. The authors endorse recent suggestions for careful observation of any sickle cell patient with traumatic hyphema, and recommend anterior chamber paracentesis, supplemental oxygen, and avoidance of osmotic agents, if secondary glaucoma develops following the initial trauma.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
10/12. Retrobulbar ischemic optic neuropathy associated with sickle cell disease.A 52-year-old black man with a history of sickle cell SS disease presented with sudden loss of vision in his right eye. Examination of the right eye revealed no light perception and an amaurotic pupil, but an otherwise normal neuro-ophthalmic examination. On initial presentation, there was no evidence of an acute vascular event on funduscopy. Computed tomography failed to demonstrate pathology of the brain or orbit. Repeat fundus examination, 2 weeks later, still failed to demonstrate retinal or optic nerve disease. However, optic nerve pallor and central cupping became evident after 2 months and continued to progress in the ensuing year. magnetic resonance imaging performed at that time did not disclose the presence of demyelinating disease, or aneurysmal dilation of the carotid or ophthalmic artery. A diagnosis of retrobulbar ischemic optic neuropathy is considered likely in this patient. The association of retrobulbar ischemic optic neuropathy and sickle cell anemia has not been previously reported.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
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