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Case Reports 2016; 37(3): 184-188 PubMed PMID: 27618595 Citation  Keywords:  Adrenal Insufficiency:diagnostic imaging, Adult, Brain:diagnostic imaging, Combined Modality Therapy, Electromyography, Esophageal Achalasia:diagnostic imaging, Female, Foot Deformities, Acquired:pathology, Humans, Magnetic Resonance Imaging, Nervous Syst.   

: We report a young woman with the clinical picture of Allgrove syndrome in whom neurological symptoms are prominent. It usually presents in the first decade of life with a deficiency of tears, recurrent vomiting and dysphagia due to achalasia, severe hypoglycemic seizures and shock due to adrenal insufficiency. Neurological symptoms such as hyperreflexia, dysarthria, hypernasal speech, ataxia, sensory impairment, muscle weakness, and mental retardation are extremely slow to develop and manifest at a later age. Diagnosis was based on clinical presentation and laboratory findings. She is the first patient from the Czech Republic with genetic confirmation of Allgrove syndrome. This patient is one of about 100 cases described in the literature and one of the few patients with all the main typical clinical features....

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Case Reports 2016; 37(1): 12-17 PubMed PMID: 26994380 Citation  Keywords:  Aged, Female, Foot Injuries:pathology, Humans, Leg Ulcer:pathology, Lentigo:pathology, Melanoma:pathology, Wound Healing,.   

: The etiology of skin integrity disorders of the lower extremities can be very diverse. In addition to common diagnoses such as venous ulcers with ischemic etiology, decubitus ulcers and diabetic foot syndrome, ulceration of a malignant etiology must also be considered. Malignant melanoma is one of the most dangerous forms of skin cancer and, although rare, may cause foot lesions. The most frequently encountered type of melanoma on acral parts of the limbs is the rare acral lentiginous variant, which only occurs in 2-10% of all melanoma types. Clinical manifestation ranges from cutaneous surface erosion to ulceration with surrounding hyperkeratosis, which can cause considerable differential diagnostic difficulties in the management of patients with non-healing foot wounds. This paper aims to present a clear case study of a Caucasian female with chronic leg ulceration that resulted in a final diagnosis of malignant acral lentiginous melanoma. Supplemental theoretical information regarding the diagnosis and treatment of malignant melanoma has also been included in the report. Malignant acral lentiginous melanoma is a rare cause of non-healing wounds, but it must be considered in cases with long-term healing complications. Precise diagnostic deliberation is crucial in the management and treatment of all chronic and long-term non-healing lesions, and appropriately performed biopsies are essential to determine whether malignancy is the primary cause....

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Case Reports 2015; 36(5): 417-420 PubMed PMID: 26707040 Citation  Keywords:  Abnormalities, Multiple, CREB-Binding Protein:genetics, Craniofacial Abnormalities, Foot Deformities, Hand Deformities, Humans, Male, Microcephaly, Rubinstein-Taybi Syndrome:diagnosis, Thyrotropin:metabolism, Thyroxine:metabolism, Triiodothyronine:metabol.   

INTRODUCTION: Rubinstein-Taybi syndrome is a rare genetic multisystem disorder comprising motor organ dysfunction, craniofacial dysmorphism and psychomotor retardation, frequently with the abnormalities of the thyroid gland.

OBJECTIVE: Presentation of a case of a 19-year-old patient with Rubinstein-Taybi syndrome in whom serum TSH, fT3 and fT4 levels were assessed.

CASE: Craniofacial abnormalities including: microcephaly, underdeveloped maxilla, micrognathia, high arched palate, malocclusion, down-slanting palpebral fissures, thick eyelashes and full eyebrows. Clinodactyly, broad thumbs and toes were observed in the musculoskeletal system. The patient presented with moderate mental retardation, short stature and obesity. Furthermore, I° thoracolumbar scoliosis, elbow joint deformation resulting from the radial head dislocation and limitation of the right hip motion as a consequence of Perthes disease were found. Genetic testing revealed a mutation affecting the CREBBP gene located on the short arm of chromosome 16. The measured serum TSH level was 1.510 μlU/ml (normal range 0.27-4.20), fT3 5.1 pmol/l (normal range 4.1-6.7), fT4 15.5 pmol/l (normal range 13.1-21.3). The patient is subjected to long-term rehabilitation.

CONCLUSIONS: The obtained results of laboratory tests of serum TSH, fT3 and fT4 levels point to a lack of thyroid gland dysfunction in the patient with Rubinstein-Taybi syndrome. Rehabilitation treatment of patients with RTS is necessary to improve the patient's mobility....

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Journal Article 2010; 31(6): 807-813 PubMed PMID: 21196910 Citation  Keywords:  Absorptiometry, Photon:methods, Animals, Bone Density, Bone Remodeling, Bone Resorption, Calcium:blood, Disease Models, Animal, Electric Stimulation:methods, Foot, Injections, Intraperitoneal, Male, Neuropsychological Tests, Norepinephrine:blood, Osteocla.   

OBJECTIVES: Bone remodeling has recently been revealed to be under sympathetic nerve control. The role of the sympathetic nerve system is not clearly understood. The present study aim to explore the effect of chemical sympathectomy and stress on bone remodeling in adult rats.

METHODS: 24 twelve-month-old Wistar rats were divided into three group (sympathectomy, stress and control). The sympathectomy and stress group rats were administered 6-hydroxydopamine (150 mg/kg each day) and saline (1 ml/kg each day) intraperitoneal respectively for one week and exposed to stress procedure for another three weeks. The stress procedure was mild, unpredictable footshock, administered for one hour once daily. Analysis of serum chemistry, microcomputed tomography, dual energy X-ray absorptiometry, biomechanical testing and bone histomorphometry were employed.

RESULTS: The stress group rats showed increased bone resorption in contrast to the sympathectomy and control group rats. The serum level of calcium and phosphorus cations and norepinephrine were enhanced, the cancellous bone volume and bone mineral density were reduced, bone mechanical property such as strength, ductility and toughness were weakened, the osteoclast counts and osteoclast surfaces were increased and the bone formatin rate were decreased significantly in the stress group rats in contrast to the other two groups rats. There was no significant difference of bone remodeling between the sympathectomy group and control group rats.

CONCLUSION: Our study showed stress-increased sympathetic nerve system activity enhanced bone resorption while chemical sympathectomy inhibited bone resorption under stress. We postulate sympathetic neurotransmitter and neuropepitide may play a role in regulating bone remodeling....

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Journal Article 2008; 29(5): 691-696 PubMed PMID: 18987599 Citation  Keywords:  Animals, Anti-Inflammatory Agents, Non-Steroidal, Antioxidants:metabolism, Arthritis, Experimental:pathology, Candida:chemistry, Foot:pathology, Inflammation:pathology, Male, Mannans:pharmacology, Mycobacterium:immunology, Oxidative Stress:drug effects, P.   

OBJECTIVES: The aim of this study was to evaluate the effects of a biological response modifier, glucomannan (GM), isolated from Candida utilis, on the progress of adjuvant arthritis in Lewis rats.

METHODS: Adjuvant arthrithis was induced in Lewis rats by a single intradermal injection of Mycobacterium butyricum. GM was administered in two different doses of 5 and 7.5 mg/kg b.w. The treatment involved daily oral or intraperitoneal administration of the substance from day 0, i.e. the day of immunization to the end of the experiment - day 28. Cyclosporin A was used as a therapeutic standard in daily oral dose of 2.5 mg/kg b.w. The following parameters were monitored: hind paw volume, total antioxidant status, protein carbonyl groups, activity of N-acetyl-beta-D-glucosaminidase in plasma, lysozyme and peroxidase activity of peritoneal macrophages and activity of gamma-glutamyltransferase in homogenates of spleen, hind paw muscle and hind paw joint.

RESULTS: Beneficial action of GM was revealed mainly in hind paw volume decrease. Further decrease of the activity of the enzyme gamma glutamyltransferase (GGT) in the spleen, hind paw joint and muscle tissue homogenates, decrease of the plasmatic activity of N-acetyl-beta-D-glucosaminidase (NAGA), and finally suppression of lysozyme and peroxidase activity assessed in peritoneal macrophages were observed in arthritic animals treated with GM. All these findings speak in favor of the anti-inflammatory activity of glucomannan. Moreover, a significant improvement of the arthritis induced suppression of total antioxidant status and decrease of the level of the arthritis-associated protein carbonyls in plasma were detected.

CONCLUSIONS: The important characteristics of GM isolated from Candida utilis, such as good water solubility and relatively small molecular weight, along with the observed in vivo anti-inflammatory and antioxidant effects, appear to be promising features for its prospective use as a natural agent in prevention and supplementary therapy of rheumatoid arthritis....

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Case Reports 2007; 28(5): 556-559 PubMed PMID: 17994005 Citation  Keywords:  Aged, Amoxicillin-Potassium Clavulanate Combination:therapeutic use, Anti-Bacterial Agents:therapeutic use, Arthropathy, Neurogenic:complications, Blood Sedimentation, Diabetic Foot:complications, Diagnosis, Differential, Forefoot, Human:diagnostic imagin.   

: Foot problems are common causes of morbidity in patients with diabetes mellitus. Foot ulcers are the leading cause of hospitalization in diabetic patients. Bones may be involved in two different clinical conditions: osteomyelitis and Charcot osteoarthropathy. Osteomyelitis usually develops by spreading from contiguous soft tissue to underlying bone. Charcot foot is deformation of foot as a result of muscle athrophy, bone and joint structure changes in a joint as a secondary complication of neuropathy. To distinguish bone infection from non-infectious bone disorders as in Charcot joint may be difficult, especially if there is no skin ulceration. So, the mere absence of skin ulcers does not exclude the diagnosis of osteomyelitis....

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Clinical Trial 2006; 27(Suppl 2): 134-137 PubMed PMID: 17159798 Citation  Keywords:  Aged, Cells, Cultured, Combined Modality Therapy, Diabetic Foot:surgery, Humans, Mesenchymal Stem Cell Transplantation:methods, Skin Transplantation:methods, Transplantation, Autologous, Wound Healing,.   

OBJECTIVES: This study was performed to test a new technique for treatment of chronic non-healing wound (diabetic ulcer) using autologous biograft composed of autologous skin fibroblasts on biodegradable collagen membrane (Coladerm) in combination with autologous mesenchymal stem cells (MSC) derived from the patient's bone marrow.

DESIGN: The bone marrow aspirate of the patient with diabetic foot was applied directly to the wound and injected into the edges of the wound, finally covered with prepared autologous biograft. The patient received two additional treatments with cultured MSC on day 7 and 17.

RESULTS: The wound showed a steady overall decrease in wound size and an increase in the vascularity of the dermis and in the dermal thickness of the wound bed after 29 days of combined treatment.

CONCLUSIONS: Closing and healing of the non-healing diabetic ulcer was achieved by using the given combined therapy....

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Clinical Trial 2005; 26(6): 752-756 PubMed PMID: 16380699 Citation  Keywords:  Biomechanical Phenomena, Female, Foot:anatomy & histology, Humans, Imaging, Three-Dimensional, Models, Anatomic, Postpartum Period:physiology, Pregnancy:physiology, Stress, Mechanical, Weight-Bearing,.   

OBJECTIVES: The aim is data detection and finding some load consequences generated by various mechanical or physiological changes in the interaction of the end segment of the body--the foot--and the environment.

DESIGN: Shape instability of the foot caused by e.g. loading of the foot by long-term frequency loads--walking, by extreme loads--sport, by hormonal changes--pregnancy, by aging, by pathologies, etc. The footprint surface was numerically described in 3D by means of stereo-photo-gram-metrical method--DMR digital relief model. Density of discrete points--250-400 per one print.

SETTING: Detailed DMR was constructed by means of triangular web including contour picture with the use of Atlas program. The specified generated web is characterized by triangles with a cca 1 mm side in the number of up to 4,500 elements per one footprint model.

RESULTS: The results enable us to deduce shape characteristics of DMR--the shape of the interactive boundary of the foot--the rest surface, to solve foot arch straining, to solve issues of discomfort and distribution of the pressure at the boundary of the foot--the rest surface, the shoe, etc. The gained findings can be interpreted in the field of prevention, therapy, orthopedics, podology, and enable us to come up with recommendations for the orthopedic practice and industrial use in the footwear production, etc. THE MAIN FINDINGS: The difference between volume reductions of the space under the foot arch characterizes the level of "fall" of the arch. This criterion is independent of the foot size, and is in 3D.

CONCLUSIONS: Shape characteristics of footprints in pregnant women and in the period after childbirth were calculated on the basis of the defined criterion. The results of the group of four women tested in three periods suggest that there is no clear tendency towards the foot arch falling/increasing of the foot arch "fall" during the pregnancy period....

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