A Different Presentation of Mal De Meleda: New Skin Lesions in a Residual Limb after Traumatic Amputation

Mal de Meleda is a rare autosomal recessive skin disease which is known as keratoderma palmoplantaris transgradiens. Here we report a case of Mal de Meleda who had skin lesions in the residual limb and pseudoainhum in the thigh after traumatic lower leg amputation. A 71-year-old female was admitted to our tertiary hospital for prosthetic rehabilitation. On the physical examination, thickening of the skin on palms, left sole and residual limb was present. The patient reported that she had these skin lesions since infancy and she realized new skin lesions after amputation in the residual limb. We requested dermatology consultation and she was diagnosed as Mal de Meleda. To our knowledge, this is the first Mal de Meleda case in the literature with new lesions at the residual limb.  Although exact pathophysiological mechanisms are not well known in Mal de Meleda, prosthesis use might have accelerated disease process in our patient. </p

Effects Of Botulinum Toxin-A On The Muscle Architecture Of Stroke Patients: An Ultrasonographic Study

Objective: The aim of this study was to explore in vivo the effects of botulinum toxin-A treatment on the muscle architecture of patients with stroke, using musculoskeletal ultrasonography. Methods: This prospective clinical trial included 26 adult stroke sufferers with a mean age of 55 years (standard deviation 14). Pennation angles between the fascicle path and the deep aponeurosis of the muscle, fascicle length, muscle thickness and muscle compressibility were scanned at the bulkiest part of the medial gastrocnemius on both limbs. Sonographic evaluations were performed initially before botulinum toxin-A injection and repeated on day 10 and after 2 months. Results: On the hemiplegic sides, anterior pennation angle and muscle thickness decreased (p=0.014, p=0.010, respectively), fascicle length increased (p=0.025) and muscle compressibility did not change after 2 months of treatment compared with the baseline values. Conclusion: The results confirm that muscle structure changes due to botulinum toxin-A. Long-term effects of botulinum toxin-A, timing for disappearance of the toxin effects, or evaluations for repeat injections, remain to be studied. The use of musculoskeletal ultrasonography appears to be promising in this regard.WoSScopu

The relationship between prosthesis use, phantom pain and psychiatric symptoms in male traumatic limb amputees

Objectives: The purpose of this study was to identify psychiatric symptoms by comparing male patients with traumatic leg amputations (LAs) with healthy controls and to determine the association between these psychiatric symptoms and phantom pain and prosthesis use characteristics. Methods: One hundred four volunteers, 51 LA patients (group 1) and 53 healthy controls (group 2) were included. Demographic data including age, height, weight, time since amputation, duration of prosthesis use, and Satisfaction with Prosthesis Questionnaire scores were recorded. Phantom pain was measured a visual analog scale (VAS). Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory. Correlations were determined between time since amputation, duration of prosthesis use and satisfaction with prosthesis questionnaire scores and psychiatric scale scores. Results: Amputee patients had higher phobic anxiety, state anxiety, trait anxiety and sleep disturbance scores (p 0.05). There were significant negative correlations between time since amputation, duration of prosthesis use, duration of daily prosthesis use, and satisfaction with prosthesis questionnaire scores and psychiatric symptoms. Conclusions: Apart from anxiety (state, trait or phobic) and disturbed sleep, other psychiatric symptoms in amputee patients undergoing lengthy prosthetic rehabilitation may not differ from those of healthy controls. The presence and severity of phantom pain appear to be unrelated to general psychiatric symptomatology. Length of time since amputation, length of prosthesis use, daily length of prosthesis use and prosthesis satisfaction are negatively correlated with general psychiatric symptoms. These characteristics must be borne in mind in psychiatric and prosthetic rehabilitation