Lucio Phenomenon: An Unusual Case of Skin Necrosis
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PROVIDER: S-EPMC10890809 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Interface segregation of solute atoms has a profound effect on properties of engineering alloys. The occurrence of solute segregation in coherent twin boundaries (CTBs) in Mg alloys is commonly considered to be induced by atomic size effect where solute atoms larger than Mg take extension sites and those smaller ones take compression sites in CTBs. Here we report an unusual solute segregation phenomenon in a group of Mg alloys-solute atoms larger than Mg unexpectedly segregate to compression sites of {10[Formula: see text]1} fully coherent twin boundary and do not segregate to the extension or compression site of {10[Formula: see text]2} fully coherent twin boundary. We propose that such segregation is dominated by chemical bonding (coordination and solute electronic configuration) rather than elastic strain minimization. We further demonstrate that the chemical bonding factor can also predict the solute segregation phenomena reported previously. Our findings advance the atomic-level understanding of the role of electronic structure in solute segregation in fully coherent twin boundaries, and more broadly grain boundaries, in Mg alloys. They are likely to provide insights into interface boundaries in other metals and alloys of different structures.
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Project description:BackgroundSkin pigmentation after adrenalectomy occurs due to an increase in adrenocorticotropic hormone (ACTH) following adrenal insufficiency. ACTH-induced pigmentation usually appears as generalized hyperpigmentation and is known to appear after bilateral adrenalectomy. We report a case of unusual transient hyperpigmentation that developed immediately after unilateral adrenalectomy for pheochromocytoma and spontaneously resolved without corticosteroid supplementation.Case descriptionA 29-year-old woman was admitted to the hospital due to sudden-onset chest pain and headache. A 2.8-cm left adrenal mass with heterogeneous enhancement was incidentally found in chest computed tomography during the evaluation. Multiple old infarctions were observed in brain magnetic resonance imaging (MRI), and left ventricular thrombi were found by echocardiography. Biochemical evidence confirmed the diagnosis of pheochromocytoma, while serum ACTH and cortisol levels were within normal ranges. The patient underwent laparoscopic left adrenalectomy via a posterior retroperitoneal approach and recovered without immediate postoperative complications. On day 3 after surgery, a crescent-shaped café-au-lait skin pigmentation occurred on both the subcostal and the lumbar areas of the abdomen. Serial serum cortisol slightly decreased during the immediate postoperative period and recovered on day 3. Serum ACTH was elevated. Under close observation without corticosteroid supplementation, the pigmentation faded on day 8 after surgery. On day 15, the pigmentation clearly disappeared and serum ACTH decreased to within the normal range. A month later, ACTH and all adrenal hormones were within normal range.ConclusionsWe hypothesized that skin pigmentation appeared due to an imbalance of the hypothalamic-pituitary-adrenal (HPA) axis after resection of one adrenal gland. Skin pigmentation may be the first and early manifestation of adrenal insufficiency in patients who undergo unilateral adrenalectomy due to a non-Cushing's tumor. Therefore, a careful physical examination may allow early detection of adrenal insufficiency and optimal treatment planning.
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Project description:Total knee arthroplasty (TKA) is a common surgical procedure performed in clinical settings. However, postoperative skin necrosis surrounding the incision can be a devastating complication. A large area of black necrotic skin was observed at the incision and anterolateral side of the right knee in a 78-year-old female patient after TKA. Skin necrosis surrounding the incision site was confirmed. Deep joint infection was excluded by synovial fluid analysis. We performed extensive debridement, joint capsule was opened, the knee prosthesis was exposed and partial synovectomy was performed. Then massive soft tissue defect (about 18 cm × 10 cm) was developed with exposed implants. After irrigation, the medial and lateral gastrocnemius muscle flaps were both released and transferred to completely fill the soft tissue defect, and the muscle flaps were then covered with split-thickness skin graft. The wound defect was reconstructed by single-staged surgery. The surgical incisions were healing well with no incisional complications. No swelling, tenderness, or evidence of knee infection was noted during follow-up. The right knee maintained good function and the range of motion was 0° to 130° at 1-year follow-up after the operation. Massive skin necrosis after TKA is rare but manageable. One-stage surgical treatment is also applicable if there is no deep infection, which could shorten the treatment period and achieve early rehabilitation.
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