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Beau Lines

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81. Nail Surgery (Follow-up)

, cryotherapy is associated with high cure rates and minimal complications. The postoperative complications of freezing include pain, blistering, and transient neuropathy; the open wound heals by secondary intention within 2-5 weeks. [ ] Less common complications such as depigmentation, nail loss, Beau lines, transient neuropathy, and anesthesia may occur. Pain during the procedure is controlled by providing prophylactic analgesia with 600 mg of aspirin 2 hours before surgery. This regimen is continued 3 (...) at avulsion are associated with failed treatment outcomes and a greater risk of recurrence. Peridigital resection may be used to treat the soft tissue hypertrophy. When this approach is used, 2 incisions are made: the first incision is a curved line, hugging the lateral surface of the digit, and the second incision is made parallel to the first and is extended to the underlying subcutaneous fat to remove a wedge-shaped sample of tissue. At closure, the nail folds in the nail groove are oriented away from

2014 eMedicine.com

82. Acute Lymphoblastic Leukemia (Overview)

survival. Leuk Res . 2017 May. 56:44-51. . [Guideline] NCCN Clinical Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia. National Comprehensive Cancer Network. Available at . Version 5.2017 — October 27, 2017; Accessed: January 16, 2018. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood . 2016 May 19. 127 (20):2391-405. . Roberts KG, Li Y, Payne-Turner D (...) of a phase II study of imatinib mesylate with hyper-CVAD for the front-line treatment of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Haematologica . 2015 May. 100 (5):653-61. . Ludwig WD, Rieder H, Bartram CR, Heinze B, Schwartz S, Gassmann W, et al. Immunophenotypic and genotypic features, clinical characteristics, and treatment outcome of adult pro-B acute lymphoblastic leukemia: results of the German multicenter trials GMALL 03/87 and 04/89. Blood . 1998 Sep 15

2014 eMedicine.com

83. Acute Myelogenous Leukemia (Overview)

Organization classification of myeloid neoplasms and acute leukemia now includes a subtype "Myeloid neoplasms with germ line predisposition". [ ] Thus, to properly classify patients with AML, these genes must be included in nextgen panels. Some hereditary cancer syndromes, such as Li-Fraumeni syndrome, can manifest as leukemia. However, cases of leukemia are less common than the solid tumors that generally characterize these syndromes. Environmental exposures Several studies demonstrate a relationship (...) the and the , as well as and . Previous References Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood . 2016 May 19. 127 (20):2391-405. . . Smith MT, Skibola CF, Allan JM, Morgan GJ. Causal models of leukaemia and lymphoma. IARC Sci Publ . 2004. 373-92. . Ghiaur G, Wroblewski M, Loges S. Acute Myelogenous Leukemia and its Microenvironment: A Molecular Conversation. Semin Hematol

2014 eMedicine.com

84. Psoriatic Arthritis (Follow-up)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) of autoimmunity, perhaps mediated by complement activation. The inflammatory nature of the skin and joint lesions in psoriatic arthritis is demonstrated by synovial-lining cell hyperplasia and mononuclear infiltration, resembling the histopathologic changes of RA. However, synovial-lining hyperplasia is less, macrophages are fewer, and vascularity is greater in psoriatic arthritis than in RA synovium. The cytokine profile for psoriatic arthritis reflects a complex interplay between T cells and monocyte

2014 eMedicine.com

85. Psoriatic Arthritis (Follow-up)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) of autoimmunity, perhaps mediated by complement activation. The inflammatory nature of the skin and joint lesions in psoriatic arthritis is demonstrated by synovial-lining cell hyperplasia and mononuclear infiltration, resembling the histopathologic changes of RA. However, synovial-lining hyperplasia is less, macrophages are fewer, and vascularity is greater in psoriatic arthritis than in RA synovium. The cytokine profile for psoriatic arthritis reflects a complex interplay between T cells and monocyte

2014 eMedicine.com

86. Psoriatic Arthritis (Follow-up)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) of autoimmunity, perhaps mediated by complement activation. The inflammatory nature of the skin and joint lesions in psoriatic arthritis is demonstrated by synovial-lining cell hyperplasia and mononuclear infiltration, resembling the histopathologic changes of RA. However, synovial-lining hyperplasia is less, macrophages are fewer, and vascularity is greater in psoriatic arthritis than in RA synovium. The cytokine profile for psoriatic arthritis reflects a complex interplay between T cells and monocyte

2014 eMedicine.com

87. Psoriasis, Nails (Follow-up)

or salmon patch of the nail bed This lesion is a translucent, yellow-red discoloration in the nail bed resembling a drop of oil beneath the nail plate. This patch is the most diagnostic sign of nail psoriasis. [ ] Pitting of the proximal nail matrix Pitting is a result of the loss of parakeratotic cells from the surface of the nail plate. Beau lines of the proximal nail matrix These lines are transverse lines in the nails due to intermittent inflammation causing growth arrest lines. Leukonychia (...) starts distally and progresses proximally, causing a traumatic uplifting of the distal nail plate. Secondary microbial colonization may occur. Nail plate crumbling Nail plate weakening due to disease of the underlying structures causes this condition. Splinter hemorrhage/dilated tortuous capillaries in the dermal papillae Splinter hemorrhages are longitudinal black lines due to minute foci of capillary hemorrhage between the nail bed and the nail plate. This is analogous to the Auspitz sign

2014 eMedicine.com

88. Cutaneous Manifestations of HIV Disease (Follow-up)

related to HIV-1 infection. [ ] Beau lines, telogen effluvium, and pallor of the nail beds are the general effects of the chronic illness. Elongation of the eyelashes and softening and straightening of the scalp hair may be observed in HIV disease, and proximal subungual onychomycosis is also usually a sign of HIV disease. The frequency of onychomycosis may be higher in men than in women. Generalized alopecia can occur in patients with HIV who are treated with indinavir, an antiretroviral protease

2014 eMedicine.com

89. Intestinal Transplantation (Diagnosis)

or overt liver failure secondary to IFALD Thrombosis of two or more central veins Two or more episodes per year of systemic sepsis secondary to line infections, or a single episode of fungal sepsis [ ] Frequent episodes of severe dehydration Additional indications for intestinal transplantation include the following: High risk of death Severe short bowel syndrome (gastrostomy, duodenostomy, residual small bowel [< 10 cm in infants, < 20 cm in adults]) Intestinal failure with frequent hospitalizations (...) , narcotic dependency, or pseudoobstruction Patient unwillingness to accept long-term parenteral nutrition The advent of ethanol lock therapy [ , ] has reduced the number of catheter-related infections dramatically. This may reduce the number of patients with recurrent infections necessitating intestinal transplant. Flushing lines with a 70% ethanol solution between feedings led to a decline in the number of catheter-related blood stream infections from 10.1 per 1000 catheter-feed days to 2.9

2014 eMedicine Pediatrics

90. Non-Hodgkin Lymphoma (Diagnosis)

of a central line. In these individuals, consider biopsy performed under local anesthesia or immediate radiation therapy to the airway, provided that another site of disease is outside the radiation field (to allow for subsequent histologic confirmation of the diagnosis). Mediastinal tumors may cause compression of the great vessels ( ), with swelling of the neck, face, and upper extremities. Esophageal compression may lead to dysphagia. is sometimes observed and may be large enough to cause symptoms (...) cellular immunity. Anticancer Res . 1994 May-Jun. 14(3A):933-6. . van den Bosch CA. Is endemic Burkitt's lymphoma an alliance between three infections and a tumour promoter?. Lancet Oncol . 2004 Dec. 5(12):738-46. . Goldsby RE, Carroll WL. The molecular biology of pediatric lymphomas. J Pediatr Hematol Oncol . 1998 Jul-Aug. 20(4):282-96. . Lones MA, Sanger WG, Le Beau MM, Heerema NA, Sposto R, Perkins SL. Chromosome abnormalities may correlate with prognosis in Burkitt/Burkitt-like lymphomas

2014 eMedicine Pediatrics

91. Intestinal Transplantation (Overview)

or overt liver failure secondary to IFALD Thrombosis of two or more central veins Two or more episodes per year of systemic sepsis secondary to line infections, or a single episode of fungal sepsis [ ] Frequent episodes of severe dehydration Additional indications for intestinal transplantation include the following: High risk of death Severe short bowel syndrome (gastrostomy, duodenostomy, residual small bowel [< 10 cm in infants, < 20 cm in adults]) Intestinal failure with frequent hospitalizations (...) , narcotic dependency, or pseudoobstruction Patient unwillingness to accept long-term parenteral nutrition The advent of ethanol lock therapy [ , ] has reduced the number of catheter-related infections dramatically. This may reduce the number of patients with recurrent infections necessitating intestinal transplant. Flushing lines with a 70% ethanol solution between feedings led to a decline in the number of catheter-related blood stream infections from 10.1 per 1000 catheter-feed days to 2.9

2014 eMedicine Pediatrics

92. Acute Lymphoblastic Leukemia (Diagnosis)

survival. Leuk Res . 2017 May. 56:44-51. . [Guideline] NCCN Clinical Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia. National Comprehensive Cancer Network. Available at . Version 5.2017 — October 27, 2017; Accessed: January 16, 2018. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood . 2016 May 19. 127 (20):2391-405. . Roberts KG, Li Y, Payne-Turner D (...) of a phase II study of imatinib mesylate with hyper-CVAD for the front-line treatment of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Haematologica . 2015 May. 100 (5):653-61. . Ludwig WD, Rieder H, Bartram CR, Heinze B, Schwartz S, Gassmann W, et al. Immunophenotypic and genotypic features, clinical characteristics, and treatment outcome of adult pro-B acute lymphoblastic leukemia: results of the German multicenter trials GMALL 03/87 and 04/89. Blood . 1998 Sep 15

2014 eMedicine.com

93. Acute Myelogenous Leukemia (Diagnosis)

Organization classification of myeloid neoplasms and acute leukemia now includes a subtype "Myeloid neoplasms with germ line predisposition". [ ] Thus, to properly classify patients with AML, these genes must be included in nextgen panels. Some hereditary cancer syndromes, such as Li-Fraumeni syndrome, can manifest as leukemia. However, cases of leukemia are less common than the solid tumors that generally characterize these syndromes. Environmental exposures Several studies demonstrate a relationship (...) the and the , as well as and . Previous References Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood . 2016 May 19. 127 (20):2391-405. . . Smith MT, Skibola CF, Allan JM, Morgan GJ. Causal models of leukaemia and lymphoma. IARC Sci Publ . 2004. 373-92. . Ghiaur G, Wroblewski M, Loges S. Acute Myelogenous Leukemia and its Microenvironment: A Molecular Conversation. Semin Hematol

2014 eMedicine.com

94. Non-Hodgkin Lymphoma (Treatment)

and antimetabolites. Current survival rates for patients with advanced disease are 65-75% for T-cell lymphoblastic lymphomas and 80-90% for those with B-cell lymphomas. Antibiotics If present, fever simply may reflect the underlying malignancy. However, consider beginning empiric, broad-spectrum antibiotic coverage until sepsis or focal infection (eg, due to bowel perforation) is excluded. Central venous access For most patients, a is necessary to manage chemotherapy. If feasible, multiple procedures (eg, line (...) the SFOP described surprising efficacy for monotherapy with vinblastine for relapsing anaplastic LCL, even in patients who previously underwent myeloablative therapy with autologous bone marrow transplantation. [ ] The role of vinblastine in front-line therapy for anaplastic LCL was examined in a Children's Oncology Group protocol (A5941), which compared the standard APO regimen with an experimental therapy that included vinblastine. Myelosuppression was more significant than anticipated and the trial

2014 eMedicine Pediatrics

95. Intestinal Transplantation (Treatment)

one third of cases, this results in a remission of the PTLD. If improvement is not evident after 2 weeks, all immunosuppression should be discontinued and serious consideration should be given to additional therapeutic measures, including chemotherapy using R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) or adoptive immunotherapy. [ ] Radiotherapy is considered a second-line intervention against PTLD in both pediatric and adult patients. [ ] If necessary (...) , et al. 51Cr-EDTA: a marker of early intestinal rejection in the rat. J Surg Res . 1989 May. 46(5):507-14. . Buchman AL, Iyer K, Fryer J. Parenteral nutrition-associated liver disease and the role for isolated intestine and intestine/liver transplantation. Hepatology . 2006 Jan. 43(1):9-19. . Cavicchi M, Beau P, Crenn P, Degott C, Messing B. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med . 2000

2014 eMedicine Pediatrics

96. Non-Hodgkin Lymphoma (Overview)

of a central line. In these individuals, consider biopsy performed under local anesthesia or immediate radiation therapy to the airway, provided that another site of disease is outside the radiation field (to allow for subsequent histologic confirmation of the diagnosis). Mediastinal tumors may cause compression of the great vessels ( ), with swelling of the neck, face, and upper extremities. Esophageal compression may lead to dysphagia. is sometimes observed and may be large enough to cause symptoms (...) cellular immunity. Anticancer Res . 1994 May-Jun. 14(3A):933-6. . van den Bosch CA. Is endemic Burkitt's lymphoma an alliance between three infections and a tumour promoter?. Lancet Oncol . 2004 Dec. 5(12):738-46. . Goldsby RE, Carroll WL. The molecular biology of pediatric lymphomas. J Pediatr Hematol Oncol . 1998 Jul-Aug. 20(4):282-96. . Lones MA, Sanger WG, Le Beau MM, Heerema NA, Sposto R, Perkins SL. Chromosome abnormalities may correlate with prognosis in Burkitt/Burkitt-like lymphomas

2014 eMedicine Pediatrics

97. Psoriatic Arthritis (Diagnosis)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) of autoimmunity, perhaps mediated by complement activation. The inflammatory nature of the skin and joint lesions in psoriatic arthritis is demonstrated by synovial-lining cell hyperplasia and mononuclear infiltration, resembling the histopathologic changes of RA. However, synovial-lining hyperplasia is less, macrophages are fewer, and vascularity is greater in psoriatic arthritis than in RA synovium. The cytokine profile for psoriatic arthritis reflects a complex interplay between T cells and monocyte

2014 eMedicine.com

98. Psoriatic Arthritis (Diagnosis)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) of autoimmunity, perhaps mediated by complement activation. The inflammatory nature of the skin and joint lesions in psoriatic arthritis is demonstrated by synovial-lining cell hyperplasia and mononuclear infiltration, resembling the histopathologic changes of RA. However, synovial-lining hyperplasia is less, macrophages are fewer, and vascularity is greater in psoriatic arthritis than in RA synovium. The cytokine profile for psoriatic arthritis reflects a complex interplay between T cells and monocyte

2014 eMedicine.com

99. Psoriatic Arthritis (Diagnosis)

with psoriatic arthritis, may include the following: Beau lines Leukonychia Onycholysis Oil spots Subungual hyperkeratosis Splinter hemorrhages Spotted lunulae Transverse ridging Cracking of the free edge of the nail Uniform nail pitting Extra-articular features are observed less frequently in patients with psoriatic arthritis than in those with rheumatoid arthritis (RA) but may include the following: Synovitis affecting flexor tendon sheaths, with sparing of the extensor tendon sheath Subcutaneous nodules (...) of autoimmunity, perhaps mediated by complement activation. The inflammatory nature of the skin and joint lesions in psoriatic arthritis is demonstrated by synovial-lining cell hyperplasia and mononuclear infiltration, resembling the histopathologic changes of RA. However, synovial-lining hyperplasia is less, macrophages are fewer, and vascularity is greater in psoriatic arthritis than in RA synovium. The cytokine profile for psoriatic arthritis reflects a complex interplay between T cells and monocyte

2014 eMedicine.com

100. Psoriasis, Nails (Diagnosis)

or salmon patch of the nail bed This lesion is a translucent, yellow-red discoloration in the nail bed resembling a drop of oil beneath the nail plate. This patch is the most diagnostic sign of nail psoriasis. [ ] Pitting of the proximal nail matrix Pitting is a result of the loss of parakeratotic cells from the surface of the nail plate. Beau lines of the proximal nail matrix These lines are transverse lines in the nails due to intermittent inflammation causing growth arrest lines. Leukonychia (...) starts distally and progresses proximally, causing a traumatic uplifting of the distal nail plate. Secondary microbial colonization may occur. Nail plate crumbling Nail plate weakening due to disease of the underlying structures causes this condition. Splinter hemorrhage/dilated tortuous capillaries in the dermal papillae Splinter hemorrhages are longitudinal black lines due to minute foci of capillary hemorrhage between the nail bed and the nail plate. This is analogous to the Auspitz sign

2014 eMedicine.com

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