Biomedical subjects
A L Moss
Publications and source records attributed to A L Moss.
Cutaneous leishmaniasis.
The incidence of leishmaniasis is increasing globally due to population and environmental changes. Ease of worldwide travel and immigrant populations means that the UK surgeon is more likely to encounter cutaneous lesions. Two cases are presented and treatment options discussed.
Aplasia cutis congenita associated with a lipoma.
Aplasia cutis congenita is a condition that can present with a wide variety of symptoms and many attempts have been made to classify it comprehensively. This report presents the first case of a child with aplasia cutis congenita confirmed on histology with an associated lipoma or lipomatosis directly underlying it. It exemplifies the difficulty in diagnosing and treating this rare condition.
The morbidity of harvesting bone from the iliac crest.
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Multiple pilomatrixomata and myotonic dystrophy: a familial association.
The association of pilomatrixoma and myotonic dystrophy has been described in the past in 13 publications in the English literature. The association seems to involve the development of pilomatrixomata before signs of myotonic dystrophy. Myotonic dystrophy is the commonest adult dystrophy and is an autosomaldominant disease with a variable phenotypic penetrance. The disease is determined by a genetic locus on chromosome 19q and can be diagnosed using methods of DNA testing. We describe the 25th case of a patient with both conditions together with a review of the literature. To our knowledge, no other patient has had such a large number of histologically proven pilomatrixomata.
Posterior interosseous nerve palsy after intravenous cannulation of forearm.
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Weight discrepancies in surgical and pathological specimens from breast reductions.
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Dressing to facilitate early radiotherapy after excision of keloid.
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Pyoderma gangrenosum in a child with congenital partial deficiency of leucocyte adherence glycoproteins.
Congenital deficiency of beta 2 integrin leucocyte adhesion molecules is a rare immunodeficiency and is often fatal. Neutrophils are unable to bind to ligands on the endothelium, and so cannot leave the circulation during inflammation or infection. When leucocyte adhesion deficiency (LAD) is caused by abnormally low expression of beta 2 integrins, it is termed LAD type 1. We describe a 5-year-old girl with a history of recurrent bacterial infections since early childhood who developed necrotic skin ulcers resembling pyoderma gangrenosum and a persistent circulating neutrophilia. Histologically, the lesions showed deep ulceration with a diffuse lymphohistiocytic infiltrate, but with a relative sparsity of neutrophils. Subsequent investigation revealed a complete absence of CD11a/CD18 beta 2 integrins on the surface of the patient's neutrophils, confirming the diagnosis of LAD type 1. The ulcers responded to treatment with oral prednisolone and colchicine.
Leech-borne Serratia marcescens infection following complex hand injury.
Leeches are commonly used in the postoperative course of plastic surgical operations where there is venous congestion in a pedicled or free flap. They provide a temporary relief to venous engorgement whilst venous drainage is re-established. It is known that leeches can carry Aeromonas hydrophila infection, and a second or third generation cephalosporin antibiotic has traditionally been given as prophylaxis against infection. We report a new observation that leeches can carry Serratia marcescens and give rise to clinically significant infection. The implication for prophylaxis and treatment of leech-associated cellulitis is discussed.
Frey's syndrome without hyperhidrosis.
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Biceps rupture in a patient on long-term anticoagulation leading to compartment syndrome and nerve palsies.
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A painful knee in an immunocompromised patient.
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Nasal deformities resulting from flow driver continuous positive airway pressure.
Over a period of six months, seven cases were documented of trauma to the nose as a result of flow driver continuous positive airway pressure in babies of very low birthweight (VLBW). There was a complication rate of 20% in the babies who required it. Deformities consisted of columella nasi necrosis which can occur within three days, flaring of nostrils which worsens with duration of continuous positive airway pressure, and snubbing of the nose which persists after prolonged continuous positive airway pressure. These complications should be preventable by modifications to the mechanism and method of use.
Congenital gingival granular cell tumour.
Congenital gingival granular cell tumours are rare lesions which have only occasionally been reported in the UK. Clinical features are of a benign lesion which occurs almost exclusively in newborn, Caucasian females and the anterior maxilla is the commonest site. Treatment consists of local excision and is curative. The terminology concerning this condition has been rather confused because of uncertainty regarding the histogenesis of these tumours and the similar histological appearance to adults granular cell myoblastoma occurring at other intraoral sites. The exact histogenesis of these tumours remains unsolved and they may be hamartomata. We describe a new case occurring within the UK, which illustrates many of the common clinical features of the condition, with an accompanying literature review.
Congenital self-healing histiocytosis.
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Dental findings in parents of children with cleft lip and palate.
The incidence of dental abnormalities in the cleft lip and palate population has been reported to be much higher than in the normal population. The role of genes in the production of a cleft lip and palate, and dental anomalies is thought to be complex, with autosomal dominant, recessive, and x-linked genes all playing a role. Noncleft parents can carry some of the cleft lip and palate genes, which produce clinically subtle manifestations in their facial skeleton. The purpose of this study was to look for evidence of increased dental anomalies in the non-cleft parents of cleft lip and palate children. The dentitions of the parents of 60 children with different types of cleft lip and palate were examined prospectively to see whether or not they exhibited features found more readily in the cleft lip and palate rather than did the normal population. Their dentitions were studied to record the following dental features: congenitally missing teeth, supernumerary teeth, or morphologic changes of the crowns of the permanent teeth. The number and position of any frenal attachments were also recorded. The results of this study did not show any differences in incidence of dental anomalies from the noncleft population. There was no evidence to support the hypothesis that congenital absence of lateral incisors is a microform of cleft lip and palate. Further, these results also failed to reveal any consistent pattern in the number and position of frenal attachments.
The relationship between fasciocutaneous perforators and their fascial branches: an anatomical study in human cadaver lower legs.
Although a variety of lower leg fascial and fasciocutaneous flaps have been developed, the vascular anatomy of these flaps has not been established fully. The aim of this study was to determine the relationship between the size of a fasciocutaneous perforator and the size and number of its fascial branches. The deep fascia was harvested from five preserved cadaver lower legs. Fasciocutaneous vessels were studied with the aid of a dissecting microscope. There was a moderately strong positive correlation between the external diameter of a fasciocutaneous vessel and the external diameter of its largest fascial branch (correlation coefficient: r = 0.644; t = 6.072; 52 df; p < 0.001). There was a weakly positive correlation between the external diameter of a fasciocutaneous perforator and the number of its fascial branches (correlation coefficient: r = 0.217; t = 11.84; 52 df; p < 0.001). The results of this study establish an anatomical basis for using large fasciocutaneous perforators in the design of lower leg fascial flaps.