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Epidermal Nerve Fiber Density Testing : An Overview

2017-10-06T15:49:14+00:00

Here’s a technique for the evaluation of small fiber peripheral neuropathy. Introduction Epidermal nerve fiber density (ENFD) testing is not a new technique; however, it is new to the diagnostic armamentarium of many in the podiatric community. This analysis is quickly becoming recognized as the gold standard among clinicians when assessing for the presence, and the degree, of small fiber peripheral neuropathy. Though podiatric clinicians have only recently discovered this test, it has been an important diagnostic procedure for neurologists for many years. In fact, ENFD analysis has been widely used by neurologists in the United States and in Europe, to [...]

Epidermal Nerve Fiber Density Testing : An Overview2017-10-06T15:49:14+00:00

Current Concepts in Psoriasis Therapy

2017-10-10T11:44:04+00:00

Largely unchanged for decades, treatment methods for this potentially disabling condition are finally evolving. Introduction Our ability to treat adverse medical conditions has long been an admixture of miraculous accomplishment and frustrating stagnation. For every disease such as osteogenic sarcoma, where recent therapeutic breakthroughs have lifted cure rates from 10-20% to over 90%, there is a condition like pulmonary adenocarcinoma, where cure rates approach their historic controls. The management of dermatologic disorders has not offered any particular exception to this rule. There recently have been profound advances in the medical management of inflammatory conditions of the skin; however, many of those [...]

Current Concepts in Psoriasis Therapy2017-10-10T11:44:04+00:00

Needle Aspiration Biopsy

2017-10-10T11:44:36+00:00

Needle aspiration biopsy is amongst the most underutilized diagnostic procedures of those available. This technique may be effectively used to rule out high‐grade malignancies when faced with nonspecific subcutaneous masses, in particular, those masses that resemble ganglion cysts. I once had three different medico‐legal cases under consultative review at one time, all of which were centered on patients who had non‐specific ganglion‐like masses. In each instance, the patient actually harbored a high‐grade sarcoma, and in each case, they were followed into their grave by their clinician with the errant diagnosis of “ganglion”. It is not overtly surprising that neoplasms masquerading as [...]

Needle Aspiration Biopsy2017-10-10T11:44:36+00:00

Cutaneous Biopsy Techniques in the Management of Chronic Wounds

2017-10-10T11:45:02+00:00

Many clinicians rely exclusively on clinical acumen when determining how to manage chronic wounds. Though an ulcer’s clinical features may be fairly indicative of its etiology, in some instances, such is not the case. Even among the most characteristic‐appearing ulcerations, masqueraders do exist. Ruling out the possibility of an unsuspected neoplastic or inflammatory condition could be necessary for the successful management of chronic wounds. In this context, cutaneous biopsy techniques may be invaluable; however, their utility does not necessarily end here. There are three common clinical settings in which a biopsy may be used in the management of a chronic wound. [...]

Cutaneous Biopsy Techniques in the Management of Chronic Wounds2017-10-10T11:45:02+00:00

Biopsy Planning and Post-Biopsy Tissue Handling : A Synopsis

2017-10-10T11:45:19+00:00

Introduction As a general rule, the podiatic profession is notorious for its underutilization of cutaneous and soft tissue biopsy techniques. In some instances, such under-use may be attributed to trepidation stemming from a lack of familiarity with the biopsy techniques themselves; however, I believe this is not the preeminent cause. In my experience, the most common reason that many podiatric clinicians don’t use biopsy techniques to their fullest is a degree of insecurity regarding when to use witch biopsy and what to do with them once the biopsy has been performed. In most offices, the support staff is ill prepared to [...]

Biopsy Planning and Post-Biopsy Tissue Handling : A Synopsis2017-10-10T11:45:19+00:00

Epidermal Nerve Fiber Density Testing

2017-10-10T11:45:51+00:00

A New Gold Standard for the Diagnosis of Small Fiber Neuropathy What is small fiber peripheral neuropathy and when might I be expected to see it amongst my patients? Small fiber peripheral neuropathy is a form of neuropathy that is limited to the terminal, intra-epidermal ends of sensory nerves. This expression of peripheral neuropathy commonly presents in a stocking or glove-like distribution. Those that exhibit neuropathy in this pattern, without involvement of large nerve fibers are said to have pure small fiber peripheral neuropathy. If the nerve pathology progresses proximally to involve larger nerves, the neuropathy becomes mixed. Of course diabetics [...]

Epidermal Nerve Fiber Density Testing2017-10-10T11:45:51+00:00
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