With the advances in health information technology and the need for increased access to specialized health care, the advent of telemedicine was designed to bring care to individuals at a distance. Telemedicine decreases barriers to health care and brings medical specialists to underserved areas and populations. We have seen a tremendous increase in the need and utilization of telemedicine during the COVID-19 pandemic due to the lockdowns and social distancing efforts. Virtual care continues to be extended to patients to maintain their health care needs when in-person clinic appointments are not feasible or ideal such as seen during a pandemic. Telemedicine is an additional tool that has proven vital to our healthcare system. To provide optimal care, a strong technological infrastructure must be in place. Once in practice, positive outcomes have been noted for patients and healthcare providers as diagnosis, treatment, and appropriate triage can be made virtually and at the patients' convenience. To ensure high-quality care is provided through the Veterans Affairs teledermatology consultation service, we investigated the concordance of teledermatology diagnoses with clinical examination findings through a retrospective chart review covering a one-year time period. Our study found a concordance of 75.3% between the teledermatology diagnoses and the in-person clinical diagnoses. The main limitation we found to virtual examination is the inability to perform total body skin examinations. We found that 60.2% of patients had additional diagnoses when examined in person, with 8.4% of patients having an additional malignant diagnosis. These findings highlight the need for in-person examinations when feasible to ensure that no other diagnoses go undiscovered if not captured on the submitted images for teledermatology consultation. Despite the limitations posed by photographic examination, teledermatology can be used as a reliable method for diagnosis when a conventional in-person examination is not readily available or ideal, such as during a pandemic, and can serve as a powerful triaging tool.
Melanocytic schwannoma is a rare nerve tumor characterized by melanin-producing neoplastic Schwann cells. Wide surgical resection is the management of choice for this tumor; however, anatomical location and proximity to nerve roots can make locating this tumor and the surgical resection challenging. Here we describe the case of 49-year-old male with a melanocytic schwannoma in the presacral area adjacent to the second sacral nerve root that was managed by wide resection aided by computer-assisted navigation due to the difficulty in identifying its location intraoperatively. The utilization of computer-assisted navigation improves accuracy and precision through the creation of a virtual continuous tridimensional map, particularly useful when oftentimes tumor margins may seem equivocal and further resection would compromise the patient's functionality. The value of computer-assisted navigation for soft tissue tumor resections in orthopedic oncology is still in its infancy, though, in certain scenarios it may advance the technique for some soft tissue resections.
An 82-year-old man presented with painful, pink, smooth, annular convalescing plaques on the right back, flank, and abdomen in a zosteriform distribution involving the T10/11 dermatome. He had a history of hypertension and type 2 diabetes mellitus, and 12 months prior to presentation he had an outbreak of herpes zoster virus in the same distribution that was treated with valacyclovir 1000 mg 3 times daily for 7 days. Over the following month he noticed a resolution of blisters and crusting as they morphed into the current lesions. WHAT'S YOUR DIAGNOSIS? a. annular elastolytic giant cell granuloma b. annular lichen planus c. granuloma annulare d. nummular eczema e. superficial erythema annulare centrifugum Drs. Gerhardt and Moore are from the
Seit v. B a e r e n s p r u n g den ersten aufhellenden Gedanken in die Pathologie des Zosters hereingebracht hat, is~ auf diesem Gebiete riehtig weitergearbeitet worden and man hat sowohl far die primgre Erkra~kung tier Spinalgangtien nnd des Ganglion Gasseri eine AnzahI yon guten anatomischen Belegen erhal~en~), als auch noeh welt zahlreichere Thatsachen, die auf die Bedeu-£ung des Zosters als Symptom peripherer ~euritis hinweisen. Ueber die Art, wie durch Neuritis die Hauterkrankung bewirk~ werden kSnne, ist eine sehr ansprechende tIypothese yon Neisser und Weigert*) gegeben worden. Das Absterben peripherer Theile in ]~olge nerv~sen Einflusses and das Eindringen infee-ti0ser Stoffe in die absterbenden Theile wird als Ursache tier Eiterung beim Zoster bezeiehnet.Die wichtigste thatsachliehe Bereieherung ist tier Zoster-Lehre ne~lerdings durch Curschmann und Eisenlohr 0 zu Theil geworden, die naeh tier tteilung des Zosters in zwei Fallen die Entstehung yon mehrfachen acut-perineuritischen Kn0tehen an den be~reffenden ~ervenastchen nachwiesen. Dabei mag erwahnt wetden, class sich seither bier bereits in drei Fallen yon Zoster ahnliehe Kn0tchen erkennen liessen. ~) E. L e s ser, Wei~ere Bei~r~ge zur Lehre veto Herpes zosCer. Virchow~s Arch. Bd. 93. S. 506. ~) E u l e n b~r g~s t~ealencyelopS, die. Bd. IV. S. 666. ~) v. Ziemssen~s Arch. Bd. 35.. S. ~09. ') Ueber die mnltiplen ISibrionen tier I~ut und ihre Beziehuugen zn den multiplen Nenromen. Berlin 188~. S. 6t.
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