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We describe a case of a leiomyosarcoma of the thigh, the resection of all the anterior muscular compartment, and the reanimation of knee extension, using a latissimus dorsi (LD) free flap and tendon transfer. Surgical technique and postoperative care management are described. Functional results, neuropathic pain, and range of motion (ROM) were assessed at 3 months and 12 months after discharge. A complete excision (R0) was carried out and rapid wound healing was obtained despite developing a seroma infection. The patient was able to walk without technical support nor limping at 3 months post-surgery. The patient was still in remission at 12 months follow-up, with Medical Research Council (MRC) scale assessed at 4/5 and ROM rated at 5-105°. In case of total quadriceps resection, knee extension reconstruction can be obtained with tendon transfers and reinnervated free muscular flaps. Combining these techniques could be a good strategy for rapid recovery, with optimal scarring and tissue coverage.
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Breast implant rupture is a common complication in plastic surgery, with various clinical presentations, due to silicone migration. In this article, we present the case of a patient with ruptured silicone implants, who developed siliconosis with rheumatoid polyarthritis, and evolved favourably after explantation surgery. The physiopathology of this disease, and the implication of silicone migration are still controversial, and yet to be confirmed.
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Artritis , Implantes de Mama , Procedimientos de Cirugía Plástica , Humanos , Implantes de Mama/efectos adversos , Siliconas/efectos adversos , Rotura , Geles de Silicona/efectos adversos , Falla de PrótesisRESUMEN
Nevoid hyperkeratosis of the nipple areola complex (NAC) is a rare dermatological pathology of unknown etiology, first described in 1923. It is a benign condition characterized by verrucous thickening and brownish discoloration of the NAC. We described the case of a 26-year-old woman with bilateral nevoid hyperkeratosis of the NAC. Several lines of treatment have been used with varying efficacy: conservative (calcipotriol and local retinoids), semi-conservative (CO2 laser) and surgical (excision and total skin graft). The final result is very satisfactory and without recurrence at 1 year follow-up.
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Enfermedades de la Mama , Queratosis , Femenino , Humanos , Adulto , Pezones/cirugía , Enfermedades de la Mama/tratamiento farmacológico , Enfermedades de la Mama/patología , Enfermedades de la Mama/cirugía , Queratosis/cirugía , Queratosis/tratamiento farmacológico , Queratosis/patología , Piel/patología , Trasplante de PielRESUMEN
INTRODUCTION: Morbidity following autologous latissimus dorsi flap (ALD), muscle sparing latissimus dorsi flap (MSLD) and thoracodorsal artery perforator flap (TAP) is controversial. The purpose of this study was to measure morbity using Quick Dash at 1 month and 1 year following breast reconstruction with one of these three flaps. The second objective was the evaluation of quality of life using Breast-Q. PATIENTS AND METHOD: Thirty four consecutive patients who had undergone breast reconstruction were included in this monocentric and prospective study: 10 patients in the ALD group, 12 patients in the MSLD group and 12 patients in the TAP group. RESULTS: At 1 month and 1 year following surgery, the variation of Quick Dash was 13,63 and 2,38 in the ALD group, 3,41 and -1,13 in the MSLD group and 5,69 and 0 in the TAP group. Satisfaction whith breasts, psychosocial, sexual and chest well-being were higher in the ALD group. Satisfaction with back was higher in the MSLD and TAP groups. Back and shoulder well-being was comparable regardless of the flap. Seroma occurrence was very rare in case of TAP, rare and not abundant in case of MSLD and frequent in case of ALD. CONCLUSION: This study appears to confirm that immediate morbidity is less important with MSLD or TAP than ALD. Hoewever at one year following surgery, morbity seems to be comparable with the 3 flaps. Patients satisfaction seems to be higher with ALD except for the aspect of the back.
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Neoplasias de la Mama , Mamoplastia , Colgajo Perforante , Músculos Superficiales de la Espalda , Humanos , Femenino , Músculos Superficiales de la Espalda/trasplante , Calidad de Vida , Mamoplastia/métodos , Satisfacción del PacienteRESUMEN
BACKGROUND: NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry. PATIENTS AND METHODS: Patients' characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497). RESULTS: Among the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P < 0.001 for all, with a hazard ratio of 0.681 (95% CI 0.618-0.749) for OS]. CONCLUSION: This nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.
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Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/cirugía , Sarcoma/mortalidad , Sarcoma/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Pronóstico , Estudios Prospectivos , Derivación y Consulta/estadística & datos numéricos , Sistema de Registros , Sarcoma/patología , Procedimientos Quirúrgicos Operativos/normas , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Tasa de Supervivencia , Adulto JovenRESUMEN
INTRODUCTION: Breast reduction is a very common intervention in plastic surgery. Its benefit on the quality of life of patients is certain. With the increasing number of conservative surgeries for breast cancer, the potential number of breast reduction on the irradiated breast has increased. The antecedent of irradiation is an absolute contraindication for the majority of breast reduction teams. The objective of this review of the literature is to evaluate the characteristics of the patients, the modalities, the complications and the overall satisfaction of the patients operated on breast reductions on irradiated ground. METHOD: A review of the literature according to the recommendations was carried out. A total of 207 articles were found with the appropriate keywords (Mammoplasty Reduction, Reduction Mammaplasty, Breast reduction crossed with the terms radiotherapy, irradiation). After selection, 11 articles were selected and analyzed. RESULTS: 126 patients were included. The average age was 50 years, the average BMI was 29kg/m2. The majority of patients were non-smokers and non-diabetics. The average resection weight was 507 grams. The average follow-up was 24.6 months. The delay between radiotherapy and surgery was 48 months. Five different surgical techniques were used. A complication rate of 50% is found. Overall satisfaction is good. CONCLUSION: This is the first review of the literature on breast reduction series on irradiated breasts. The results are inspiring and critical. Appropriate selection of patients seems essential. The publication of larger series and the description of a standardized technique would be interesting.
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Neoplasias de la Mama/radioterapia , Mamoplastia/métodos , Femenino , Humanos , Satisfacción del Paciente/estadística & datos numéricos , Selección de Paciente , Complicaciones PosoperatoriasRESUMEN
INTRODUCTION: Breast reconstruction techniques are multiple and they should be chosen in order to improve women's satisfaction and well-being, thus obtaining a personalized treatment. This report's major purpose was to study, through the Breast-Q questionnaire, how the functional and aesthetic outcomes, as well as the complications, of the main autologous breast reconstruction techniques, can affect patients quality of life and well-being at long-term. The secondary purpose was to analyse, thus to identify, the independent factors characterizing the different reconstructive techniques, which may affect patients' satisfaction. METHODS: Women who underwent autologous breast reconstruction through deep inferior epigastric artery perforator or Latissimus dorsi muscle flap from May 2006 to May 2013 were included. The assessment was based on the Breast-Q reconstruction questionnaire. All times of post-mastectomy reconstruction were concerned: immediate, delayed, after previous procedure failure or conversion to another reconstructive technique due to the patient's dissatisfaction. RESULTS: A total of 98 patients were included. Concerning patients satisfaction, the breast-Q score is highest in patients who underwent immediate breast reconstruction, while scores after delayed breast reconstruction, previous surgery failure or conversion to another technique are generally equivalent. Higher scores have been observed in patients who underwent reconstruction through autologous Latissimus dorsi compared to Latissimus dorsi with prosthetic implant reconstruction. CONCLUSION: The authors identified factors of higher patients' satisfaction, like absence of major complication and advanced patient's age, in order to personalize the surgical planning according to the patient's priorities.
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Mamoplastia , Satisfacción del Paciente , Calidad de Vida , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Autoinforme , Factores de TiempoRESUMEN
INTRODUCTION: Complex heel injuries in children are rare and their management requires coverage combining resistance and thinness, to allow walking and footwear. The objective of this study was to create a decision-making algorithm for heel defect in children. MATERIALS: Children received for heel defect, reconstructed with flap in our plastic surgery unit of Bordeaux with a follow-up greater than 10 years were investigated. Three children operated between 1999 and 2003 were included. A free contralateral reinnervated medial plantar flap, a free latissimus dorsi flap and a lateral supramalleolar flap were performed. Patients were reviewed in consultation to assess quality of reconstruction and functional outcomes. Three scores were used, the Foot Function Index (FFI), the AOFAS Ankle and Hindfoot Scale and the Maryland Foot Score. RESULTS: No growth disorder has been found. Scores greater than 80 for the Maryland Foot Score and AOFAS Ankle and Hindfoot Scale and less than 10 for the FFI were very satisfactory in cases 1 and 3. We found pain and greater functional impairment in the second case. CONCLUSIONS: "Like-with-like" reconstruction remains the gold standard, whether in loco-regional or free flap. The fasciocutaneous flaps allow custom reliable coverage with little donor site morbidity. Loco-regional flaps remain easily accessible but donor site sequelae are not negligible.
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Colgajos Tisulares Libres , Talón/lesiones , Talón/cirugía , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/etiología , Colgajos Quirúrgicos , Tendón Calcáneo/lesiones , Tendón Calcáneo/cirugía , Algoritmos , Trasplante Óseo/métodos , Niño , Preescolar , Técnicas de Apoyo para la Decisión , Lesiones por Desenguantamiento/cirugía , Femenino , Estudios de Seguimiento , Colgajos Tisulares Libres/inervación , Humanos , Masculino , Microcirugia , RoturaRESUMEN
OBJECTIVES: Combined aesthetic procedures are an increasing procedure and demands of the patients. The authors have assembled concrete arguments detailing the risks of combined-surgery associating abdominoplasty and mammoplasty relative to abdominoplasty alone. The purpose of this study was to compare abdominoplasty alone versus abdominoplasty combined with breast surgery in terms of short-term complications, in support of surgical choices. RESEARCH STRATEGY: Through application of the PRISMA criteria, we have realized a systematic review of the literature from 1969 to April 2015 in English and French languages by searching in MEDLINE®, PubMed central, Embase and Cochrane Library databases. DATA COLLECTION AND ANALYSIS: The levels of evidence for each article were evaluated. Statistical analysis of the results was carried out through association parameters including statistical tests and Odds ratios were calculated for each complication when data was available. RESULTS: We included 32 observational studies that met the inclusion criteria but only four with usable data. We highlighted a combined Odds ratio of respectively 5.35 and 14.71 for major complications in these studies for combined-surgery compared with abdominoplasty alone. CONCLUSIONS: The results of this systematic review appears in favor of an increase in major complications related to abdominoplasty combined with breast surgery compared to abdominoplasty alone but the level of evidence of included studies is low or moderate. Prospective cohort comparative studies are necessary to provide strong evidence. However, we recommend to avoid this procedure in massive weight loss patients or patients with thromboembolism history.
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Abdominoplastia , Mamoplastia , Complicaciones Posoperatorias/etiología , Cirugía Bariátrica , Terapia Combinada , Femenino , Humanos , Complicaciones Posoperatorias/cirugía , RiesgoRESUMEN
Perforators flaps take a special place in reconstructive surgery. These flaps can be dissected and turned as a propeller blade on its pedicule axis. We report the case of a 54-year-old man presenting a recurrence of a dermatofibrosarcoma in the right hypochondrium. Tumor resection caused a large abdominal wall defect taking the anterior aponeurosis of the rectus abdominis. An angioscanner was realized in preoperative to locate the perforators of the deep superior epigastric artery. We realized a propeller flap based on a perforator of the left superior epigastric artery who allowed to cover the wall defect. We set up a patch of Vicryl® to reconstruct the aponeurosis plan at the same operative time. We didn't note any necrosis and complete healing occurred in 2 weeks. The margins were healthy. The cosmetic result and the low morbidity make this flap a good therapeutic option. This flap seems reliable, arteries perforators are constant with good diameter.
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Pared Abdominal/cirugía , Colgajo Perforante , Arterias Epigástricas , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodosRESUMEN
PURPOSE: The purpose of this study was to evaluate, during a national workshop, the inter-observer variability in target volume delineation for primary extremity soft tissue sarcoma radiation therapy. METHODS AND MATERIALS: Six expert sarcoma radiation oncologists (members of French Sarcoma Group) received two extremity soft tissue sarcoma radiation therapy cases 1: one preoperative and one postoperative. They were distributed with instructions for contouring gross tumour volume or reconstructed gross tumour volume, clinical target volume and to propose a planning target volume. The preoperative radiation therapy case was a patient with a grade 1 extraskeletal myxoid chondrosarcoma of the thigh. The postoperative case was a patient with a grade 3 pleomorphic undifferentiated sarcoma of the thigh. Contour agreement analysis was performed using kappa statistics. RESULTS: For the preoperative case, contouring agreement regarding GTV, gross tumour volume GTV, clinical target volume and planning target volume were substantial (kappa between 0.68 and 0.77). In the postoperative case, the agreement was only fair for reconstructed gross tumour volume (kappa: 0.38) but moderate for clinical target volume and planning target volume (kappa: 0.42). During the workshop discussion, consensus was reached on most of the contour divergences especially clinical target volume longitudinal extension. The determination of a limited cutaneous cover was also discussed. CONCLUSION: Accurate delineation of target volume appears to be a crucial element to ensure multicenter clinical trial quality assessment, reproducibility and homogeneity in delivering RT. radiation therapy RT. Quality assessment process should be proposed in this setting. We have shown in our study that preoperative radiation therapy of extremity soft tissue sarcoma has less inter-observer contouring variability.
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Variaciones Dependientes del Observador , Oncólogos de Radiación , Sarcoma/diagnóstico por imagen , Sarcoma/radioterapia , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/radioterapia , Extremidades/diagnóstico por imagen , Francia , Humanos , Imagen por Resonancia Magnética , Terapia Neoadyuvante , Planificación de la Radioterapia Asistida por Computador , Radioterapia Adyuvante , Radioterapia Conformacional , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: To find arguments in favour of pneumococcal origin in community-acquired pneumonia. POPULATION AND METHODS: A retrospective analysis of the files of 230 children hospitalized between January 1st 1999 and June 30th 2001 for community acquired pneumonia was performed. The files were classified into 3 subgroups: I (N=7), confirmed (positive blood culture); II (N=134), probable (biological arguments); III (N=89), possible pneumococcal infection. Age of the children was also taken into consideration. RESULTS: All children in the subgroup I had fever>39 degrees C at admission and at least 1 of the 3 criteria (WBC> or=20.10(9)/l, neutrophils > or =10.10(9)/l, C-reactive protein level> or =60 mg/l). Dyspnea was more frequently asthmatiform in the subgroup III. Chest X-ray was not contributive. Before admission, 39% of the children were given one or several antibiotics, and so some of patients belonging to the subgroups II and III could have been infected by pneumococcus without possibility to confirm that. CONCLUSION: Results of this analysis suggest that some criteria may be useful for selecting initial antibiotherapy even though systematic early specific antipneumococcal immunization should reduce the frequency of this infection.
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Neumonía Neumocócica/diagnóstico , Antibacterianos/uso terapéutico , Proteína C-Reactiva/análisis , Niño , Preescolar , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Femenino , Fiebre/microbiología , Francia/epidemiología , Hospitalización , Humanos , Lactante , Recuento de Leucocitos , Masculino , Neutrófilos/metabolismo , Neumonía Neumocócica/tratamiento farmacológico , Neumonía Neumocócica/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND AND OBJECTIVES: Conservative surgery for soft-tissue sarcoma (STS) within multimodality treatment attempts to reconcile two contradictory requirements: assuring a good oncological outcome through a wide resection and preserving the function. The aim of our study is to verify whether our conservative approach to STS met these objectives. METHODS: A retrospective database analysis was performed in adults with primary limb or trunk wall STS operated in a single center from 1989 to 2012. Predictive factors for postoperative complications and functional impairment were tested in a multivariate analysis. RESULTS: 728 patients were operated (resection R0: 68%). Neoadjuvant chemotherapy (NAC) was given to 28%, postoperative radiotherapy to 70% of patients. Median follow-up was 103 months. At five years, overall survival was 80% and local recurrences 11%. Major postoperative complications occurred in 8% and functional impairment in 13% of the patients. Independent predictive factors for postoperative complications were American Society of Anesthesiologist classes 2 and 3 (OR: 2.3, CI: 1.2-4.5 and 4.0 CI: 1.7-9.3), tumor size >80 mm (OR: 2.5, CI: 1.3-4.9), tumor site (trunk wall/lower limb, OR: 4.1, CI: 1.3-13.6) and multifocal/multicompartmental spread (OR: 2, CI: 1.1-3.6). Independent predictive factors for function impairment were postoperative complications (OR: 5.3, CI: 2.8-10.1), NAC (OR: 3.6, CI: 2.2-5.8), and bone or neurovascular involvement (OR 3.3, CI 2.0-5.3), whereas Early Rehabilitation after Surgery (ERAS) improved outcome (OR: 0.5, CI: 0.3-0.9). CONCLUSION: Postoperative complications induced functional impairment. They may be reduced by acting on comorbidity factors and careful tumor evaluation prior to surgery. Furthermore, ERAS measures improved function.
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Actividades Cotidianas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia del Cáncer por Perfusión Regional/métodos , Extremidades/cirugía , Complicaciones Posoperatorias/epidemiología , Radioterapia Adyuvante/métodos , Sarcoma/terapia , Neoplasias de los Tejidos Blandos/terapia , Torso/cirugía , Pared Abdominal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Dacarbazina/uso terapéutico , Doxorrubicina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Ifosfamida/uso terapéutico , Masculino , Mesna/uso terapéutico , Persona de Mediana Edad , Análisis Multivariante , Terapia Neoadyuvante/métodos , Estudios Retrospectivos , Factores de Riesgo , Sarcoma/patología , Neoplasias de los Tejidos Blandos/patología , Tasa de Supervivencia , Pared Torácica , Carga Tumoral , Adulto JovenRESUMEN
Soft-tissue sarcoma of the limbs or the trunk wall determine a heterogeneous group of tumours that tends to receive a more individualized approach. The surgeon in charge with soft-tissue sarcoma has to be familiar with these tumours in order to deliver an adequate treatment. Most important is the initial diagnostic procedure, comprising imaging with MRI, a core needle biopsy, and in France, referral to a centre of expertise within the clinical network NETSARC. Prior to surgery, a multidisciplinary conference determines its moment and the extent of surgical resection within the frame of a multidisciplinary approach, and also plans reconstructive surgery, when needed. A standardized operative report summarizes items necessary to describe the resection quality (i.e. tumour seen, tumour infiltrated?). In multidisciplinary staff meetings, they are compared to margins measured by the pathologist on the operative specimen. Hence, resection quality is determined collegially and defined by resection type R (R0, R1, R2) as a qualitative result. The quality of resection directly determines the 5-year risk of local recurrence, estimated between 10 and 20% in specialized centres, with the objective to attain 10%. Early rehabilitation favours better functional outcome. The surgeon's experience with soft-tissue sarcoma, as part of a multidisciplinary treatment, is key in achieving the best adequacy between oncological resection and favourable functional outcome. In France, a specific university course for soft-tissue sarcoma will be set-up.
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Extremidades/cirugía , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/cirugía , Torso/cirugía , Biopsia , Humanos , Imagen por Resonancia Magnética , Márgenes de Escisión , Cuidados Posoperatorios , Cuidados Preoperatorios , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
BACKGROUND: Enhanced recovery after surgery (ERAS) programs are implemented in multiple fields of surgery, but not yet in soft-tissue sarcoma (STS) surgery. We wondered whether its introduction into STS surgery might have impacted postoperative outcome. METHODS: Two hundred and fifty seven adult patients with primary limb or trunk wall STS received ERAS from 2008 to 2012 as a part of the intra-operative management. We evaluated, in retrospect, the intra-operative management, post-operative outcomes, functional and oncological results of these patients and compared them with 459 prior patients treated under a standard recovery after surgery (SRAS) program from 1989 to 2007. RESULTS: The most visible change from SRAS to ERAS in the perioperative management was decrease of wound drainage (72% vs. 15%, p < 0.001) and increase of wound bandaging (16% vs. 66%; p < 0.001), underlining the appliance of the ERAS protocol. Post-operatively, hospital stay dropped from nine (0-74) to three (0-22) days (p < 0.001) without affecting major morbidity (8% vs. 5%, NS) or readmission to the hospital (5% vs. 4%, NS). Functional outcome improved (p = 0.009) but whether this change was due to ERAS remains to be proved because complementary treatments changed over time. Tumour control remained unaffected, with an estimated risk of local recurrence at 5 years of 12% in both groups. CONCLUSION: Introducing a rapid recovery program was associated with a shorter hospitalization stay without compromising surgical or oncological outcomes. The program appears to be safe and reliable to use in patients undergoing STS surgery.
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Neoplasias de los Músculos/rehabilitación , Cuidados Posoperatorios/métodos , Recuperación de la Función , Sarcoma/rehabilitación , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Tiempo , Adulto JovenRESUMEN
CASE REPORT: A three-year-old girl was admitted for persistent fever, erythermatous rash with subsequent desquamation, stomatitis, cheleitis and cervical lymphadenopathy following development of a buttock abscess secondary to an insect bite. A TSS-positive Staphylococcus aureus strain was isolated from the abscess. COMMENTS: Both clinical and bacteriological features led to discuss a "toxic shock syndrome without shock", an atypical form of Kawasaki syndrome without thrombocytosis and coronary arteritis or a staphylococcal skin syndrome. An early treatment with antibiotics could have limited the toxin production explaining both symptomatology and favourable course of the disease.
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Síndrome Mucocutáneo Linfonodular/diagnóstico , Infecciones Cutáneas Estafilocócicas/diagnóstico , Absceso/tratamiento farmacológico , Absceso/microbiología , Nalgas , Preescolar , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Hospitalización , Humanos , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico , Penicilina V/uso terapéutico , Penicilinas/uso terapéutico , Choque Séptico/tratamiento farmacológico , Choque Séptico/etiología , Infecciones Cutáneas Estafilocócicas/complicaciones , Infecciones Cutáneas Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/aislamiento & purificación , Factores de TiempoRESUMEN
INTRODUCTION: The authors present the results of a retrospective series of 17 cases of dislocations or perilunate fracture-dislocations of the carpus, treated in emergency (period of less than 7 days). The objective aim of our study was to evaluate the radioclinical fate prognosis of these lesions pathologies and their social commitment impact. PATIENTS AND METHODS: It is a retrospective study covering the period from July 2004 to December 2009 (or 54 months). Were included in the study, patients hospitalised for a pure dislocation or a perilunate fracture-dislocation authenticated confirmed by an x-ray postero-anterior and lateral views were included. The series included 15 men and two women, nine manual workers, with an average age of 38.9 years. Based on Herzberg radiological classification, the series included six pure perilunate dislocations (35%) and 11 fracture-dislocations (59%) including seven forms trans-scapho-perilunate and four fractures of the lower end of radius. On the profile x-ray, 16 of the lesions were posterior displacement, including 12 stages I lesions (lunatum in place under the radius), and four stage II (lunatum dislocated in front of the radius). A patient had an anterior dislocation stage II, associated with a radial styloid fracture. All patients were operated using surgical treatment, percutaneous, either open pit, or open approaches combining with broaching scapholunate, scaphocapitate and triquetrolunate pinning. Then, an immobilization for 6 weeks was put in place and was performed using a forearm cast. Rehabilitation began as early as the removal of osteosynthesis was done at pin removal. RESULTS: The average decline follow-up in the series was 26 months. The mean score of Cooney was 63/100. There were two excellent results, two good results, seven middle moderate results, and six bad results. The average Quick-DASH score was 24.6/55 and the PRWE 41/150. The average duration of the work stoppage leave was 8 months, including one retired. The average of flexion-extension arc of the traumatized side was 77% (101°) in comparison to the healthy side. The average strength of the traumatized side was 71% (34kg) in comparison with the healthy side. The average radial-ulnar tilt arc of the traumatized side was 67% (37°) in comparison with the healthy side. DISCUSSION: There is no formal radioclinical prognostic in the radioclinic correlation. However, it seems to emerge that the timing and the type of support treatment bear the most important prognostic guarantors of a better result factors. Perilunate fracture-dislocations have major arthrogeneous arthrogenic potential, yet with a despite functional outcome consistent allowing resumption of recovery of past previous activities. It would seem that perilunate fracture-dislocations have a better functional outcome than those of pure dislocations. Thus, this work is the beginning of a long-term study, including a larger number of patients.