RESUMO
The development of a tracheocutaneous fistula (TCF) is a well-documented complication after tracheostomy, especially in chronic morbid patients, in whom tubes or cannulas are left in place over time, or in irradiated patients. Surgical treatments are therefore needed which range from simple curettage and dressings to local skin flaps, muscle flaps and, in the more complex cases, microsurgical free tissue transfers. We present a novel combined technique used to successfully treat recurrent TCFs in irradiated patients, involving a superiorly based turnover fistula flap and a sternocleidomastoid transposition flap.
RESUMO
Tuberous sclerosis complex is an autosomal dominant disorder that can cause nonmalignant hamartomas in any organ. Angiofibromas are the most disturbing marker of the disease because they are conspicuously present on the face. We report the case of a 15-year-old girl affected by tuberous sclerosis, whose facial angiofibromas were satisfactorily treated by a green light vascular laser (532 nm).
Assuntos
Angiofibroma/terapia , Terapia a Laser/métodos , Esclerose Tuberosa/terapia , Adolescente , Angiofibroma/patologia , Face , Feminino , Hamartoma/patologia , Hamartoma/terapia , Humanos , Esclerose Tuberosa/patologiaRESUMO
BACKGROUND: Risk-reducing mastectomy (RRM) decreases breast cancer (BC) risk in BRCA1/2 mutation carriers by up to 95%, but the Italian attitude towards this procedure is reluctant. PATIENTS AND METHODS: This is an observational study with retrospective design, using quantitative and qualitative research methods, aimed at evaluating the attitude towards RRM by rapid genetic counselling and testing (RGCT), at the time of BC diagnosis, compared with traditional genetic counselling and testing (TGCT), after previous BC surgery. Secondary aims were to investigate patient satisfaction after RRM and the rate of occult tumour in healthy breasts. A total of 1168 patients were evaluated: 1058 received TGCT, whereas 110 underwent RGCT. RESULTS: In TGCT, among 1058 patients, 209 (19.7%) mutation carriers were identified, with the rate of RRM being 4.7% (10 of 209). Conversely in RGCT, among 110 patients, 36 resulted positive, of which, 15 (41.7%) underwent bilateral mastectomy at the BC surgery time, showing an overall good satisfaction, measured by interpretative phenomenological analysis 12 months after the intervention. CONCLUSIONS: Our study shows that RGCT in patients with a hereditary profile is associated with a high rate of RRM at the BC surgery time, this being the pathway offered within a multidisciplinary organization.
Assuntos
Neoplasias da Mama/genética , Genes BRCA1 , Genes BRCA2 , Aconselhamento Genético , Testes Genéticos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Itália , Mastectomia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemAssuntos
Úlcera da Perna/terapia , Sucção/instrumentação , Adulto , Idoso , Desenho de Equipamento , Humanos , Pessoa de Meia-Idade , Vácuo , CicatrizaçãoAssuntos
Drenagem/métodos , Mamoplastia , Implantes de Mama , Drenagem/instrumentação , Feminino , Humanos , ReoperaçãoRESUMO
Twelve patients with ptosis of the brow caused by facial nerve paralysis were treated by endoscopic forehead lift. Four had an isolated paralysis of the temporal branch of the facial nerve and in eight the entire facial nerve was affected. In two of these patients the facial paralysis was bilateral, caused by Finnish hereditary amyloidosis. A standard subperiosteal endoforehead approach was used and the forehead was fixed by biodegradable pins (n = 8), anchor screws (n = 3), or a suture to the posterior scalp (n = 1). The procedure was a success in 10 patients, and failed in two after initially good results. The endoscopic brow lift is a good method of treating ptosis of the brow caused by paralysis of the temporal branch of the facial nerve.
Assuntos
Endoscopia , Sobrancelhas/cirurgia , Paralisia Facial/complicações , Ritidoplastia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Romberg's disease is a rare condition characterized by progressive hemifacial atrophy. The atrophic process typically has its onset in the first or second decade of life, it continues for a few years (usually 2, but up to 10), and then it stops spontaneously. The subcutaneous tissue is the first to be involved by the disease, followed by muscles, bones, and, rarely, the skin. The etiology of the disease is unknown. The only available treatment is surgical. Several techniques have been reported in the literature, from fat transplant, to silicon prostheses, to the use of flaps. We present our experience in successfully treating six patients (3 males and 3 females) affected by Romberg's hemifacial atrophy of intermediate or severe degree. A technique including a free parascapular microvascular flap with the adjunct of porous polyethylene implants was used. Further correction was performed with remodeling or resuspension.
Assuntos
Hemiatrofia Facial/cirurgia , Prótese Maxilofacial , Retalhos Cirúrgicos , Tecido Adiposo/transplante , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Prótese Maxilofacial/efeitos adversos , Fístula Bucal/etiologia , Polietilenos , Escápula , Transplante de PeleRESUMO
Os autores descrevem um surto de leishmaniose tegumentar americana (LTA) instalado na regiao nordeste do Estado de Sao Paulo em 1992. Após a notificaçao de doze casos humanos em uma área rural do município de Itupeva, foi realizado um inquérito epidemiológico, destacando-se 34 por cento de positividade da populaçao à Reaçao Intradérmica de Montenegro. Constatou-se uma grande diversidade da fauna flebotomínica local, com predominância de L. migonei, L. intermedia e L. whitmani, tanto no domicílio, quanto na margem da mata. Ressalta-se a presença na margem da mata de L. longipalpis.