الملخص
Los tumores estromales de potencial maligno incierto (STUMP) se enmarcan dentro de las lesiones de células fusadas de la próstata, entidades de relativa infrecuencia en la práctica urológica habitual, contabilizándose entre 0,1-0,2 por ciento 1 de todas los tumores malignos prostáticos. Corresponden a una proliferación no epitelial mesenquimática de células fusadas estromales, que pueden adquirir la capacidad de infiltrar el epitelio glandular prostático. Representan un desafío tanto para el patólogo, por la dificultad diagnóstica, como para el clínico, pues no existe consenso respecto a su manejo. Materiales y métodos: estudio retrospectivo descriptivo. Se filtró la base de datos del servicio de Anatomía Patología del Hospital San Borja Arriarán con los términos clave STUMP, Tumor estromal próstata, tanto de biopsias transrrectales como de piezas operatorias. De los pacientes con diagnóstico histológico e inmunohistoquímico compatible, se registraron características epidemiológicas, estudio, manejo y sobrevida global. Resultados: se encontraron 3(tres) pacientes con diagnóstico histológico de STUMP. Edad promedio al diagnóstico 66años. Dos de los casos (66,6 ´po0r ciento) correspondieron a hallazgo en biopsia diferida por cirugía benigna prostática, (una por Adenomectomía transvesical y otra por RTU-P). El tercer caso correspondió a un hallazgo en biopsia por punción transrrectal ecodirigida, en contexto de PSA elevado (100ng/mL) y 4 biopsias previas: 3 normales, y una con informe de posible sarcoma prostático. La terapia de elección en 2 casos fue seguimiento y en uno se indicó cirugía radical. En los casos descritos no se registra mortalidad, con seguimiento promedio de 32 meses. Conclusión: Los tumores estromales de potencial maligno incierto son un diagnóstico histológico infrecuente, descrito como hallazgo tanto en la biopsia transrrectal como de pieza quirúrgica. No existen consensos internacionales ni guías de manejo. En nuestra experiencia...
Stromal tumors of uncertain malignant potential (STUMP) are included in the spindle cell lesions of the adult prostate, a very rare diagnostic entity in the clinical practice, accounting no more than 0,1-0,2 percent of all prostate malignancies. STUMP is defined as a non epithelial proliferation of spindle cells, which can acquire the ability of infiltrate the prostate glands. This lesions represent a challenge for both clinical and pathology physician. Material and methods: retrospective cohort study. A research was performed at the San Borja Hospital Pathology Services database, using keywords STUMP, Stromal prostate tumor. From eligible patients we took epidemiology and clinical data. Results: a total of three patients were included. Average age was 66 years. STUMP was founded in two patients in the pathology report after benign prostatic surgery (Simple prostatectomy and TUR-P). A third patient was diagnosed by a needle biopsy (TRUS Biopsy). This patient had an elevated PSA (>100 ng/mL), 4 previous biopsies, three normal and a fourth suspicious of prostate sarcoma. Surveillance was the therapy chosen for those patients diagnosed with STUMP after benign surgery. Radical prostatectomy was offered to the third patient. Average follow up was 32 month Conclusion: STUMP is a rare diagnostic, and is a challenge for both clinical and pathology physician. There are no guidelines for the management. In our series we confirmed the low frequency of this condition, and the management in our service is similar as other series described in literature...
الموضوعات
Humans , Male , Middle Aged , Stromal Cells/pathology , Prostatic Neoplasms/surgery , Prostatic Neoplasms/epidemiology , Epidemiology, Descriptive , Retrospective Studies , Prostatic Neoplasms/pathologyالملخص
Examinar factores pronósticos y analizar la supervivencia en pacientes sometidos a cistectomía radical (CR) por cáncer vesical. MATERIAL Y MÉTODO: estudio de cohortes retrospectivo de 46 pacientes sometidos a CR por cáncer vesical entre julio de 2003 y septiembre de 2012, considerándose como variable dependiente la supervivencia y como variables independientes: las características demográficas, comorbilidades, riesgo anestésico, condición clínica, lapso entre la RTU y la cistectomía, derivación urinaria utilizada, resultados anatomopatológicos y complicaciones postoperatorias. Se analizó la supervivencia mediante Kaplan-Meier, elaborando curvas que fueron comparadas mediante el método de Mantel-Cox. Se efectuó un análisis de supervivencia a 2 años de la cistectomía, mediante regresión logística binaria multivariante. RESULTADOS: La media de la supervivencia global fue 31,8 meses (mediana = 12 meses) y la de la específica 38,2 meses (mediana = 16). La supervivencia global fue mayor en enfermos menores de 70 años, con función renal o albuminemia normales, ASA <3 y en quienes se elaboró una neovejiga. La supervivencia específica fue mayor en los pacientes con estadio tumoral (pT) <3, densidad ganglionar <20 por ciento, margen quirúrgico negativo, sin compromiso ganglionar o masa residual (R0) y en los sometidos a linfadenectomía. Los factores de riesgo para fallecer dentro de los primeros 2 años fueron edad sobre 69 años, ASA >2, pT >2 (OR 25), compromiso ganglionar, metástasis a distancia, masa residual y margen positivo. CONCLUSION: La infiltración local, la afectación ganglionar y una edad mayor a 69 años fueron los tres factores de riesgo más determinantes de un peor pronóstico.
To review prognostic factors and analyze the survival of patients treated with radical cystectomy (RC) for bladder cancer. MATERIALS AND METHODS: Retrospective cohort study of 46 patients underwent RC for bladder cancer between July 2003 and September 2012 was carried out, considering survival as the dependent variable and as independent variables the following: demographic characteristics, comorbidities, anesthetic risk, clinical condition, delay between transurethral resection (TUR) and cystectomy, urinary diversion performed, pathologic findings, and postoperative complications. A survival analysis using the Kaplan-Meier method was performed; as a result curves were obtained and compared using the Mantel-Cox test. A multivariate binary logistic regression was performed, and prognostic factors of survival at 2 years of cystectomy were evaluated. RESULTS: The median overall survival was 31.8 months (median 12 months) and specific overall survival was 38.2 months (median = 16). Overall survival was higher in patients younger than 70 years, with normal renal function and normal albumin, ASA minor than 3 and in those that a neobladder was developed. Specific survival was higher in patients with tumor stage (pT) <3, node density <20 percent, negative surgical margins, without lymph node involvement or residual mass (R0) and in those underwent to lymphadenectomy. Risk factors for death within the first 2 years were: age over 69 years, ASA> 2, pT> 2 (OR 25), nodal involvement, distant metastases, residual mass and positive margins. CONCLUSIONS: Local infiltration, lymph node involvement and age over 69 years were the three most crucial risk factors for a worse prognosis.
الموضوعات
Humans , Male , Female , Middle Aged , Aged, 80 and over , Cystectomy/mortality , Cystectomy/methods , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/mortality , Multivariate Analysis , Survival Analysis , Lymph Node Excision , Retrospective Studies , Prognosisالملخص
La base del tratamiento de la disfunción eréctil (DE) son los inhibidores de la fosfodiesterasa 5, disponibles mayoritariamente para dosificación a demanda. En 2008 la FDA aprobó el Tadalafilo 5 mg de uso diario. OBJETIVO: Evaluar la efectividad del Tadalafilo 5 mg de uso diario para el tratamiento de la DE y la satisfacción de los pacientes frente a su uso. PACIENTES Y METODOS: Se reclutaron pacientes con DE entre Junio de 2011 y Mayo de 2012. Se registraron datos sociodemográficos, clínicos y andrológicos. La DE se clasificó según el puntaje del cuestionario IIEF. Todos los pacientes iniciaron tratamiento diario con Tadalafilo 5 mg y fueron reevaluados luego de un mes. La satisfacción y calidad de vida se evaluó con cuestionarios validados (EDITS, SEAR y GAQ). Para el análisis estadístico se consideró significativo un P<0.05.RESULTADOS: Se reclutaron 49 pacientes con edad promedio de 59,9 +/- 8,8 años. Un 14,3 por ciento presentaba DE severa, 36,7 por ciento moderada, 36,7por ciento leve-moderada y 12,2 por ciento leve. Al mes de tratamiento, el puntaje IIEF aumentó significativamente (P<0.0005), encontrándose un 18,4 por ciento sin DE, 53,1 por ciento con DE leve, 28,6 por ciento con DE leve-moderada y ninguno con DE moderada o grave. El 87,7 por ciento de los pacientes refirió mejores erecciones y el 81,6 por ciento una mejor capacidad para mantener la relación sexual. La satisfacción global con el tratamiento fue de 64,1 por ciento. CONCLUSIÓN: El tratamiento diario con Tadalafilo 5 mg es efectivo para el manejo de la DE y se asocia a niveles adecuados de satisfacción y confianza al cabo de un mes de tratamiento.
The base of the treatment of erectile dysfunction (ED) are the phosphodiesterase-5 inhibitors, mostly available for on demand dosing. In 2008, the FDA approved Tadalafil 5mg for daily use. OBJECTIVE: To evaluate the effectiveness of Tadalafil 5 mg daily dose for the treatment of ED and the patients satisfaction with its use. PATIENTS AND METHODS: Patients with ED were enrolled between June 2011 and May 2012. Sociodemographic, clinical and andrologic data was recorded. The severity of ED was classified according to the score of the IIEF questionnaire. All patients started daily treatment with Tadalafil 5 mg and were reevaluated after one month. Satisfaction and quality of life was assessed using validated questionnaires (EDITS, SEAR and GAQ). A P<0.05 was considered significant in all statistical analysis. RESULTS: A total of 49 patients were enrolled, with mean age of 59.9 +/- 8.8 years. A 14.3 ´percent suffered severe ED, 36.7 percent moderate, 36.7 percent mild-moderate and 12.2 percent mild. After one month, the IIEF score significantly increased (P<0.0005), finding a 18.4 percent of patients without ED, 53.1 percent with mild ED, 28.6 percent with mild-moderate ED and no cases with moderate or severe ED. 87.7 percent of patients reported better erections and 81.6 percent stated a better capacity to maintain erections during. The global satisfaction rate with the treatment was of 64.1 percent. CONCLUSION: The treatment with daily dose of Tadalafil 5 mg is effective for the management of ED and is associated with adequate levels of satisfaction and confidence after one month of use.
الموضوعات
Humans , Male , Adult , Middle Aged , Aged, 80 and over , Erectile Dysfunction/psychology , Erectile Dysfunction/drug therapy , Phosphodiesterase Inhibitors/administration & dosage , Tadalafil/administration & dosage , Quality of Life , Surveys and Questionnaires , Follow-Up Studies , Patient Satisfactionالملخص
Introducción: Nuestro grupo ha reportado previamente una asociación entre sensibilidad a quimioterapia y la expresión de proteínas MDR (P-Gp y MRP1) en líneas celulares y cultivos primarios de cáncer de próstata, quedando por estudiar la actividad de las mismas. Material y métodos: Se utilizó líneas celulares de cáncer de próstata PC3 y DU145. Se evaluaron los niveles de mARN de P-Gp y MRP1 mediante RT-PCR. La expresión de ambas proteínas se determinó mediante inmunofluorescencia. Se estableció un ensayo funcional en base a la acumulación de sustratos fluorescentes (DiOC2(3) para P-gp y CFDA para MRP1) y al uso de inhibidores específicos para cada proteína (Ciclosporina A para P-Gp y MK571 para MRP1). Las células se incubaron durante 60 minutos a 37ºC con o sin el inhibidor específico, seguido de otra incubación por 60 minutos agregando el sustrato fluorescente. La acumulación del sustrato fluorescente se determinó por citometría de flujo. Resultados: Las líneas celulares utilizadas sólo expresaron MRP1, mientras no se detectó P-Gp (mARN ni proteína). Mediante el ensayo funcional se observó que las células acumulaban más CFDA cuando eran tratadas con MK571. No se observó diferencias en la acumulación de DiOC(2)3 frente al tratamiento con Ciclosporina A. Conclusión: La mayor acumulación intracelular de CFDA frente al tratamiento con MK571 indica que la proteína MRP1 expresada en las líneas celulares utilizadas es funcional. P-Gp no se expresa en las líneas evaluadas. En estudios en curso nos encontramos evaluando la expresión y función de ambas proteínas en cultivos primarios.
Introduction: We have previously reported an association between sensitivity to chemotherapy and the expression of multidrug resistance proteins (MDR) (P-Gp and MRP1) in cell lines and primary cultures of prostate cancer. Activity remains to be studied. Material and methods: Prostate cancer cell lines PC3 and DU145 were used. Levels of mRNA of P-Gpand MRP1 using RT-PCR, were evaluated. The expression of both proteins was determined using immunofluorescence. A functional assay based on the accumulation of fluorescence substrates (DiOC2(3) for P-Gp and CFDA for MRP1) was established. Cells were incubated for 60 minutes at 37C with/without the specific inhibitor, followed by another 60 minutes incubation adding the fluorescence substrate. Accumulation of fluorescence substrate was determined by flow citometry. Results: Cell lines expressed only MRP1, whereas P-Gp (mRNA/protein) was not detected. Using the functional assay, we found that cells accumulated more CFDA when treated with MK571. No differences were seen in the accumulation of DiOC2(3) after treatment with ciclosporin A. Conclusion: The higher intracellular accumulation of CFDA after treatment with MK571 indicates that the MRP1 protein expressed in these cell lines is functional. P-Gp was not expressed in these cell lines. We are currently evaluating the expression and function of both proteins in primary cultures.
الموضوعات
Humans , Prostatic Neoplasms , ATP Binding Cassette Transporter, Subfamily B, Member 1 , Drug Therapyالملخص
Renal abscesses are infrequent event and may occasionally be fatal. In order to characterize its main clinical features, its diagnosis and evolution, a retrospective-descriptive study was done with cases identified between 1996 and 2006 in a teaching hospital. Forty-four cases were collected (mean age 49.9 years). Diabetes mellitus was present in 38.6 percent, urinary calculi in 36.4 percent, and previous urinary tract infection in 11.4 percent of the studied population. Enterobacteriaceae were the most frequent isolated microorganisms (44.4 percent), and 33.3 percent had a poli-microbial culture in abscess samples. S. aureus was rarely identified. Main therapeutic approaches were minimally invasive procedures (pigtails, percutaneous drainage or nephrostomy) in 50 percent followed by surgical interventions (nephrectomy or surgical debridement) in ~30 percent. Only 20.5 percent of patients were treated exclusively by antibiotics. Minimally invasive procedures were applied progressively after 2001 (p < 0.005). In this series case-fatality rate was 4.5 percent; 13.6 percent (n = 6) developed septic shock. Nephrectomy was performed in 9 cases (20.5 percent). Patients selected for nephrostomy had a lower risk for ICU admission (Odds Ratio 0.083 IC95 0.008-0.911). Renal abscesses are cause of morbidity but had a low case-fatality ratio; the therapeutic approach has changed in recentyears favoring at present minimally invasive procedures.
Los abscesos renales son eventos infrecuentes pero potencialmente letales. Objetivo: Conocer sus características clínicas, diagnóstico y evolución. Metodología: Se efectuó un trabajo descriptivo-retrospectivo con los casos detectados entre 1996 y el 2006 en un centro universitario. Resultados: Se identificaron 44 pacientes (edad promedio 49,9 años) asociados en algunos casos a diabetes mellitus (38,6 por ciento), litiasis urinaria (36,4 por ciento) o infección urinaria previa (11,4 por ciento). Los microorganismos más frecuentes fueron Enterobacteriaceae (44,4 por ciento) y 33,3 por ciento> de los cultivos fueron polimicrobianos. Staphylococcus aureus se identificó infrecuentemente. La estrategia terapéutica principal fue el uso de técnicas mínimamente invasoras (pigtails, drenaje percutáneo o nefrostomía; 50 por ciento), y luego quirúrgicas (nefrectomía o aseos quirúrgicos; ~30 por ciento>). Sólo 20,5 por cientoo fue tratado exclusivamente con antimicrobianos. Los procedimientos mínimamente invasores se usaron en forma progresiva después del 2001 (p < 0,005). La letalidad en esta serie fue 4,5 por ciento> (n = 2) y 13,6 por ciento (n = 6) desarrolló shock séptico. La nefrectomía se aplicó en 9 casos (20,5 por ciento). Los pacientes seleccionados para nefrostomía tuvieron menos riesgo de ingresar a UCI (Odds Ratio 0,083 IC95 0,008-0,911). Conclusiones: Los abscesos renales son causa de morbilidad mayor aunque de baja letalidad. Su estrategia terapéutica ha ido cambiando en los últimos años a favor de procedimientos mínimamente invasores como los drenajes percutáneos y/o endoscópicos.
الموضوعات
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , Abdominal Abscess , Kidney Diseases , Abdominal Abscess/diagnosis , Abdominal Abscess/microbiology , Abdominal Abscess/therapy , Kidney Diseases/diagnosis , Kidney Diseases/microbiology , Kidney Diseases/therapy , Retrospective Studies , Young Adultالملخص
Eosinophilic esophagitis is and uncommon disorder with an increasing incidence. We report four cases with ages ranging from 25 to 70 years. Disphagia of different intensity was present in all of them, the diagnosis was suggested by the endoscopic aspect and confirmed by histophatological finding of and increased eosinophilic infiltrate. A good response to treatment was observed in all the patients. This diagnosis should be considered in patients presenting with dysphagia or food impactation, mainly when stricture or narrowing are absent.
La esofagitis eosinofílica es una enfermedad poco frecuente con una incidencia en aumento. Se presentan 4 casos con un rango de edad entre 25 a 70 años. Todos presentaron disfagia de diferente intensidad, el diagnóstico se sospechó por el aspecto endoscópico y fue confirmado por el hallazgo histopatológico de un denso infiltrado eosinófilo. Una buena respuesta al tratamiento se observó en todos ellos. Este diagnóstico debe considerarse en presencia de disfagia o impactación de un bolo alimentario en ausencia de estrechez del lumen esofágico.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Anti-Inflammatory Agents/therapeutic use , Anti-Ulcer Agents/therapeutic use , Eosinophilia/diagnosis , Eosinophilia/drug therapy , Esophagitis/diagnosis , Esophagitis/drug therapy , Androstadienes/therapeutic use , Esophagoscopy , Omeprazole/therapeutic use , Treatment Outcomeالملخص
El órgano vomeronasal (OVN) es una estructura que estudiamos alguna vez en anatomía, sin embargo su ubicación, frecuencia y función específica en humanos ha sido poco estudiada. Por este motivo se realizó una revisión bibliográfica actualizada acerca del OVN humano, enfatizando en puntos importantes como su anatomía y relación con algunas conductas. Hoy en día es considerado como un órgano olfatorio accesorio, capaz de percibir la presencia de vomeroferinas. Estas corresponden a un grupo de sustancias químicas identificadas, capaces de provocar cambios conductuales tanto a nivel social, sexual como maternal. Se localiza lateralmente al septo nasal y posee células periféricas, capaces de actuar como receptores, los cuales al ser estimuladas son capaces de generar una respuesta, susceptible de ser medida a través de un electrodo ubicado en el epitelio vomeronasal. Los últimos estudios sugieren que además tendría una conexión directa hacia el sistema nervioso central, mediante neuronas sensoriales bipolares, lo que implica un cuidado adicional en pacientes sometidos a cirugías cercanas a su ubicación.
The human vomeronasal organ (OVN) is a structure that is once studied in Anatomy, but commonly Iittie is known about its location, frequency and specific function. For this reason recent literature on the subject was reviewed, emphasizing important topics such as its anatomy and relation to some behaviors. The vomeronasal organ is nowadays considered an accessory olfactory organ, capable of detecting the presence of vomeropherins. These belong to a group of identified chemical substances, capable of induce behavioral changes at the social, sexual and maternal level. It is located lateral to the nasal septum, and it contains peripheral cells that act as receptors, which upon stimulation are capable of triggering a response that can be recorded via an electrode located in the vomeronasal epithelium. In addition, recent studies suggest that the vomeronasal organ has a direct connection to the central nervous system, by way of bipolar sensory neurons, which would demand additional care in patients having surgery in its vicinity.
الموضوعات
Humans , Male , Female , Vomeronasal Organ/anatomy & histology , Vomeronasal Organ/physiology , Sex Characteristics , Pheromones/physiology , Vomeronasal Organ/embryologyالملخص
El reflujo faringolaríngeo (RFL) es un síndrome que se asocia a una constelación de síntomas. Entre ellos los más frecuentemente descritos son la disfonía, la fatiga vocal, el globus faríngeo, la tos crónica y la carraspera. Se realizó una búsqueda exhaustiva en bases de datos internacionales y nacionales en relación a RFL. Se utilizaron palabras clave como globus, carraspera, laringitis, disfonía y reflujo gastroesofágico. Se obtuvieron alrededor de 35 referencias en relación al tema estudiado, siendo la mayoría publicadas con posterioridad al año 2000. En relación a su etiología, se cree que el flujo retrógrado de contenido gástrico hacia la faringe sería el hecho más importante para su génesis, pero recientemente se ha demostrado que si bien este hecho patológico es fundamental en la producción de los síntomas, existen factores adicionales, capaces de perpetuarlo, permitiendo considerar al RFL como una entidad diferente del reflujo gastroesofágico (RGE).
Pharyngolaryngeal reflux (RFL) is a syndrome associated to a variety of symptoms. Among them, the most frequently described are dysphonia, vocal fatigue, pharyngeal globus, chronic coughing and throat clearing. An exhaustive search of international and national databases was performed. Globus, throat clearing, laryngitis and gastroesophageal reflux were used as keywords. Some 35 search-related references were retrieved, of which most were published from 2000 to date. Respect to the etiology of pharyngolaryngeal reflux, the current view is that gastric contain reflux to the pharynx is the most important factor, but recently it has been demonstrated that, although this pathological trait is pivotal for symptoms appearance, there are additional factors that could perpetuate the symptoms in time, which contribute to consider RFL as a different entity from gastroesophageal reflux (RGE).
الموضوعات
Humans , Laryngeal Diseases/diagnosis , Laryngeal Diseases/therapy , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Laryngeal Diseases/epidemiology , Laryngeal Diseases/etiology , Laryngeal Diseases/physiopathology , Laryngoscopy , Gastroesophageal Reflux/epidemiology , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/physiopathologyالملخص
Eagle syndrome is characterized by recurrent clinical symptoms like globus, dysphagia and odynophagia, which can be explain by an abnormal elongation of the Estiloid Apophysis or the calcification of the estilohioid ligament. It affects in equal proportion to men and women, being most common in people older than 50 years. Its importance is that it appears as a differential diagnosis compared with other causes of cervicofacial pain, being its election treatment, the surgical resection of the Estiloid apophysis. The following is a review of the literature and a clinical case of a 44 years old man, who consulted with a history of 6 months of odynophagia, foreign body sensation and cervicalgia. After the clinical, endoscopic and the complementary study of images evaluation, it was concluded that this was an Eagle Syndrome.
الموضوعات
Humans , Male , Adult , Ossification, Heterotopic/diagnosis , Ossification, Heterotopic/therapy , Diagnosis, Differential , Facial Pain/etiology , Ossification, Heterotopic/physiopathology , Deglutition Disorders/etiologyالملخص
Takayasu arteritis is a chronic idiopathic granulomatous vasculitis, which affects the aorta and its major branches, causing narrowing of the vascular lumen, which explains his particular symptoms. In children, its main manifestations are hypertension, cardiomegaly, increasing of the erythrocyte sedimentation rate, among others. We present a case of a girl aged 16, who has a long history of ozena. At physical examination there are nasal scabs and cacosmia. In the laboratory study highlights high levels of C Reactive Protein and erythrocyte sedimentation rate. The study through angio-Tac, shows a significant narrowing of supraaortic vascular structures.
الموضوعات
Humans , Adolescent , Female , Takayasu Arteritis/surgery , Takayasu Arteritis/complications , Takayasu Arteritis , Otorhinolaryngologic Diseases/etiology , Angiography , Aortic Diseases/etiology , Aortic Diseases , Otorhinolaryngologic Diseases , Paranasal Sinuses , Tomography, X-Ray Computedالملخص
Keloids and hypertrophic scars are frequent observed. These two conditions are considered part of the abnormal wound-healing spectrum. The main difference between keloids and hypertrophic scars is the scar extension in relation to the original incision, where former extends beyond the original incision while the latter respects it. The main issue with both conditions is that treatment modalities used today offer unacceptable high recurrence rates, between 50 to 70 percent, when they are applied as monotherapy. With combined treatment modalities recurrence rates have improved partially depending mainly in the chosen combination and so, this strategy is likely the optimal choice for the management of these lesions. The objective of this review was to highlight the pathophysiology, clinical features, and management of keloids with mono or combined therapy, focusing mainly in the surgical and radiotherapy/brachytherapy modalities.