RESUMEN
The advance of clinical diagnosis and treatment in oral and maxillofacial-head and neck tumors has been through the process of specialization and multidisciplinary cooperation. In most cases, a single discipline cannot meet the requirements of diagnosis and treatment, which needs the cooperation of oral and maxillofacial surgery, otolaryngology and oncology approach and therapeutic method such as surgery, radiotherapy and chemotherapy. Holistic integrative medicine aims at integrating the most effective clinical practice experience and patients' individual situation and prognosis, establishing new medical mode conforming to the modern concept and fulfilling the medical system adapting to the specific characteristics of the diseases.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Medicina Integrativa , Neoplasias Maxilares/diagnóstico , Neoplasias Maxilares/terapia , Neoplasias Faciales/diagnóstico , Neoplasias Faciales/terapia , Salud Holística , Humanos , Cirugía Bucal , Resultado del TratamientoRESUMEN
A previously healthy 86-year-old male was transported by ambulance to the trauma bay of the emergency department (ED) for profuse bleeding from the left temple. The ambulance crew raised concern that the volume and force of the bleed may suggest arterial involvement. The patient reported having applied a natural topical remedy to a mole two weeks prior at the recommendation of a naturopath. The patient described progressive blackening and swelling of the area in the days following the single application of the product. After gaining control of the bleeding in the ED, the area was found to have a raised, 2 cm eschar.
Asunto(s)
Antineoplásicos Fitogénicos/efectos adversos , Benzofenantridinas/efectos adversos , Quemaduras Químicas/etiología , Cloruros/efectos adversos , Neoplasias Faciales/tratamiento farmacológico , Hemorragia/inducido químicamente , Isoquinolinas/efectos adversos , Nevo/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Compuestos de Zinc/efectos adversos , Administración Cutánea , Anciano de 80 o más Años , Antineoplásicos Fitogénicos/administración & dosificación , Benzofenantridinas/administración & dosificación , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/terapia , Cloruros/administración & dosificación , Neoplasias Faciales/diagnóstico , Hemorragia/terapia , Humanos , Isoquinolinas/administración & dosificación , Masculino , Nevo/diagnóstico , Automedicación/efectos adversos , Neoplasias Cutáneas/diagnóstico , Resultado del Tratamiento , Compuestos de Zinc/administración & dosificaciónRESUMEN
Patients with head and neck cancer are particularly susceptible to using denial as a coping mechanism. While some forms of denial may help patients achieve better levels of physical functioning, persistent denial can serve as a major barrier to treatment. We report a case of extreme denial by a 60-year-old woman with an extensive basal cell carcinoma of the face that had been neglected for more than 20 years. We present this case to raise awareness of the potential danger of denial, and we discuss strategies that physicians can undertake to properly manage patients who engage in it. Since the diagnosis and treatment of head and neck cancer can result in profound psychological trauma, gaining an appreciation for how patients cope with it is an important part of the comprehensive care of head and neck oncology patients.
Asunto(s)
Carcinoma Basocelular/psicología , Negación en Psicología , Neoplasias Faciales/psicología , Cuero Cabelludo , Neoplasias Cutáneas/psicología , Adaptación Psicológica , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/cirugía , Neoplasias Faciales/diagnóstico , Neoplasias Faciales/cirugía , Femenino , Humanos , Persona de Mediana Edad , Relaciones Médico-Paciente , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , Negativa del Paciente al TratamientoAsunto(s)
Hemangioma , Neoplasias Cutáneas , Diagnóstico Diferencial , Embolización Terapéutica , Neoplasias Faciales/diagnóstico , Neoplasias Faciales/patología , Hemangioma/clasificación , Hemangioma/complicaciones , Hemangioma/congénito , Hemangioma/diagnóstico , Hemangioma/patología , Hemangioma/radioterapia , Humanos , Lactante , Recién Nacido , Síndrome de Kasabach-Merritt/etiología , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Terapia por Luz de Baja Intensidad , Linfangioma/diagnóstico , Linfangioma/patología , Linfangioma/terapia , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/patología , Remisión Espontánea , Factores de Riesgo , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/congénito , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapia , Neoplasias de los Tejidos Blandos/diagnóstico , Síndrome de Sturge-Weber/diagnóstico , Telangiectasia/diagnóstico , Úlcera/etiología , Malformaciones Vasculares/diagnóstico , Malformaciones Vasculares/patología , Malformaciones Vasculares/terapiaRESUMEN
The 2005 EORTC/WHO classification includes three CD30+ lymphoproliferative disorders: 1) primary cutaneous anaplastic large cell lymphoma, 2) lymphomatoid papulosis and 3) borderline cases. These entities may present with many different clinical appearances. Therefore, a precise differentiation among them often is impossible. We present a 40-year-old female who initially presented with a neutrophil-rich, anaplastic CD30+ T cell lymphoma followed by lymphomatoid papulosis.
Asunto(s)
Neoplasias Faciales/diagnóstico , Linfoma Anaplásico Cutáneo Primario de Células Grandes/diagnóstico , Papulosis Linfomatoide/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Neutrófilos/patología , Neoplasias Cutáneas/diagnóstico , Adulto , Antimetabolitos Antineoplásicos/uso terapéutico , Diagnóstico Diferencial , Eosinófilos/patología , Neoplasias Faciales/patología , Femenino , Humanos , Linfocitos/patología , Linfoma Anaplásico Cutáneo Primario de Células Grandes/tratamiento farmacológico , Linfoma Anaplásico Cutáneo Primario de Células Grandes/patología , Papulosis Linfomatoide/tratamiento farmacológico , Papulosis Linfomatoide/patología , Metotrexato/uso terapéutico , Neoplasias Primarias Múltiples/tratamiento farmacológico , Neoplasias Primarias Múltiples/patología , Terapia PUVA , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patologíaRESUMEN
A 73-year-old man presented with a two year history of multiple nodules and follicular papules accompanied by slight itching on the face and the forearm. A physical examination showed multiple, soft, erythematous nodules on the forehead, cheek, and jaw, contributing to a generally leonine appearance of the face. Histopathological examination from the forehead revealed dense, massive concentrations of atypical lymphocytes in the dermis, and the forearm showed infiltration of atypical lymphocytes predominantly around the follicles. We diagnosed this condition as folliculotropic cutaneous T cell lymphoma (CTCL). EPOCH therapy was very effective and the lesions of the forehead and forearm showed a decrease in tumor elevation; the histology showed a precipitous decrease in the number of the atypical lymphocytes.
Asunto(s)
Neoplasias Faciales/diagnóstico , Folículo Piloso/patología , Micosis Fungoide/diagnóstico , Neoplasias Cutáneas/diagnóstico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Brazo/patología , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Doxorrubicina/análogos & derivados , Etopósido/administración & dosificación , Neoplasias Faciales/complicaciones , Neoplasias Faciales/tratamiento farmacológico , Neoplasias Faciales/patología , Humanos , Interferón-alfa/uso terapéutico , Masculino , Micosis Fungoide/complicaciones , Micosis Fungoide/tratamiento farmacológico , Micosis Fungoide/patología , Terapia PUVA , Prednisolona/administración & dosificación , Prednisona/administración & dosificación , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología , Vincristina/administración & dosificaciónRESUMEN
Ulceration is a common complication of hemangiomas of infancy and presents a therapeutic dilemma for the head and neck-facial plastic surgeon. Multiple therapies are available, further complicating treatment of patients. We review the common characteristics of ulcerated hemangiomas and discuss the treatment modalities available. We present case reports to illustrate management options and a stepwise algorithm for treatment of ulcerated hemangiomas.
Asunto(s)
Neoplasias de Cabeza y Cuello/terapia , Hemangioma/terapia , Úlcera Cutánea/terapia , Corticoesteroides/uso terapéutico , Terapia Combinada , Neoplasias Faciales/diagnóstico , Neoplasias Faciales/terapia , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/diagnóstico , Hemangioma/diagnóstico , Humanos , Lactante , Recién Nacido , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Terapia por Luz de Baja Intensidad/métodos , Proteínas Recombinantes , Medición de Riesgo , Muestreo , Úlcera Cutánea/diagnóstico , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: The use of escharotic or caustic pastes to treat skin cancer is based on the centuries-old observation that selected minerals and plant extracts may be used to destroy certain skin lesions. Zinc chloride and Sanguinaria canadensis (bloodroot) are 2 agents that are used as part of the Mohs chemosurgery fixed-tissue technique. The use of escharotics without surgery has been discredited by allopathic medicine but persists and is promoted among alternative practitioners. Patients may now purchase "herbal supplements" for the primary self-treatment of skin cancer, and physicians will see patients who elect this therapy for their skin cancers. OBSERVATIONS: We reviewed the history of escharotic use for skin disease and performed an Internet search for the availability and current use of escharotics. Our search located numerous agents for purchase via the Internet that are advertised as highly successful treatments for skin cancer. We report 4 cases from our practice in which escharotic agents were used by patients to treat basal cell carcinomas in lieu of the recommended conventional treatment. One patient had a complete clinical response, but had a residual tumor on follow-up biopsy. A second patient successfully eradicated all tumors, but severe scarring ensued. A third patient disagreed with us regarding his care and was lost to follow-up. One patient presented with a nasal basal cell carcinoma that "healed" for several years following treatment elsewhere with an escharotic agent but recurred deeply and required an extensive resection. The lesion has since metastasized. CONCLUSIONS: Escharotic agents are available as herbal supplements and are being used by patients for the treatment of skin cancer. The efficacy of these agents is unproven and their content is unregulated. Serious consequences may result from their use. Conventional medicine has an excellent track record in treating skin cancer. Physicians should recommend against the use of escharotic agents for skin cancer, and the Food and Drug Administration should be given the authority to regulate their production and distribution.
Asunto(s)
Alcaloides/uso terapéutico , Carcinoma Basocelular/tratamiento farmacológico , Neoplasias Faciales/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Administración Tópica , Biopsia con Aguja , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/cirugía , Terapia Combinada , Neoplasias Faciales/diagnóstico , Neoplasias Faciales/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cirugía de Mohs/métodos , Sensibilidad y Especificidad , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , Resultado del TratamientoRESUMEN
It is shown that a spin-echo sequence may be used to acquire T(2)-weighted, high-resolution, high-SNR sections at quasi-real-time frame rates for interactive, diagnostic imaging. A single-shot fast spin-echo sequence was designed which employs driven equilibrium to realign transverse magnetization remaining at the final spin echo. Driven equilibrium is shown to improve T(2) contrast at a given TR, or conversely to reduce TR by approximately 1000 msec and thus increase temporal resolution while maintaining a given level of contrast. Wiener demodulation of k-space data prior to reconstruction is shown to reduce blurring caused by T(2)-decay while constraining noise often associated with other inverse filters. Images are continuously acquired, reconstructed, and displayed at rates of one image every one to two seconds, while section position and contrast may be altered interactively. The clinical utility of this method is demonstrated with applications to dynamic pelvic floor imaging and interactive obstetric imaging.