Manejo del neonato con piel frágil / Handling neonates with fragile skin / Manejo do neonatos com pele frágil

El presente documento se realizó gracias a la activa participación de diferentes profesionales de la salud, entre ellos, médicos dermatólogos, residentes de dermatología, neonatólogos, licenciadas y enfermeras del Servicio de Neonatología del Centro Hospitalario Pereira Rossell. Se hizo una búsqueda sistemática de la literatura, sin embargo, debido a que la EA es una condición poco frecuente, con un pequeño número de pacientes, la gran mayoría de trabajos publicados son estudios no analíticos o recomendaciones basadas en opinión de expertos (nivel de evidencia 3-4 o D). De esos estudios se han realizado guías y consensos en diferentes países e instituciones. Dicha literatura también ha sido evaluada y analizada por los autores de estas pautas. Este documento busca servir como una guía práctica y no intenta reemplazar el juicio clínico que el profesional debe emplear para cada paciente o situación en particular. Se presenta una variedad de materiales con los que contamos en el medio y alternativas mediante un pautado de estrategia de tratamiento.

Preoperative evaluation of sentinel lymph node status in melanoma by means of 99m Tc-MIBI and lymphoscintigraphy : a case report

Previous reports have shown that 99m sestamibi(MIBI)could detect clinically occult metastatic melanoma lesions. This article reports on a patient with invasive melanoma of the right heel in whom the sentinl node status was preoperatively evaluated with this trace. Although regional lymph nodes were clinically negative, 99mTc MIBI scintigraphy showed focal increased tracer uptake in the right groin that corresponded to the location of 2 sentinel nodes visualized by lymphoscintigraphy with 99m Tc-colloidal rhenium sulfide performed the same day. A y-probe was used intraoperatively to guide the excision of the sentinel nodes that were further classified as metastatic by histopathology. This double.technique approach is technically feasible and has the potential of selecting a groups of patients who might benefit from a selective complete lymphadenectomy

Comparison of 99m Tc-MIBI scintigraphy and sentinel node biopsy in the detection of occult lymph node metastases from cutaneous melanoma

99mTc-MIBI scintigraphy has been proposed as a technique that can diagnose clinically undetectable melanoma metastases. The aim of the study was to compare the sensitivity of 99mTc-MIBI with that of sentinel node biopsy (SNB) in the detection of nodal disease. Twenty-eight patients with melanoma <1.0mm thick were enrolled. Patients underwent 99mTc-MIBI scintigraphy and a preoperative lymphoscientigraphy followed by SNB. Sentinel nodes were identified in 27/28 patients. Twelve patients had an involved sentinel node (SN), being 99mTc-MIBI positive in 10. No patient with negative SNB developed regional recurrence during the study. 99mTc-MIBI had a sensitivity of 83 percent and a specificity of 93 percent. We conclude that SNB remains the procedure of choice for detecting subclinical lymph node involvement from melanoma. 99mTc-MIBI could have an alternative role in lymph node staging of patients who are not good candidates of SNB, that needs to be tested in appropriate trials

Cutaneous malignant melanoma : scintigraphic detection of recurrent disease with Tc-99m MIBI

The posturgical risk of recurrence in patients with malignant melanoma is relatively high and at the time of diagnosis regional progression is frequently present. Therefore, the development of a technique for the early detection of local recurrence or subclinical nodal and distant metastases may be of considerable help in the postsurgical follow-up. The authors report on three cases of recurrent malignant melanoma imaged with Tc-99mMIBI, which is a radiopharmaceutical classically used for myocardial perfusion imaging. One patient revealed abnormal accumulation of the radiopharmaceutical in a locally recurrent lesion. The second patient showed increased MIBI uptake in skin nodules and also in clinically non-palpable lymph node metastases. In the remaining patient, Tc-99mMIBI revealed intense focal accumulation in the scar of the surgical excision, at mediastinal and pulmonary locations and also in the brain. Our results suggest that Tc-99m MIBI scanning may be a sensitive technique for the detection of locally recurrent MM as well as nodal or distant metastases. Thus, this technique could be helpful in the follow-up of patients with MM in order to detect early recurrent disease