RESUMEN
Multiple glomus tumors are extremely rare and differ from the more common solitary glomus tumors in their clinical presentation and histological features. The authors report a case of multiple glomus tumors of the right hand in a 65-year-old man, its treatment, and a review of the features of this uncommon tumor. The tumor usually presents as a painful, firm, purplish, solitary nodule of the extremities, especially in the nail bed. Multiple glomus tumors are described as softer, more compressible, bluish nodules and they occur with less frequency than solitary tumors. They are often inherited in an autosomal dominant pattern. The authors present a case of multiple glomus tumors of the right hand, in which many small, painful, red papules were grouped in the right hypothenar region. The patient was treated by wide excision of the lesion and coverage of the defect with an ulnar artery forearm flap.
Asunto(s)
Tumor Glómico/cirugía , Mano , Neoplasias Cutáneas/cirugía , Anciano , Tumor Glómico/diagnóstico , Tumor Glómico/patología , Humanos , MasculinoRESUMEN
The expanding indications for coronary artery bypass graft (CABG) and cardiac valves replacement have caused an increase in the number of sternal infections. The common treatment includes appropriate antibiotics, early debridement, and transposition of muscle flaps with or without skin grafts. When other treatments have proved unsatisfactory, we have used the great omentum for wound closure. During the last five years, 16 patients (10 women, six men, median age 63 years) underwent repair of infected sternotomy wounds by the transposition of the great omentum, after failure of pectoralis major or rectus abdominis muscle flaps (n = 9). Seven patients underwent transposition of the great omentum as the first choice. The omentum covers the sternal defect well and the closure was reliable.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Epiplón/cirugía , Esternón/cirugía , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Skin surface proteolytic activity in the living animal was determined by a sensitive, non-invasive methodology developed in our laboratory. A non-leaky well was constructed on the shaved back of an anesthetized guinea pig. The well contained the reaction mixture including the substrate 125I-S-carboxymethylated insulin B-chain (ICMI). The proteolytic activity was shown to be time-dependent. The activity was strongly inhibited by pepstatin A, indicating the involvement of aspartic proteinase(s) such as cathepsin D and/or E. Pretreatment of the skin with propylene glycol blocked the proteolytic activity. The present study demonstrates the presence of proteolytic activity located on skin surface using a unique, non-invasive method for in situ proteinase determination in the living animal.
Asunto(s)
Endopeptidasas/metabolismo , Piel/enzimología , Animales , CobayasRESUMEN
The present study demonstrated a noninvasive procedure for in situ determination of stratum corneum aspartic proteinase in the living animal. A non-leaky well, containing [125I]S-carboxymethylated insulin B-chain (ICMI) as a substrate, was constructed on the shaved back of anesthetized guinea pigs and rats. The enzymatic activity was determined by measuring the radiolabeled trichloroacetic acid soluble material. We demonstrated pepstatin-sensitive proteinase activity bound to the skin surface indicating the involvement of aspartic proteinase(s) such as cathepsin D and/or E. Aged rats had about six fold lower activity than young animals. The proteinase activity was inhibited by the alkylating agent mechlorethamine and by the cosmetic propylene glycol. A similar procedure was carried out with intact human skin pieces obtained during plastic surgery. The activity was inhibited by antihuman cathepsin D antibodies. Cathepsin D was immunohistochemically localized in the corneal and granular layers of the epidermis. Skin surface aspartic proteinase/cathepsin D activity may serve as a marker for skin aging or for certain skin disorders leading to a new approach to their medical treatments.
Asunto(s)
Ácido Aspártico Endopeptidasas/análisis , Catepsina D/análisis , Piel/enzimología , Envejecimiento/metabolismo , Alquilantes/farmacología , Animales , Ácido Aspártico Endopeptidasas/antagonistas & inhibidores , Catepsina D/antagonistas & inhibidores , Inhibidores Enzimáticos/farmacología , Cobayas , Humanos , Inmunohistoquímica , Irritantes/farmacología , Mecloretamina/farmacología , Propilenglicol/farmacología , Ratas , Piel/efectos de los fármacosRESUMEN
Forty-three women, in a series of 150, participated in a prospective study that examined their chest walls for deformities 3 months after maximal tissue expansion for single-breast reconstruction. Computed tomography imaging was used for this purpose. Twenty-one patients underwent immediate breast reconstruction and the other 22 patients underwent delayed reconstruction. Fifty-three percent had some chest wall abnormality. In the delayed group, chest wall deformities were more statistically significant (p < 0.001). Our findings suggest that chest wall deformity is a common occurrence after maximal tissue expansion for breast reconstruction.
Asunto(s)
Tórax en Embudo/diagnóstico por imagen , Mamoplastia/instrumentación , Complicaciones Posoperatorias/diagnóstico por imagen , Dispositivos de Expansión Tisular , Tomografía Computarizada por Rayos X , Adulto , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Femenino , Estudios de Seguimiento , Humanos , Mastectomía , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
To assess the efficacy of the topical anesthetic cream, EMLA, in alleviating the pain produced by infiltration of local anesthetic prior to surgical skin biopsies, a randomized, double-blind, placebo-controlled study was performed on 54 patients undergoing 162 excisional biopsies. Both pain induced by needle insertion and pain induced by local injection were significantly diminished after topical application of EMLA cream. However, part of the effect was placebo, because the placebo ointment (Vaseline) also produced significant pain alleviation.
Asunto(s)
Anestesia Local , Anestésicos Locales , Biopsia , Lidocaína , Dimensión del Dolor , Prilocaína , Piel/patología , Adulto , Combinación de Medicamentos , Femenino , Humanos , Inyecciones , Combinación Lidocaína y Prilocaína , Masculino , Neoplasias Cutáneas/patología , Resultado del TratamientoRESUMEN
This article describes a rare malignant schwannoma invading the left mandible in a 42-year-old man. The clinical presentation, inconclusive radiographic findings, and light microscopic histology are included. The appropriate surgical treatment could be determined only intraoperatively when frozen sections provided the exact tumor margins. The patient subsequently received adjuvant treatment by brachytherapy.
Asunto(s)
Neoplasias de los Nervios Craneales/cirugía , Nervio Mandibular , Neurilemoma/cirugía , Adulto , Braquiterapia , Neoplasias de los Nervios Craneales/patología , Neoplasias de los Nervios Craneales/radioterapia , Secciones por Congelación , Humanos , Imagen por Resonancia Magnética , Masculino , Neurilemoma/patología , Neurilemoma/radioterapia , Radioterapia AdyuvanteRESUMEN
A low voltage (24 V) electrical deep burn of the hand injured a professor of applied physics when performing an experiment in his laboratory. The potential hazard of the equipment is described, the injuries are reported and the literature is reviewed.
Asunto(s)
Quemaduras por Electricidad/patología , Traumatismos de la Mano/patología , Accidentes de Trabajo , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Surgery has become progressively more reliant on technology. The technique of colonic anastomosis utilizing the biofragmentable anastomotic ring (BAR) is one such example. The benefits of therapeutic laparoscopy have been applied to the arena of colorectal surgery. A case is presented that combines these two modalities in a patient with colon cancer, laparoscopic mobilization of the large bowel, exteriorized resection, and BAR anastomosis.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias del Colon/cirugía , Laparoscopía , Anastomosis Quirúrgica/instrumentación , Anastomosis Quirúrgica/métodos , Materiales Biocompatibles , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Desmoid tumors in various anatomic sites were treated in 4 females and 3 males, ranging in age from 16-50 years, during a 6-year period. In 5 the tumor was completely excised with free margins. In the other 2 excision was incomplete and the tumor recurred within a few months. Desmoid tumors have a marked tendency to local recurrence, and therefore should be widely excised. There is no evidence that adjuvant therapy has a place in the management of these tumors.
Asunto(s)
Fibroma/cirugía , Adolescente , Adulto , Femenino , Fibroma/patología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de NeoplasiaRESUMEN
We report and discuss a patient with characteristics of Marfan syndrome associated with a bicuspid aortic valve, premature aging, and primary hypogonadism.