Primary osteosarcoma of the skull in teenager.

Osteosarcoma of the skull is a rare primary malignant bone tumour in children, representing 1-2% of all cranial tumours. We describe a case of a 17-year-old adolescent with chondroblastic osteosarcoma of the parietal-occipital bone and no distant metastases at presentation treated with neoadjuvant chemotherapy, surgery and, later, concurrent chemoradiotherapy. The patient suffered progressive disease and died 15 months after diagnosis. There are at least 15 paediatric cases of osteosarcoma of the skull described in the literature. Due to its rarity, there are no broad prospective studies on this entity, which has distinctive features when compared to other craniofacial tumours, carrying a worse prognosis. Complete surgical resection is needed for long-term survival, whereas chemotherapy and radiotherapy have still questionable indications.

Treatment of bilateral ovarian dysgerminoma with 11-year follow-up: A case report.

INTRODUCTION: Malignant ovarian germ cell tumors (MOGCTs) are rare malignancies with an incidence of about 0.5/100,000. They account for less than 5% of all ovarian tumors, of which 32.8% are dysgerminomas, the female analogue of seminomas. These tumors occur in all age groups, with peak incidence below the age of 20 years in women. AIM: To describe the case of a bilateral ovarian dysgerminoma treatment with 11-year follow-up. METHODS: Case report with details regarding clinical history, surgical treatment, chemotherapy and follow up. We include a brief literature review. RESULTS: The patient underwent radical surgery for an advanced dysgerminoma, 20 cm in length, that compromised the contralateral ovary and sigmoid. Neoplastic cells were found in ascitic fluid. Subsequently, she underwent adjuvant chemotherapy according to a standard protocol. She has survived disease-free for more than 11 years. CONCLUSIONS: Dysgerminoma is a malignant neoplasm that, similar to other cancers, is easier to treat when diagnosed early. However, cures may be obtained even in advanced cases.

Avaliação pré e pós-operatória do efeito da cirurgia reparadora na qualidade de vida e da autoestima do paciente: um estudo prospectivo envolvendo 52 pacientes / Pre- and postoperative evaluation of the effect of reconstructive surgery on patient quality of life and self-esteem: a prospective study of 52 patients

Introdução: As lesões de pele benignas e malignas podem afetar a qualidade de vida (QV) e a autoestima dos pacientes, tendo a cirurgia plástica reparadora im-portante papel nesses indivíduos. O objetivo é estudar o efeito da cirurgia plástica reparadora sobre a QV e a autoestima de pacientes. Métodos: Foi realizado um estudo quase-experimental (antes e de-pois). A QV foi medida pelo questioná-rio SF-36. Para a medida da autoestima, foi utilizada a escala de autoestima de Rosemberg. Alterações nos escores de ambos os instrumentos foram medidas antes e após o procedimento cirúrgico e a significância estatística da diferença foi avaliada pelo teste t. A proporção de indivíduos com aumento de escore de QV e autoestima, segundo as categorias de variáveis sociodemográficas, caracte-rísticas da lesão ou da doença, classifica-ção do tratamento cirúrgico e eventos estressantes, foi medida, e a significância estatística foi avaliada pelo teste do Qui-quadrado. Resultados: Foram entrevis-tados 52 pacientes. Após a intervenção cirúrgica, houve melhora significativa no escore de QV na maioria dos domínios de SF-36 (aspectos emocionais, físicos, sociais, dor, estado geral de saúde e saú-de mental) e melhora na escala de autoes-tima de Rosemberg. Os fatores associa-dos a maior probabilidade de melhora na QV e autoestima após a cirurgia foram idade igual ou superior a 60 anos, cor de pele branca, maior escolaridade, ocorrên-cia de evento estressante e tipo maligno de neoplasia. Conclusões: A cirurgia reparadora teve um impacto positivo em vários domínios de QV e autoestima, mostrando outras melhorias na saúde do paciente, além dos benefícios clínicos.

Introduction: Benign and malignant skin lesions can affect patients' quality of life and self-esteem; thus, reconstructive plastic surgery is important for these individuals. The objective is to assess the effect of reconstructive plastic surgery on the quality of life (QoL) and self-esteem in patients with benign or malignant skin lesions. Methods: This quasi-experimental "prepost study" measured QoL using the 36-Item Short Form Health Survey (SF-36) questionnaire. For the measure of self-esteem, the Rosenberg Self-Esteem Scale was used. The changes in scores of both instruments were measured before and after surgery, and the statistical significance of the difference was evaluated using a paired sample t test. The proportion of individuals with an increased QoL score and self-esteem according to sociodemographic variables, lesion or disease characteristics, surgical treatment classification, and stressful events was measured, whereas the statistical significance was assessed using the chi-square test. Results: Fifty-two patients were interviewed. After the surgical intervention, significant improvement in QoL score in most SF-36 domains (emotional, physical, social, pain, general health, and mental health aspects) and improvement in the Rosenberg Self-Esteem Scale score were noted. The factors associated with a higher probability of improvements in QoL and self-esteem after surgery were age ≥60 years, white skin color, higher education level, occurrence of a stressful event, and malignant neoplasia. Conclusions: Reconstructive surgery positively affected several domains of QoL and self-esteem, showing other improvements in patient health beyond its technical and clinical benefits.

Leiomioma cutâneo piloeretor: relato de caso e análise de possibilidades terapêuticas / Cutaneous pilar leiomyoma: case report and analysis of therapeutic possibilities

Introdução: O leiomioma cutâneo piloeretor (LCP) é um tumor benigno de pele, de incidência rara, proveniente do músculo eretor do pelo. Sua apresentação clínica mais frequente é o aparecimento de nódulos isolados ou em grande número. Em geral, são dolorosos, sensíveis ao frio, toque, pressão e à emoção. Vários agentes farmacológicos têm sido utilizados com algum sucesso para redução da dor e do desconforto local. Entretanto, em casos nos quais os sintomas dolorosos são intensos ou causam restrição social, a cirurgia torna-se uma abordagem alternativa a ser considerada. Neste artigo relatamos o caso de um paciente do sexo masculino, portador de múltiplos leiomiomas cutâneos na parede torácica anterior à esquerda e no abdome, bem como a terapêutica utilizada para seu caso. Métodos: O tratamento compreendeu a ressecção cirúrgica total da lesão, com fechamento da ferida com o uso de enxerto de pele parcial, retirado da região anterolateral da coxa direita. Resultados: A reconstrução imediata do defeito resultante, com enxerto de pele parcial, assegurou a cicatrização sem intercorrências. Após o tratamento, houve completa remissão do quadro doloroso, o que permitiu completa reintegração social do paciente, tendo sido alcançado ainda resultado estético aceitável. Conclusão: O LCP constitui patologia de difícil tratamento, embora tenha várias possibilidades terapêuticas. A ressecção cirúrgica completa de múltiplos leiomiomas cutâneos pode impedir a recorrência da doença, embora alguma recidiva local seja relatada na literatura.

Introduction: Cutaneous pilar leiomyoma (CPL) is a rare benign skin tumor arising from arrector pili muscles. Its most common clinical manifestation is the appearance of nodules that may either be isolated or clustered. In general, these tumors are painful and sensitive to cold, touch, pressure, and emotional stimuli. Several pharmacological agents have been used with some success to reduce local pain and discomfort. However, in cases with intensely painful symptoms or that cause social constraints to the patient, surgery becomes an alternative approach. Here, we report the case of a male patient with multiple cutaneous leiomyomas in the left anterior chest wall and abdomen, and the therapeutic approaches used for this case. Methods: The treatment included a complete surgical resection of the tumor and wound closure with partial skin graft taken from the anterolateral region of the right thigh. Results: The immediate reconstruction of the resulting defect with a partial skin graft ensured healing without complications. After the treatment, complete remission of the pain symptoms occurred, in addition to an acceptable aesthetic outcome, which allowed the full social reintegration of the patient. Conclusion: CPL is a disease that is difficult to treat; however, several therapeutic approaches can be used. The complete surgical resection of multiple cutaneous leiomyomas can prevent the recurrence of the disease, although some local recurrences have been reported in the literature.

Grado de cumplimiento de la técnica inhalatoria aplicada por las madres en niños menores de 3 años con Síndrome Bronquial Obstructivo Recurrente, hospitalizados en emergencia del Hospital Nacional Dos de Mayo desde Marzo al 30 de Abril del 2011 / Level of compliance of the inhalation technique applied for mothers in children under 3 years with Recurrent Bronchial Obstructive Syndrome, hospitalized in the Emergency at the National Hospital Dos de Mayo from March to April 2011

The success of the therapy inhalation (aerosol therapy), depends on the quality that is conducted, with the inhalation technique (TI), probably more important than the characteristics of the administered drug, the inhalation system, the patient's age and his respiratory condition. Also considering the frequent readmissions to the emergency of children with obstructive lower airways, clinically manifested by wheezing, we ask the following question: What is the degree of compliance with the inhalation technique applied by mothers of children under 3 years with recurrent wheezing bronchitis, hospitalized in the hospital emergency at the National Dos de Mayo from March to April 30, 2011?. The degree of compliance with the inhalation technique shake the inhaler applied by mothers of children under 3 years with recurrent Bronchial Obstructive Syndrorne. hospitalized in the emergency, was 90 per cent, 83 per cent meets insert the inhaler in the holding chamber and administered a single puff, 80 per cent to repeat the whole cycle, 70 per cent expect 10 seconds to 10 aspirations of the patient, 67 per cent correctly press the holding chamber, 60 per cent correctly positioning the patient, 53 per cent stir again inhaler, 27 per cent wait 30 to 60 seconds before repeating the cycle, and 23 per cent removes the holding chamber. Inhalation technique applied by the mothers of children under 3 years, diagnosed with recurrent obstructive bronchial syndrome treated in emergency at the National Hospital Dos de Mayo is not effective.

Impact on the quality of life of dermatological patients in southern Brazil / Impacto na qualidade de vida de pacientes dermatológicos no sul do Brasil

BACKGROUNDS: Skin diseases are extremely frequent and may affect quality of life; therefore, it is important to assess it and identify which factors are associated with it. OBJECTIVES: To assess quality of life and its associated factors in dermatological patients. METHODS: A cross-sectional study involving a sample of 548 patients seen at the Dermatology Outpatient Clinic of Sistema Único de Saúde (the Brazilian National Public Health System), University Hospital, Federal University of Rio Grande do Sul (RS). Information related to socio-demographic data, medical consultation and quality of life was collected by means of the Dermatology Life Quality Index. RESULTS: A median of 7 and a mean of 7.7 (SD = 5.0) were obtained with the Dermatology Life Quality Index. The skin diseases with higher scores on the Dermatology Life Quality Index were psoriasis (median = 15.5), vitiligo (median = 13), atopic dermatitis (median = 12) and acne (median = 10). With respect to factors associated with quality of life, it was found that younger, single patients with a low income, one skin disease and longer disease duration presented poorer quality of life. CONCLUSION: The assessment of the impact of dermatoses on patients' quality of life is important for clinical management. It is essential to detect patients at higher risk of experiencing worse quality of life in order to treat them in a more integrated way.

FUNDAMENTOS: As doenças de pele são extremamente freqüentes e os pacientes podem ter a qualidade de vida afetada. Assim é importante medi-la, bem como verificar quais os fatores que podem estar associados. OBJETIVOS: Verificar a qualidade de vida em pacientes dermatológicos e os fatores associados. MÉTODOS: Estudo tranversal com uma amostra de 548 pacientes atendidos no ambulatório de dermatologia do Sistema Único de Saúde do Hospital Universitário da Universidade Federal do Rio Grande. As informações foram coletadas em um questionário pré-codificado e referiam-se à dados sócio-demográficos, da consulta e qualidade de vida. RESULTADOS: O escore total do Dermatology Life Quality Index foi uma mediana de 7 e uma média de 7,7 (DP=5,0). As dermatoses com escore maior no Dermatology Life Quality Index foram psoríase (mediana = 15,5), vitiligo (mediana =13), dermatite atópica (mediana = 12), acne (mediana=10). Com respeito aos fatores associados à qualidade de vida, identificou-se que pacientes mais jovens, com menor renda, solteiros, com uma dermatose e com um tempo maior de evolução da doença, apresentam pior qualidade de vida. CONCLUSÃO: A avaliação do impacto na qualidade de vida em pacientes com dermatoses é importante para o manejo clínico. É essencial a detecção daqueles pacientes com maior risco de apresentar uma qualidade de vida pior, para poder abordá-los de uma forma mais integrada.

Impact on the quality of life of dermatological patients in southern Brazil.

BACKGROUNDS: Skin diseases are extremely frequent and may affect quality of life; therefore, it is important to assess it and identify which factors are associated with it. OBJECTIVES: To assess quality of life and its associated factors in dermatological patients. METHODS: A cross-sectional study involving a sample of 548 patients seen at the Dermatology Outpatient Clinic of Sistema Único de Saúde (the Brazilian National Public Health System), University Hospital, Federal University of Rio Grande do Sul (RS). Information related to socio-demographic data, medical consultation and quality of life was collected by means of the Dermatology Life Quality Index. RESULTS: A median of 7 and a mean of 7.7 (SD = 5.0) were obtained with the Dermatology Life Quality Index. The skin diseases with higher scores on the Dermatology Life Quality Index were psoriasis (median = 15.5), vitiligo (median = 13), atopic dermatitis (median = 12) and acne (median = 10). With respect to factors associated with quality of life, it was found that younger, single patients with a low income, one skin disease and longer disease duration presented poorer quality of life. CONCLUSION: The assessment of the impact of dermatoses on patients' quality of life is important for clinical management. It is essential to detect patients at higher risk of experiencing worse quality of life in order to treat them in a more integrated way.

Faringo-laringo-traqueo-esofagectomia+ DRMC y restitución inmediata de la vía digestiva con gastrofaringoplastía en carcinoma papilífero avanzado HNERM / Larynx and pharynx-traqueo-esofagectomia + DRMC and immediate return of the digestive route with gastrofaringoplastía carcinoma papilífero advanced HNERM

Si bien el cáncer papilífero de tiroides (Ca bien diferenciado) es el de mejor pronostico dentro del cáncer de tiroides en todas sus variedades; cuando es avanzado llega a infiltrar e invadir las vías aerodigestivas y cervicales, es realmente mutilante y muchas veces mortal. Felizmente este porcentaje es bajo (-2 por ciento). El avance de la Cirugía Reconstructiva hoy en día permite que estos pacientes puedan seguir viviendo muchos años más y alimentándose por la boca. El servicio de Cirugía de Cabeza y Cuello y el de Cirugía General del Hospital Edgardo Rebagliatti Martins, ha intervenido a una paciente por cáncer de tiroides papilífero avanzado con restablecimiento digestivo alto inmediato con tubo gástrico vascularizado por vía transdiafragmática por mediastino posterior y faringo gastro plastía con un postoperatorio inmediato y alejado satisfactoriamente. Finalmente diremos que esta modalidad quirúrgica de reconstrucción supera a las otras existentes por ser más rápida, de menos complicaciones pudiendo el paciente alimentarse por la boca a muy corto plazo.