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1.
J Cutan Pathol ; 47(1): 47-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31381162

RESUMO

Cutaneous metastases from hepatocellular carcinoma (HCC) are extremely rare and can represent a sign of an underlying malignancy or relapse/progression from an existing tumor. We report a case of a cutaneous metastasis arising in a patient with metastatic HCC following orthotopic liver transplantation. Diagnosis is a multistep process as cutaneous HCC metastases must be differentiated from primary cutaneous malignancies as well as other cutaneous metastases. Making this even more challenging, HCC metastases have heterogeneous clinical and histologic appearances. Therefore, the use of immunohistochemical stains, including hepatocyte paraffin-1, arginase-1, and glypican-3, and correlation with the clinical context are essential for a correct diagnosis.

2.
Dermatol Online J ; 25(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31553857

RESUMO

Patient falls remain a major cause of adverse events in the medical setting. Many patients receiving Mohs micrographic surgery are at high risk, both for falling and resultant injuries. Although the incidence of patient falls in dermatologic surgery is low, falls can have significant consequences for both patient and provider. Therefore, effective interventions to improve organizational safety are critical. Though there is a considerable amount of research pertaining to fall prevention strategies, the majority of studies have been confined to the inpatient setting and long-term care facilities. Implementation of fall prevention initiatives in the outpatient setting has rarely been evaluated and no studies have focused on the Mohs patient population to date. METHODS: We reviewed the literature pertaining to fall risk and prevention guidelines in the inpatient and outpatient settings as it applies to the dermatologic surgery environment. RESULTS: Herein we will discuss patient risk factors for falling relevant to the Mohs setting and review existing validated fall risk assessment tools and strategies for fall prevention. CONCLUSION: Identifying fall risk factors can improve patient safety and reduce falls in the dermatologic surgery clinic.


Assuntos
Acidentes por Quedas/prevenção & controle , Instituições de Assistência Ambulatorial , Procedimentos Cirúrgicos Ambulatórios , Cirurgia de Mohs , Fatores Etários , Assistência Ambulatorial , Humanos , Segurança do Paciente , Medição de Risco
3.
J Am Acad Dermatol ; 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31302190

RESUMO

BACKGROUND: The use of immunotherapies in the treatment of metastatic cancers has significantly advanced oncology. However, due to safety concerns, solid organ transplant recipients (SOTRs) are routinely excluded from immunotherapy trials; thus, there is limited data for these agents in this population. METHODS: A systematic review was performed to evaluate the safety and efficacy of immunotherapies in SOTRs with metastatic cancers. Fisher's exact test and Kruskal-Wallis test were used for analysis. RESULTS: In total, 37% of patients experienced organ rejection, and 14% died as a result of graft rejection. Nivolumab was associated with the highest rejection rate (52.2%), followed by pembrolizumab (26.7%) and ipilimumab (25%; P = .1774). The highest rejection rate was seen in patients with kidney transplants (40.1%), then liver (35%) and heart (20%) transplants (P = .775), and 64% of patients succumbed to the progression of malignancy. For all cases, rates of progression or death secondary to disease were highest for ipilimumab (75%), followed by nivolumab (43%) and pembrolizumab (40%; P = .1892). The overall response rate was highest for pembrolizumab (40%), followed by nivolumab (30%) and ipilimumab (25%; P = .7929). LIMITATIONS: The small sample size. CONCLUSION: Physicians must be cautious when administering immunotherapy to SOTRs. However, rejection is not the most common cause for death in this population.

4.
Int J Surg Case Rep ; 53: 228-230, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30428437

RESUMO

INTRODUCTION: Surgical defects of the popliteal fossa pose a reconstructive challenge to the surgeon, given the intimate relationship of this area with the knee joint and underlying vital neuro-vasculature. CASE PRESENTATION: An 88-year-old woman was treated for a biopsy proven invasive squamous cell carcinoma of the right popliteal fossa with Mohs micrographic surgery. The resultant defect (4.5 × 4.3 cm) was repaired using a random patterned bilobed flap with an undersized secondary lobe and porcine xenograft with excellent functional and cosmetic outcome. DISCUSSION: Numerous approaches to reconstruction of the popliteal fossa have been proposed, including primary closure, secondary intent healing, skin grafting, random flaps, muscle flaps, fasciocutaneous flaps, freeflaps, and tissue expansion. Sub-optimal repair of the popliteal fossa can reduce mobility of the knee joint, carry a high risk of wound dehiscence and may result in significant scarring. Here, we present the use of a bilobed flap with an undersized secondary lobe, in a patient with limited tissue laxity, for the repair of the popliteal fossa. CONCLUSION: Utilizing a random pattern bilobed flap with an undersized secondary lobe is an excellent alternative for the repair of moderate sized popliteal fossa defects.

5.
Clin Dermatol ; 36(3): 399-419, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29908582

RESUMO

The plant and mushroom kingdoms have species used for intoxication, inebriation, or recreation. Some of these species are toxic. Given that many of these plants or substances are illegal and have histories of abuse, much of the research regarding therapeutic application is based on basic science, animal studies, and traditional use. This review examines Cannabis, Euphorbia, Ricinus, Podophyllum, Veratrum, mushrooms, and nightshades, along with resveratrol and cocaine as they relate to dermatology.


Assuntos
Agaricales , Cannabis , Fitoterapia , Preparações de Plantas/uso terapêutico , Dermatopatias/tratamento farmacológico , Pele/patologia , Solanum , Animais , Canabinoides/uso terapêutico , Dermatologia , Dermatomicoses/tratamento farmacológico , Dronabinol/uso terapêutico , Etanolaminas/uso terapêutico , Euphorbia , Fibrose , Humanos , Inflamação/tratamento farmacológico , Ácidos Palmíticos/uso terapêutico , Preparações de Plantas/farmacologia , Podophyllum peltatum , Resveratrol , Ricinus , Envelhecimento da Pele/efeitos dos fármacos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/prevenção & controle , Estilbenos/uso terapêutico , Veratrum
7.
8.
Dermatol Surg ; 43(5): 635-648, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28375972

RESUMO

BACKGROUND: Striae distensae (SD) are aesthetically troublesome to patients and therapeutically challenging. OBJECTIVE: Herein, the authors comprehensively review the literature pertaining to the history, pathogenesis, clinical presentation, clinical rating scales, and laboratory, imaging, and histologic features of SD. METHODS AND MATERIALS: A review of PubMed, MEDLINE, Scopus, Embase, and Google scholar was conducted, including literature published from 1773 to August 6, 2016. RESULTS: The authors identified 68 articles that met inclusion and exclusion criteria. CONCLUSION: There are few randomized controlled trials evaluating the long-term efficacy and safety of various topical and energy-based devices. Based on clinical and anecdotal experience, both nonablative and ablative fractionated lasers have shown modest SD improvement compared with other treatment modalities (including Excimer laser, CuBr laser, pulsed dye laser, and 1,064-nm Nd:YAG laser). In the authors' experience, 1,540-nm nonablative fractionated laser is a worthy first-line modality for the treatment of SD. Future researchers may consider greater focus on enhanced study design, including larger, long-term split-body, or split-SD head-to-head randomized comparative trials with objective outcome measures and end points, such as biopsy and molecular studies demonstrating increased collagen and elastic fibers that correlate to clinical improvement.


Assuntos
Estética , Terapia a Laser , Estrias de Distensão/prevenção & controle , Estrias de Distensão/terapia , Humanos , Estrias de Distensão/etiologia , Estrias de Distensão/patologia
9.
Cutis ; 98(2): E22-6, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27622265

RESUMO

Drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) has been associated with numerous drugs, but there are limited reports of its association with aromatase inhibitor anastrozole. We report the case of a patient undergoing treatment with anastrozole for breast cancer who presented with clinical, serological, and histological evidence consistent with DI-SCLE. Her condition quickly began to improve after the use of anastrozole was discontinued and hydroxychloroquine therapy was initiated. Cases such as ours as well as several others that implicate antiestrogen drugs in association with DI-SCLE seem to be contradictory to studies looking at the usefulness of treating systemic lupus erythematosus (SLE) with antiestrogen therapy. Further research on this relationship is warranted.


Assuntos
Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Lúpus Eritematoso Cutâneo/induzido quimicamente , Nitrilos/efeitos adversos , Triazóis/efeitos adversos , Idoso , Anastrozol , Anticorpos Antinucleares/imunologia , Braço , Feminino , Humanos , Lúpus Eritematoso Cutâneo/imunologia , Lúpus Eritematoso Cutâneo/patologia , Tórax
10.
J Drugs Dermatol ; 15(5): 545-50, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27168263

RESUMO

BACKGROUND: Optical coherence tomography (OCT) is a technique that enables real-time in-vivo examination of tissue. This technology provides the clinician with the potential to use a non-invasive tool in the identification and diagnosis of many skin lesions. However, the diagnostic features of basal cell carcinoma have not yet been described with comparison to their histopathology.
OBJECTIVES: To identify and describe key features of basal cell carcinoma (BCC) and its subtypes as they present in multi-beam Swept Source - OCT (MSS-OCT), and to correlate those against conventional histopathology.
METHODS: A total of 40 lesions were assessed by MSS-OCT prior to biopsy. 60-slice OCT images of the lesions were obtained and correlated with histology sections taken in the same plane. OCT scans were assessed retrospectively by a panel to determine the OCT criteria for BCC and its subtypes.
RESULTS: The following diagnostic criteria were identified: hyporeflective ovoid structures (40/40), dark halo boundaries (38/40), epidermal thinning (28/40), and collagen compression (14/40). Lesional tissue also showed a destruction of layers when compared to the surrounding normal tissue. In addition to the shared criteria, other subtypes showed distinct diagnostic criteria.
CONCLUSION: With its higher sensitivity, using MSS-OCT allowed for non-invasive, accurate identification of the key diagnostic features of BCC and its subtypes with high correlation to the histopathologic features found with biopsy.

J Drugs Dermatol. 2016;15(5):545-550.


Assuntos
Carcinoma Basocelular/classificação , Carcinoma Basocelular/diagnóstico por imagem , Neoplasias Cutâneas/classificação , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Diagnóstico Diferencial , Feminino , Humanos , Masculino
11.
Dermatol Surg ; 39(4): 627-33, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23293854

RESUMO

BACKGROUND: Optical coherence tomography (OCT) is a noninvasive imaging technique that uses a low-power infrared laser to image up to 2 mm beneath the skin's surface. OBJECTIVE: To test the feasibility and diagnostic value of using in vivo OCT to define excision margins before Mohs micrographic surgery (MMS) of basal cell carcinoma (BCC). METHODS: Patients with biopsy confirmed BCC undergoing MMS were recruited (n = 52). Excision margins defined by experienced dermatologists were compared with those of OCT-assessed borders and validated with histologic assessments. RESULTS: Forty-one (79%) lesions were clear after one MMS procedure; 11 (21%) lesions required a second MMS stage after excision of the clinician-predicted boundary. Generally, the OCT instrument indicated that the estimated clinical margin was 0.4-mm larger than the OCT margin. For lesions requiring a single MMS stage, OCT indicated that lesions were 1.4 ± 1.3 mm smaller than the Mohs excision. Before excision of lesions requiring more than one MMS stage, OCT always indicated that the lesion boundary would extend outside the planned MMS defect boundary. CONCLUSIONS: The present study shows the prospective utility of using OCT to refine clinically estimated borders for MMS. OCT assessment has the potential to reduce the excised area without compromising the integrity of tumor-free borders.


Assuntos
Carcinoma Basocelular/cirurgia , Cirurgia de Mohs , Tomografia de Coerência Óptica , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Humanos , Pessoa de Meia-Idade
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