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1.
Dermatol Surg ; 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32897941
7.
Br J Hosp Med (Lond) ; 80(11): C166-C171, 2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31707882

RESUMO

Following injury, the skin undergoes a wound healing process culminating in the formation of a mature scar. Millions of patients worldwide are left with scars every year as a result of trauma or surgery. Scars can be painful, disfiguring and disabling, yet patients report that clinicians are often dismissive of their concerns, unable to identify pathological scars and unaware of treatment options. The normal wound healing process comprises three overlapping stages: inflammation, proliferation and remodelling. In some patients this process is deranged, resulting in the formation of hypertrophic or keloid scars. Clinicians can minimize the risk of these pathological scars developing with good surgical technique and wound aftercare. If pathological scars do form, they should be identified early and patients referred for treatment, most often topical or intralesional corticosteroids. In resistant cases, pathological scars may be treated with phototherapy, radiotherapy or surgical resection.


Assuntos
Queloide/fisiopatologia , Cicatrização/fisiologia , Corticosteroides/uso terapêutico , Assistência ao Convalescente , Humanos , Queloide/patologia , Queloide/terapia , Fototerapia , Suturas
8.
J Dermatolog Treat ; 30(3): 294-302, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30049244

RESUMO

BACKGROUND: Striae distensae are caused by rapid stretching of the skin. They are often secondary to obesity or pregnancy and can lead to significant cosmetic disfigurement. AIM: To determine the efficacy, indications, and side effects of commonly used energy devices in the treatment of striae. METHODS: A comprehensive literature search was performed using the PubMed and Medline databases. RESULTS: A total of 41 relevant articles were identified. Radiofrequency (RF) was the commonest employed modality (11 studies), followed by the CO2, and pulsed dye lasers (10 and 5 studies, respectively). The best results against striae alba were seen with a combination of RF, platelet-rich plasma and ultrasound (either excellent or very good results in 71.9%), followed by intense pulsed light in isolation (very good results in 40%). The response of SR was assessed by fewer studies. The best outcomes were seen after treatment with either the Nd:YAG (excellent results in 40% and good in 40%) or Er:Glass lasers (excellent results in 10% and good in 20%). CONCLUSIONS: The therapeutic measures for striae are multiple and no current treatment offers consistent and complete resolution. However, energy devices are a safe and potentially effective modality in the treatment of striae.


Assuntos
Terapia a Laser/métodos , Terapia por Radiofrequência/métodos , Estrias de Distensão/terapia , Terapia por Ultrassom/métodos , Terapia Combinada , Feminino , Humanos , Plasma Rico em Plaquetas , Pele/efeitos da radiação
9.
Healthc Manage Forum ; 31(5): 167-171, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30133340

RESUMO

Nearly a decade has passed since Alberta folded nine regional health authorities and three government agencies into one province-wide health system: Alberta Health Services (AHS). Deemed a reckless experiment by some at the time, there is now mounting evidence province-wide integration of services across the healthcare continuum is an enabler of improved quality, safety, and financial sustainability. The article highlights specific examples of how AHS is strengthening partnerships, standardizing best practices, and driving innovation, making Alberta a national and international leader in areas such as stroke care and potentially inappropriate use of antipsychotics in long-term care. It also shows how province-wide integration is being leveraged to build workplace culture, enhance patient safety, and find operational efficiencies that result in cost savings and cost avoidance.


Assuntos
Assistência à Saúde/organização & administração , Reforma dos Serviços de Saúde/organização & administração , Alberta , Assistência à Saúde/economia , Prestação Integrada de Cuidados de Saúde/organização & administração , Financiamento da Assistência à Saúde , Humanos , Segurança do Paciente , Qualidade da Assistência à Saúde/organização & administração , Programas Médicos Regionais/organização & administração
10.
Am J Kidney Dis ; 72(6): 890-894, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29941220

RESUMO

Sézary syndrome is a rare aggressive leukemic variant of primary cutaneous T-cell lymphoma, typically presenting with erythroderma, lymphadenopathy, and an atypical clonal T-cell population. Though it often involves the spleen and liver, we report a case of Sézary syndrome with renal involvement that was treated successfully. Visceral involvement confers a poor prognosis requiring systemic treatment. The patient we describe was a 66-year-old man who was referred from Dermatology services for deteriorating kidney function. Polymerase chain reaction of genomic DNA from skin and kidney biopsies confirmed a clonal T-cell population matching a population isolated in peripheral blood. The patient was treated initially with alemtuzumab, which led to a significant improvement in kidney function, and he has subsequently received a successful allogeneic stem cell transplant. This case represents a rare cause of decreased kidney function and highlights the role of biopsy in patients with suspected Sézary syndrome.


Assuntos
Alemtuzumab/administração & dosagem , Transplante de Células-Tronco Hematopoéticas/métodos , Neoplasias Renais/secundário , Síndrome de Sézary/patologia , Neoplasias Cutâneas/patologia , Idoso , Biópsia por Agulha , Terapia Combinada , Seguimentos , Humanos , Imuno-Histoquímica , Testes de Função Renal , Neoplasias Renais/terapia , Masculino , Síndrome de Sézary/terapia , Neoplasias Cutâneas/terapia , Transplante Homólogo , Resultado do Tratamento
15.
Dermatol Surg ; 43(4): 485-493, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28272080

RESUMO

BACKGROUND: Warts or verrucae vulgaris are common cutaneous infections with currently no definitive curative treatments available. OBJECTIVE: To determine the efficacy of pulsed dye laser (PDL) in the treatment of warts. MATERIALS AND METHODS: A literature search was performed using the PubMed and MEDLINE databases. A search using {(Wart[s], verruca or condylomata)} AND [(Pulsed dye laser)] was used. Forty-four articles were identified as relevant to this review. RESULTS: Simple warts were very responsive to PDL, being treated successfully in over 95% of patients. Facial and anogenital warts also demonstrated excellent outcomes. Recalcitrant warts, displayed significant variability in their response, ranging between 50% and 100% across all articles. The response rates seen in peripheral warts (involving the hands and feet) were also very variable, ranging between 48% and 95%. Recurrence rates at 4 months of follow-up were documented as 0% to 15%. Complications have been described as very few and rare, the main ones being topical discomfort and erythema. CONCLUSION: Pulsed dye laser is a safe and effective modality in the treatment of warts that can be applied to most body parts. Cost and availability remain a limitation to the use of PDL; however, this modality can be used when other more traditional and accessible treatments have failed.


Assuntos
Lasers de Corante/uso terapêutico , Verrugas/cirurgia , Doenças do Ânus/cirurgia , Dermatoses Faciais/cirurgia , Feminino , Dermatoses do Pé/cirurgia , Doenças dos Genitais Femininos/cirurgia , Doenças dos Genitais Masculinos/cirurgia , Dermatoses da Mão/cirurgia , Humanos , Masculino
17.
Indian J Crit Care Med ; 20(5): 280-4, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27275076

RESUMO

Tracheostomy is one of the most common procedures undertaken in critically ill patients. It offers many theoretical advantages over translaryngeal intubation. Recent evidence in a heterogeneous group of critically ill patients, however, has not demonstrated a benefit for tracheostomy, in terms of mortality, length of stay in Intensive Care Unit (ICU), or incidence of ventilator-associated pneumonia. It may be a beneficial intervention in articular subsets of ICU patients. In this article, we will focus on the evidence for the timing of tracheostomy and its effect on various subgroups of patients in critical care.

18.
Case Rep Dermatol Med ; 2016: 3793986, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27144040

RESUMO

A 49-year-old lady presented with multiple recurring painful lesions over her thighs, arms, and back. Past medical history included a left sided nephrectomy for renal cell carcinoma and a hysterectomy for multiple uterine fibroids (leiomyomas). Histopathological examination revealed changes consistent with pilar leiomyomas. Gene mutation analysis confirmed a diagnosis of hereditary leiomyomatosis and renal cell carcinoma. Hereditary leiomyomatosis and renal cell carcinoma is an uncommon autosomal dominant condition characterised by the concurrent presentation of cutaneous and uterine leiomyomas. Renal cell carcinoma associated with this condition is more aggressive and a significant cause of mortality. Due to this association with potentially fatal renal cell carcinoma we felt that it was important to highlight this case with an update on pathophysiology and management.

19.
BMJ Case Rep ; 20152015 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-26677153

RESUMO

A 29-year-old man was admitted with fevers, cough, left-sided chest pain and lethargy for 1 week. He had a cardiac transplant 10 years prior and was on immunosuppressive drugs. He was found to have a pulmonary lesion and went on to develop a lung abscess. Propionibacterium acnes was identified on matrix-assisted laser desorption ionisation mass spectrometry-time of flight and 16s rRNA gene sequencing after drainage. He was curatively treated with co-trimoxazole and co-amoxiclav. He divulged a longstanding history of seborrhoeic dermatitis with frequent flares leading to large volumes of squames collecting on his bed sheets. We hypothesise this was a possible route of entry: inhalation of the Propionibacterium. This case highlights how a common commensal bacterium, P. acnes, was able to cause pathology in an immunosuppressed patient. This is the only case of a patient with transplantation developing a P. acnes pulmonary infection and the only case of P. acnes causing these clinical features to be reported in the literature.


Assuntos
Infecções por Bactérias Gram-Positivas/diagnóstico , Transplante de Coração , Hospedeiro Imunocomprometido , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/microbiologia , Propionibacterium acnes/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Abscesso Pulmonar/tratamento farmacológico , Masculino , Propionibacterium acnes/genética , RNA Ribossômico 16S/análise , RNA Viral/análise , Análise de Sequência de RNA , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
20.
Case Rep Dermatol Med ; 2015: 840193, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26688760

RESUMO

We report an unusual manifestation of vitiligo colocalizing with lichen planus (LP). A 76-year-old Greek male presented with a history of a red, scaly, itchy, asymmetrical patch located at the umbilicus within a well-demarcated depigmented macule of vitiligo. Histology showed features of a lichenoid interface dermatitis, favouring a diagnosis of LP. Colocalization of LP and vitiligo has rarely been reported in the literature. After reviewing the literature, we believe that at present there is insufficient evidence to resolve the uncertainties in the aetiology of this colocalization. It seems to us that the association between LP and vitiligo is more than coincidental, but none of the theories discussed in this paper can sufficiently account for it. Rather, the association is likely to be multifactorial in its pathogenesis.

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