A Systematic Review on the Treatment of Dermatosis Papulosa Nigra.

Dermatosis papulosa nigra (DPN) is a benign skin condition that is primarily reported in skin of color patients. While prevalent, treatment options are limited and the benign course of DPNs may cause them to be overlooked by clinicians. However, large and multiple lesions in cosmetically sensitive areas may be emotionally and socially distressful to patients. There are few literature reviews examining treatment options for this condition. A literature search was performed using PubMed, Medline, Embase, and Web of Science databases. 67 articles were identified and 15 studies met the inclusion criteria. Our findings demonstrate that laser therapy is becoming increasingly utilized as a safe and efficacious treatment for DPNs in skin of color patients. J Drugs Dermatol. 20(4):467-472. doi:10.36849/JDD.2021.5555.

Actinic Keratoses: Reconciling the Biology of Field Cancerization with Treatment Paradigms.

This Perspective briefly reviews the relationship between UV-induced mutations in habitually sun-exposed human skin and subsequent development of actinic keratoses (AKs) and skin cancers. It argues that field therapy rather than AK-selective therapy is the more logical approach to cancer prevention and hypothesizes that treatment early in the process of field cancerization, even prior to the appearance of AKs, may be more effective in preventing cancer as well as more beneficial for and better tolerated by at-risk individuals. Finally, the Perspective encourages use of rapidly advancing DNA analysis techniques to quantify mutational burden in sun-damaged skin and its reduction by various therapies.

Early postoperative compilations of bone filling in curettage defects.

BACKGROUND: Curettage is widely used in orthopedic oncology; the defect created frequently requires filling for mechanical and functional stability for the bones and adjacent joint. Allograft, bone graft substitute, and polymethyl methacrylate (PMMA) are the most common substances used each with their benefits and drawbacks. The aim of the study is to show that good functional result can be achieved with curettage and bone filler, regardless of type. METHODS: A series of 267 cases were reviewed between 1994 and 2015 who received curettage treatment and placement of a bone filler. Endpoints included fracture, infection, cellulitis, pulmonary embolism, and paresthesia. Complication rates at our single institution were compared against literature values for three study cohorts: allograft, bone graft substitute, and PMMA bone fillers. Friedman test, Wilcoxon test, and Z-score for two populations were used to compare our subset against literature values and between different bone filling types. RESULTS: Our cases included 18 autografts, 74 allografts, 121 bone graft substitute, and 54 PMMA of which the bulk of complications occurred. Our overall complication rate was 3.37%. Allograft has a complication rate of 1.35%, bone graft substitute of 4.13%, and PMMA of 5.56%. Other techniques did not yield any complications. Combination filling techniques PMMA + allograft and PMMA + bone graft substitute had sample sizes too small for statistical comparison. Statistical comparison yielded no significant difference between complications in any of the filling groups (P = 0.411). CONCLUSIONS: Some has even argued that bone defects following curettage do not require bone filling for good outcome. However, many structural or biologic benefits that aid in earlier return to functionality can be conferred by filling large bone defects. There was no significant difference in postoperative complication rates between allograft, bone graft substitute, and PMMA when compared at our institution and with literature values. Nevertheless, one complication with a large defect filled with allograft, requiring a subsequent reconstruction using vascularized fibular graft. Taking everything into account, we see bone graft substitute as a suitable alternative to other bone filling modalities.

Hemorragia posparto secundaria o tardía / Secondary postpartum haemorrhage

Introducción: la hemorragia posparto secundaria puede estar asociada a entidades poco conocidas, pero con capacidad para incrementar la morbimortalidad materna, por lo cual es necesario su conocimiento con el fin de instaurar las medidas terapéuticas oportunas. Objetivo: conocer la incidencia de la hemorragia posparto secundaria (HPS), los factores de riesgo, así como la prevalencia de las principales entidades implicadas en esta patología. Material y métodos: estudio descriptivo, observacional y retrospectivo, mediante el análisis poblacional de las pacientes hospitalizadas con el diagnóstico de HPS, en el Complexo Hospitalario Universitario de Ourense, en el periodo comprendido entre 2004 y el 31 de marzo de 2014. El criterio de selección se realizó de acuerdo con la definición de la OMS de la HPS: 'sangrado uterino excesivo que ocurre entre las 24 horas y las 12 semanas posteriores al parto'. Resultados: la incidencia de HPS fue del 0,29%. Esta enfermedad se asocia con mayor frecuencia al antecedente de parto vaginal en el actual episodio. La causa más prevalente de HPS fue la retención de restos placentarios, la cual representó el 75,51% del total de casos. El tratamiento realizado con mayor frecuencia fue el legrado evacuador (77,55%). Hasta en el 14% de los casos se asocia con anemia severa que requiere transfusión sanguínea. Conclusiones: la principal causa de la HPS es la retención de restos placentarios. Existen otras causas menos frecuentes y menos conocidas, pero con un alto potencial de generar morbimortalidad (AU)

Background: Secondary postpartum hemorrhage may be associated with little known entities but with ability to increase maternal mortality and morbidity by which its knowledge is necessary in order to establish appropriate therapeutic measures. Objective: To determine the incidence of secondary postpartum hemorrhage (HPS), risk factors, and the prevalence of the main entities involved in this pathology. Material and methods: Descriptive and retrospective study using the population analysis of patients hospitalized with the diagnosis of HPS in the University Hospital Complex of Ourense, in the period between 2004 and March 31, 2014. Inclusion criteria was the WHO’s definition for HPS: 'excessive uterine bleeding from 24 hours to 12 weeks after childbirth'. Results: The incidence of HPS was 0.29%. This entity is more strongly associated with previous vaginal deliveries in the current episode. The most prevalent cause of HPS was retained placental remnants, representing 75.51% of all cases. The treatment most frequently performed was evacuator curettage (77.55%). Severe anemia is observed in 14% of the women requiring blood transfusion. Conclusions: The principal cause of the HPS is placental retention. There are other less common and less well-known causes but with a high potential for morbidity and mortality (AU)

Curettage after medical induced abortions in second trimester.

We evaluated the use of curettage in second trimester medical induced abortions retrospectively in 186 women at Herning Hospital, Denmark. Curettage was carried out in a total of 55% of the women. The incidence of curettage was associated with low gestational age (r = 0.32, p < 0.001) but not with age, parity, and BMI. The average incidence of curettage dropped from 62% to 25% at the time before 2007 compared with the time after 2007 (p < 0.001). The indications for abortion were not associated with subsequent use of curettage.

Tratamiento médico de la gestación ectópica cervical: nuevos avances / Medical management of cervical ectopic pregnancies: new developments

Presentamos un caso de gestación ectópica cervical con tratamiento conservador satisfactorio. Se trató mediante inyecciones sistémicas de metotrexato, que resultaron inicialmente efectivas, aunque posteriormente apareció cuadro hemorrágico genital severo que precisó dilatación y legrado cervical para su resolución, no siendo necesario ningún tipo de actitud terapéutica radical (AU)

We report a case of cervical ectopic pregnancy with successful conservative treatment. The patient was treated with systemic methotrexate injections, which initially proved effective. However, severe genital bleeding subsequently developed, requiring cervical dilation and curettage for resolution. A radical change in the therapeutic approach was not required (AU)

Aplicaciones de la histeroscopia guiada por ecografía / Role of ultrasound-guided hysteroscopy in resolving the complications of curettage in a malformed uterus

Presentamos el caso clínico de una paciente de 35 años, diagnosticada de un útero bicorne unicollis, que fue derivada a nuestro centro para legrado evacuador de un aborto diferido de 9 semanas. Durante el legrado, la cavidad que alberga la gestación se colapsa y se recurre a la histeroscopia guiada por ecografía 2D para evacuar la gestación. Gracias a dicha técnica, se alcanza el diagnóstico de útero septo completo bicorne y unicollis, se logra evacuar la gestación y se reseca el septo que separa ambos hemiúteros. Siete meses tras la intervención, la paciente logra de nuevo una gestación (AU)

We report the case of a 35-year-old woman, diagnosed with a bicornuate unicollis uterus, who was admitted to our hospital for curettage following a missed miscarriage at 9 weeks. During curettage, the cavity containing the pregnancy collapsed and 2D ultrasound-guided hysteroscopy was used to evacuate the fetal remains. Based on this technique, a diagnosis of bicornuate and complete septum uterus was reached. Resectoscopy was used to perform the curettage and to remove the septum. Seven months later, the patient became pregnant again (AU)

Tratamiento de anemia aguda grave por hemorragia vaginal en la testigo de Jehová: a propósito de dos casos / Treating severe acute anemia due to vaginal bleeding in the Jehova’s Witness: a report of 2 cases

Los Testigos de Jehová (TJ) no aceptan la transfusiónsanguínea ni la administración de derivados hemáticosdebido a sus creencias religiosas. En situaciones de anemiaextrema, con riesgo vital para el paciente, si ésterechaza la transfusión puede producirse un grave conflictoético y legal, enfrentándose el principio de autonomíadel paciente, que implica la libertad para rechazaro aceptar un tratamiento médico, y el deber delmédico de salvaguardar la vida del paciente utilizandotodos los medios a su alcance. Presentamos dos casos deanemia grave, uno por menorragia y otro por hemorragiapuerperal, en mujeres TJ. Debemos conocer los tratamientosalternativos a la transfusión de hemoderivados(en nuestras dos pacientes fueron eficaces), y sabercómo actuar ante una situación crítica inesperada eneste tipo de pacientes. En la menorragia, el tratamientohormonal es efectivo cuando la mujer quiere preservarla fertilidad y evitar la cirugía (ablación endometrial ehisterectomía); en la hemorragia postparto refractariaal tratamiento conservador, la embolización selectiva delos vasos sangrantes puede evitar la necesidad de actitudesterapéuticas más agresivas como la histerectomíaobstétrica(AU)

For reasons of religious belief, Jehova’s Witnesses donot accept blood transfusions or the infusion of bloodproducts. In situations in which severe, life-threateninganemia develops, patient refusal to receive a transfusioncan create serious ethical and legal problems. Theprinciple of patient autonomy, which implies the freedomto accept or reject treatment, comes into conflict with thephysician’s obligation to safeguard the patient’s life usingall means possible. We report 2 cases of severe anemia inJehova’s Witnesses. One was due to menorrhagia and theother to postpartum bleeding. The physician should beaware of alternatives to infusion of blood products andknow how to cope with an unexpected critical event inthese patients. The measures we took were effective in ourpatients. In the case of menorrhagia, hormone treatmentis effective when the woman wishes to preserve the abilityto conceive and avoid surgery (endometrial ablation andhysterectomy). In postpartum bleeding refractory toconservative treatment, selective embolization of bleedingvessels may make it unnecessary to resort to moreaggressive treatment, such as obstetric hysterectomy(AU)

Past and present instrument use in pediatric adenotonsillectomy.

OBJECTIVE: Examine changing trends/instrument usage for pediatric adenotonsillectomy. STUDY DESIGN AND SETTING: Survey of 300 members of the American Society of Pediatric Otolaryngology assessing instruments used in adenotonsillectomy currently and over the past 15 years. RESULTS: A total of 120 surveys were returned. The most common total tonsillectomy instruments for obstruction/infection were: monopolar electrocautery (ME) (53.1%/54.5%) and coblation (CT) (16.0%/16.1%). The most common subtotal tonsillectomy instrument for obstruction/infection was microdebrider (51.4%/30.8%). Over the past 15 years, ME predominated, cold utilization declined, and CT rose. The most common adenoidectomy instruments were ME (25.0%/25.0%), curette with touch-up ME (22.4%/22.4%), and microdebrider with touch-up ME (19.0%/14.7%). Over the past 15 years, curette with touch-up ME predominated early, curette utilization alone declined, and ME, microdebrider, and CT have risen. CONCLUSION: Pediatric otolaryngologist technique/instrument use for adenotonsillectomy has changed over the past 15 years. This study may be limited by the low survey response rate.

Caracterización clínico-epidemiológica de las pacientes atendidas por aborto en el Instituto Hondureño de Seguridad Social: San Pedro Sula / Clinical and epidemiological characterization of patients assisted by abortion at the Instituto Hondureño de Seguridad Social: San Pedro Sula

Objetivo. Determinar algunas características sociodemográficas, económicas y clínicas, de una muestra de pacientes atendidas por aborto en el Hospital del Instituto Hondureño de Seguridad Social de San Pedro Sula. METODOS. Se encuestaron 46 pacientes con diagnósticos de aborto incompleto en quienes se practicó legrado intrauterino. RESULTADOS. La edad promedio fue de 27 años (rango 20-40 años). La mayoría procedía de San Pedro Sula(39.1 por ciento), Choloma(19.6 por ciento) y Villanueva (17.4 por ciento),e informó trabajar como operaria de maquila (63.0 por ciento), en posición de pie (58.7 por ciento) y con un salario mensual inferior o igual a L 5,000.00 (aprox. US$270). El 58.7 por ciento informó estar practicando algún método de planificación familiar. El espacio intergenético promedio fue de 5 años (DS = 3 años), el (67.4 por ciento) respondió que el embarazo era deseado y el 54.3 por ciento, informó haber iniciado control prenatal. CONCLUSIONES. El bajo nivel de escolaridad detectado, 54.3 por ciento con educación primaria incompleta o ninguna educación formal, podría ser la causa del uso incorrecto de los métodos de planificación. La educación y cultura general de la mujer son determinantes en la salud sexual y reproductiva de ella misma y de su familia. Por lo tanto, las intevenciones educativas en grupos con estas características requieren atención especial

Legrado uterino con anestesia regional / Uterine cirettage with pundental and paracervical blocks

Para evaluar la tolerancia y morbilidad de los legrados uterinos efectuados con anestesia regional (bloqueos paracervical y pudendo), se estudiaron 113 pacientes entre noviembre de 1991 y junio de 1992 que, con diagnóstico de aborto completo, menor de 12 semanas de gestación, no infectado, ingresaron a la Unidad de Emergencia Gineco-Obstetrica del Hospital Universitario "Dr. Antonio María Pineda" (HUAMP) de la ciudad de Barquisimeto. La cantidad de 107 pacientes (95 por ciento) tuvieron buena tolerancia al procedimiento independientemente de la edad y peso corporal de ellas, de la edad gestacional requirió anestesia general y la recuperación fue inmediata en todos los casos. No se presentaron complicaciones ni ginecológicas

Fertilidad post-legrado uterino / Fertility uterine Post-curettage

Se tomaron 300 historias clínicas con antecedentes de abortos previos para evaluación de fertilidad posterior a legrados uterinos; sólo 58 regresaron a controlar su próximo embarazo. El tiempo transcurrido para un nuevo embarazo osciló entre 15 días y 2 años; en 34 pacientes fue menor o igual a 6 meses mientras que en 24 fue mayor. Estas 24 pacientes fueron interrogadas nuevamente encontrándose que 50 porciento alegaron no haber tenido relaciones sexuales, 45,83 porciento tomaron anticonceptivo orales y 4,16 porciento alegaron no haber utilizado método anticonceptivo alguno y haber tenido relaciones sexuales activas. Las conductas aplicadas en todos los casos fue el legrado uterino con cureta. Estos datos fueron analizados estadísticamente por el método del Chi cuadrado, no encontrándose significación estadística