Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.153
Filtrar
1.
J Cosmet Dermatol ; 23 Suppl 1: 13-18, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38587296

RESUMO

BACKGROUND: Scarring is one of the most prevalent long-term complications of acne vulgaris and has cosmetic, psychological, and social burdens. Contemporary management programs integrate multiple modalities to best address the multiple factors underlying their development and persistence. This work assessed the impact of sequential multimodal laser therapy on acne scar geometrics and texture. METHODS: Adult patients (n = 16) with Fitzpatrick skin type II-IV and presenting with facial acne scars, underwent three combination ablative (CO2), and nonablative (1570 nm) laser treatment sessions at two-month intervals. Treatment was delivered using a ProScan Hybrid applicator, with each regimen including illumination with both ablative and a nonablative lasers applied in a grid mode sequence. Scar microtopography was assessed at baseline and 6 months after the last treatment session. RESULTS: At baseline, all patients had both box and rolling scars, while only three had icepick scars. Six months following treatment, mean scar volume improved from 5.7 ± 5.2 mm3 at baseline to 3.1 ± 3.0 mm3 and mean affected area improved from 165.6 ± 134.0 mm2 94.0 ± 80.1 mm2, translating to 47.0 ± 7.9% and 43.2 ± 8.6% reductions from baseline, respectively. Patients were highly satisfied with treatment outcomes, and no serious adverse reactions were documented during the course of treatment or follow-up. CONCLUSION: Multimodal CO2 and 1570-nm laser treatment improved the surface profilometry of patients with atrophic facial acne scars. Customization of both treatment intervals and laser settings to cosmetic regions, scar profiles and skin phototypes may further enhance treatment outcomes and expand its applicability to additional skin deformities.


Assuntos
Acne Vulgar , Terapia a Laser , Anormalidades da Pele , Adulto , Humanos , Cicatriz/etiologia , Cicatriz/radioterapia , Dióxido de Carbono , Terapia a Laser/efeitos adversos , Resultado do Tratamento , Acne Vulgar/etiologia , Atrofia/etiologia
2.
BMC Pregnancy Childbirth ; 24(1): 277, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38622521

RESUMO

BACKGROUND: Transverse uterine fundal incision (TUFI) is a beneficial procedure for mothers and babies at risk due to placenta previa-accreta, and has been implemented worldwide. However, the risk of uterine rupture during a subsequent pregnancy remains unclear. We therefore evaluated the TUFI wound scar to determine the approval criteria for pregnancy after this surgery. METHODS: Between April 2012 and August 2022, we performed TUFI on 150 women. Among 132 of the 150 women whose uteruses were preserved after TUFI, 84 women wished to conceive again. The wound healing status, scar thickness, and resumption of blood flow were evaluated in these women by magnetic resonance imaging (MRI) and sonohysterogram at 12 months postoperatively. Furthermore, TUFI scars were directly observed during the Cesarean sections in women who subsequently conceived. RESULTS: Twelve women were lost to follow-up and one conceived before the evaluation, therefore 71 cases were analyzed. MRI scans revealed that the "scar thickness", the thinnest part of the scar compared with the normal surrounding area, was ≥ 50% in all cases. The TUFI scars were enhanced in dynamic contrast-enhanced MRI except for four women. However, the scar thickness in these four patients was greater than 80%. Twenty-three of the 71 women conceived after TUFI and delivered live babies without notable problems until August 2022. Their MRI scans before pregnancy revealed scar thicknesses of 50-69% in two cases and ≥ 70% in the remaining 21 cases. And resumption of blood flow was confirmed in all patients except two cases whose scar thickness ≥ 90%. No evidence of scar healing failure was detected at subsequent Cesarean sections, but partial thinning was found in two patients whose scar thicknesses were 50-69%. In one woman who conceived seven months after TUFI and before the evaluation, uterine rupture occurred at 26 weeks of gestation. CONCLUSIONS: Certain criteria, including an appropriate suture method, delayed conception for at least 12 months, evaluation of the TUFI scar at 12 months postoperatively, and cautious postoperative management, must all be met in order to approve a post-TUFI pregnancy. Possible scar condition criteria for permitting a subsequent pregnancy could include the scar thickness being ≥ 70% of the surrounding area on MRI scans, at least partially resumed blood flow, and no abnormalities on the sonohysterogram. TRIAL REGISTRATION: Retrospectively registered.


Assuntos
Placenta Acreta , Ferida Cirúrgica , Ruptura Uterina , Gravidez , Feminino , Humanos , Cicatriz/diagnóstico por imagem , Cicatriz/etiologia , Estudos Retrospectivos , Útero/diagnóstico por imagem , Útero/cirurgia , Cesárea/efeitos adversos , Cesárea/métodos
3.
Int Wound J ; 21(4): e14837, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38629613

RESUMO

The accurate assessment of wound healing post-caesarean section, especially in twin pregnancies, remains a pivotal concern in obstetrics, given its implications for maternal health and recovery. Traditional methods, including conventional abdominal ultrasonography (CU), have been challenged by the advent of transvaginal ultrasonography (TU), offering potentially enhanced sensitivity and specificity. This meta-analysis directly compares the efficacy of TU and CU in evaluating wound healing and scar formation, crucial for optimizing postoperative care. Results indicate that TU is associated with significantly better outcomes in wound healing, demonstrated by lower REEDA scores (SMD = -20.56, 95% CI: [-27.34.20, -13.77], p < 0.01), and in scar formation reduction, evidenced by lower Manchester Scar Scale scores (SMD = -25.18, 95% CI: [-29.98, -20.39], p < 0.01). These findings underscore the potential of integrating TU into routine post-caesarean evaluation protocols to enhance care quality and patient recovery.


Assuntos
Cesárea , Cicatriz , Gravidez , Humanos , Feminino , Cicatriz/diagnóstico por imagem , Cicatriz/etiologia , Cicatriz/cirurgia , Cesárea/efeitos adversos , Cicatrização , Ultrassonografia , Sensibilidade e Especificidade
4.
Trials ; 25(1): 226, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38556879

RESUMO

BACKGROUND: Burn-related injuries are a major global health issue, causing 180,000 deaths per year. Early debridement of necrotic tissue in association with a split-thickness skin graft is usually administered for some of the 2nd- and 3rd-degree injuries. However, this approach can be complicated by factors such as a lack of proper donor sites. Artificial skin substitutes have attracted much attention for burn-related injuries. Keratinocyte sheets are one of the skin substitutes that their safety and efficacy have been reported by previous studies. METHODS: Two consecutive clinical trials were designed, one of them is phase I, a non-randomized, open-label trial with 5 patients, and phase II is a randomized and open-label trial with 35 patients. A total number of 40 patients diagnosed with 2nd-degree burn injury will receive allogenic keratinocyte sheet transplantation. The safety and efficacy of allogeneic skin graft with autograft skin transplantation and conventional treatments, including Vaseline dressing and topical antibiotic, will be compared in different wounds of a single patient in phase II. After the transplantation, patients will be followed up on days 3, 7, 10, 14, 21, and 28. In the 3rd and 6th months after the transplantation scar, a wound closure assessment will be conducted based on the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale. DISCUSSION: This study will explain the design and rationale of a cellular-based skin substitute for the first time in Iran. In addition, this work proposes this product being registered as an off-the-shelf product for burn wound management in the country. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) IRCT20080728001031N31, 2022-04-23 for phase I and IRCT20080728001031N36, 2024-03-15 for phase II.


Assuntos
Queimaduras , Transplante de Células-Tronco Hematopoéticas , Humanos , Queimaduras/diagnóstico , Queimaduras/terapia , Queimaduras/complicações , Cicatriz/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Irã (Geográfico) , Queratinócitos , Transplante de Pele/efeitos adversos
6.
Medicine (Baltimore) ; 103(10): e37062, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38457552

RESUMO

BACKGROUND: Endoscopic treatment is increasingly used for refractory gastroesophageal reflux disease (rGERD). Unlike the mechanism of conventional surgical fundoplication, gastroesophageal junction ligation, anti-reflux mucosal intervention, and radiofrequency ablation have extremely similar anti-reflux mechanisms; hence, we collectively refer to them as endoscopic cardia peripheral tissue scar formation (ECSF). We conducted a systematic review and meta-analysis to assess the safety and efficacy of ECSF in treating rGERD. METHODS: We performed a comprehensive search of several databases, including PubMed, Embase, Medline, China Knowledge Network, and Wanfang, to ensure a systematic approach for data collection between January 2011 and July 2023. Forest plots were used to summarize and combine the GERD-health-related quality of life (HRQL), gastroesophageal reflux questionnaire score, and DeMeester scores, acid exposure time, lower esophageal sphincter pressure, esophagitis, proton pump inhibitors use, and patient satisfaction. RESULTS: This study comprised 37 studies, including 1732 patients. After ECSF, significant improvement in gastroesophageal reflux disease health-related quality of life score (mean difference [MD] = 18.27 95% CI: 14.81-21.74), gastroesophageal reflux questionnaire score (MD = 4.85 95% CI: 3.96-5.75), DeMeester score (MD = 42.34, 95% CI: 31.37-53.30), acid exposure time (MD = 7.98, 95% CI: 6.03-9.92), and lower esophageal sphincter pressure was observed (MD = -5.01, 95% CI: -8.39 to 1.62). The incidence of serious adverse effects after ECSF was 1.1% (95% CI: 0.9%-1.2%), and postoperatively, 67.4% (95% CI: 66.4%-68.2%) of patients could discontinue proton pump inhibitor-like drugs, and the treatment outcome was observed to be satisfactory in over 80% of the patients. Subgroup analyses of the various procedures showed that all 3 types improved several objective or subjective patient indicators. CONCLUSIONS: Based on the current meta-analysis, we conclude that rGERD can be safely and effectively treated with ECSF as an endoscopic procedure.


Assuntos
Cárdia , Refluxo Gastroesofágico , Humanos , Qualidade de Vida , Cicatriz/etiologia , Cicatriz/tratamento farmacológico , Refluxo Gastroesofágico/tratamento farmacológico , Endoscopia , Fundoplicatura/métodos , Resultado do Tratamento , Inibidores da Bomba de Prótons/uso terapêutico
8.
Medicina (Kaunas) ; 60(3)2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38541213

RESUMO

Background and Objectives: Cesarean scar pregnancy (CSP) represents a type of ectopic pregnancy in which the embryo implants inside the scar of a previous cesarean section. This condition can lead to maternal morbidity and mortality. The best therapeutic approach in terms of clinical effectiveness and patient safety for CSP has not been described yet, although different therapeutic strategies are currently available. The purpose of the present study was to analyze the success rate of two different treatments in a single institution. Materials and Methods: A retrospective study was performed among patients diagnosed with CSP at the Gynecology and Obstetrics Department of the "Cannizzaro" Hospital in Catania (University of Enna-Italy) from January 2016 to December 2022. The diagnosis was made by 2D/3D transvaginal ultrasound, following Timor-Tritsch criteria. Two treatment strategies were performed: local and systemic methotrexate (MTX) injection and uterine artery embolization (UAE) with subsequent dilatation and curettage (D&C). All treated women underwent subsequent clinical and sonographic follow-up. Complete recovery was defined as the reduction of ß-HCG values until it was undetectable and the disappearance of the mass in the uterine scar on ultrasound. Results: Nineteen patients were included; nine were in the MTX group and ten were in the UAE + D&C group. No significant differences were found between the two groups in terms of clinical parameters. Treatment was successful in 4 of 10 (44%) patients in the MTX group and 10 of 10 (100%) in the UAE + D&C group (p = 0.01); the length of hospital stay was significantly shorter in the latter group (p < 0.0001). Conclusions: In our experience, administration of MTX is not recommended as the primary treatment or pre-treatment. Dilatation and curettage after uterine artery embolization are better than methotrexate injection for the treatment of cesarean scar pregnancy in a single-institution series in terms of complete recovery and length of hospital stay.


Assuntos
Gravidez Ectópica , Embolização da Artéria Uterina , Gravidez , Humanos , Feminino , Metotrexato/uso terapêutico , Cesárea/efeitos adversos , Estudos Retrospectivos , Cicatriz/etiologia , Cicatriz/terapia , Gravidez Ectópica/etiologia , Gravidez Ectópica/terapia , Dilatação e Curetagem/efeitos adversos , Resultado do Tratamento
9.
Ugeskr Laeger ; 186(10)2024 03 04.
Artigo em Dinamarquês | MEDLINE | ID: mdl-38445344

RESUMO

Intramuscular injection of site enhancement oil is a cosmetic procedure used primarily in the bodybuilder environment to enlarge and reshape muscles. It comes with potential lifelong complications in the musculoskeletal system with scars, chronic wounds, pain, deformities of muscles and loss of muscle function. Magnetic resonance imaging is the best tool to diagnose and determine the propagation of the condition in the tissues. Treatment is complex and may consist of antibiotics, anti-inflammatories, compression therapy and surgical revision when possible. However, as stated in this review, prevention is crucial.


Assuntos
Antibacterianos , Cicatriz , Humanos , Injeções Intramusculares , Cicatriz/etiologia , Cicatriz/terapia , Dor , Reoperação
10.
Lasers Surg Med ; 56(4): 337-345, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38436118

RESUMO

OBJECTIVES: Subcutaneous mastectomy is a crucial component of gender affirmation therapy for transgender men (TM), but the scars that result from this procedure can frequently impair their quality of life. This study aimed to assess the efficacy and safety of 1064-nm fractional picosecond laser (FxPico) treatment for hypertrophic and atrophic postmastectomy scars in TM. METHODS: Twenty-two patients with a total of 35 pairs of bilateral symmetric mastectomy scars were enrolled. One of each pair of symmetric scars was randomly assigned to receive four FxPico treatments at 4-week intervals. All scars were evaluated using the modified Vancouver Scar Scale (mVSS) and three-dimensional imaging for scar roughness, melanin index, and hemoglobin index before each treatment session and at 1, 3, and 6 months following the last treatment. Additionally, participant-rated scar satisfaction (PSS) and scar improvement (Global Assessment Score, GAS), as well as adverse events were recorded. RESULTS: During the 6-month follow-up period after the end of laser treatment sessions, the treated scars showed significant reductions in the mVSS compared to the untreated controls (p < 0.001), whereas the melanin index and hemoglobin index were not significantly different. Subgroup analysis of hypertrophic scars demonstrated statistically significant reductions in mVSS at 1 (p = 0.003) and 3 months (p = 0.041) after the end of laser treatments. PSS was significantly higher on the laser-treated scars than the controls (p = 0.008), and a participant-rated GAS of 2.95 ± 0.65 was found. There were no serious adverse events reported. CONCLUSIONS: 1064-nm FxPico could be utilized to treat mastectomy scars among TM, particularly the hypertrophic type.


Assuntos
Neoplasias da Mama , Cicatriz Hipertrófica , Lasers de Gás , Pessoas Transgênero , Masculino , Humanos , Cicatriz/etiologia , Cicatriz/radioterapia , Cicatriz/cirurgia , Neoplasias da Mama/cirurgia , Qualidade de Vida , Melaninas , Resultado do Tratamento , Mastectomia , Cicatriz Hipertrófica/patologia , Lasers , Hipertrofia/cirurgia , Hemoglobinas
11.
Turk Neurosurg ; 34(2): 308-313, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38497184

RESUMO

AIM: To retrospectively analyze and compare ultrasound-assisted localization in situ with the traditional, open incision method for treating cubital tunnel syndrome (CuTS). MATERIAL AND METHODS: We retrospectively analyzed 51 patients treated between 2018 and 2022 and categorized them according to treatment method: ultrasound-assisted precise localization in situ decompression (n=21; Cohort 1) and traditional open incision in situ decompression (n=30; Cohort 2). We additionally collected Visual Analogue Scale (VAS) scores, Vancouver Scar Scale (VSS) scores, modified Bishop scores, aesthetic appearance, preoperative Dellon's stage, and analgesics requirements. Additional dependent variables of interest included operation time, hospital stay duration, complications, and reoperation rate. RESULTS: Neither cohort demonstrated significant changes in Dellon's stage, modified Bishop score, or VAS scores between baseline and 6 weeks postoperative. Cohort 1 showed better aesthetics and postoperative VSS and VAS scores than Cohort 1. In addition, Cohort 1 enjoyed a significantly shorter mean operation time and hospital stay. Cohort 1 had 5 (23.80%) complications, including superficial infection (n=1), hematoma (n=1), and incomplete decompression (n=3). Cohort 2 had 9 complications (30.00%), including superficial infection (n=2), hematoma (n=2), and severe scarring (n=5). The partial, incomplete decompression cases in Cohort 1 and the severe scar case in Cohort 2 were treated with reoperation. CONCLUSION: Both procedures effectively treated most cases of CuTS and were associated with good postoperative outcomes. Patients who underwent ultrasound-assisted localization in situ decompression had shorter surgeries and hospital stays, better postoperative aesthetics, better VSS and VAS scores, and required less pain medication during the postoperative period. Traditional open incision in situ produced a more thorough decompression.


Assuntos
Síndrome do Túnel Ulnar , Ferida Cirúrgica , Humanos , Síndrome do Túnel Ulnar/diagnóstico por imagem , Síndrome do Túnel Ulnar/cirurgia , Estudos Retrospectivos , Cicatriz/diagnóstico por imagem , Cicatriz/cirurgia , Cicatriz/etiologia , Descompressão Cirúrgica/métodos , Hematoma/etiologia
12.
J Drugs Dermatol ; 23(3): 146-151, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38443124

RESUMO

BACKGROUND: Topical minoxidil (TM) has been a cornerstone in treating various hair loss disorders, while low-dose oral minoxidil (LDOM) is emerging as an effective alternative. Despite their widespread use, there is a notable gap in the literature regarding their use in treating scarring alopecia. OBJECTIVE: This study evaluates the efficacy and safety of TM and LDOM in managing scarring alopecia. METHODS: A systematic literature search identified relevant studies on TM and LDOM use in central centrifugal cicatricial alopecia, frontal fibrosing alopecia, lichen planopilaris, and traction alopecia. Key metrics included disease stabilization, hair thickness improvement, hair regrowth, and side effect profiles. RESULTS: Analysis of the selected studies revealed mixed outcomes. Most participants experienced benefits in terms of disease stabilization and hair regrowth with TM and LDOM. The majority of cases reported good tolerability of the treatment, although some side effects were noted. CONCLUSION: TM and LDOM show promise in scarring alopecia treatment, demonstrating benefits in disease stabilization and hair regrowth. Despite these positive indications, the variability in results and reported side effects underline the need for further research to establish their consistent efficacy and safety profiles in scarring alopecia treatment. J Drugs Dermatol. 2024;23(3):     doi:10.36849/JDD.7743.


Assuntos
Alopecia , Cicatriz , Minoxidil , Humanos , Alopecia/diagnóstico , Alopecia/tratamento farmacológico , Cicatriz/tratamento farmacológico , Cicatriz/etiologia , Cabelo , Minoxidil/uso terapêutico
13.
Int Wound J ; 21(3): e14822, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38468433

RESUMO

Incisional scarring is a factor of cosmetic appearance evaluated after breast reconstruction, along with the shape, position, and size of the breast. This study aimed to examine the effect of the incision scar location on patient satisfaction after breast reconstruction. Using the Japanese version of the SCAR-Q, we assessed the scar appearance, symptoms and psychosocial effects. Plastic surgeons performed assessments using the Manchester Scar Scale. The patients were divided into two groups: those with scars on the margins of the breast (MB group) and those with scars in the breast area (IB group). The results revealed that patients in the MB group reported significantly higher satisfaction with the scar appearance and psychological impact than those in the IB group. However, assessments using the Manchester Scar Scale did not reveal any significant differences between the two groups. In conclusion, this study underscores the importance of patient-reported outcomes in the evaluation of scar satisfaction after breast reconstruction. Patients tend to prefer and have higher satisfaction with scars along the breast margin, which offers valuable insights into surgical decisions. Further studies with larger and more diverse sample sizes are required for validation.


Assuntos
Implante Mamário , Neoplasias da Mama , Mamoplastia , Ferida Cirúrgica , Humanos , Feminino , Cicatriz/etiologia , Cicatriz/cirurgia , Neoplasias da Mama/cirurgia , Implante Mamário/métodos , Mama , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Ferida Cirúrgica/cirurgia
14.
Medicine (Baltimore) ; 103(11): e37329, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38489702

RESUMO

To evaluate the impact of CO2 fractional laser combined with recombinant human epidermal growth factor (rhEGF) gel on skin barrier in acne scar patients. In a retrospective analysis, we examined 105 acne scar patients admitted between July 2018 and August 2021. Of these, 51 received only CO2 fractional laser (control group), while 54 underwent a combination of CO2 fractional laser and rhEGF gel (observation group). We assessed treatment efficacy, symptom relief, skin barrier parameters, pre- and posttreatment inflammatory factors, adverse reactions, posttreatment quality of life, and patient satisfaction. The observation group exhibited a higher overall response rate, significantly shorter wound healing, scab formation, and scab detachment times. Additionally, this group showed increased stratum corneum water content, decreased pH, and transdermal water loss (TEWL), and reduced hypersensitive C-reactive protein and interleukin-6 expression posttreatment. Quality of life scores were higher, with fewer adverse reactions and greater treatment satisfaction. Combining CO2 fractional laser with rhEGF gel markedly improves acne scar treatment efficacy, enhances skin barrier function, reduces inflammation, and elevates quality of life. Its safety profile supports its broader clinical adoption.


Assuntos
Acne Vulgar , Lasers de Gás , Humanos , Cicatriz/etiologia , Cicatriz/terapia , Dióxido de Carbono , Acne Vulgar/terapia , Estudos Retrospectivos , Qualidade de Vida , Resultado do Tratamento , Fator de Crescimento Epidérmico/uso terapêutico , Água , Lasers , Lasers de Gás/uso terapêutico
15.
BMC Pediatr ; 24(1): 207, 2024 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-38521911

RESUMO

BACKGROUND: Anorectal malformations (ARMs) are the most common congenital anomaly of the digestive tract. And colostomy should be performed as the first-stage procedure in neonates diagnosed with intermediate- or high-type ARMs. However, the most classic Pe˜na's colostomy still has some disadvantages such as complicated operation procedure, susceptibility to infection, a greater possibility of postoperative incision dehiscence, difficulty of nursing and large surgical trauma and incision scarring when closing the stoma. We aimed to explore the effectiveness of middle descending colon-double lumen ostomy (MDCDLO) in the treatment of high and intermediate types of anorectal malformations. METHODS: We retrospectively reviewed the data of patients who underwent MDCDLO for high or intermediate types of ARMs between June 2016 and December 2021 in our hospital. The basic characteristics were recorded. All patients were followed up monthly to determine if any complication happen. RESULTS: There were 17 boys and 6 girls diagnosed with high or intermediate types of ARMs in our hospital between June 2016 and December 2021. All 23 patients were cured without complications such as abdominal incision infection, stoma stenosis, incisional hernia, and urinary tract infection in the postoperative follow-up time of 6 months to 6 years except one case of proximal intestinal prolapse was restored under anesthesia. CONCLUSION: MDCDLO offers the advantages of simplicity, efficiency, safety, mild trauma, and small scarring in the treatment of high and intermediate types of anorectal malformations.


Assuntos
Malformações Anorretais , Recém-Nascido , Masculino , Feminino , Humanos , Malformações Anorretais/cirurgia , Malformações Anorretais/etiologia , Estudos Retrospectivos , Cicatriz/etiologia , Colo Descendente , Colostomia/efeitos adversos , Colostomia/métodos
16.
Eur J Obstet Gynecol Reprod Biol ; 296: 163-169, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38447278

RESUMO

OBJECTIVE: Although vaginal repair of isthmocele is an effective and safe surgical option, data on reproductive and obstetrical outcomes are lacking. The aim of this study is to evaluate reproductive outcomes of women undergone vaginal repair of isthmocele. We also systematically reviewed the existent literature to offer a general view of available data. STUDY DESIGN: Retrospective analysis of a database prospectively collected between January 2018 and January 2022 at San Raffaele Hospital, Milan, Italy. We included secondary infertile women with ultrasound documented isthmocele who undergone vaginal repair. Post-surgical clinical, reproductive and obstetric outcomes were recorded. An advanced systematic search of the literature up to January 2023 was conducted. RESULTS: 17 women were included. The mean age of the included patients was 37.2 ± 2.7 years. The median of previous caesarian sections was 1 (1-2). One intra-operative complication (5.9 %) was reported (bladder injury, repaired at the time of surgery). At follow up, bleeding was successfully treated in 8 women (8/10; 80 %). Pregnancy was obtained in 7 women (7/17; 41.2 %): the conception was spontaneous in 4 women (4/7; 57.1 %) and trough assisted reproductive technology in 3 patients (3/7; 42.9 %). The mean time from surgery to pregnancy was 10.8 (±6.7) months. One spontaneous abortion was reported (1/7; 14.3 %), while live birth was achieved in 6 pregnancies (6/7; 85.7 %). All deliveries were by caesarian section at a median gestational age of 37.5 (36-38.25) weeks. No obstetrical complications were reported. At the time of caesarean section, no defects on the lower segment were retrieved. Regarding the systematic research, among the 21 studies screened, only 4 articles were included in the review. Pregnancy rate was around 60-70 % with very few obstetrical complications (0.01 %) such as abnormal placentation or preterm birth. CONCLUSIONS: Vaginal repair of isthmocele is a minimally invasive, safe and effective surgical approach in terms of postsurgical residual myometrium tichness. Systematic review to date has found low-quality evidences on the impact of vaginal surgery in the management of secondary infertility and obstetrics outcomes in women with isthmocele.


Assuntos
Infertilidade Feminina , Nascimento Prematuro , Recém-Nascido , Gravidez , Humanos , Feminino , Adulto , Lactente , Cesárea/efeitos adversos , Infertilidade Feminina/etiologia , Estudos Retrospectivos , Cicatriz/etiologia
17.
Acta Chir Plast ; 65(3-4): 155-159, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38538304

RESUMO

Abdominal wall defects encompass a broad spectrum of musculo-fasciocutaneous anomalies. We present case of a 42-year-old woman with a history of multimorbidity and bilateral subcostal scars. The patient underwent incisional ventral hernia repair and abdominoplasty performed by a general surgeon at another institution. However, she developed extensive necrosis of the cutaneous-fatty panniculus between the bilateral subcostal incisions and the abdominoplasty incision. The patient presented with a medial area of 50 × 60 cm with loss of soft tissue vitality and necrotic plaques. Tangential escharotomies were performed to remove devitalized tissue, and management of the open wound included hydrocolloid and alginate dressings. Finally, a defect of 45 × 40 cm was achieved. Three tissue expanders were used to reconstruct the abdominal wall, allowing sufficient adjacent autologous tissue to be harvested for definitive correction of the abdominal defect. An acceptable aesthetic result was observed 5 years after surgery. This report highlights the importance of adequate evaluation of the previously scarred abdominal wall prior to abdominoplasty.


Assuntos
Parede Abdominal , Abdominoplastia , Hérnia Ventral , Hérnia Incisional , Feminino , Humanos , Adulto , Parede Abdominal/cirurgia , Cicatriz/etiologia , Cicatriz/cirurgia , Abdominoplastia/efeitos adversos , Hérnia Ventral/cirurgia , Hérnia Incisional/cirurgia
18.
J Plast Reconstr Aesthet Surg ; 91: 363-371, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38447506

RESUMO

In breast conserving surgery, the reconstruction of defects in small breasts where volume displacement techniques are not feasible can be challenging. In contrast, patients with bigger breasts may not wish to undergo major breast remodeling surgery or breast symmetrization procedures. In such cases, volume replacement techniques can be beneficial, but these leave additional scars and are time consuming. The authors propose an "in between" single scar approach to perform both lumpectomy and reconstruction of small peripheral breast tumors. This approach reduces morbidity and operating time compared with standard volume replacement techniques. The tumors are resected from below, guided by wire, using an incision in the lateral breast crease or inframammary fold, depending on their location. The same incision is used to raise an adipose or adipofascial flap based on perimammary perforators, lateral thoracic artery perforator flap (LTAP), lateral intercostal artery perforator flap (LICAP), or anterior intercostal artery perforator flaps (AICAP) flaps, without skin donor site. Between March and November 2022, eight patients underwent this procedure. In four cases LICAP flap was used; in three-AICAP flap was chosen; and in one-LTAP perforator flap was used. Clear surgical margins were achieved in all cases. The average follow-up time was 9.9 months, during which no local recurrences were detected. All flaps survived. Two patients experienced seromas at the donor site, and an organized hematoma was also reported. This approach represents a viable alternative to volume displacement techniques or no reconstruction for small peripheral lumpectomy defects.


Assuntos
Neoplasias da Mama , Mamoplastia , Retalho Perfurante , Humanos , Feminino , Mastectomia Segmentar , Retalho Perfurante/irrigação sanguínea , Cicatriz/etiologia , Cicatriz/prevenção & controle , Cicatriz/cirurgia , Mamoplastia/métodos , Mama/cirurgia , Obesidade/cirurgia , Neoplasias da Mama/cirurgia
19.
World J Surg Oncol ; 22(1): 52, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38347606

RESUMO

BACKGROUND: Endoscopic thyroidectomy has been preliminarily proven effective and safe for thyroid diseases. The cosmetic outcomes and life quality are critical contents of postoperative assessment. This review will primarily focus on the assessment methods and results related to cosmetic outcomes, sensory alteration of surgical area, and quality of life following endoscopic thyroidectomy. METHODS: A comprehensive search of published articles within the last decade was conducted using the terms "endoscopic/robotic thyroidectomy," "patient satisfaction scores," "questionnaire," "quality of life," and "cosmetic" in PubMed. RESULTS: Assessment methods for postoperative cosmetic satisfaction and sensory alterations encompassed verbal/visual analog scales, scar evaluations, Semmes-Weinstein monofilament tests, and more. The evaluation of postoperative quality of life in endoscopic thyroidectomy involved tools such as SF-36, SF-12, thyroid-specific questionnaires, thyroid cancer-specific quality of life questionnaires (THYCA-QOL), as well as assessments related to voice and swallow function. The cosmetic results of endoscopic thyroidectomy generally surpassed those of open thyroidectomy, while the quality of life in endoscopic procedures was either superior or equivalent to that in open thyroidectomy, especially with respect to general health, role emotion, and vitality. CONCLUSIONS: Assessments of cosmetic outcomes and sensory alterations following endoscopic thyroidectomy predominantly relied on patients' subjective feelings. The objective and subjective perspectives of scar assessments remain underutilized. In addition, postoperative laryngoscopy and voice function assessments in endoscopic thyroidectomy procedures require more attention.


Assuntos
Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Qualidade de Vida , Cicatriz/etiologia , Cicatriz/prevenção & controle , Cicatriz/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Endoscopia/métodos , Resultado do Tratamento
20.
N Engl J Med ; 390(6): 530-535, 2024 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-38324486

RESUMO

Dystrophic epidermolysis bullosa is a rare genetic disease caused by damaging variants in COL7A1, which encodes type VII collagen. Blistering and scarring of the ocular surface develop, potentially leading to blindness. Beremagene geperpavec (B-VEC) is a replication-deficient herpes simplex virus type 1-based gene therapy engineered to deliver functional human type VII collagen. Here, we report the case of a patient with cicatrizing conjunctivitis in both eyes caused by dystrophic epidermolysis bullosa who received ophthalmic administration of B-VEC, which was associated with improved visual acuity after surgery.


Assuntos
Colágeno Tipo VII , Epidermólise Bolhosa Distrófica , Terapia Genética , Humanos , Vesícula/etiologia , Cicatriz/etiologia , Colágeno Tipo VII/genética , Epidermólise Bolhosa Distrófica/complicações , Epidermólise Bolhosa Distrófica/genética , Epidermólise Bolhosa Distrófica/terapia , Conjuntivite/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...