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1.
J Obstet Gynaecol ; 44(1): 2349714, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38775009

RESUMO

BACKGROUND: The trend of increasing caesarean section (CS) rates brings up questions related to subfertility. Research regarding the influence of CS on assisted reproduction techniques (ART) is conflicting. A potential mechanism behind CS-induced subfertility is intra uterine fluid resulting from a caesarean scar defect or niche. The vaginal microbiome has been repeatedly connected to negative ART outcomes, but it is unknown if the microbiome is changed in relation to a niche. METHODS: This systematic review describes literature investigating the effect of a niche on live birth rates after assisted reproduction. Furthermore, studies investigating a difference in microbial composition in subfertile persons with a niche compared to no niche are evaluated. Pubmed, Embase and Web of Science were searched on March 2023 for comparative studies on both study questions. Inclusion criteria were i.e., English language, human-only studies, availability of the full article and presence of comparative pregnancy data on a niche. The quality of the included studies and their risk of bias were assessed using the Newcastle-Ottawa scale for cohort studies. The results were graphically displayed in a forest plot. RESULTS: Six retrospective cohort studies could be included on fertility outcomes, with a total of 1083 persons with a niche and 3987 without a niche. The overall direction of effect shows a negative impact of a niche on the live birth rate (pooled aOR 0.58, 95% CI 0.48-0.69) with low-grade evidence. Three studies comparing the microbiome between persons with and without a CS could be identified. CONCLUSION: There is low-grade evidence to conclude that the presence of a niche reduces live birth rates when compared to persons without a niche. The theory that a caesarean has a negative impact on pregnancy outcomes because of dysbiosis promoted by the niche is interesting, but there is no sufficient literature about this.


The increasing number of caesarean deliveries has raised concerns about how it might affect a woman's ability to get pregnant afterwards. Some studies suggest that having a caesarean section (CS) could make it harder to conceive, particularly through in vitro fertilisation (IVF). The reason could be the scar or niche from a previous caesarean. This niche can cause fluid inside the uterus. We also know that the mix of bacteria in the vagina, called the vaginal microbiome, can affect a woman's chances of getting pregnant, especially with treatments like IVF. But we are not sure if having a caesarean affects the vaginal microbiome.To understand this better, van den Tweel's team looked at studies on whether having a niche from a caesarean affects a woman's chance of having a baby through IVF. They also looked at studies comparing the bacteria in the vagina of women who have had a caesarean with those who have not. They found that having a caesarean niche makes it harder for a woman to have a baby through IVF. However, the evidence from these studies is not very strong. We still do not know enough about whether having a caesarean niche affects the bacteria in the vagina.


Assuntos
Cesárea , Cicatriz , Humanos , Feminino , Cicatriz/etiologia , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Vagina/microbiologia , Microbiota , Infertilidade Feminina/etiologia , Infertilidade Feminina/microbiologia , Nascido Vivo , Fertilidade , Adulto , Coeficiente de Natalidade
2.
PLoS One ; 19(5): e0285648, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38718052

RESUMO

BACKGROUND: Acne is a common disease that is associated with scarring and substantial psychosocial burden. The Global Burden of Skin Disease reported that the burden from acne as measured by disability-adjusted life years (DALYs) from 188 countries and specifically that it is greatest in Western Europe, high-income North America and Southern Latin America. This paper aimed to identify risk factors for acne scarring specific to the Ecuadorian population in order to adapt the 4-ASRAT tool accordingly. METHODS: This was an observational prospective study. Participants were recruited to complete a survey that was developed based on the potential risk factors for acne scarring and had facial photographs taken. To determine risk factors and their respective weighting, a logistic regression was performed. RESULTS: The study included 404 participants. Results from univariate analyses indicated that being male (OR = 2.76 95%CI [1.72; 4.43]), having severe or very severe acne scarring (OR = 4.28 95%CI [1.24; 14.79]), acne duration over 1 year (OR = 1.71 95%CI [1.12; 2.60]), oily skin (OR = 2.02 95%CI [1.27; 3.22]) and the presence of acne on the neck (OR = 2.26 95%CI [1.30; 3.92]), were all significantly associated with the presence of acne scarring. Male sex (2.56 95%CI [1.58;4.17]), oily skin (1.96 95%CI [1.20;3.20]) and severe or very severe acne (3.75 95%CI [1.05;13.37]) remained significant risk factors for acne scarring in the multivariate analysis. CONCLUSION: By identifying acne scarring risk factors and applying the tool in everyday dermatology visits, we can reduce the physical and psychological burden that acne scarring causes in the adolescent and adult populations. Further research should be conducted to reassess potential risk factors and complete the adaptation of the tool for the Ecuadorian population, with a larger and more representative study population.


Assuntos
Acne Vulgar , Cicatriz , Humanos , Equador/epidemiologia , Acne Vulgar/epidemiologia , Acne Vulgar/complicações , Masculino , Fatores de Risco , Feminino , Cicatriz/etiologia , Cicatriz/epidemiologia , Adulto , Estudos Prospectivos , Adolescente , Adulto Jovem
3.
J Plast Surg Hand Surg ; 59: 72-76, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769787

RESUMO

BACKGROUND: The purpose of this article is to introduce a method that combines limited debridement and ReCell® autologous cell regeneration techniques for the treatment of deep second-degree burn wounds. METHOD: A total of 20 patients suffered with deep second-degree burns less than 10% of total body surface area (TBSA) who were admitted to our department, from June 2019 to June 2021, participated in this study. These patients first underwent limited debridement with an electric/pneumatic dermatome, followed by the ReCell® technique for secondary wounds. Routine treatment was applied to prevent scarring after the wound healed. Clinical outcomes were scored using the Vancouver Scar Scale (VSS). RESULTS: All wounds of the patients healed completely. One patient developed an infection in the skin graft area and finally recovered by routine dressing changes. The average healing time was 12 days (range: 10-15 days). The new skin in the treated area was soft and matched the colour of the surrounding normal skin and the VSS score ranged from 3~5 for each patient. Of the 20 patients, 19 were very satisfied and 1 was satisfied. CONCLUSIONS: This article reports a useful treatment method that combines electric dermatome-dependent limited debridement and the ReCell® technique for the treatment of deep second-degree burn wounds. It is a feasible and effective strategy that is easy to implement and minimally invasive, and it is associated with a short healing time, mild scar formation and little damage to the donor skin area.


Assuntos
Queimaduras , Desbridamento , Transplante de Pele , Humanos , Queimaduras/cirurgia , Queimaduras/terapia , Desbridamento/métodos , Masculino , Adulto , Feminino , Transplante de Pele/métodos , Pessoa de Meia-Idade , Adulto Jovem , Cicatrização/fisiologia , Cicatriz , Adolescente , Poliésteres
4.
Reprod Biol Endocrinol ; 22(1): 54, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38734672

RESUMO

BACKGROUND: To investigate factors associated with different reproductive outcomes in patients with Caesarean scar pregnancies (CSPs). METHODS: Between May 2017 and July 2022, 549 patients underwent ultrasound-guided uterine aspiration and laparoscopic scar repair at the Gynaecology Department of Hubei Maternal and Child Health Hospital. Ultrasound-guided uterine aspiration was performed in patients with type I and II CSPs, and laparoscopic scar repair was performed in patients with type III CSP. The reproductive outcomes of 100 patients with fertility needs were followed up and compared between the groups. RESULTS: Of 100 patients, 43% had live births (43/100), 19% had abortions (19/100), 38% had secondary infertility (38/100), 15% had recurrent CSPs (RCSPs) (15/100). The reproductive outcomes of patients with CSPs after surgical treatment were not correlated with age, body mass index, time of gestation, yields, abortions, Caesarean sections, length of hospital stay, weeks of menopause during treatment, maximum diameter of the gestational sac, thickness of the remaining muscle layer of the uterine scar, type of CSP, surgical method, uterine artery embolisation during treatment, major bleeding, or presence of uterine adhesions after surgery. Abortion after treatment was the only risk factor affecting RCSPs (odds ratio 11.25, 95% confidence interval, 3.302-38.325; P < 0.01) and it had a certain predictive value for RCSP occurrence (area under the curve, 0.741). CONCLUSIONS: The recurrence probability of CSPs was low, and women with childbearing intentions after CSPs should be encouraged to become pregnant again. Abortion after CSP is a risk factor for RCSP. No significant difference in reproductive outcomes was observed between the patients who underwent ultrasound-guided uterine aspiration and those who underwent laparoscopic scar repair for CSP.


Assuntos
Cesárea , Cicatriz , Gravidez Ectópica , Humanos , Feminino , Gravidez , Cicatriz/etiologia , Cicatriz/cirurgia , Cesárea/efeitos adversos , Cesárea/métodos , Adulto , Gravidez Ectópica/cirurgia , Gravidez Ectópica/etiologia , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/diagnóstico , Resultado da Gravidez/epidemiologia , Laparoscopia/métodos , Resultado do Tratamento , Estudos Retrospectivos
5.
Pan Afr Med J ; 47: 83, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38737224

RESUMO

Uterine rupture is a life-threatening obstetric complication. The purpose of this study was to investigate the epidemiological features, maternal and foetal prognosis and different treatment options for uterine rupture in healthy and scarred uteri. We conducted a retrospective monocentric descriptive and analytical study of 60 cases of uterine rupture collected in the Department of Gynaecology-Obstetrics of the Center of Maternity and Neonatology, Monastir, from 2017 to 2021. Patients were classified according to the presence or absence of a uterine scar. Sixty patients were enrolled in the study. The majority of cases of rupture occurred in patients with scarred uterus (n=55). The most common clinical sign was abnormal foetal heart rate. No maternal deaths were recorded and perinatal mortality rate was 11%. Mean BMI, fetal macrosomia rate and mean parity were significantly higher in the healthy uterus group than in the scarred uterus group (p=0.033, 0.018, and 0.013, respectively). The maternal complications studied (post-partum haemorrhage, hysterectomy, blood transfusion, prolonged hospitalisation) were significantly more frequent in patients with unscarred uterine rupture (p=0.039; p=0.032; p=0.009; p=0.025 respectively). Uterine rupture is a life-threatening obstetrical event for the foetus and the mother. Fetal heart rate abnormality is the most common sign associated with uterine rupture. Management is based on conservative treatment in most cases. Patients with scarred uterus have a better prognosis.


Assuntos
Hemorragia Pós-Parto , Ruptura Uterina , Humanos , Feminino , Tunísia/epidemiologia , Estudos Retrospectivos , Ruptura Uterina/epidemiologia , Ruptura Uterina/etiologia , Adulto , Gravidez , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Hemorragia Pós-Parto/etiologia , Adulto Jovem , Cicatriz , Prognóstico , Histerectomia/estatística & dados numéricos , Mortalidade Perinatal , Macrossomia Fetal/epidemiologia , Recém-Nascido , Frequência Cardíaca Fetal , Transfusão de Sangue/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos
6.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 49(2): 197-206, 2024 Feb 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-38755716

RESUMO

Scars are classified into 5 types: Superficial scars, hypertrophic scars, atrophic scars, depressed scars, and keloid. These types are primarily characterized by abnormal production of fibroblasts and collagen, as well as the disorderly arrangement of connective tissue. Laser treatment for scars involves the coordinated activation of various signaling pathways and cytokines. However, the exact pathological mechanism for scar formation remains unclear, leading to a lack of radical treatment. Recently, laser treatment has gained popularity as a new minimally invasive approach for scar treatment. The emergence of new theories such as fractional, picosecond laser, and laser-assisted drug delivery has led to continuous advance in laser treatment. Up to now, it has been developed numerous novel treatments, including combined with drug, physical, and other treatments, which have shown superior therapeutic effects. In order to optimize laser treatment in the future, it is crucial to combine new materials with postoperative care. This will help clinicians develop more comprehensive treatment strategies. Therefore, it is important to explore treatment options that have broader applicability.


Assuntos
Cicatriz , Queloide , Terapia a Laser , Humanos , Cicatriz/terapia , Terapia a Laser/métodos , Queloide/radioterapia , Queloide/terapia , Cicatriz Hipertrófica/radioterapia , Cicatriz Hipertrófica/terapia
7.
Tech Hand Up Extrem Surg ; 28(2): 51-59, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38764415

RESUMO

Syndactyly release aims to address skin deficits by resurfacing web spaces and sides of digits to allow independent digital motion while minimizing the risk of web creep and scar contractures. Conventional methods include the use of a dorsal and interdigitating flaps with full-thickness skin grafts. More recently, there have been several descriptions of "graftless" syndactyly release without skin grafts, thus avoiding a further (usually distant) donor site. However, the indications of when and when not to use these techniques remain unclear. In addition, the inevitable scarring from extra recruitment of local adjacent skin is perhaps underemphasized. In this article, we revisit the trilobed flap technique which serves to balance the amount of skin needed for resurfacing digits while minimizing local donor site scarring. The geometry and nuances of the flap inset are illustrated in detail to guide those embarking on this technique. The trilobed syndactyly release technique is a reproducible, safe, and reliable method for the release of simple syndactyly.


Assuntos
Retalhos Cirúrgicos , Sindactilia , Humanos , Sindactilia/cirurgia , Cicatriz/prevenção & controle
8.
Bull Exp Biol Med ; 176(5): 640-644, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38733481

RESUMO

Creating of a scar model in laboratory animals is the most acceptable option for the preclinical search of scar treatment. However, due to high skin regeneration rate in laboratory rodents, creating an optimal animal model of scar formation is a challenge. Here we describe five methods for modeling a scar tissue in rats that we have tested. These methods allowed achieving different histopathological features and different stages of skin scar formation.


Assuntos
Queimaduras Químicas , Cicatriz , Modelos Animais de Doenças , Ratos Sprague-Dawley , Pele , Animais , Cicatriz/patologia , Cicatriz/fisiopatologia , Ratos , Pele/patologia , Pele/lesões , Queimaduras Químicas/patologia , Masculino , Cicatrização/fisiologia
11.
Int Wound J ; 21(5): e14934, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38783559

RESUMO

Preservation and restoration of hand function after burn injuries are challenging yet imperative. This study aimed to assess the curative effect of a composite skin graft over an acellular dermal matrix (ADM) and a thick split-thickness skin graft (STSG) for treating deep burns on the hand. Patients who met the inclusion criteria at the First Affiliated Hospital of Wenzhou Medical University between September 2011 and January 2020 were retrospectively identified from the operative register. We investigated patient characteristics, time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery, donor site recovery, complications and days to complete healing. Patients were followed up for 12 months to evaluate scar quality using the Vancouver Scar Scale (VSS) and hand function through total active motion (TAM) and the Jebsen-Taylor Hand Function Test (JTHFT). A total of 38 patients (52 hands) who received thin STSG on top of the ADM or thick STSG were included. The location of the donor sites was significantly different between Group A (thick STSG) and Group B (thin STSG + ADM) (p = 0.03). There were no statistical differences in age, gender, underlying disease, cause of burn, burn area, dominant hand, patients with two hands operated on and time from burn to surgery between the two groups (p > 0.05). The time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery and days to complete healing were not significantly different between Group A and Group B (p > 0.05). The rate of donor sites requiring skin grafting was lower in Group B than in Group A (22.2% vs. 100%, p < 0.001). There were no statistically significant differences in complications between the groups (p = 0.12). Moreover, 12 months postoperatively, the pliability subscore in the VSS was significantly lower in Group A than in Group B (p = 0.01). However, there were no statistically significant differences in vascularity (p = 0.42), pigmentation (p = 0.31) and height subscores (p = 0.13). The TAM and JTHFT results revealed no statistically significant differences between the two groups (p = 0.22 and 0.06, respectively). The ADM combined with thin STSG is a valuable approach for treating deep and extensive hand burns with low donor site morbidity. It has a good appearance and function in patients with hand burns, especially in patients with limited donor sites.


Assuntos
Derme Acelular , Queimaduras , Traumatismos da Mão , Transplante de Pele , Humanos , Queimaduras/cirurgia , Masculino , Feminino , Transplante de Pele/métodos , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Traumatismos da Mão/cirurgia , Adulto Jovem , Cicatrização/fisiologia , Cicatriz , Resultado do Tratamento
12.
Arch Dermatol Res ; 316(6): 212, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38787406

RESUMO

The use of botulinum toxin for off-label indications has become more prevalent, but the specific benefits in Mohs micrographic surgery (MMS) have not yet been fully elucidated. A systematic review was performed of PubMed, Cochrane, EMBASE, and Scopus databases to identify all articles describing the use of botulinum toxin in MMS. Analysis was subdivided into scar minimization, parotid injury, and pain management. A total of nine articles were included. Scar minimization and treatment of parotid injury were the most reported uses. One case reported the use of botulinum toxin for pain management. Off label uses of botulinum toxin are being explored. Additional research is warranted to determine the efficacy and utility of botulinum toxin in MMS.


Assuntos
Cicatriz , Cirurgia de Mohs , Uso Off-Label , Humanos , Cicatriz/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/tratamento farmacológico , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/uso terapêutico , Toxinas Botulínicas/administração & dosagem , Manejo da Dor/métodos , Glândula Parótida/cirurgia
13.
Arch Dermatol Res ; 316(6): 223, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38787423

RESUMO

Treatments for breast cancer can have an array of adverse effects, including hair loss, scarring, and irritated skin. These physical outcomes can, in turn, lead to body image concerns, anxiety, and depression. Fortunately, there is growing evidence that certain cosmetic therapies can improve patient self-image. Here we review various cosmetic treatment options including hair camouflage, eyebrow and eyelash camouflage, treatments for hirsutism, nipple and areola tattooing, post-mastectomy scar tattooing, treatments for dry skin/xerosis, removal of post-radiation telangiectasias, and lightening of post-radiation hyperpigmentation. For each patient concern, we report potential procedures, clinical evidence of impact on quality of life, special considerations, and safety concerns. This article aims to equip dermatologists with resources so that they may effectively counsel breast cancer survivors who express treatment-related cosmetic concerns.


Assuntos
Neoplasias da Mama , Qualidade de Vida , Humanos , Neoplasias da Mama/terapia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/radioterapia , Feminino , Técnicas Cosméticas/efeitos adversos , Mastectomia/efeitos adversos , Imagem Corporal/psicologia , Cicatriz/etiologia , Cicatriz/psicologia , Cicatriz/terapia , Sobreviventes de Câncer/psicologia , Tatuagem/efeitos adversos
14.
Arch Dermatol Res ; 316(5): 146, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38696005

RESUMO

Secondary malignancies are rare but devastating complications of longstanding burn scars. Squamous cell carcinoma is the most common, followed by basal cell carcinoma and melanomas. There are fewer than 50 total reported cases of malignant melanomas arising in burn scars. We report a case of malignant melanoma arising within a longstanding burn scar confirmed by histology, FISH, and PRAME staining to further characterize melanomas arising in burn scars and to illustrate the diagnostic challenges they present.


Assuntos
Queimaduras , Cicatriz , Melanoma , Neoplasias Cutâneas , Humanos , Melanoma/diagnóstico , Melanoma/patologia , Melanoma/complicações , Queimaduras/complicações , Queimaduras/diagnóstico , Queimaduras/patologia , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/etiologia , Masculino , Pessoa de Meia-Idade , Antígeno gp100 de Melanoma , Melanoma Maligno Cutâneo , Feminino , Hibridização in Situ Fluorescente
15.
Elife ; 122024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38690990

RESUMO

Caesarean section scar diverticulum (CSD) is a significant cause of infertility among women who have previously had a Caesarean section, primarily due to persistent inflammatory exudation associated with this condition. Even though abnormal bacterial composition is identified as a critical factor leading to this chronic inflammation, clinical data suggest that a long-term cure is often unattainable with antibiotic treatment alone. In our study, we employed metagenomic analysis and mass spectrometry techniques to investigate the fungal composition in CSD and its interaction with bacteria. We discovered that local fungal abnormalities in CSD can disrupt the stability of the bacterial population and the entire microbial community by altering bacterial abundance via specific metabolites. For instance, Lachnellula suecica reduces the abundance of several Lactobacillus spp., such as Lactobacillus jensenii, by diminishing the production of metabolites like Goyaglycoside A and Janthitrem E. Concurrently, Clavispora lusitaniae and Ophiocordyceps australis can synergistically impact the abundance of Lactobacillus spp. by modulating metabolite abundance. Our findings underscore that abnormal fungal composition and activity are key drivers of local bacterial dysbiosis in CSD.


Assuntos
Bactérias , Cesárea , Cicatriz , Divertículo , Feminino , Cesárea/efeitos adversos , Humanos , Divertículo/microbiologia , Divertículo/metabolismo , Bactérias/metabolismo , Bactérias/genética , Cicatriz/microbiologia , Cicatriz/metabolismo , Disbiose/microbiologia , Fungos/metabolismo , Fungos/genética , Fungos/fisiologia , Interações Microbianas , Microbiota
16.
BMJ Case Rep ; 17(4)2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38565229

RESUMO

Marjolijn's ulcer is a malignant ulcer in a burn scar. Types of malignancy are squamous cell carcinoma, basal cell carcinoma and malignant melanoma. Soft tissue sarcoma case reports indicate only one type of cancer. We present a patient in her 60s with a 10-year-old burn scar developing a biopsy-proven squamous cell carcinoma on the lateral aspect of the left thigh with metastatic superficial inguinal node. A wide excision and grafting of ulcer with ilioinguinal dissection done on left side. On the 12th postoperative day 2, subcutaneous swellings adjacent to the grafted area developed, on biopsy revealed to be pleomorphic sarcoma. PET CT scan revealed tumour deposits in the muscles of the left lower limb, liver and lung. There are no case reports of synchronous carcinoma and sarcoma in a burn scar. The case is reported for its rarity and the decision-making dilemma.


Assuntos
Queimaduras , Carcinoma de Células Escamosas , Sarcoma , Neoplasias Cutâneas , Neoplasias de Tecidos Moles , Feminino , Humanos , Queimaduras/complicações , Queimaduras/patologia , Carcinoma de Células Escamosas/patologia , Cicatriz/complicações , Cicatriz/patologia , Sarcoma/complicações , Sarcoma/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias de Tecidos Moles/complicações , Úlcera/complicações , Pessoa de Meia-Idade , Idoso
17.
Ann Plast Surg ; 92(4S Suppl 2): S142-S145, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38556663

RESUMO

INTRODUCTION: Burn neck contractures pose a great challenge for reconstructive surgeons. A paucity of literature exist regarding long-term outcomes based on different surgical management strategies. The aim of this study was to evaluate the long-term outcomes of the treatment of neck burn scar contractures and evaluate surgical strategies according to their long-term effectiveness and associated complications. METHODS: A retrospective cohort study was conducted to review outcomes of neck contractures release after burn injury. All patients operated on between January 2009 and February 2023 at a single institution were included. RESULTS: A total of 20 patients developed neck burn scar contracture and were included in this study. The mean age was 32.9 ± 20.3 years. The burn injuries were most commonly thermal (n = 19, 95%). All burn injuries were full-thickness burns, with an average neck defect size of 130.5 ± 106.0 cm2. Overall, 45 surgical scar release procedures were performed on the 20 patients who developed a neck contracture. Patients underwent 1.65 ± 1.04 surgeries on average to address neck contracture. Although 25% of patients only received 1 surgery to treat neck contracture, some patients underwent as many as 8 surgeries. Contracture recurrence (CR) was the most common complication and occurred in 28.9% of the cases. The mean percentage total body surface area did not significantly differ in CR patients (26.7% ± 14.9%) and no-CR patients (44.5% ± 30.2%). However, there was a significant difference (P = 0.01) in the average neck defect size between CR patients (198.5 ± 108.3 cm2) and no-CR patients (81.1 ± 75.1 cm2). CONCLUSIONS: This study showed that risk factors for initial burn scar contractures may differ from those associated with CR, highlighting the importance of neck defect size as a predictor. The study also examines various surgical approaches, with Z-plasty showing promise for managing CR. However, the absence of data on neck range of motion is a limitation. This research underscores the complexity of managing CR and emphasizes the need for ongoing postoperative monitoring.


Assuntos
Queimaduras , Contratura , Procedimentos de Cirurgia Plástica , Torcicolo , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Cicatriz/cirurgia , Cicatriz/complicações , Contratura/etiologia , Contratura/cirurgia , Queimaduras/complicações , Queimaduras/cirurgia , Transplante de Pele/efeitos adversos
18.
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
19.
Med Sci Monit ; 30: e943550, 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38566372

RESUMO

Cesarean scar pregnancy (CSP) is a rare but potentially dangerous condition that occurs when an embryo implants and develops within the scar tissue from a previous cesarean section. Treatment of cesarean scar pregnancy depends on several factors, including the gestational age of the pregnancy, the presence of complications, and the individual patient's circumstances. We performed a systematic review of the published literature on management of cesarean scar pregnancy and the outcomes, complications, and effects on fertility. A systematic review of recent scientific literature published up to April 2023 in the databases PubMed, Google Scholar, and Web of Science was performed according to the PRISMA guidelines. We used the search keywords "cesarean scar pregnancy," "methotrexate," "systemic," "chemoembolization," and "uterine artery embolization." The baseline search resulted in 413 articles. After the exclusion of 342 irrelevant articles, the abstracts and titles of the remaining 71 articles were read for potential inclusion, resulting in exclusion of a further 16 articles. Therefore, the full texts of 55 articles were investigated. Finally, 42 papers were included in the study. The main finding was that chemoembolization is more successful than systemic methotrexate therapy, and is associated with less blood loss and shorter hospital stay. Transarterial chemoembolization appears to be safe and effective method of treatment in patients with CSP and should thus be considered during multidisciplinary evaluation of these patients.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Preservação da Fertilidade , Neoplasias Hepáticas , Gravidez Ectópica , Gravidez , Humanos , Feminino , Metotrexato/uso terapêutico , Cicatriz/terapia , Cesárea/efeitos adversos , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Gravidez Ectópica/etiologia , Gravidez Ectópica/terapia , Estudos Retrospectivos , Resultado do Tratamento
20.
Acta otorrinolaringol. esp ; 75(2): 129-132, Mar-Abr. 2024. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-231384

RESUMO

Introduction: Pinna infections are usually due to Staphylococcus aureus infection. It is common for the patient to have had an earring in the area of infection. Monkeypox infection has gone from being an endemic infection to a worldwide health emergency. Case summary: In this article we present five cases of monkeypox earring infection of the pinna and what common features we have seen that differentiate them from Staphylococcus aureus infection. Discussion: Symptoms of monkeypox include general malaise, fever with uni- or bilateral lymphadenopathy, and then the appearance within one or two days of skin lesions, we want to alert he otolaryngologist and the medical society to the possibility the diagnostic possibility of monkeypox in patients with an auricular perichondritis.(AU)


Introducción: Las infecciones del pabellón auricular se deben habitualmente a la infección por Staphilococcus Aureus. Es habitual que el paciente se haya realizado un pendiente en la zona de la infección. La infección por viruela del Mono ha pasado de ser una infección endémica a una emergencia sanitaria a nivel mundial. Caso: Exponemos en este artículo cinco casos de infección del pabellón auricular por pendiente por viruela del mono y que características comunes hemos visto que las diferencian de la infección por Staphilococcus Aureus. Discusión:Los síntomas de la viruela del mono incluyen malestar general, fiebre con linfadenopatía uni o bilateral, y posteriormente la aparición en uno o dos días de lesiones cutáneas, queremos alertar al otorrinolaringólogo y a la sociedad médica de la posibilidad diagnóstica de viruela del mono en pacientes con una pericondritis auricular.(AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Mpox , Pavilhão Auricular/lesões , Doenças da Laringe , Piercing Corporal/efeitos adversos , Cicatriz , Diagnóstico Diferencial , Otolaringologia , Pacientes Internados , Exame Físico
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