Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.393
Filtrar
2.
Medicine (Baltimore) ; 98(44): e17741, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689823

RESUMO

OBJECTIVES: We compared the clinical efficacy of contrast-enhanced ultrasound (CEUS) to transvaginal ultrasound (TVS) for diagnosing cesarean scar pregnancy (CSP). METHODS: A total of 485 cases of suspected CSP were recruited from January 2017 to March 2018. All received TVS and CEUS by two sonologists blinded to diagnosis by the other. Diagnostic features of CSP that significantly differed between modalities by univariate analysis (P < .05) were included in a logistic regression model. The sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), and accuracy (ACC) of CSP diagnosis by TVS and CEUS were compared according to operational and pathological outcomes as the reference standard. RESULTS: There were 220 CSP cases (including 85 cases of type I, 93 of type II, and 42 of type III). The sensitivities of CEUS for detection of types I - III CSP were 94.1%, 92.5%, and 97.6%, respectively, and corresponding sensitivities of TVS were 82.4%, 80.6%, and 95.2%. Compared to TVS, CEUS yielded significantly better overall sensitivity (97.27% vs 88.18%), specificity (96.60% vs 75.47%), +LR (28.60 vs 3.59), -LR (0.03 vs 0.16), and diagnostic ACC (96.9% vs 81.23%) (all P < .001). CONCLUSIONS: CEUS is superior to TVS for detecting cesarean scar pregnancy and distinguishing among CSP types.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Meios de Contraste , Complicações Pós-Operatórias/diagnóstico por imagem , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Gravidez , Gravidez Ectópica/etiologia , Estudos Prospectivos , Sensibilidade e Especificidade , Vagina/diagnóstico por imagem
3.
Pan Afr Med J ; 33: 246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692840

RESUMO

Buruli ulcer is infectious necrotizing panniculitis due to Mycobacterium ulcerans. Buruli ulcer is healed by leaving dystrophic, fibrous and retractile scars. On these scars can occur long-term squamous cell carcinoma. We report the first case of squamous cell carcinoma occurring on healing of Buruli ulcer. A 32-year-old woman with Buruli ulcer who has been cured for about 10 years is seen for ulcero-bulging knee swelling. The examination had revealed a large swelling of about ten centimeters in diameter, ulcero-budding, with an easily bleeding cauliflower appearance. The diagnosis of squamous cell carcinoma being retained without metastasis, resection of the tumor with scarring after one month without chemotherapy. There was no recurrence after six months of decline. The epidemiology of Buruli ulcer, responsible for scarring, explains the young age of our patient and the localization of carcinoma on the limb. The carcinomatous degeneration of scars, especially the scars of old burns, is constantly reported. The characteristics of Buruli ulcer scars, which bring them closer to burn scars, may explain why they are particularly affected by carcinomatous degeneration. One could also mention the chronicity of the wound in this infection, or wonder if the mycobacteria itself could play a role in carcinogenesis. This observation is, in our opinion, an alarm signal. We must fear an outbreak of cases in the years to come. To this end, preventive measures should already be taken by sensitizing the patients for an early consultation before any modification of their scars. After recovery, Buruli ulcer seems to present a risk of long-term evolution to a cancer. The scars of this condition, which could be considered precancerous lesions.


Assuntos
Úlcera de Buruli/complicações , Carcinoma de Células Escamosas/diagnóstico , Cicatriz/complicações , Adulto , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Cicatriz/etiologia , Costa do Marfim , Feminino , Humanos
4.
J Drugs Dermatol ; 18(9): 937-938, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524351

RESUMO

Botulinum toxin type A (BTA) is a neurotoxic protein that prevents the release of neurotransmitters from presynaptic nerves and has shown promise in treating neuropathic pain. Recently, BTA has been used to treat painful keloids and scars. We present a patient with refractory neuropathic pain in a normotrophic spread-scar treated with the injection of BTA. A 47-year-old Caucasian female with a history of invasive melanoma of the left upper arm presented with pain in her excision scar, which she described as a "pins and needles" sensation alternating with a dull, deep ache. She had previously tried topical lidocaine, topical and intralesional steroids, and oral gabapentin without improvement. We treated the patient with 50 U of onabotulinumtoxinA intradermally at 1-1.5 cm intervals within and immediately around the perimeter of the scar. At 1-week follow-up, she reported a 10% decrease in her pain. Four weeks after the procedure, she reported a 50% decrease in pain with smoothening of the scar surface, which has been durable for over 5 months. Scar pain can significantly impair quality of life and treatment protocols have not been established for normotrophic scars. Many trials have focused on improving appearance and reducing symptoms in hypertrophic and keloid scars, but few have evaluated therapies for normotrophic scars. BTA has been studied as a treatment for painful hypertrophic and keloid scars with promising results. Our patient had a marked reduction in pain and improvement in scar texture at 1-month follow-up, which has been maintained thus far, indicating that intradermal BTA may be a simple and useful tool in treating painful normotrophic scars. J Drugs Dermatol. 2019;18(9):937-938.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Cicatriz/tratamento farmacológico , Neuralgia/tratamento farmacológico , Cicatriz/complicações , Feminino , Humanos , Injeções Intralesionais , Pessoa de Meia-Idade , Neuralgia/diagnóstico , Neuralgia/etiologia , Medição da Dor , Resultado do Tratamento
6.
Rev. bras. cir. plást ; 34(3): 331-335, jul.-sep. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047148

RESUMO

Introdução: Em 1988, Baroudi et al. publicaram um trabalho descrevendo a utilização de pontos de adesão entre o retalho dermoadiposo e a bainha anterior do músculo reto do abdome, no intuito de diminuir a formação de seroma. O presente estudo propõe-se a demonstrar uma provável correlação entre os pontos de adesão de Baroudi com a força tensional do retalho, através da medida da distância da cicatriz abdominal inferior ao xifoide antes e após os pontos de Baroudi, no transoperatório de dermolipectomia. Métodos: Trata-se de um estudo prospectivo observacional. Foram selecionadas submetidas a lipoabdominoplastia no Serviço de Cirurgia Plástica da Santa Casa de Misericórdia de Porto Alegre, no período de janeiro a abril de 2019. Aferiram-se as medidas transoperatórias da distância do apêndice xifoide esternal à cicatriz umbilical, e da primeira à cicatriz cirúrgica, pré e pós-realização dos pontos de adesão de Baroudi. A análise estatística foi realizada com o software Excel®. Resultados: Verificou-se a diminuição das distâncias apêndice xifoidecicatriz umbilical e apêndice xifoide-cicatriz após a realização da sutura de Baroudi (média de 1,5cm), pressupondo-se diminuição da tensão da cicatriz. Conclusão: As medidas aferidas no presente estudo mostraram uma diminuição da distância xifoide-cicatriz umbilical e xifoide-cicatriz abdominal inferior após a realização dos pontos de Baroudi, evidenciando uma menor tensão na cicatriz. Sugere-se estudos para avaliar como essas medidas se comportam a longo prazo e se realmente se correlacionam a uma cicatriz de melhor qualidade.


Introduction: In 1988, Baroudi et al. published a paper describing the use of adhesion points between the dermoadipose flap and the anterior rectus abdominis sheath to reduce seroma formation. This study aimed to demonstrate a probable correlation between the use of Baroudi adhesion points and reduction in flap tension force by measuring the distance from the lower abdominal scar to the xiphoid before and after using Baroudi points in dermolipectomy transoperatory. Methods: This was a prospective observational study that selected patients who underwent lipoabdominoplasty at the Santa Casa de Misericórdia Plastic Surgery Service of Porto Alegre from January to April 2019. The transoperatory measurements of distance from the sternal xiphoid appendix to the umbilical scar and from the pre-xiphoid to the postxiphoid scar before and after execution of Baroudi's adhesion points were compared. Statistical analysis was performed using Excel® software. Results: A reduction in the distances between the xiphoid-umbilical scar appendix and xiphoidscar appendix was verified after execution of Baroudi suture (mean 1.5 cm), indicating a decrease in scar tension. Conclusion: There was a decrease in the xiphoid-umbilical scar and xiphoid-lower abdominal scar distance after Baroudi stitches, indicating lower scar-tissue tension. Further studies should be conducted to evaluate these measurements in the long term and their correlation with a better-quality scar.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Pesos e Medidas , Análise Estatística , Estudos Prospectivos , Cicatriz , Pontos de Referência Anatômicos , Abdominoplastia , Pesos e Medidas/normas , Cicatriz/cirurgia , Cicatriz/complicações , Pontos de Referência Anatômicos/cirurgia , Pontos de Referência Anatômicos/lesões , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , /métodos
7.
Rev. bras. cir. plást ; 34(3): 391-398, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047162

RESUMO

Introdução: Queloides surgem de resposta excessiva à lesão da derme, resultando em proliferação de fibroblastos, produção exagerada de colágeno e comprometimento da pele sadia adjacente. O diagnóstico é clínico e muitos métodos conservadores e cirúrgicos já foram utilizados para tratamento. Porém, dados da eficácia desses tratamentos são limitados e não há consenso na literatura quanto a melhor técnica a ser empregada, permanecendo uma lacuna que necessita ser preenchida, a fim de que seus usos sejam indicados com maior confiabilidade, em um modelo de medicina baseada em evidências. Métodos: Revisão não sistemática da literatura sobre "queloides" nas bases de dados PubMed, Scielo, MEDLINE, UptoDate e livros-texto das áreas de Dermatologia e Cirurgia Dermatológica. Revisão de Literatura: Foram enumeradas e abordadas as principais informações sobre técnicas cirúrgicas e adjuvantes empregadas para essas lesões, que são: excisão, injeções intralesionais, crioterapia, laserterapia, revestimento com gel de silicone, radioterapia e pressoterapia. Torna-se relevante o levantamento dessas informações, tendo em vista que, além de poder causar dor, prurido e restrição de movimento, o principal motivo da procura de assistência médica para queloide é devido ao aspecto cosmético/estético, e as taxas de reincidência e falha terapêutica ainda são altas, sendo necessário conscientizar o paciente sobre o procedimento e seus efeitos. Conclusão: São muitos os tratamentos disponíveis para o queloide, sejam cirúrgicos ou não, todavia não há consenso sobre uma abordagem universalmente aceita. São necessários mais estudos, com a finalidade de definir a melhor conduta e atingir melhores resultados, visto a qualidade mediana das evidências apresentadas nos estudos.


Introduction: Keloids are characterized by an abnormal response to dermal trauma, resulting in fibroblast proliferation, excessive collagen production, and impairment of adjacent healthy tissue. The diagnosis is clinical, and many conservative and surgical methods can be used as treatments. However, data on the efficacy of these treatments are limited, and there is no consensus regarding the best treatment option. This gap needs to be filled by developing comprehensive evidence-based therapies. Methods: A non-systematic literature review of keloid scars was carried out using PubMed, Scielo, MEDLINE, UptoDate, and dermatology and dermatological surgery textbooks. Literature review: The search retrieved relevant information on surgical and adjuvant therapies used for keloids, including excision, intralesional injections, cryotherapy, laser therapy, silicone gel sheeting, radiation therapy, and pressure therapy. These data are crucial because, in addition to complaints of pain, itching, and restriction of movement, the main reason for seeking treatment for keloids is for cosmetic and aesthetic improvement, and the rates of recurrence and treatment failure are high, emphasizing the importance of creating awareness regarding the available procedures and their effectiveness. Conclusion: Many surgical and adjuvant therapies for keloids are available. Nonetheless, there is no consensus on a universally accepted treatment. Therefore, additional high-quality studies are needed to identify the most effective therapeutic approaches to achieve better results.


Assuntos
Humanos , História do Século XXI , Recidiva , Cirurgia Plástica , Terapêutica , Fator 1 de Crescimento de Fibroblastos , Fibroblastos , Procedimentos Cirúrgicos Dermatológicos , Queloide , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Terapêutica/métodos , Ferimentos e Lesões , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/terapia , Fator 1 de Crescimento de Fibroblastos/análise , Fator 1 de Crescimento de Fibroblastos/efeitos adversos , Cicatriz , Cicatriz/complicações , Procedimentos Cirúrgicos Dermatológicos/métodos , Queloide/cirurgia
8.
Zhonghua Shao Shang Za Zhi ; 35(6): 405-409, 2019 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-31280531

RESUMO

Objective: To explore the effects of using free transplantation of expanded perforator flaps in the treatment of severe scar contracture deformities in children. Methods: From January 2010 to December 2018, 18 pediatric patients with severe scar contracture were admitted to Xijing Hospital of Air Force Medical University, and 3 pediatric patients with severe scar contracture were admitted to Shenzhen Hospital, Southern Medical University. There were 14 males and 7 females among the 21 pediatric patients, who were 3-12 years old, with 15 cases of cervicothoracic adhesion, 5 cases of chin-chest adhesion, and 1 case of ankle joint contracture. According to the location of scar contracture and the size of wound after release, the donor site of perforator flap and expander volume were selected, and the expander was inserted to expand the flap. After expanding to proper volume, the contracted scar was resected and released. The perforator flap was designed and transplanted freely according to the wound. The flap area ranged from 14 cm×6 cm to 18 cm×15 cm. The location of the expanded flaps, the number, location, rated volume, and the location of injection port of the inserted expanders, the survival condition of flaps, the complications, the repair of donor sites, and the follow-ups were analyzed. Results: Among this group of pediatric patients, 16 cases used expanded thoracodorsal artery perforator flap, 3 cases used expanded circumflex scapular artery perforator flap, and 2 cases used expanded anterolateral thigh perforator flap, with 14 cases of pure donor site expansion and 7 cases of donor site expansion together with expansion beside donor site. Thirty-four expanders were inserted in 21 pediatric patients, with 21 under flaps, 6 near scars, and 7 near donor sites. The rated volumes of 26 expanders were 200 mL, while those of the remaining 8 expanders were 400 mL. Eight injection ports were placed externally, while the rest were placed internally. All the 21 flaps survived completely. Vascular crisis occurred in 1 pediatric patient 5 days after operation, and exploratory operation and reanastomosis were performed. The donor sites of 19 pediatric patients were closed directly, while the small wounds in lateral thoracic donor sites of 2 pediatric patients were repaired with thin intermediate split-thickness skin graft collected beside the donor site. Follow-up for 6 to 36 months showed that the texture and color of area repaired by the flaps were close to the surrounding skin. The flaps in the neck region of 8 pediatric patients were slightly bulky, requiring debulking operation, while the other cases had good appearance. The movement function of the involved regions was basically restored to normal, and no recurrence of contracture occurred. Conclusions: Free transplantation of expanded perforator flaps can achieve favorable appearance, texture, and function restore in treating severe scar contracture deformities in children, and the curative effect is stable and lasts long.


Assuntos
Cicatriz/cirurgia , Contratura/cirurgia , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Articulação do Tornozelo , Criança , Pré-Escolar , Cicatriz/complicações , Feminino , Humanos , Masculino , Transplante de Pele , Resultado do Tratamento
9.
Int J Gynaecol Obstet ; 146(3): 289-295, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172522

RESUMO

OBJECTIVE: To establish a risk scoring system to predict the successful treatment of cesarean scar pregnancy. METHODS: A prospective observational study was conducted between June 2016 and March 2018 in a tertiary care center. Patients received evacuation followed by uterine artery embolization and laparoscopic local resection/hysterectomy successively as salvage measures if necessary. Optimal scaling regression determined the extent of each potential prognostic factor predicted. RESULTS: Out of 228 women, 144 cases required evacuation before recovery, 73 women required uterine artery embolization, and 11 women eventually required laparoscopic surgery. Six variables were included in the predictive model: number of cesarean deliveries; maximal diameter of gestational sac; remnant myometrial thickness; grading of Doppler signals; presence of fetal heartbeat; and location of gestational sac. A 10-point scoring system was established by weighting their prediction of the method of successful treatment. In the risk score rank of 1-4, only 4 (2.8%) out of 142 women needed uterine artery embolization as a salvage treatment, while in the risk score rank of 8-10, 41 (80.4%) cases needed uterine artery embolization; laparoscopic operations were performed by physicians for the other 10 (19.6%) cases. CONCLUSION: The successful treatment of cesarean scar pregnancy was accurately predicted by a 10-point scoring system. CHINESE CLINICAL TRIALS REGISTRY: ChiCTR-OOC-16008467.


Assuntos
Histerectomia/efeitos adversos , Gravidez Ectópica/cirurgia , Embolização da Artéria Uterina/métodos , Hemorragia Uterina/cirurgia , Adulto , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , China , Cicatriz/complicações , Cicatriz/cirurgia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Gravidez , Gravidez Ectópica/etiologia , Estudos Prospectivos , Resultado do Tratamento , Hemorragia Uterina/etiologia
10.
Clin Chim Acta ; 496: 134-139, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31173731

RESUMO

OBJECTIVE: To demonstrate the feasibility of utilizing contrast-enhanced ultrasound (CEUS) in scar pregnancies misdiagnosed by transvaginal ultrasound (TVS). METHODS: CEUS was performed in three patients with clinically suspected abnormal pregnancy, and the diagnosis were inconclusive by TVS. Clinical manifestations and features of TVS and CEUS in these cases were analyzed. RESULTS: Three cases included an intramural pregnancy (IMP) after hysteromyomectomy, and two mass-based cesarean scar pregnancy (CSP), the mass was caused by curettage and spontaneous abortion, respectively. In all these cases, early enhancement with high intensity was observed by CEUS at the site of implantation. Moreover, prominently enhanced signal was detected inside the mass, with or without peritrophoblastic ring. No enhancement was detected in clots or masses after effective treatment. CONCLUSION: CEUS can be used as a supplementary method to diagnose scar pregnancy and evaluate the treatment efficacy, especially in cases with ambiguous results by TVS.


Assuntos
Cicatriz/complicações , Meios de Contraste , Erros de Diagnóstico , Gravidez Ectópica/diagnóstico por imagem , Adulto , Estudos de Viabilidade , Feminino , Humanos , Gravidez , Ultrassonografia
11.
Ceska Gynekol ; 84(2): 121-128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238682

RESUMO

OBJECTIVE: To analyze cases of uterine rupture during pregnancy and delivery. To report risk factors, maternal and neonatal outcomes. DESIGN: Restrospective cohort study. SETTING: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno. METHODS: This study used data from medical records of 36 195 labours between 2011-2016 in the Department of Obstetrics and Gynecology Masaryk University Hospital Brno. We identified all cases of complete and incomplete uterine rupture diagnosed during pregnancy, delivery and puerperium. We analyzed risk factors, symptoms and signs and maternal and neonatal outcomes. RESULTS: We identified 15 uterine ruptures. Three cases occurred during pregnancy in absence of labour, ten cases in association with delivery, one case during puerperium and one case of uterine rupture was associated with induction of abortion in the 2nd trimester. Eight patients had a previous cesarean section. Other uterine surgery was reported in history of four cases, including myomectomy, perforation of uterine fundus during hysteroscopy, curretage. Three patients had unscarred uterus. Most of the cases presented with abnormal fetal heart rate tracing, abdominal pain, vaginal bleeding and hypotension. There were two perinatal deaths associated with uterine rupture and perinatal asphyxia was observed in five infants. No mother died in association with uterine rupture. Estimated blood loss higher than 1000 ml occurred in 11 cases. Three patients underwent hysterectomy. CONCLUSION: Overall prevalence of uterine rupture during pregnancy and delivery was 0,04%, in women with previous cesarean section was 0.2%, in women with unscarred uterus was 0.08. Suspicious fetal heart rate tracing and acute abdominal pain are the most common symptoms. Adverse neonatal outcomes were identified in seven cases.


Assuntos
Histerectomia , Ruptura Uterina/etiologia , Adulto , Cesárea , Cicatriz/complicações , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco , Ruptura Uterina/cirurgia
12.
Rev. iberoam. micol ; 36(2): 83-85, abr.-jun. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-185481

RESUMO

Background: Sporotrichosis is a fungal disease caused by the Sporothrix schenckii species complex. It is usually acquired by trauma with plants. Lymphatic-cutaneous is the most common clinical manifestation. Case report: The present case describes the development of an epidermoid carcinoma as a late complication on a long evolution sporotrichosis scar. During a period of 50 years, the patient had lesions in the right hand. Sporotrichosis was diagnosed and treated with potassium iodide. Eleven years after the healing of the lesions, a squamous cell carcinoma on the scar of this mycosis was diagnosed. Conclusions: The chronic sporotrichosis injury was probably the cause of the tumor developed on the scar


Antecedentes: La esporotricosis es una enfermedad causada por el complejo de especies Sporothrix schenckii. Generalmente se adquiere por traumatismos con plantas. El compromiso linfocutáneo es la manifestación clínica más común. Caso clínico: El presente caso describe la aparición de un carcinoma epidermoide como complicación tardía en la cicatriz de una esporotricosis de larga evolución. Durante 50 años el paciente presentó lesiones en la mano derecha, se diagnosticó esporotricosis y se trató de manera tópica con yoduro de potasio. Once años después de la cicatrización de la esporotricosis, se diagnosticó un carcinoma de células escamosas en la cicatriz de esta micosis. Conclusiones: El daño en el tejido producido por la esporotricosis crónica podría ser la causa que desencadenó el proceso tumoral sobre la cicatriz


Assuntos
Humanos , Masculino , Idoso , Carcinoma de Células Escamosas/etiologia , Cicatriz/complicações , Dermatoses da Mão/complicações , Neoplasias Cutâneas/etiologia , Esporotricose/complicações , Carcinoma de Células Escamosas/patologia , Mãos , Dermatoses da Mão/patologia , Fotografação , Iodeto de Potássio/administração & dosagem , Neoplasias Cutâneas/patologia , Esporotricose/tratamento farmacológico , Esporotricose/patologia , Fatores de Tempo
13.
Rev. bras. cir. plást ; 34(2): 291-294, apr.-jun. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1015994

RESUMO

Introdução: As queimaduras constituem uma das lesões traumáticas mais graves e seu tratamento requer uma abordagem multidisciplinar, em que o papel do cirurgião plástico é fundamental. Restabelecer a função de proteção da pele, mas também recuperar a estética da área, queimada são objetivos desafiadores que o cirurgião plástico procura atingir. Relato de Caso: Paciente feminino de 27 anos submetida a mastopexia com inclusão de implantes, em que se aproveitou a pele retirada da mama para realizar um enxerto de espessura total em região mandibular e submentoniana para tratamento de cicatriz. A paciente teve uma integração completa do enxerto, sem evidenciar-se áreas de epidermólise. Os resultados estéticos foram excelentes, conseguindo a satisfação da paciente e melhoria das áreas discrômicas e hipertróficas cicatriciais. Conclusão: O enxerto autólogo a partir da pele da mama constitui uma boa alternativa para o tratamento de sequelas de queimaduras em face, possibilitando ótimos resultados estéticos.


Introduction: Burns are one of the most severe traumatic injuries and their treatment requires a multidisciplinary approach, where the role of the plastic surgeon is vital. The plastic surgeon is entrusted with the challenging goal of restoring the skin's protective function and simultaneously recovering the aesthetic aspect of the burnt area. Case report: A 27-year-old woman underwent a mastopexy with inclusion of implants, where the skin removed from the breast was used as a full-thickness graft in the mandibular and submental area for the treatment of a scar. The patient showed complete integration of the graft, and no areas of epidermolysis were observed. The aesthetic results were excellent, and the patient was completely satisfied; moreover, an improvement in the dyschromic and hypertrophic cicatricial areas was observed. Conclusion: An autologous graft using breast skin is a good alternative for the treatment of sequelae of burns on the face and provides excellent aesthetic results.


Assuntos
Humanos , Feminino , Adulto , Curativos Biológicos/efeitos adversos , Queimaduras/cirurgia , Queimaduras/fisiopatologia , Cicatriz/complicações , Satisfação do Paciente , Traumatismos Faciais/cirurgia , Traumatismos Faciais/complicações , Cicatriz/cirurgia
14.
Med Arch ; 73(1): 58-60, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31097863

RESUMO

Introduction: Cesarean scar pregnancy is potentially life-threatening condition because of heavy complications and includes adherent placenta: accreta, increta or percreta as a result of deep placental invasion. Aim: To present a rare case of ectopic cesarean scar pregnancy combined with placenta percreta in 38-year old woman who undergone previous cesarean section delivery. Case report: A multiparous woman aged 38 years with prior cesarean section delivery, admitted first time to the Clinic in 7th week of gestation, due to her medical record (light bleeding). Diagnosis was: graviditas hbd 7, gemellar pregnancy, blighted ovum gemellus I, graviditas isthmico-cervicalis gemellus II. Due to diagnosis it was performed vacuum aspiration et curettage and woman leaved hospital same day. One month later same woman was admitted again to the Clinic due to bleeding and ultrasound finding suspicious to residual trophoblastic tissue. Beta human chorionic gonadotropin serum concentration at the day of admittance was 8,419 IU/ml. Ultrasound finding showed inhomogeneous supracervical formation with dimension 2,73x1,89 cm with increased vascularity and resistant index 0.36 and suspicious placenta increta. We made decision to surgery, and performed hysterectomy in view of heavy intraoperative haemorrhage. Woman was discharged at fifth day after surgery in good condition. Histological finding showed cervical pregnancy complicated with placenta percreta parietis isthmicocervicalis of the uterus. Conclusion: We showed the importance of early and opportune diagnosis of cervical pregnancy specially complicated with one of kind of throphoblastic disease, to prevent life-threatening complication.


Assuntos
Cesárea/efeitos adversos , Cicatriz/complicações , Placenta Acreta/etiologia , Gravidez Ectópica/etiologia , Adulto , Feminino , Humanos , Histerectomia , Placenta Acreta/cirurgia , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/cirurgia
15.
Eur J Obstet Gynecol Reprod Biol ; 238: 138-142, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31132691

RESUMO

OBJECTIVE: To report the efficacy of combined systemic and local methotrexate treatment for cesarean scar pregnancy and review data from selected, similar case series. STUDY DESIGN: A retrospective case series of 12 patients with cesarean scar pregnancy treated in a university hospital between 2014 and 2018. The intervention was combined treatment of systemic and local methotrexate. RESULTS: Twelve patients were treated with combined systemic and local methotrexate. Clinical characteristics, clinical course and treatment efficacy were evaluated. Mean gestational age at diagnosis was 7.5 weeks (range 5.9-9.1). ßhCG levels at diagnosis ranged from 1581 to 345,427 U/L with a mean of 77,795 U/L. All 12 patients were successfully treated without surgical intervention and with no significant side-effects. Mean hospitalization duration was 9 days (5.8-12.6) and mean time to normalization of ßhCG levels was 98 days (63-132). CONCLUSIONS: Treatment of cesarean scar pregnancy with a combination of systemic and local methotrexate was effective and safe. Although the treatment course tends to be longer than with other modalities, this protocol offers excellent success rates, with fertility preservation and few complications.


Assuntos
Abortivos não Esteroides/administração & dosagem , Cicatriz/complicações , Metotrexato/administração & dosagem , Gravidez Ectópica/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Gravidez , Gravidez Ectópica/etiologia , Estudos Retrospectivos
16.
Acta Dermatovenerol Croat ; 27(1): 44-46, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31032793

RESUMO

Lichen sclerosus (LS), also known as lichen sclerosus et atrophicus, is a chronic inflammatory mucocutaneous disease affecting the genital and/or extragenital areas. Although LS usually occurs alone, its coexistence in morphea patients has been reported in 5.7% and 38.0% (genital LS) of cases, in two series (1). A 74-year-old woman presented with a 6-month history of multiple asymptomatic, shiny , indurated, brownish large flat plaques located on the abdomen (Figure 1, a-b) and back, intermingled with slightly atrophic, white-colored, guttate, and patchy areas (Figure 1, d-e). Both punch biopsies of the sclerotic plaques on the back and abdomen showed findings consistent with morphea (Figure 1, c, f). Furthermore, the punch biopsy of a well-demarcated white plaque on the back revealed findings compatible with LS (Figure 1, f). Remarkably, there were also multiple white-colored lesions on the sites of pregnancy-induced striae distensae (SD) (Figure 2, a-b) on the lower abdomen and an old appendectomy scar (Figure 2, c). There was no anogenital involvement. A diagnosis of morphea-LS overlap was established and white lesions located on the surgical scar and SD were clinically evaluated as LS. Methotrexate (15 mg/week) achieved a partial regression of morphea plaques in three months. However, white LS lesions remained unchanged. Our patient presented with coexistence of LS and morphea on different sites of the trunk and on the same lesion. Additionally, one of the isolated LS lesions was located on a surgical scar. Occurrence of LS on skin grafts, irradiated areas, injection sites, or burn/surgical scars has been attributed to the Koebner phenomenon, also called isomorphic response, defined as "the formation of the skin lesions in the same morphology of the existing disease on the areas of various cutaneous injuries" (2). LS is classified under the Koebner category-III (occasional lesions) (2). However, in a case of morphea with features of LS that developed in 1 month following a herpes zoster infection has been suggested to represent "Wolf's isotopic response" (3), which was originally defined as "the occurrence of a new skin disease at the site of another, unrelated and already healed skin disorder" with a time interval between the first and second diseases ranging from months to several years (4). Remarkably, typical morphea plaques in our patient did not involve the surgical scar, in contrast to a cohort in which 16% of 329 patients developed initial morphea lesions at sites of prior (surgery) or ongoing/repetitive (chronic friction) skin trauma (5). SD appear on skin as atrophic linear bands mostly due to rapid weight changes, pregnancy, Cushing syndrome, or prolonged use of corticosteroids (6). The mechanism underlying the occurrence of several diseases on striae is still elusive. Blunt trauma occurring during the development of striae has been suggested to cause the Koebner phenomenon in patients with vitiligo, psoriasis, and lichen planus (7), but it has been suggested that the occurrence of leukemia cutis on SD in a patient reflects Wolf's isotopic response (8). Although chronic graft-versus-host disease, urticarial vasculitis, keloid, lupus erythematosus, diffuse normolipemic plane xanthoma, and drug-induced cutaneous eruptions have been reported to occur on striae (6,9), such an association with LS as in our patient has not been previously documented in the literature. Concomitant occurrence of LS patches on different previous lesions such as a surgical scar and SD in our patient raises the possibility of a common underlying mechanism. As mentioned above, the terms "Koebner phenomenon" or "Wolf's isotopic response" have been used to designate the development of some diseases in injured areas. However, Happle and Kluger (10) claimed in a recent statement that "there is no clear-cut criterion to distinguish isotopic response from Koebner phenomenon and all reactions of this kind represent examples of Koebner phenomenon", which seems to be the best way to describe the site-specific occurrence of LS lesions in our patient.


Assuntos
Cicatriz/patologia , Líquen Escleroso e Atrófico/patologia , Esclerodermia Localizada/patologia , Estrias de Distensão/patologia , Idoso , Cicatriz/complicações , Feminino , Humanos , Líquen Escleroso e Atrófico/complicações , Esclerodermia Localizada/complicações , Estrias de Distensão/complicações
17.
J Pediatr Ophthalmol Strabismus ; 56: e34-e37, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31034087

RESUMO

The authors report a rare case of slipped medial rectus muscle with stretched scar in the left eye of a 45-year-old woman following pterygium surgery. There was total limitation of adduction in her left eye with complaints of diplopia in all gazes with maximum separation of images in dextroversion on diplopia charting. Hess charting showed underaction of the medial rectus muscle of the left eye and overaction of the lateral rectus muscle of the right eye. Based on the history and findings, a diagnosis of medial rectus muscle disinsertion of the left eye during pterygium surgery was made. Medial rectus muscle exploration was done and the slipped medial rectus muscle was found attached to its original insertion site via pseudotendon/stretched scar. The capsule was dissected, the scar tissue was excised, and the slipped medial rectus muscle was identified, hooked, and secured with sutures. The muscle was reattached with advancement. Postoperatively, the patient was orthotropic and there was no diplopia. Accidental medial rectus muscle disinsertion during pterygium surgery is a rare but serious complication. Proper care should be taken intraoperatively during pterygium surgery to avoid this complication. However, meticulous surgical exploration and reattachment of the muscle yields satisfactory results. [J Pediatr Ophthalmol Strabismus. 2019;56:e34-e37.].


Assuntos
Cicatriz/complicações , Exotropia/etiologia , Músculos Oculomotores/fisiopatologia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Complicações Pós-Operatórias , Pterígio/cirurgia , Visão Binocular , Cicatriz/diagnóstico , Exotropia/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade
18.
Heart Fail Clin ; 15(2): 179-189, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30832810

RESUMO

The cardiology community lacks a taxonomy to prioritize the origins of the complex myocardial pathology underlying heart failure. The key question, "Why does heart muscle fail?", remains unanswered. A large body of literature indicates that myocardial fibrosis represents a principal pathway mediating outcomes in heart failure. Cardiac amyloidosis illustrates how excess protein in the myocardial interstitium culminates in severe heart failure with a dismal prognosis. Robust methods now exist to quantify myocardial fibrosis. Investigators possess the tools to finally establish unequivocally that myocardial fibrosis represents one of the principal pathways mediating outcomes in heart failure that imparts vulnerability.


Assuntos
Cicatriz/patologia , Fibrose/patologia , Insuficiência Cardíaca/patologia , Miocárdio/patologia , Amiloidose/complicações , Amiloidose/patologia , Cicatriz/complicações , Fibrose/complicações , Humanos
20.
Zhonghua Shao Shang Za Zhi ; 35(3): 233-236, 2019 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-30897874

RESUMO

Scars formed by various injuries can affect the appearance and psychology of patients. Therefore, more and more people pay attention to the prevention and treatment of scar. With the development of the autologous fat grafting, it has been gradually applied to the prevention and treatment of scar. At present, it has been confirmed by scholars that the autologous fat grafting could be an effective method to prevent and treat scar from basic research and clinical practice. At the same time, the deficiency of autologous fat grafting in the prevention and treatment of scar was also pointed out. This paper reviews the application, mechanism, and deficiency of autologous fat grafting in scar prevention and treatment.


Assuntos
Cicatriz/prevenção & controle , Cicatriz/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Gordura Subcutânea/transplante , Transplante Autólogo/métodos , Tecido Adiposo , Cicatriz/complicações , Humanos , Transplante Autólogo/tendências
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA