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1.
Med Clin North Am ; 105(4): 599-610, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34059240

RESUMO

Alopecia is a dermatologic condition in which sudden or gradual loss of hair occurs on 1 or more areas of the body, most commonly the scalp. Hair loss can be acute or chronic in nature as a result of underlying inflammation, autoimmune processes, stressors, chemotherapy, or hairstyling practices. Alopecia can have substantial psychological consequences, having a negative impact on the quality of life in affected patients. The ability to both recognize and distinguish these condition holds great significance not only in providing adequate and timely treatment to improve outcomes but also meeting patient needs.


Assuntos
Alopecia/patologia , Alopecia/terapia , Cicatriz/patologia , Qualidade de Vida/psicologia , Adolescente , Adulto , Alopecia/epidemiologia , Alopecia/psicologia , Criança , Cicatriz/diagnóstico , Cicatriz/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Adulto Jovem
2.
Khirurgiia (Mosk) ; (6. Vyp. 2): 7-14, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34032783

RESUMO

OBJECTIVE: To evaluate an efficacy of lipoaspirate-based products in pathologic scarring management. MATERIAL AND METHODS: There were 118 patients with external scars. Depending on scar type, localization and need for soft tissue augmentation, three different methods were used for lipoaspirate-based product preparation: 15-minute sedimentation, centrifugation at 1200 g for 3 minutes and emulsification with a channel diameter of 1.2 mm. Results were assessed using the Manchester Scar Scale (MSS) and photographing. RESULTS: According to MSS analysis, the following results were obtained: before treatment - 11.6 (9.3-13.3) scores, 3 months after treatment - 6.5 (5.1-7.2) scores, 6 months after treatment - 5.2 (4.5-6.1) scores. Significant differences were obtained for baseline values and both control points. Stable results were obtained in long-term follow-up period (12-24 months). No major adverse effects were observed. Minor complications were registered in 10.1% of patients. CONCLUSION: Injections of lipoaspirate-based products is an effective option for the treatment of patients with pathologic scarring. This approach is intermediate between conservative and conventional surgical treatment.


Assuntos
Cicatriz , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/terapia , Humanos
3.
BMC Pregnancy Childbirth ; 21(1): 286, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33836692

RESUMO

BACKGROUND: The current fact of increasing rates of cesarean deliveries is a catastrophe. Recurrent cesareans result in intraperitoneal adhesions that would lead to maternal morbidity during delivery. Great efforts are directed towards the prediction of intraperitoneal adhesions to provide the best care for laboring women. The aim of the current study was to evaluate the role of abdominal striae and cesarean scar characters in the prediction of intraperitoneal adhesions. METHODS: This was a case- control study conducted in the emergency ward of the obstetrics and gynecology department of a tertiary hospital from June to December 2019. The study was carried on patients admitted to the ward fulfilling particular inclusion and exclusion criteria. The study included two groups, group one was assessed for the presence of striae, and the degree of intraperitoneal adhesions was evaluated during the current cesarean section. Group two included patients without evidence of abdominal striae. They were evaluated for the severity of adhesions also after evaluation of the previous scar. Evaluation of the striae was done using Davey's scoring system. The scar was assessed using the Vancouver Scar Scale. The modified Nair's scoring system was used to evaluate intraperitoneal adhesions. RESULTS: The study group included 203 women, while the control group included 205 women. There were significant differences in the demographic characters of the recruited patients (p-value 0.001 for almost all variables). The mean Davey score in those with mild, moderate, and severe striae was 1.82 ± 0.39, 3.57 ± 0.5, and 6.73 ± 0.94, respectively (p-value < 0.001). Higher scores for the parameters of the Vancouver scale were present in patients with severe striae (1.69 ± 1.01, 1.73 ± 0.57, 2.67 ± 1.23, and 1.35 ± 1.06 for scar vascularity, pigmentation, pliability, and height respectively with a p-value of < 0.001 each). Thick intraperitoneal adhesions were noted significantly in women with severe striae [21 (43.75%), p-value < 0.001)]. The Davey's and Vancouver scores showed highly significant predictive performance in the prediction of intraperitoneal adhesions (p-value < 0.001). CONCLUSION: Abdominal striae and cesarean scar were significant predictors for intraperitoneal adhesions.


Assuntos
Recesariana/efeitos adversos , Cicatriz/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estrias de Distensão/diagnóstico , Aderências Teciduais/epidemiologia , Adulto , Estudos de Casos e Controles , Recesariana/estatística & dados numéricos , Cicatriz/etiologia , Feminino , Humanos , Cavidade Peritoneal/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Gravidez , Medição de Risco , Índice de Gravidade de Doença , Estrias de Distensão/etiologia , Aderências Teciduais/etiologia , Aderências Teciduais/patologia , Adulto Jovem
4.
J Obstet Gynaecol Res ; 47(6): 2014-2020, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33779116

RESUMO

AIM: This study aimed to examine the characteristics, management, and outcomes of delayed diagnosis of cesarean scar pregnancy (CSP) with hemorrhage intra- or postuterine curettage for early pregnancy termination. METHODS: The retrospective study, cases were identified from the interrogation of the hospital database and clinical data including the success rate of different treatments, vaginal bleeding time, abnormal beta-human chorionic gonadotropin (ß-hCG) time, and menstrual recovery time, preservation of uterus were analyzed. RESULTS: Medical records of 80 confirmed CSP cases with dilation and curettage (D&C) as primary treatment were analyzed; among them, 22 were treated with uterine arterial embolization (UAE) + methotrexate (MTX); 32 with UAE + surgery; 26 with only surgery or resection and repair. Treatment with UAE had less intraoperative blood loss (p < 0.05). UAE + surgery treatment had the highest success rate (96.8%, p < 0.05), the least vaginal bleeding duration after treatment (11.9 ± 9.6 days, p < 0.05), and least ß-hCG normalization time (17.4 ±  7.8 days, p < 0.05). CONCLUSION: UAE + surgery treatment is a favorable and effective option to control massive hemorrhage intra- or post-uterine curettage for early CSP termination.


Assuntos
Cicatriz , Embolização da Artéria Uterina , Cesárea/efeitos adversos , Cicatriz/diagnóstico , Curetagem , Diagnóstico Tardio , Dilatação , Feminino , Humanos , Metotrexato , Gravidez , Estudos Retrospectivos , Resultado do Tratamento
5.
Radiol Med ; 126(6): 774-785, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33743143

RESUMO

Radial scar (RS) or complex sclerosing lesions (CSL) if > 10 mm is a benign lesion with an increasing incidence of diagnosis (ranging from 0.6 to 3.7%) and represents a challenge both for radiologists and for pathologists. The digital mammography and digital breast tomosynthesis appearances of RS are well documented, according to the literature. On ultrasound, variable aspects can be detected. Magnetic resonance imaging contribution to differential diagnosis with carcinoma is growing. As for the management, a vacuum-assisted biopsy (VAB) with large core is recommended after a percutaneous diagnosis of RS due to potential sampling error. According to the recent International Consensus Conference, a RS/CSL lesion, which is visible on imaging, should undergo therapeutic excision with VAB. Thereafter, surveillance is justified. The aim of this review is to provide a practical guide for the recognition of RS on imaging, illustrating radiological findings according to the most recent literature, and to delineate the management strategies that follow.


Assuntos
Doenças Mamárias/diagnóstico , Mama/diagnóstico por imagem , Cicatriz/diagnóstico , Gerenciamento Clínico , Mamografia/métodos , Doenças Mamárias/terapia , Cicatriz/terapia , Feminino , Humanos
7.
Plast Reconstr Surg ; 146(2): 156e-164e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740578

RESUMO

BACKGROUND: Scarpa fascia preservation during abdominoplasty has been shown to reduce complications associated with the traditional technique. As an extension of a previously published randomized controlled trial, this study aims to clarify whether preservation of Scarpa fascia during abdominoplasty has an influence on scar quality or sensibility recovery. METHODS: This was a single-center clinical trial, involving 160 patients randomly assigned to one of two surgical procedures: classic full abdominoplasty (group A) and abdominoplasty with preservation of Scarpa fascia (group B). Patients were later convoked to assess scar quality and abdominal cutaneous sensibility. Scar quality was evaluated through the Patient and Observer Scar Assessment Scale. Cutaneous sensibility was measured on the upper and lower abdomen, using light touch, Semmes-Weinstein testing (5.07/10-g monofilament), and a 25-gauge needle. RESULTS: A total of 99 patients (group A, 54 patients; group B, 45 patients) responded to contact, with a mean follow-up time of 44 months. Concerning scar quality, Patient and Observer Scar Assessment Scale scores were similar between groups. On the upper abdomen, there was a statistically significant difference between groups on cutaneous sensibility, on the examination with the Semmes-Weinstein 5.07/10-g monofilament (group A, 79.6 percent; group B, 93.3 percent; p = 0.046) and pain (group A, 90.7 percent; group B, 100 percent; p = 0.044). No statistically significant differences were found between groups on the lower abdomen. A considerable proportion of patients (two-thirds) still presented sensibility alterations in the subumbilical area 3½ years after abdominoplasty. CONCLUSION: Scarpa fascia preservation during abdominoplasty does not influence scar quality, but it improves sensibility recovery in the supraumbilical area. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Abdominoplastia/métodos , Cicatriz/diagnóstico , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/diagnóstico , Tato/fisiologia , Parede Abdominal , Abdominoplastia/efeitos adversos , Adulto , Cicatriz/etiologia , Fáscia/inervação , Fasciotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Pele/inervação , Resultado do Tratamento , Adulto Jovem
8.
Plast Reconstr Surg ; 146(3): 331e-338e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842115

RESUMO

BACKGROUND: Each year, millions of individuals develop scars secondary to surgery, trauma, and/or burns. Scar-specific patient-reported outcome measures to evaluate outcomes are needed. To address the gap in available measures, the SCAR-Q was developed following international guidelines for patient-reported outcome measure development. This study field tested the SCAR-Q and examined its psychometric properties. METHODS: Patients aged 8 years and older with a surgical, traumatic, and/or burn scar anywhere on their face or body were recruited between March of 2017 and April of 2018 at seven hospitals in four countries. Participants answered demographic and scar questions, the Fitzpatrick Skin Typing Questionnaire, the Patient and Observer Scar Assessment Scale (POSAS), and the SCAR-Q. Rasch measurement theory was used for the psychometric analysis. Cronbach's alpha, test-retest reliability, and concurrent validity were also examined. RESULTS: Consent was obtained from 773 patients, and 731 completed the study. Participants were aged 8 to 88 years, and 354 had surgical, 184 had burn, and 199 had traumatic scars. Analysis led to refinement of the SCAR-Q Appearance, Symptoms, and Psychosocial Impact scales. Reliability was high, with person separation index values of 0.91, 0.81, and 0.79; Cronbach alpha values of 0.96, 0.91, and 0.95; and intraclass correlation coefficient values of 0.92, 0.94, and 0.88, respectively. As predicted, correlations between POSAS scores and the Appearance and Symptom scales were higher than those between POSAS and Psychosocial Impact scale scores. CONCLUSIONS: With increasing scar revisions, a scar-specific patient-reported outcome measure is needed to measure outcomes that matter to patients from their perspective. The SCAR-Q represents a rigorously developed, internationally applicable patient-reported outcome measure that can be used to evaluate scars in research, clinical care, and quality improvement initiatives.


Assuntos
Cicatriz , Medidas de Resultados Relatados pelo Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras/complicações , Canadá , Criança , Chile , Cicatriz/diagnóstico , Cicatriz/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Complicações Pós-Operatórias/diagnóstico , Psicometria , Autorrelato , Pele/lesões , Estados Unidos , Adulto Jovem
10.
Khirurgiia (Mosk) ; (4): 53-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352669

RESUMO

Development of tracheal surgery was associated with introduction of fundamentally new procedures: two-level reconstruction, redo tracheal resection, tracheal resection with simultaneous dissection of tracheoesophageal fistula. There are combined and staged techniques when tracheal repair or endoscopic interventions are performed as a stage before circular resection of trachea. However, a single algorithm for prevention and correction of postoperative complications is still absent in tracheal surgery. Further development of tracheal surgery directly depends on introduction of preventive measures and analysis of adverse factors associated with increased risk of complications. In this regard, ongoing researches in this area are very perspective.


Assuntos
Traqueia/cirurgia , Estenose Traqueal/cirurgia , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/terapia , Constrição Patológica/cirurgia , Dissecação , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/patologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Traqueotomia
11.
Am J Ophthalmol ; 217: 212-223, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32353368

RESUMO

PURPOSE: To report the outcomes of initial high-dose and extended taper of antiviral and steroid prophylaxis for the treatment of eyes with high-risk vascularized herpetic corneal scars that underwent 2-piece mushroom keratoplasty (MK). DESIGN: Prospective interventional case series. METHODS: In this single-center study, 52 consecutive eyes with vascularized (≥2 quadrants) herpetic corneal scars underwent 2-piece microkeratome-assisted MK. Initial high-dose and extended taper of combined oral and topical antiviral and steroid prophylaxis was administered. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), endothelial cell density, immunologic rejection, herpetic recurrence, and graft failure rates. RESULTS: Excluding patients with vision-impairing comorbidities, baseline BSCVA (1.73 ± 0.67 logMAR) significantly improved annually during the first 2 years (P < .001, P = .016), reaching 0.17 ± 0.18 logMAR at year 2, and remaining stable up to 10 years (P = .662). At 2 years, 86% of eyes saw ≥20/40, 55% saw ≥20/25, and 18% saw ≥20/20 Snellen BSCVA. RA exceeded 4.5 diopters in 7% of cases after wound revision for high-degree astigmatism in 7 cases. Endothelial cell loss was 40.9% at 1 year with an annual decline of 3.1% over 10 years. The 10-year cumulative risk for immunologic rejection, herpetic recurrence, and graft failure was 9.7%, 7.8%, and 7.6%, respectively. CONCLUSIONS: Initial high dose and extended taper of antiviral and steroid prophylaxis for MK in high-risk, vascularized herpetic corneal scars achieves clinical outcomes that remain stable for up to 10 years after surgery with minimal risk of immunologic rejection, herpetic recurrence and graft failure.


Assuntos
Cicatriz/prevenção & controle , Córnea/patologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Infecções Oculares Virais/cirurgia , Glucocorticoides/administração & dosagem , Ceratite Herpética/complicações , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Cicatriz/diagnóstico , Cicatriz/etiologia , Córnea/cirurgia , Relação Dose-Resposta a Droga , Infecções Oculares Virais/complicações , Infecções Oculares Virais/diagnóstico , Feminino , Sobrevivência de Enxerto , Humanos , Ceratite Herpética/diagnóstico , Ceratite Herpética/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Refração Ocular , Microscopia com Lâmpada de Fenda , Acuidade Visual , Adulto Jovem
12.
JAMA Netw Open ; 3(3): e200725, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32159810

RESUMO

Importance: Patients are satisfied when surgical outcomes meet their expectations. Dissatisfaction with surgical scars is one of the most common reasons that patients sue surgeons who perform Mohs micrographic surgery (MMS). Objective: To measure the accuracy of patient and physician estimations of scar length prior to skin cancer removal with MMS. Design, Setting, and Participants: This cross-sectional study was conducted between December 1, 2017, and February 28, 2018, at the MMS clinic of a single tertiary referral center health system. A total of 101 adults presenting for MMS for treatment of facial skin cancers volunteered for this study, and 86 surgeons who performed the MMS procedure participated. Main Outcomes and Measures: Patients and physicians independently drew the anticipated scar length on the patients' skin prior to surgery. Preoperative estimates by patients and surgeons were compared with actual postoperative scar length. Results: Of the 101 patients who participated, 57 patients (56.4%) were men and 57 patients (56.4%) were aged 65 years or older. Eighty-four patients (83.2%) underestimated scar length, whereas 67 of the 86 surgeons (77.9%) correctly estimated the scar length (P < .001). The actual postoperative scar length was 2.2 (interquartile range, 1.5-3.6) times larger than the patients' preoperative estimate but only 1.1 (interquartile range, 1.0-1.2) times larger than the surgeons' preoperative estimate (P < .001). Preoperative consultation with the surgeon, a personal history of MMS, or patient-directed research about MMS were not associated with improvement of patients' estimations of scar length. Conclusions and Relevance: This study's findings suggest that patients with facial skin cancers have unrealistic expectations regarding scars that measure, on average, less than half the length of the actual postoperative scars. Surgeons appear to accurately estimate the length of most surgical scars and have an opportunity to set realistic patient expectations about scar length before surgery.


Assuntos
Cicatriz/diagnóstico , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Idoso , Cicatriz/cirurgia , Estudos Transversais , Face , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
13.
Anticancer Res ; 40(2): 1123-1126, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014963

RESUMO

BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive form of skin cancer that is often found in sun-exposed regions of the skin in older or immunocompromised individuals. To date there have only been four cases reported of MCC found in the nasal vestibule. CASE REPORT: We document an unusual case of MCC in the nasal vestibule of a 66-year-old female which was clinically believed to be an inflammatory reaction to a previous suture scar. The patient also had a history of dermatitis treated with UV light. The lesion was less than 5 mm in the greatest dimension and biopsied. There was small blue cell infiltrate in the dermis and the tumor cells were positive for synaptophysin, chromogranin and cytokeratin 20. They were negative for S100 proteins, melan A, human melanoma black 45 (HMB45) and lymphocyte common antigen CD45. For Ki-67, staining was positive in 90% of the tumor cells and tumor protein 53 immunoreactivity showed a wild type staining pattern. The pathological diagnosis was MCC and the patient underwent Mohs surgery with no tumor recurrence or metastasis identified at 2.5 years of follow-up. CONCLUSION: To the best of our knowledge, cases of MCC arising in the nasal vestibule with clinical features mimicking a suture scar have not been reported. The importance of early diagnosis and treatment of MCC to improve patient prognosis are discussed.


Assuntos
Carcinoma de Célula de Merkel/diagnóstico , Cicatriz/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
15.
Dermatol Surg ; 46(4): 546-553, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31584528

RESUMO

BACKGROUND: The V-Y island advancement flap is a useful reconstruction technique for nasal alar defects, but flap mobility is limited by the insertion of the muscles of facial expression into the dermis of the alae. OBJECTIVE: To describe a V-Y muscle sling myocutaneous island advancement flap (SMIAF) for improved mobility and intrasubunit reconstruction of alar defects. MATERIALS AND METHODS: A retrospective review of patient records and preoperative and postoperative photographs was performed on all patients with alar defects repaired with the SMIAF between April 2008 and October 2017. Patients and physicians rated aesthetic outcomes with the Patient and Observer Scar Assessment Scale (POSAS). RESULTS: A total of 18 nasal alar defects were repaired with the SMIAF after Mohs micrographic surgery. All defects were located on the anterior two-thirds of the alar lobule and had a mean surface area of 0.42 ± 0.19 cm. No patients experienced flap necrosis. Patients and 3 independent dermatologic surgeons rated favorable aesthetic outcomes. CONCLUSION: The SMIAF is a reliable reconstruction option with good aesthetic outcomes for small defects on the anterior two-thirds of the nasal ala.


Assuntos
Cicatriz/prevenção & controle , Cirurgia de Mohs/efeitos adversos , Retalho Miocutâneo/transplante , Neoplasias Nasais/cirurgia , Rinoplastia/métodos , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Cicatriz/diagnóstico , Cicatriz/etiologia , Estética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retalho Miocutâneo/patologia , Necrose/epidemiologia , Necrose/etiologia , Nariz/anatomia & histologia , Nariz/patologia , Nariz/cirurgia , Medidas de Resultados Relatados pelo Paciente , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
16.
Am J Ophthalmol ; 209: 3-9, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560878

RESUMO

PURPOSE: To characterize the clinical features of patients with direct immunofluorescence (DIF)-negative mucous membrane pemphigoid (MMP). DESIGN: Retrospective case series. METHODS: Thirty-six patients who underwent a conjunctival biopsy for suspected MMP were included. Demographic and clinical information was collected. Main outcome measures included visual acuity, Foster stages, presence of extraocular involvement, history of autoimmune disease, and durations of follow-up. RESULTS: Thirty-two patients had a negative DIF. Of those, 2 had a positive DIF on repeat biopsy. Eleven showed progression of conjunctival scarring during a median follow-up of 42 months (range, 8-100 months) and were diagnosed with biopsy-negative MMP. Another 11 patients with a median follow-up of 54 months (range, 15-138 months) were diagnosed with cicatrizing conjunctivitis of other causes. The median visual acuity of patients with biopsy-negative MMP at presentation was significantly lower compared to patients with cicatrizing conjunctivitis of other causes (20/400 vs 20/40, P = .02). Conjunctival scarring score at presentation in both biopsy-positive and biopsy-negative MMP groups was significantly higher compared to patients with cicatrizing conjunctivitis of other causes (median Foster stage, 3 vs 1, P = .009; and 3 vs 1, P = .01, respectively). CONCLUSIONS: Patients with progressive cicatrizing conjunctivitis likely have MMP in the absence of alternate diagnoses. Our findings emphasize that suspicion for MMP must remain high for patients who have Foster stage 3 conjunctival scarring on presentation or worsening of scarring during follow-up, even in the setting of negative DIF.


Assuntos
Doenças Autoimunes/diagnóstico , Cicatriz/diagnóstico , Conjuntivite/diagnóstico , Técnica Direta de Fluorescência para Anticorpo/métodos , Penfigoide Mucomembranoso Benigno/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibióticos Antineoplásicos/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/fisiopatologia , Biópsia , Cicatriz/tratamento farmacológico , Cicatriz/fisiopatologia , Conjuntivite/tratamento farmacológico , Conjuntivite/fisiopatologia , Ciclofosfamida/uso terapêutico , Progressão da Doença , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Penfigoide Mucomembranoso Benigno/tratamento farmacológico , Penfigoide Mucomembranoso Benigno/fisiopatologia , Estudos Retrospectivos , Coloração e Rotulagem/métodos , Acuidade Visual/fisiologia
17.
J Minim Invasive Gynecol ; 27(3): 593-602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31698049

RESUMO

OBJECTIVE: This network meta-analysis compared treatment via laparoscopy, hysteroscopy (HP), combined laparoscopy with HP (LH), and vaginal repair (VR) for reducing intermittent abnormal uterine bleeding and cesarean scar defect (CSD) diverticulum depth in patients with CSD. DATA SOURCES: Electronic databases (PubMed, EMBASE, The Cochrane Central Register of Controlled Trials, MEDLINE, ClinicalTrials.gov, Chinese Biomedical Literature Database, and China National Knowledge Integrated) were searched for articles published through June 13, 2018. METHODS OF STUDY SELECTION: The search included randomized controlled trials (RCTs) and observational studies of surgical treatment for CSD. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were reported. RCTs were evaluated by the Cochrane risk-of-bias tool, observational studies by Risk of Bias in Nonrandomized Studies of Intervention, and overall evidence quality by grade. Data were analyzed by STATA (version 15.0; StataCorp, College Station, TX) and R software for windows (version 3.5.0; R Core Team, 2018). TABULATION, INTEGRATION, AND RESULTS: Ten studies (n = 858; 4 RCTs and 6 observational studies) were included. Patients who underwent uterine diverticulum resection by LH had a shorter duration of abnormal uterine bleeding than those by HP (SMD = 1.36, 95% CI, 0.37-2.36; p = .007) and VR (SMD = 1.58, 95% CI, 0.97-2.19; p <.0001). LH reduced the CSD diverticulum depth more than VR (SMD = 1.57, 95% CI, 0.54-2.61; p = .003). There was no significant difference in efficacy among the surgical procedures. CONCLUSION: LH reduced intermittent abnormal uterine bleeding and scar depth more than the other surgical interventions. Larger clinical trials are warranted to verify this analysis.


Assuntos
Cesárea/efeitos adversos , Cicatriz/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Cesárea/estatística & dados numéricos , China/epidemiologia , Cicatriz/diagnóstico , Cicatriz/epidemiologia , Cicatriz/patologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/classificação , Humanos , Histeroscopia/métodos , Laparoscopia/métodos , Metrorragia/epidemiologia , Metrorragia/etiologia , Metrorragia/cirurgia , Metanálise em Rede , Estudos Observacionais como Assunto/estatística & dados numéricos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Resultado do Tratamento , Vagina/cirurgia
18.
J Cosmet Dermatol ; 19(1): 69-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31074185

RESUMO

BACKGROUND: Acne is a common condition that affects up to 80% of all adolescents. Scarring may affect some 95% as a function of severity and delay before treatment. The pathogenesis includes enzymatic degradation of collagen fibers and subcutaneous fat. OBJECTIVE: This study aimed to treat atrophic acne scars using the Dual-Plane injection of Hyaluronic Acid. METHODS: A total of 12 patients with moderate-to-severe atrophic acne scars were treated with a novel NAHYCO™ based Hyaluronic Acid filler, using a dual-plane technique for two treatment sessions at a 4-week interval. Results were objectively assessed by two blinded Dermatologists and subjectively evaluated by the patients themselves. RESULTS: A total of 8 out of the 12 patients reported moderate improvement, two indicated marked improvement and two rated minimal improvement. Dermatologists' mean global evaluation score was 2.5 ± 0.43. LIMITATIONS: The small sample size and regional nature of a single-center study. Nevertheless, both the expert dermatologists' and the patients' evaluations of standardized high-resolution medical photographs were consistent, suggesting that this inherent bias was negligible. CONCLUSION: The treatment led to impressive improvement in the depth of the scars, suggesting that this technique can result in safe and rapid amelioration of atrophic acne scars in only two sessions.


Assuntos
Acne Vulgar/complicações , Cicatriz/terapia , Preenchedores Dérmicos/administração & dosagem , Ácido Hialurônico/administração & dosagem , Adulto , Atrofia/diagnóstico , Atrofia/etiologia , Atrofia/terapia , Cânula , Cicatriz/diagnóstico , Cicatriz/etiologia , Feminino , Humanos , Injeções Subcutâneas/instrumentação , Injeções Subcutâneas/métodos , Masculino , Pessoa de Meia-Idade , Agulhas , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
20.
J Minim Invasive Gynecol ; 27(1): 129-134, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30858053

RESUMO

STUDY OBJECTIVE: Cesarean scar defect (CSD) is often associated with postmenstrual bleeding, infertility, and pain. Hysteroscopic CSD repair was described in the past, mainly as excision of the proximal edge of the defect to allow continuous blood flow during menstruation. In this study we aimed to evaluate the efficacy of extensive hysteroscopic cesarean scar niche excision in symptomatic patients. DESIGN: A retrospective cohort study. PATIENTS: Symptomatic patients treated with hysteroscopic CSD excision who were considered eligible for the procedure when myometrial thickness of 2 mm or more was observed on sonohysterography. SETTING: Tertiary referral center. INTERVENTIONS: Extensive CSD excision was performed using a cutting loop and pure cutting current. The proximal and distal edges of the defect were resected. This was followed by resection of tissue at the base of the niche, until underling muscular tissue was evident. Tissue sampled from the base of the CSD was collected for histologic examination. Patients were followed for a minimum of 1 year after hysteroscopic CSD excision. Clinical information obtained included detailed obstetric history and preoperative and postoperative menstruation pattern. MEASUREMENTS AND MAIN RESULTS: Between 2011 and 2016, 95 patients underwent extensive hysteroscopic niche excision; 67 were included in the study, whereas the remaining were lost to follow-up. Patient mean age at the time of the procedure was 38 ± 5.5 years. Twenty-nine patients (43%) had a history of high-order repeat cesarean surgeries. Sixty-six patients (98.5%) presented with postmenstrual bleeding, 26 with secondary infertility (38.8%), and 2 with pelvic pain (2.9%). After hysteroscopic niche excision, 63.4% of patients reported significant improvement or resolution of postmenstrual bleeding. A statistically significant reduction in number of bleeding days per cycle (15.5 ± 4.8 vs 9.8 ± 4.7, p < .001) was also noted. Histologic evidence for myometrial tissue within the obtained samples was associated with better outcomes. A histologic specimen from patients who experienced significant improvement or resolution of postmenstrual bleeding was more likely to reveal myometrial tissue (p = .04). Of the 26 patients who suffered from infertility, 19 attempted to conceive spontaneously after CSD excision. Of those, 10 patients (52.6%) conceived and 9 delivered at least once (47.36%). CONCLUSION: Extensive hysteroscopic surgical excision of cesarean scar niche should be considered in symptomatic patients suffering from irregular menstrual bleeding. The quality of the excision at the apex of the niche could be associated with a higher success rate. The role of niche excision to overcome secondary infertility should be further evaluated.


Assuntos
Cesárea/efeitos adversos , Cicatriz/etiologia , Cicatriz/cirurgia , Histeroscopia/métodos , Miométrio/patologia , Miométrio/cirurgia , Adulto , Cicatriz/diagnóstico , Cicatriz/epidemiologia , Estudos de Coortes , Feminino , Humanos , Histeroscopia/efeitos adversos , Histeroscopia/estatística & dados numéricos , Infertilidade/diagnóstico , Infertilidade/epidemiologia , Infertilidade/etiologia , Infertilidade/cirurgia , Metrorragia/diagnóstico , Metrorragia/epidemiologia , Metrorragia/etiologia , Metrorragia/cirurgia , Miométrio/diagnóstico por imagem , Dor Pélvica/diagnóstico , Dor Pélvica/epidemiologia , Dor Pélvica/etiologia , Dor Pélvica/cirurgia , Período Pós-Operatório , Gravidez , Taxa de Gravidez , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
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