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1.
J Craniofac Surg ; 32(6): e547-e548, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34516062

RESUMO

ABSTRACT: Necrotizing fasciitis of the face and scalp is a severe bacterial infection that can result in long-term morbidity or even mortality if not properly managed. In a third-world country like Ghana, where most of the population relies on daily income for livelihood, citizens with diseases that have long-term morbidity suffer financial difficulty, particularly when the patient is the breadwinner.This brief clinical study demonstrates the severity of necrotizing fasciitis of the face and scalp originated from oral infection, and its capability to affect any part of the body if proper treatment is not established at early onset of disease. Correct diagnosis, patient education, early antibiotic treatment, and timely surgery are crucial for controlling infection and for preventing irreparable damage. Therefore, public education is crucial in preventing such infection by discouraging use of over-the-counter medication in such situations.


Assuntos
Infecções Bacterianas , Fasciite Necrosante , Antibacterianos/uso terapêutico , Face , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/terapia , Humanos , Couro Cabeludo
2.
BMJ Open ; 11(9): e046609, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489271

RESUMO

OBJECTIVE: This study aimed to assess the cost-effectiveness of combined scalp acupuncture therapy with speech and language therapy for patients with Broca's aphasia after stroke. DESIGN: A within-trial cost-effectiveness analysis. SETTINGS: Community health centres. SUBJECTS: A total of 203 participants with Broca's aphasia after stroke who had been randomly assigned to receive scalp acupuncture with speech and language therapy (intervention) or speech and language therapy alone (control). INTERVENTION: Both groups underwent speech and language therapy (30 min per day, 5 days a week, for 4 weeks), while the intervention group simultaneously received scalp acupuncture. PRIMARY OUTCOMES: All outcomes were collected at baseline, and after the 4-week intervention and 12-week follow-up. Cost-effectiveness measures included the Chinese Rehabilitation Research Center Standard Aphasia Examination (CRRCAE) and Boston Diagnostic Aphasia Examination (BDAE). Cost-utility was evaluated using quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios were expressed, and sensitivity analysis was conducted. RESULTS: The total cost to deliver the intervention was €4001.72, whereas it was €4323.57 for the control group. The incremental cost-effectiveness ratios showed that the intervention was cost-effective (€495.1 per BDAE grade gained; €1.8 per CRRCAE score gained; €4597.1 per QALYs gained) relative to the control over the 12 weeks. The intervention had a 56.4% probability of being cost-effective at the ¥50 696 (€6905.87) Gross Domestic Product (GDP) per capita threshold. Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS: Compared with speech and language therapy alone, the addition of scalp acupuncture was cost-effective in Chinese communities. As the costs of acupuncture services in China are likely to differ from other countries, these results should be carefully interpreted and remain to be confirmed in other populations. TRIAL REGISTRATION NUMBER: ChiCTR-TRC-13003703.


Assuntos
Terapia por Acupuntura , Afasia , Acidente Vascular Cerebral , Afasia/etiologia , Afasia/terapia , Análise Custo-Benefício , Humanos , Terapia da Linguagem , Couro Cabeludo , Fala , Acidente Vascular Cerebral/complicações
3.
Ned Tijdschr Geneeskd ; 1652021 08 18.
Artigo em Holandês | MEDLINE | ID: mdl-34523828

RESUMO

A male infant with multiple skin lesions of the scalp was born in our hospital at term. An ultrasound of the lesions and cranial ultrasound showed no abnormalities. The clinical diagnosis is Aplasia Cutis Congenita. Depending on patient characteristics and size of the lesions, conservative treatment or referral to an expertise center is required.


Assuntos
Displasia Ectodérmica , Dermatopatias , Displasia Ectodérmica/diagnóstico , Humanos , Lactente , Masculino , Couro Cabeludo
4.
Zhen Ci Yan Jiu ; 46(9): 809-14, 2021 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-34558250

RESUMO

The scalp acupuncture therapy, an important component of the microneedle system of the acupuncturology, is effective in the treatment of multiple types of diseases. In the present paper, we made a comparative analysis about the theoretical basis, acupoint location and main clinical indications of the ten academic schools of scalp-acupuncture, including FANG Yun-peng's Scalp Acupuncture, JIAO Shun-fa's Scalp Acupuncture, ZHU Ming-qing's Scalp Acupuncture, etc. which are widely used in clinic at present after collecting the related articles published in recent 60 years from databases of CNKI, Wanfang and VIP, and relevant books. These nine academic schools are similar in clinical indications (such as neurological disorders, brain-derived di-seases) and in needle inserting angle and depth, and different in the needling manipulations, needlingmethods, needle retaining time, theoretical basis, attending diseases of the same one stimulated region, and the position and yin or yang of holograms. The main problems facing the scalp acupuncture are non-uniform positioning method, non-uniform needling method, and non-uniform indications of the same scalp acupoint. Up to now, it remains unclear that which academic school is better in the therapeutic efficacy, thus, we should strengthen clinical research to find out its inherent law in diagnosis and treatment, constantly optimize the needle scheme, determine the best scalp-acupoint position and best needling manipulations, quantize and standardize the related issues, and accelerate the integration of the different academic schools, so as to improve clinical curative effect and to further promote the application and popularization, serving the patients in a better way.


Assuntos
Terapia por Acupuntura , Acupuntura , Pontos de Acupuntura , Humanos , Couro Cabeludo , Instituições Acadêmicas
5.
Croat Med J ; 62(4): 338-346, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34472736

RESUMO

AIM: To compare the effect of adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia vs general anesthesia only on pro-inflammatory cytokine concentrations in patients with non-ruptured brain aneurysms undergoing elective open surgery. METHODS: This parallel, randomized, controlled, open-label trial was conducted at Clinical Hospital Center Zagreb between March 2019 and March 2020. At the beginning of anesthesia, lidocaine group received 40 mg of 2% lidocaine for laryngotracheal topical anesthesia and 4 mg/kg for the scalp block. Control group underwent general anesthesia only. Plasma concentrations of IL-6, TNF-α, and IL-1ß were measured before anesthesia (S0); at the incision (S1); at the end of surgery (S2); 24 hours postoperatively (S3). Cerebrospinal fluid (CSF) cytokine concentrations were measured at the incision (L1) and the end of surgery (L2). RESULTS: Forty patients (each group, 20) were randomized; 37 were left in the final analysis. IL-6 plasma concentrations increased significantly compared with baseline at S3 in lidocaine group, and at S2 and S3 in control group. In both groups, changes in TNF-α and IL-1ß were not significant. CSF cytokine concentrations in lidocaine group did not change significantly; in control group IL-6 and IL-1ß were significantly higher at L2 than at L1. CSF IL-6 in control group significantly increased at L2, but TNF-α and IL-1ß did not. No differences in clinical outcome and complication rates were observed. CONCLUSION: Adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia might attenuate CSF IL-6 concentration increase in patients with brain aneurysm.


Assuntos
Aneurisma Intracraniano , Anestesia Geral , Anestesia Local , Anestésicos Locais , Citocinas , Humanos , Aneurisma Intracraniano/tratamento farmacológico , Aneurisma Intracraniano/cirurgia , Lidocaína , Couro Cabeludo
6.
Clin Chim Acta ; 522: 1-7, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34364855

RESUMO

BACKGROUND: Ewing's sarcoma is a very rare type of cancerous tumor that grows in bones or the soft tissue around the bones, such as cartilage or the nerves. It frequently affects the people at the age of 10 to 20 years and has elevated rate of being cured. METHODS: Assessment of essential trace [zinc (Zn)] and toxic [cadmium (Cd)] elements in biological samples (scalp hair and blood) of Ewing sarcoma patients (n = 87 age ranging 07-19 years) residents of various cities of Pakistan was done. For comparative study, the biological samples of age matched healthy (referent) subjects (n = 62) were also analyzed for selected metals. The matrices of biological samples was oxidized with the help of HNO3 (65%) and H2O2 (30%) mixture at the ratio of 2:1 with the aid of microwave oven. The oxidized biological samples were subjected to atomic absorption spectrometry for their determination. RESULT: The Zn contents in the scalp hair and blood samples of different types of Ewing sarcoma patients were found to be lower, in the range of (45.9-141.2 µg/g) and (0.65-3.12 mg/l), respectively than the biological samples of referent subjects (246-265 µg/g) and (6.40-7.25 mg/l), respectively. Whilst, the Cd concentrations in the scalp hair and blood samples of different types of Ewing sarcoma patients were found to be higher, in the range of (2.70-5.60 µg/g) and (2.46-5.64 µg/l), respectively than the biological samples of controls (1.49-1.79 µg/g) and (1.52-1.90 µg/l), respectively. The biochemical parameters including hemoglobin% and RBC counts were significantly lower in patients than referents (p < 0.001), whereas WBC counts was alarmingly higher in patients than referents (p < 0.001). CONCLUSION: The resulted data will be helpful to treat patients of Ewing sarcoma with mineral supplement contains essential trace element (Zn) in recommended dose to further increase their survival rate.


Assuntos
Sarcoma , Oligoelementos , Adolescente , Adulto , Cádmio , Criança , Voluntários Saudáveis , Humanos , Peróxido de Hidrogênio , Couro Cabeludo/química , Espectrofotometria Atômica , Adulto Jovem , Zinco
7.
J Transl Med ; 19(1): 343, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376209

RESUMO

Mental disorders widely contribute to the modern global disease burden, creating a significant need for improvement of treatments. Scalp stimulation methods (such as scalp acupuncture and transcranial electrical stimulation) have shown promising results in relieving psychiatric symptoms. However, neuroimaging findings haven't been well-integrated into scalp stimulation treatments. Identifying surface brain regions associated with mental disorders would expand target selection and the potential for these interventions as treatments for mental disorders. In this study, we performed large-scale meta-analyses separately on eight common mental disorders: attention deficit hyperactivity disorder, anxiety disorder, autism spectrum disorder, bipolar disorder, compulsive disorder, major depression, post-traumatic stress disorder and schizophrenia; utilizing modern neuroimaging literature to summarize disorder-associated surface brain regions, and proposed neuroimaging-based target protocols. We found that the medial frontal gyrus, the supplementary motor area, and the dorsal lateral prefrontal cortex are commonly involved in the pathophysiology of mental disorders. The target protocols we proposed may provide new brain targets for scalp stimulation in the treatment of mental disorders, and facilitate its clinical application.


Assuntos
Transtorno do Espectro Autista , Transtorno Bipolar , Transtornos Mentais , Transtorno Bipolar/diagnóstico por imagem , Transtorno Bipolar/terapia , Humanos , Transtornos Mentais/diagnóstico por imagem , Transtornos Mentais/terapia , Neuroimagem , Couro Cabeludo
8.
Ann Plast Surg ; 87(3): 271-277, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397516

RESUMO

INTRODUCTION: Locally advanced nonmelanoma skin cancers of the head and neck are well described in the current literature. However, data about clinical and survival outcomes are lacking. We present survival data from a tertiary head and neck cancer unit in London. METHODS: A retrospective analysis of data collected from a single institution was conducted. All patients with locally advanced cutaneous scalp carcinomas invading the skull between 2011 and 2019 were included. Data included patient demographics, tumor, comorbidities, interventions, flap survival, and metal work exposure. Survival outcomes were examined using Kaplan-Meier analysis. RESULTS: Twenty-three patients were identified. The mean age was 72 years. Eighteen patients were male, and 5 were female. Five patients were immunosuppressed. Nineteen patients underwent outer cortex drill-down/full-thickness calvarial resection, followed by reconstruction with free tissue transfer. Six patients had titanium mesh reconstruction after segmental skull resections. Three patients underwent further surgery because of exposed metalwork. Disease-free survival at 3 years after surgery was 60%. CONCLUSIONS: Locally advanced nonmelanoma skin cancers invading the bone are sporadic. There are little published data on clinical and survival outcomes in this group. Despite the nature of these skin lesions, a high degree of local control can be obtained by extensive surgical resection, outer table drill-down, and calvarial resection. We conclude that aggressive management of the bony invasion improves disease-free survival and improves local control.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Cutâneas , Idoso , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Couro Cabeludo , Neoplasias Cutâneas/cirurgia , Crânio
10.
BMJ Case Rep ; 14(8)2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353825

RESUMO

Frontal fibrosing alopecia (FFA) is a progressive frontotemporal hairline recession with eyebrow loss. Facial papules are present in up to 14% of FFA cases and can start with facial flushes. Nevertheless, these flushes are commonly associated with rosacea, a much more prevalent disease. In this case, a woman with FFA had, at first, clinical and histopathological findings of rosacea and was treated with ivermectin 1% cream with no improvement. She returned reporting new papules in the frontal region, reaching the frontotemporal hairline. Trichoscopy of the scalp showed mild perifollicular erythema and follicular scale. The new skin biopsy was compatible with FFA, and oral finasteride (5 mg/day) and hydroxychloroquine were introduced to stabilise the disease.


Assuntos
Testa , Líquen Plano , Alopecia/tratamento farmacológico , Feminino , Humanos , Estudos Retrospectivos , Couro Cabeludo
11.
An Bras Dermatol ; 96(5): 569-573, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34272078

RESUMO

Monilethrix is a rare defect of the hair shaft, with most cases showing an autosomal dominant pattern of inheritance and variable clinical expression. It is characterized by hypotrichosis secondary to hair fragility. The diagnosis is made through trichoscopy, detecting typical findings such as periodic narrowing at regular intervals, giving the hair the appearance of beads in a rosary. This article reports the case of six members of a family diagnosed with monilethrix with alopecia of varying degrees.


Assuntos
Alopecia em Áreas , Doenças do Cabelo , Alopecia/diagnóstico , Alopecia/genética , Cabelo , Humanos , Couro Cabeludo
12.
Curr Oncol ; 28(4): 2452-2465, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34287251

RESUMO

One side-effect of oncological treatment is chemotherapy-induced alopecia (CIA), a temporary form of hair loss that could influence patients' mental health. Digitised scalp cooling systems are assuming an important role in the clinical setting during adjuvant treatment, promising hair loss prevention and allowing an efficient procedure to reinforce patients' mental health during chemotherapy by avoiding CIA. The present study was carried out through two research protocols: in Research Protocol 1, we conducted a randomised clinical study to evaluate the emotional impact of using scalp cooling technology in women with BC compared with a traditional chemotherapy setting; in Research Protocol 2, we conducted an observational pre-post study involving women with BC diagnosis being under adjuvant chemotherapy in two experimental conditions: no scalp cooling application and scalp cooling application. Seventy-four women undergoing chemotherapy, aged 30-55 years, were enrolled in both research protocols. We investigated oncological patients' psychological dimensions including body image, body appreciation, expectations, and satisfaction with the scalp cooling treatment, with reference to chemotherapy treatment applying the scalp cooling solution. Our data evidenced the need to implement a supportive clinical approach via brief, tailored psychological intervention addressing patients' progressive adaptation to chemotherapy adverse events and their concerns regarding induced alopecia and the value of the scalp cooling system. Patients receiving the innovative chemotherapy probably coped with it by neglecting its physical impact, instead focusing on avoiding alopecia by using the technological solution and neglecting the emotional impact of chemotherapy as a severe pharmacological treatment.


Assuntos
Hipotermia Induzida , Qualidade de Vida , Alopecia/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica , Feminino , Humanos , Couro Cabeludo
13.
Pediatr Clin North Am ; 68(4): 743-757, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34247706

RESUMO

There are a wide variety of scalp and skull lesions that can affect the pediatric population, many of which are first encountered by primary care physicians. The differential consists of a broad range of more common congenital lesions, sequelae of trauma, and vascular anomalies, to very rare neoplastic processes. It is important to understand signs and symptoms that may indicate whether a lesion may be benign versus life threatening, what imaging studies are appropriate and how to interpret them, and when to seek referrals to specialists.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Neurocirúrgicos/métodos , Atenção Primária à Saúde/organização & administração , Couro Cabeludo/cirurgia , Neoplasias da Base do Crânio/cirurgia , Criança , Traumatismos Craniocerebrais/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Neurocirurgia , Couro Cabeludo/patologia , Neoplasias da Base do Crânio/patologia
14.
Microb Biotechnol ; 14(5): 2152-2163, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34318587

RESUMO

Seborrheic dermatitis (SD) is a recurrent common inflammatory skin disease that affects all ethnic groups in all regions worldwide. However, no specific treatment or preventive measure is yet available. Identifying effective treatments with acceptable safety and tolerability is desirable. In this study, scalp microbiota alterations were measured in SD, showing significantly greater abundance of Malassezia and Staphylococcus and diminished fungal and bacterial diversity compared with healthy controls. We investigated the benefit of a 4-week treatment with 0.5 mg ml-1 recombinant human thymosin ß4 (rhTß4) gel or 2% ketoconazole lotion on the scalp condition of 71 patients with SD compared with 21 healthy individuals. Clinical assessment (Adherent Scalp Flaking Score, and the Maximum Erythema Area) and physiological conditions (transepidermal water loss, hydration, and sebum secretion) were evaluated. The rhTß4 treatment provided significantly greater efficacy than ketoconazole and a sustained effect in the treatment of scalp SD. More importantly, rhTß4 dramatically improved the microbiome homeostasis and prompted a shift of scalp microflora towards healthy composition, helping symptoms and ameliorating physiological conditions more effectively and durably than ketoconazole. Our research demonstrated the scalp microbe dysbiosis of SD and highlighted rhTß4 as a promising therapeutic strategy in the prevention and treatment of SD.


Assuntos
Dermatite Seborreica , Microbiota , Dermatite Seborreica/tratamento farmacológico , Homeostase , Humanos , Couro Cabeludo , Timosina
15.
Artigo em Chinês | MEDLINE | ID: mdl-34304476

RESUMO

Angiosarcoma of the scalp is an aggressive tumor with a high rate of local recurrence and distant metastasis. We present two cases of metastasis in parotid region at the time of one year after radical surgery of scalp angiosarcoma. It is suggested that regional lymph nodes should be treated more aggressively at the first treatment, which may achieve better results or, at least, prolong the time to local recurrence and distant metastasis.


Assuntos
Neoplasias de Cabeça e Pescoço , Hemangiossarcoma , Neoplasias Cutâneas , Neoplasias de Cabeça e Pescoço/cirurgia , Hemangiossarcoma/cirurgia , Humanos , Recidiva Local de Neoplasia/cirurgia , Região Parotídea , Couro Cabeludo , Neoplasias Cutâneas/cirurgia
17.
An Bras Dermatol ; 96(5): 565-568, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34261602

RESUMO

The paper presents a case of lentigo maligna melanoma of the scalp in an elderly patient treated for the nodular part with surgery and the residual melanoma in situ with 5% Imiquimod and subsequently with 3.75% Imiquimod (each concentration for 4 months, 5 times per week), with complete regression of the lesion. 3.75% Imiquimod, which is already used for the treatment of actinic keratosis, could be a useful weapon with the same effectiveness and fewer side effects compared to 5% Imiquimod.


Assuntos
Sarda Melanótica de Hutchinson , Melanoma , Neoplasias Cutâneas , Idoso , Aminoquinolinas/uso terapêutico , Humanos , Sarda Melanótica de Hutchinson/tratamento farmacológico , Imiquimode , Melanoma/tratamento farmacológico , Couro Cabeludo , Neoplasias Cutâneas/tratamento farmacológico
18.
Zhonghua Shao Shang Za Zhi ; 37(8): 752-757, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34192851

RESUMO

Objective: To explore the clinical effects of expanded flap made by skin and soft tissue expander (hereinafter referred to as expander) in repairing the wounds with exposed titanium mesh after cranioplasty with titanium mesh. Methods: A retrospective observational study was conducted. From April 2015 to October 2019, 13 patients with wounds with exposed titanium mesh after cranioplasty with titanium mesh were admitted to the First Affiliated Hospital of Air Force Medical University, including 10 males and 3 females, aged 18 to 70 years. Exposure of titanium mesh occurred 3 months to 4 years after cranioplasty with titanium mesh. The wound area of exposed titanium mesh ranged from 1.5 cm×0.6 cm to 6.3 cm×6.0 cm. In the first stage, one or two square expanders with rated capacity of 50-200 mL were placed under the normal scalp 1 cm away from the edge of the wound surface of exposed titanium mesh. The water injection time was 2 to 3 months with the total water injection volume being 1.6 to 2.0 times of the rated capacity of expander. In the second stage, the expander was removed and the expanded flap (size ranging from 4.1 cm×1.8 cm to 9.1 cm×7.9 cm) was transferred to repair the wound of exposed titanium mesh. The placement site of the expander, the transfer form of the expanded flap, the postoperative wound healing of the titanium mesh exposed site, and the survival of expanded flap were recorded. The scar of the head incision and the appearance of head were followed up. Results: Among the patients in this group, the expanders of 7 were placed in the temporal region, while the other 6 were placed at the top. The 11 patients were treated with advanced expanded flap, while the other 2 patients were treated with pedicled expanded flap. The head wounds of patients in this group successfully healed with retaining of the titanium mesh. The wound was healed after dressing change in 1 patient with necrosis at the tip of the expanded flap. The expanded flaps of 12 patients survived after transfer. Patients in this group were followed up for 12 months after surgery, the exposed titanium meshes were retained, the incisions healed well with the scars concealed, the hair on the scalp grew well, and the appearance of head was comparatively good. Conclusions: Using expanded flap in the repair of the wounds with exposed titanium mesh after cranioplasty with titanium mesh can effectively cover the wound and retain the titanium mesh, achieving good function and appearance.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Feminino , Humanos , Masculino , Couro Cabeludo/cirurgia , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Telas Cirúrgicas , Titânio , Resultado do Tratamento
19.
J Med Case Rep ; 15(1): 383, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281601

RESUMO

BACKGROUND: Morel-Lavallée lesions are posttraumatic, closed degloving injuries in which the skin and subcutaneous tissue are separated abruptly from superficial underlying fascia. This condition leads to an effusion containing hemolymph and necrotic fat. Magnetic resonance imaging, when available, is the modality of choice in the evaluation of Morel-Lavallée lesion. Early diagnosis and management is essential as any delay in diagnosis or missed lesion will lead to the effusion becoming infected or leading to extensive skin necrosis. We present a condition of a Morel-Lavallée lesion involving the scalp and complicated by conjunctival chemosis. CASE PRESENTATION: We report on a 3-year-old black African girl who presented a fluctuant swelling of entire scalp, extending to upper part of the face on the seventh day after a forehead trauma due to falling on a rock while playing. Skull x-ray revealed soft-tissue swelling, giving an impression of large fluid collection in the deep subcutaneous tissues with no bone fracture. A diagnosis of Morel-Lavallée lesion of the scalp complicated by conjunctival chemosis was made. The patient was managed with percutaneous drainage and compression bandage. The patient improved well and was subsequently discharged without any vision impairment. There was no recurrence of the lesion on follow-up. CONCLUSIONS: The Morel-Lavallée lesion of the scalp complicated with conjunctival chemosis is a rare presentation of this condition. Prompt diagnosis and management are crucial for preventing complications. Image-guided diagnosis and treatment still remain a challenge in the setting of low-resource health facilities.


Assuntos
Couro Cabeludo , Lesões dos Tecidos Moles , Pré-Escolar , Drenagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Radiografia , Lesões dos Tecidos Moles/diagnóstico por imagem
20.
Eur J Obstet Gynecol Reprod Biol ; 263: 153-158, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34216939

RESUMO

BACKGROUND: The Fetal Blood Sample (FBS) is used as an indicator of fetal acidosis during labor. Its place is discussed through the lack of randomized trials, as well as the limitations related to the technical procedure. An alternative could be the Fetal Scalp Stimulation (FSS). AIM: Our objective was to describe the FSS diagnostic value to predict fetal wellbeing defined from FBS. METHODS: The FSS consisted in a digital scalp stimulation for 15 s. Test was negative when an acceleration and/or a normal variability were elicited in the 2 min following. FSS was performed before each FBS which was classified as normal when pH was > 7.25. The diagnostic value was assessed by sensibility, specificity, positive and negative predictive values. FINDINGS: 148 women were included in our center from February to December 2019. Of the 191 FBS procedures, when accelerations were elicited sensibility was 58,3 (36.8-77.1), specificity was 67,5 (59.3-75), positive predictive value was 20,9 (12.5-32.9) and negative predictive value was 91.7 % (95 %CI, 85-95.5). DISCUSSION: FBS is considered as the gold standard in our study which could be discussed as it is abandoned in some countries because of its questioned reliability and the lack of controlled randomized trials. CONCLUSION: This study suggests that FSS could be an interesting alternative adjunctive test to perform in the first instance as it seems to be reliable, non-invasive and easy to perform in order to limit FBS only to absence of acceleration after FSS.


Assuntos
Trabalho de Parto , Couro Cabeludo , Cardiotocografia , Feminino , Sangue Fetal , Monitorização Fetal , Frequência Cardíaca Fetal , Humanos , Concentração de Íons de Hidrogênio , Gravidez , Reprodutibilidade dos Testes , Estudos Retrospectivos
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