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1.
Bone Joint J ; 102-B(2): 177-185, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009426

RESUMO

AIMS: To investigate the benefits of denosumab in combination with nerve-sparing surgery for treatment of sacral giant cell tumours (GCTs). METHODS: This is a retrospective cohort study of patients with GCT who presented between January 2011 and July 2017. Intralesional curettage was performed and patients treated from 2015 to 2017 also received denosumab therapy. The patients were divided into three groups: Cohort 1: control group (n = 36); cohort 2: adjuvant denosumab group (n = 9); and cohort 3: neo- and adjuvant-denosumab group (n = 17). RESULTS: There were 68 patients within the study period. Six patients were lost to follow-up. The mean follow-up was 47.7 months (SD 23.2). Preoperative denosumab was found to reduce intraoperative haemorrhage and was associated with shorter operating time for tumour volume > 200 cm3. A total of 17 patients (27.4%) developed local recurrence. The locoregional control rate was 77.8% (7/9) and 87.5% (14/16) respectively for cohorts 2 and 3, in comparison to 66.7% (24/36) of the control group. The recurrence-free survival (RFS) rate was significantly higher for adjuvant denosumab group versus those without adjuvant denosumab during the first two years: 100% vs 83.8% at one year and 95.0% vs 70.3% at two years. No significant difference was found for the three-year RFS rate. CONCLUSION: Preoperative denosumab therapy was found to reduce intraoperative haemorrhage and was associated with shorter operating times. Adjuvant denosumab was useful to prevent early recurrence during the first two years after surgery. Cite this article: Bone Joint J 2020;102-B(2):177-185.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/cirurgia , Denosumab/uso terapêutico , Tumor de Células Gigantes do Osso/cirurgia , Sacro/cirurgia , Adolescente , Adulto , Neoplasias Ósseas/tratamento farmacológico , Criança , Terapia Combinada , Curetagem/métodos , Feminino , Tumor de Células Gigantes do Osso/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
2.
Dermatol Clin ; 37(4): 425-433, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466583

RESUMO

Nonmelanoma skin cancer (NMSC) is the most commonly diagnosed malignancy in the United States. Surgery is considered the gold standard treatment. Techniques include curettage and electrodesiccation, surgical excision, and Mohs micrographic surgery. While each is effective, there are relative advantages and disadvantages with respect to cost, time, quality of life, and role in patients with limited life expectancy. Preventing local tumor recurrence is the primary objective; however, recurrence rates are based on retrospective data, and high-quality comparator studies assessing effectiveness are scarce. Prospective and randomized controlled trials are imperative to create comprehensive, evidence-based recommendations for the surgical management of NMSC.


Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Análise Custo-Benefício , Curetagem/métodos , Procedimentos Cirúrgicos Dermatológicos/métodos , Dessecação/métodos , Medicina Baseada em Evidências , Humanos , Expectativa de Vida , Margens de Excisão , Participação do Paciente , Preferência do Paciente , Seleção de Pacientes , Guias de Prática Clínica como Assunto
3.
J Dtsch Dermatol Ges ; 17(6): 613-634, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31241843

RESUMO

Extragenital cutaneous warts are benign epidermal tumors caused by human papillomaviruses (HPVs) and a frequent reason for patients to consult a dermatologist. Depending on wart type and site involved, the clinical presentation is highly varied. Given that warts represent a self-limiting condition, a wait-and-see approach may be justified. However, treatment is always indicated if the lesions become painful or give rise to psychological discomfort. Factors to be considered in this context include subjective disease burden, patient age, site affected, as well as the number and duration of lesions. Destructive treatment methods involve chemical or physical removal of diseased tissue. Nondestructive methods consist of antimitotic and antiviral agents aimed at inhibiting viral proliferation in keratinocytes. Some of the various immunotherapies available not only have localized but also systemic effects and are thus able to induce remission of warts located at any distance from the injection site. Especially patients with warts at multiple sites benefit from this form of treatment. Intralesional immunotherapy using the mumps-measles-rubella (MMR) vaccine is a particularly promising option for the treatment of recalcitrant warts in adult patients. For children, on the other hand, HPV vaccination is a novel and promising approach, even though it has not been approved for the treatment of cutaneous warts. At present, there is no universally effective treatment available. Moreover, many frequently employed therapies are currently not supported by conclusive clinical trials.


Assuntos
Dermatopatias Virais/terapia , Verrugas/terapia , Acetatos/uso terapêutico , Adulto , Antivirais/uso terapêutico , Crioterapia/métodos , Curetagem/métodos , Feminino , Fluoruracila/uso terapêutico , Formiatos/uso terapêutico , Humanos , Terapia a Laser/métodos , Masculino , Fototerapia/métodos , Ácido Salicílico/uso terapêutico , Dermatopatias Virais/patologia , Dermatopatias Virais/transmissão , Verrugas/patologia , Verrugas/transmissão , Conduta Expectante
4.
Medicine (Baltimore) ; 98(25): e16152, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232970

RESUMO

To compare the efficacy of curettage and bone grafting combined with elastic intramedullary nailing (EIN) vs curettage and bone grafting in the treatment of long bone cysts in children and to clarify the necessity of using EIN in the treatment of bone cysts.Sixty-two patients were involved in this study from Jan. 2009 to Sept. 2017 (43 males, 19 females; 27 humeri, 35 femurs); the patients were assigned to an EIN group, comprising 30 patients who underwent curettage and bone grafting combined with EIN, or to a non-elastic intramedullary nailing (NEIN) group, comprising 32 patients who underwent curettage and bone grafting alone. The prognosis of the 2 groups was assessed with reference to the standard of Capanna.No statistically significant differences in sex, age, location, activity, pathological fracture, cyst volume, operative time and intraoperative blood loss were found between the 2 groups (P > .05). The effective rate was 90.0% in the EIN group and 68.8% in the NEIN group, and the difference was statistically significant (P < .05).Compared to simple curettage and bone grafting, curettage and bone grafting combined with EIN treatment can significantly improve the prognosis of children with bone cysts. It is recommended that EIN be added to bone cyst curettage and bone grafting.


Assuntos
Cistos Ósseos/cirurgia , Transplante Ósseo/normas , Fixação Intramedular de Fraturas/normas , Pinos Ortopédicos/normas , Pinos Ortopédicos/estatística & dados numéricos , Transplante Ósseo/métodos , Transplante Ósseo/estatística & dados numéricos , Criança , Curetagem/métodos , Feminino , Fêmur/anormalidades , Fêmur/cirurgia , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/estatística & dados numéricos , Humanos , Úmero/anormalidades , Úmero/cirurgia , Masculino , Radiografia/métodos , Estudos Retrospectivos , Resultado do Tratamento
5.
J Laryngol Otol ; 133(4): 289-293, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31046870

RESUMO

OBJECTIVE: To compare endoscopic assisted powered adenoidectomy with conventional curettage adenoidectomy. METHODS: A randomised controlled trial was conducted at a tertiary care teaching hospital. Fifty patients with a symptom complex pertaining to adenoid hypertrophy and requiring adenoidectomy were chosen and divided into 2 groups of 25 each. Patients in group A underwent conventional curettage adenoidectomy and those in group B underwent endoscopic assisted powered adenoidectomy. Comparison was based on the parameters of surgical time, intra-operative bleeding, post-operative pain and completeness of adenoid removal. RESULTS: The surgical time was significantly longer with the powered instrument. Mean blood loss was greater in the powered group, but was statistically insignificant. The powered procedure fared significantly better, with lower pain scores and more instances of complete tissue resection. CONCLUSION: A curved microdebrider blade can be used safely and precisely for adenoidectomy under endoscopic vision. It enables complete resection of adenoid tissue. This method also proves to be an excellent teaching aid.


Assuntos
Adenoidectomia/métodos , Tonsila Faríngea/patologia , Curetagem/métodos , Endoscopia/métodos , Tonsila Faríngea/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Hospitais Universitários , Humanos , Hipertrofia , Masculino , Duração da Cirurgia , Atenção Terciária à Saúde , Resultado do Tratamento
6.
Wiad Lek ; 72(3): 336-342, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31050977

RESUMO

OBJECTIVE: Introduction: Scientific information sources point to the significant effectiveness of curettage of uterine cavity (CUC) as a diagnostic and treatment mode of gynecologic oncology. Today the anesthesia service is able to satisfy virtually all the requirements of a surgeon and a female patient, however, some institutional factors, as for example postoperative recovery of consciousness, and factors influencing it, remain unaddressed. The aim: to explore the possibilities of influence of different combinations and dosages of medical preparations used to provide monitored anesthesia care of CUC, to change the time of postoperative recovery of patient's consciousness. PATIENTS AND METHODS: Materials and methods: an interview of 96 patients by VAS, studies of cortisol, insulin and glucose levels in blood serum, measurements of time from the end of surgery to the awakening and complete recovery of consciousness and statistical processing of the results have been conducted. RESULTS: Results: A combination of 50 mg of dexketoprofen and half-dose drugs for narcosis can hasten the postoperative wake-up time by 38%, while maintaining dosages can prolong by 37% on the contrary. There is a dose-dependent effect of drugs for narcosis on the time of full post-operative recovery of consciousness. The reduction of their dosages by half can reduce this time by almost 40%. CONCLUSION: Conclusions: the dosage modification of anesthetic drugs and their combinations may have a significant effect on the time of postoperative awaking and complete recovery of consciousness in female patients after CUC. As a result, it has a positive physiological, psychological and social effect.


Assuntos
Anestesia , Curetagem/métodos , Estado de Consciência/efeitos dos fármacos , Feminino , Humanos , Período Pós-Operatório
7.
Arch Orthop Trauma Surg ; 139(12): 1659-1666, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31020410

RESUMO

BACKGROUND: The traditional treatment for chondrosarcoma is wide local excision (WLE), as these tumors are resistant to chemotherapy and radiation treatment. While achieving negative margins has traditionally been the goal of chondrosarcoma resection, multiple studies have demonstrated good short-term results after intralesional procedures for low-grade chondrosarcomas (LGCS) with curettage and adjuvant treatments (phenol application, cauterization or cryotherapy) followed by either cementation or bone grafting. Due to the rarity of this diagnosis and the recent application of this surgical treatment modality to chondrosarcoma, most of the information regarding treatment outcomes is retrospective, with short or intermediate-term follow-up. The aim of this study was to assess the long-term results of patients with LGCS of bone treated with intralesional curettage (IC) treatment versus WLE. This retrospective analysis aims to characterize the oncologic outcomes (local recurrence, metastases) and functional outcomes in these two treatment groups at a single institution. METHODS: Using an institutional musculoskeletal oncologic database, we retrospectively reviewed medical records of all patients with LGCS of the appendicular skeleton that underwent surgical treatment between 1985 and 2007. Thirty-two patients (33 tumors) were identified with LGCS; 17 treated with IC and 15 with WLE. RESULTS: Seventeen patients (18 tumors) with a minimum clinical and radiologic follow-up of 10 years were included. Nine patients were treated with IC (four with no adjuvant, three with additional phenol, one with liquid nitrogen and one with H2O2) with either bone graft or cement augmentation, and nine others were treated with WLE and reconstruction with intercalary/osteoarticular allograft or megaprosthesis. The mean age at surgery was 41 years (range 14-66 years) with no difference (p = 0.51) between treatment cohorts. There was a mean follow-up of 13.5 years in the intralesional cohort (range 10-19 years) and 15.9 years in the WLE cohort (range 10-28 years, p = 0.36). Tumor size varied significantly between groups and was larger in patients treated with WLE (8.2 ± 3.1 cm versus 5.4 ± 1.2 cm, at the greatest dimension, p = 0.021). There were two local recurrences (LR), one in the intralesional group and one in the wide local excision group, occurring at 3.5 months and 2.9 years, respectively, and both required revision. No further LR could be detected with long-term follow-up. The MSTS score at final follow-up was significantly higher for patients managed with intralesional procedures (28.7 ± 1.7 versus 25.7 ± 3.4, p = 0.033). There were less complications requiring reoperation in the intralesional group compared with the wide local excision group, although this difference was not found to be statistically significant (one versus four patients, respectively; p = 0.3). CONCLUSION: This series of low-grade chondrosarcoma, surgically treated with an intralesional procedures, with 10-year follow-up, demonstrates excellent local control (88.9%). Complications were infrequent and minor and MSTS functional scores were excellent. Wide resection of LGCS was associated with lower MSTS score and more complications. In our series, the LR in both groups were detected within the first 3.5 years following the index procedure, and none were detected in the late surveillance period.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Extremidades/cirurgia , Adolescente , Adulto , Idoso , Cimentos para Ossos/uso terapêutico , Neoplasias Ósseas/fisiopatologia , Transplante Ósseo/métodos , Cimentação/métodos , Condrossarcoma/fisiopatologia , Terapia Combinada , Curetagem/métodos , Feminino , Humanos , Peróxido de Hidrogênio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Osteotomia/métodos , Reoperação , Estudos Retrospectivos , Adulto Jovem
8.
Georgian Med News ; (287): 13-19, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30958281

RESUMO

Anesthesia of curettage of uterine cavity (CUC) at postoperative period causes additional expenses. Preventive intraoperative anesthesia makes it possible to reduce these expenses and provide significant positive economic effect on state budget. The objective of this research is determination of influence of different methods of anesthesia of CUC on cash value of anesthetic maintenance of CUC and the possibility of saving of budgetary funds. 128 women took part in the research. They underwent the procedure of CUC. Anesthetic maintenance was performed using different medicamental combinations and their dosages. Mathematical calculation of the cost of each CUC stage was done considering the cost of consumables, medical preparations and value of labor of medical staff. In the course of this research, it was proven that a combination of additional use of dexketoprofen (at the stage of premedication of CUC) and performing preventive intraoperative applicational anesthesia with bupivacaine solution can save 130 452,26UAH of wage fund per year and general budget savings within the confines of a state can each 9 954 617,67UAH per year.


Assuntos
Serviço Hospitalar de Anestesia/economia , Anestesia/economia , Bupivacaína/economia , Curetagem/métodos , Útero/cirurgia , Serviço Hospitalar de Anestesia/organização & administração , Bupivacaína/administração & dosagem , Redução de Custos , Curetagem/economia , Feminino , Humanos , Período Pós-Operatório
9.
Photodiagnosis Photodyn Ther ; 27: 276-279, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30965148

RESUMO

BACKGROUND: Cutaneous warts are an extremely common problem, whose eradication can be challenging. Topical PDT involves applying a porphyrin precursor, 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) to the affected area. ALA-PDT has been well documented to be successful in the treatment of recalcitrant warts. PDT has a limited role in the treatment of thicker lesions because the photosensitizer does not penetrate keratotic lesions well, though this is vehicle dependent. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of curettage + microneedling + ALA-PDT for the treatment of resistant acral warts. We hypothesized that microneedling may increase the efficacy of PDT, providing a channel to deliver the ALA to deeper areas of warts. METHODS: Our study was carried out between November 2017 and July 2018. Eligible participants had one or more resistant plantar or palmar warts. Thirteen patients were recruited. They underwent a thorough curettage, followed by the application of 5-ALA 10% cream on the wart, and by microneedling. Later, the pricked skin was covered for three hours by an occlusive polyurethane dressing, and finally irradiated with a red-light source. Patients performed one session every three weeks for a total of three cycles. RESULTS: After 3 treatments of curettage + microneedling + ALA-PDT, 11 patients (84.6%) showed complete remission (defined as complete disappearance of their warts). One patient (7.7%) showed partial remission (defined as greater than 50% decrease in the wart area) after 3 sessions; this patient needed other 2 sessions to achieve complete remission. The mean follow-up period after healing was 4.3 months. Adverse effects were recorded. CONCLUSION: We have demonstrated, for the first time to our knowledge, that the combination of curettage + microneedling + topical ALA-PDT may offer an effective and safe alternative for the treatment of acral resistant warts, even when PDT alone has already been insufficient.


Assuntos
Ácido Aminolevulínico/análogos & derivados , Curetagem/métodos , Agulhas , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Verrugas/terapia , Adolescente , Adulto , Ácido Aminolevulínico/administração & dosagem , Ácido Aminolevulínico/efeitos adversos , Ácido Aminolevulínico/uso terapêutico , Terapia Combinada , Curetagem/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/administração & dosagem , Fármacos Fotossensibilizantes/efeitos adversos , Verrugas/tratamento farmacológico , Adulto Jovem
10.
Vet Dermatol ; 30(4): 334-e96, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31025463

RESUMO

BACKGROUND: The diagnosis of otoacariasis due to Otodectes cynotis is based on the visualization of the parasite, either directly by otoscopy or indirectly after microscopic examination of cerumen collected by several methods. OBJECTIVES: To compare the sensitivity of three techniques: conventional handheld otoscopy, Volkmann's curette sampling and cotton-tipped swabbing. ANIMALS: Five dogs and 12 cats (30 naturally infested ears). METHODS AND MATERIALS: For each case, following otoscopy, the order of examinations (swab or curette) was chosen randomly and the samples were observed on a slide mixed with lactophenol and covered with a coverslip. Parasite detection was noted as positive or negative and parasitic stages were counted separately. RESULTS: The diagnostic sensitivity of otoscopy alone was 67% (positive in 20 of 30 cases), using the curette sampling it was 93% (28/30) and 57% (17/30) for the swabbing. The curette technique had a significantly higher sensitivity than classic ear-swabbing (P = 0.001) or otoscopy alone (P = 0.02). Combining otoscopy and the curette, we obtained a sensitivity of 100% compared to 86% when otoscopy and swabbing were combined. Moreover, the parasite count in the curette samples (average 25 ± 30 SD) was significantly higher than the swab samples (4.5 ± 11) (P < 0.001). CONCLUSIONS AND CLINICAL IMPORTANCE: When suspecting O. cynotis infestation, otoscopic examination should be performed. To confirm the nature of the parasites observed or whenever this examination result is negative, doubtful or cannot be performed, the curettage sampling method for microscopic cerumen examination is recommended.


Assuntos
Doenças do Gato/diagnóstico , Curetagem/métodos , Doenças do Cão/diagnóstico , Infestações por Ácaros/veterinária , Otoscopia/métodos , Animais , Doenças do Gato/parasitologia , Gatos , Cerume/parasitologia , Doenças do Cão/parasitologia , Cães , Orelha/parasitologia , Infestações por Ácaros/diagnóstico , Psoroptidae , Sensibilidade e Especificidade
11.
J Shoulder Elbow Surg ; 28(9): 1654-1657, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31028011

RESUMO

BACKGROUND: Although curettage of an aneurysmal bone cyst (ABC) of the clavicle has a high rate of local recurrence, segmental resection is often avoided for treatment as it causes functional impairment and shoulder deformity. We evaluated the rate of local recurrence and functional outcomes of extended curettage vs. segmental resection with bone reconstruction for the treatment of clavicular ABC. METHODS: A total of 14 patients with clavicular ABC were studied. Extended curettage and segmental resection with bone reconstruction were done for 6 and 8 patients, respectively. The number of local recurrences and postoperative complications was recorded for each group. The function of the shoulder was assessed using the Constant-Murley score. RESULTS: The mean age of the patients was 26.2 ± 14.7 years (range, 4-56 years). At a mean follow-up of 60 ± 37.6 months, 2 recurrences developed, both in the curettage group. Two postoperative complications (1 infection and 1 nonunion) were also recorded, both in the segmental resection group. The mean Constant-Murley score was 88.2 ± 3.4 in the extended curettage group and 87.3 ± 2.4 in the segmental resection group (P = .85). CONCLUSIONS: Considering the comparable function of the shoulder in curettage and segmental resection with bone reconstruction in clavicular ABC, we recommend the latter approach because of the lower recurrence rate, albeit with a higher rate of potential complications.


Assuntos
Cistos Ósseos Aneurismáticos/cirurgia , Curetagem/métodos , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Adulto , Criança , Pré-Escolar , Clavícula , Curetagem/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Recidiva , Articulação do Ombro/fisiopatologia , Adulto Jovem
12.
J Pediatr Orthop ; 39(4): e312-e317, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30839485

RESUMO

BACKGROUND: Chondroblastoma is a rare cartilaginous benign bone tumor that commonly arises in long bones of young people. Surgical management is the primary treatment of choice for chondroblastoma and it entails adequate intralesional curettage alone or in combination with adjuvants. This study was performed to describe the epidemiological characteristics and clinical and radiologic results of intralesional curettage of chondroblastoma. METHODS: This was a retrospective study which included an analysis of 91 patients with chondroblastoma who were treated with intralesional curettage and were followed up between 1994 and 2014 for at least 3 years. Epidemiological data, clinical symptoms, radiologic and histologic investigations, surgery, functional outcomes, complications, and local recurrence rate were analyzed. RESULTS: There were 60 males (65.9%) and 31 females (34.1%) with a mean age of 16.4 years. The most commonly involved bone was the proximal tibia in 24 patients (26.4%), followed by distal femur in 20 patients (22%), proximal humerus in 17 patients (18.7%) and proximal femur in 15 patients (16.6%). All patients underwent intralesional curettage. High-speed burr was used in 66 patients (72.5%). The resultant cavity was filled with autogenous bone graft, bone substitute, bone cement or a combination of bone graft and cement. Four patients (4.4%) had complications. Three patients (3.3%) developed local recurrence. Age, site, history of previous intervention or pathologic fracture had no impact on the rate of recurrence. The mean Musculoskeletal Tumor Society (MSTS) score was 28.88 (range, 24 to 30) points. CONCLUSIONS: Thorough curettage using high-speed burr and bone-grafting or bone cement in the treatment of chondroblastoma has good local control, low recurrence rate and excellent functional long-term outcome. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Assuntos
Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Condroblastoma/cirurgia , Curetagem/métodos , Atividade Motora/fisiologia , Adolescente , Adulto , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/fisiopatologia , Criança , Condroblastoma/diagnóstico , Condroblastoma/fisiopatologia , Feminino , Fêmur , Humanos , Úmero , Masculino , Estudos Retrospectivos , Tíbia , Resultado do Tratamento , Adulto Jovem
13.
Med Sci Monit ; 25: 1558-1565, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30814484

RESUMO

BACKGROUND The aim of this study was to assess the clinical outcomes of conservative treatments for cervical ectopic pregnancy (CEP). MATERIAL AND METHODS The series of CEP cases at our hospital between 2009 and 2016 were reviewed retrospectively. The patients were treated using systemic methotrexate infusion (MTX group, n=9), angiographic uterine artery embolization (UAE group, n=11), or transcatheter intra-artery methotrexate infusion combined with UAE (UAE+MTX group, n=13). Clinical outcomes, complications, and fertility were evaluated. RESULTS The median serum ß-hCG was 6449 mIU/mL for MTX group, 17384 mIU/mL for UAE group, and 21361 mIU/mL for UAE+MTX group. The difference was statistically significant. In the MTX group, 1 patient developed hepatotoxicity and 2 patients occurred continuous vaginal bleeding during curettage. These 3 patients were successfully treated with emergency UAE. In the UAE group, 2 patients had vaginal re-bleeding on postoperative day 17 and 26, respectively, and received a second UAE procedure. In the UAE+MTX group, no patients developed severe complications. Moreover, a quick regression of serum ß-hCG level, shortened recovery of normal menstruation, rapid cervical mass elimination, and a short hospital stay were observed in patients of the UAE+MTX group. CONCLUSIONS The triple therapy of transcatheter intra-arterial methotrexate infusion combined with UAE followed by immediate curettage is feasible and advantageous in treating CEP.


Assuntos
Metotrexato/administração & dosagem , Gravidez Ectópica/cirurgia , Embolização da Artéria Uterina/métodos , Adulto , Colo do Útero , Cesárea , China , Cicatriz , Tratamento Conservador , Curetagem/métodos , Feminino , Humanos , Infusões Intra-Arteriais/métodos , Metotrexato/farmacologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Hemorragia Uterina
14.
Rev Esp Cir Ortop Traumatol ; 63(3): 181-186, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30914237

RESUMO

INTRODUCTION: The proximal humerus is a common site for primary bone sarcomas, of which chondrosarcoma represents 15%. There are few reports about this select group of tumours. We set out to analyse a group of patients with proximal humerus chondrosarcoma treated with surgery and to assess their long term surgical and oncological outcomes. MATERIAL AND METHODS: A retrospective review was performed and all patients with a proximal humerus chondrosarcoma treated with surgery were included in the study. Overall survival and local recurrence rates were analyzed. Post-operative complications were recorded and limb salvage surgery failures classified according to the Henderson classification. RESULTS: 37 patients were included in the study. The median age was 46 years (SD: 15.6, range: 17-24), 24 (65%) were female and the mean follow-up was 8.5 years (SD: 6.4, range: 2 -26). Eighteen patients were classified as grade 1 (49%), 15 as grade 2 (40%), 2 as grade 3 (5%) and 2 dedifferentiated chondrosarcomas (5%). The 10-year overall survival was 94.5% and the 10-year event-free survival was 84.5%. Five patients developed local recurrences (13%) and none of them was grade 1. The reconstruction failure rate was 27% at 5 years and 34% at 10 years. There were no complications or local recurrence in patients treated with curettage. CONCLUSION: Proximal humerus chondrosarcoma presented high survival rates. Curettage and bone grafting is a safe procedure, with low risk of complications and local recurrence for grade 1 chondrosarcomas and should be the first indication for the proximal humerus. Reconstruction of the proximal humerus after a wide resection has a 5-year failure rate of 27% and 10-year failure rate of 34%.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Úmero/cirurgia , Adolescente , Adulto , Idoso , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Transplante Ósseo , Condrossarcoma/mortalidade , Condrossarcoma/patologia , Curetagem/métodos , Feminino , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Ombro , Resultado do Tratamento , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-30901063

RESUMO

INTRODUCTION: Sebaceous hyperplasia (SH) is a common cutaneous disorder associated with cosmetic problems. Some optional treatments and various laser devices have been reported to be effective, but recurrence and cosmetic outcome have not been resolved. METHODS: This interventional study was performed on SH lesions. First, the lesions were treated with a CO2 laser, and then the shrunken lesions were removed with a fine, sharp curette. RESULTS: A total of 46 patients (32 females and 14 males, mean age 39.9 ± 5.7 years) with SH skin lesions varying in severity were included in this study. The mean time of repair was 11.5 ± 1.9 days; a shorter repair time was seen in females and for mild extension lesions (p < 0.001). A fair cosmetic outcome was seen in 76.1% of cases, with better results reported for females and for skin types II and III (p < 0.001). CONCLUSIONS: The method reported herein is an easy, rapid, and effective procedure for the complete removal of SH lesions with few complications in the majority of patients with numerous lesions and Fitzpatrick skin types II-IV. Cosmetic outcomes are better in females and skin types II and III.


Assuntos
Curetagem/métodos , Dermatoses Faciais/terapia , Terapia a Laser/métodos , Glândulas Sebáceas/patologia , Dermatopatias/terapia , Adulto , Estudos de Coortes , Terapia Combinada/métodos , Estética , Dermatoses Faciais/patologia , Feminino , Seguimentos , Humanos , Hiperplasia/patologia , Hiperplasia/terapia , Lasers de Gás/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Dermatopatias/patologia , Resultado do Tratamento
16.
Cochrane Database Syst Rev ; 3: CD010778, 2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30845364

RESUMO

BACKGROUND: Grade I or low-grade chondrosarcoma (LGCS) is a primary bone tumour with low malignant potential. Historically, it was treated by wide resection, since accurate pre-operative exclusion of more aggressive cancers can be challenging and under-treatment of a more aggressive cancer could negatively influence oncological outcomes. Intralesional surgery for LGCS has been advocated more often in the literature over the past few years. The potential advantages of less aggressive treatment are better functional outcome and lower complication rates although these need to be weighed against the potential for compromising survival outcomes. OBJECTIVES: To assess the benefits and harms of intralesional treatment by curettage compared to wide resection for central low-grade chondrosarcoma (LGCS) of the long bones. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE and Embase up to April 2018. We extended the search to include trials registries, reference lists of relevant articles and review articles. We also searched 'related articles' of included studies suggested by PubMed. SELECTION CRITERIA: In the absence of prospective randomised controlled trials (RCTs), we included retrospective comparative studies and case series that evaluated outcome of treatment of central LGCS of the long bones. The primary outcome was recurrence-free survival after a minimal follow-up of 24 months. Secondary outcomes were upgrading of tumour; functional outcome, as assessed by the Musculoskeletal Tumor Society (MSTS) score; and occurrence of complications. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recognised by Cochrane. We conducted a systematic literature search using several databases and contacted corresponding authors, appraised the evidence using the ROBINS-I risk of bias tool and GRADE, and performed a meta-analysis. If data extraction was not possible, we included studies in a narrative summary. MAIN RESULTS: We included 18 studies, although we were only able to extract participant data from 14 studies that included a total of 511 participants; 419 participants were managed by intralesional treatment and 92 underwent a wide resection. We were not able to extract participant data from four studies, including 270 participants, and so we included them as a narrative summary only. The evidence was at high risk of performance, detection and reporting bias.Meta-analysis of data from 238 participants across seven studies demonstrated little or no difference in recurrence-free survival after intralesional treatment versus wide resection for central LGCS in the long bones (risk ratio (RR) 0.98; 95% confidence interval (CI) 0.92 to 1.04; very low-certainty evidence). MSTS scores were probably better after intralesional surgery (mean score 93%) versus resection (mean score 78%) with a mean difference of 12.69 (95% CI 2.82 to 22.55; P value < 0.001; 3 studies; 72 participants; low-certainty evidence). Major complications across six studies (203 participants) were lower in cases treated by intralesional treatment (5/125 cases) compared to those treated by wide resection (18/78 cases), with RR 0.23 (95% CI 0.10 to 0.55; low-certainty evidence). In four people (0.5% of total participants) a high-grade (grade 2 or dedifferentiated) tumour was found after a local recurrence. Two participants were treated with second surgery with no evidence of disease at their final follow-up and two participants (0.26% of total participants) died due to disease. Kaplan-Meier analysis of data from 115 individual participants across four studies demonstrated 96% recurrence-free survival after a maximum follow-up of 300 months after resection versus 94% recurrence-free survival after a maximum follow-up of 251 months after intralesional treatment (P value = 0.58; very low-certainty evidence). Local recurrence or metastases were not reported after 41 months in either treatment group. AUTHORS' CONCLUSIONS: Only evidence of low- and very low-certainty was available for this review according to the GRADE system. Included studies were all retrospective in nature and at high risk of selection and attrition bias. Therefore, we could not determine whether wide resection is superior to intralesional treatment in terms of event-free survival and recurrence rates. However, functional outcome and complication rates are probably better after intralesional surgery compared to wide resection, although this is low-certainty evidence, considering the large effect size. Nevertheless, recurrence-free survival was excellent in both groups and a prospective RCT comparing intralesional treatment versus wide resection may be challenging for both practical and ethical reasons. Future research could instead focus on less invasive treatment strategies for these tumours by identifying predictors that help to stratify participants for surgical intervention or close observation.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Curetagem/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Condrossarcoma/mortalidade , Condrossarcoma/patologia , Curetagem/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia , Estudos Retrospectivos , Adulto Jovem
17.
J Laryngol Otol ; 133(4): 294-299, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30885281

RESUMO

OBJECTIVE: To compare conventional cold curettage adenoidectomy with endoscopic assisted coblation adenoidectomy in terms of operative time, primary blood loss, post-operative residual tissue and post-operative pain. METHODS: This prospective non-randomised study was carried out on 60 patients aged 5-12 years. One group underwent conventional cold curettage adenoidectomy and the other underwent endoscopic assisted coblation adenoidectomy, with 30 patients per group. RESULTS: Mean operation duration was significantly higher for endoscopic assisted coblation adenoidectomy. Mean blood loss was 44.33 ml in conventional cold curettage adenoidectomy and 32.47 ml in endoscopic assisted coblation adenoidectomy. The pain grade was significantly lower in endoscopic assisted coblation adenoidectomy. Forty per cent of patients who underwent conventional cold curettage adenoidectomy had adenoid tissue post-surgery, while it was completely absent in endoscopic assisted coblation adenoidectomy patients. CONCLUSION: Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of reduced blood loss, no post-operative residual tissue and lower pain grade on day 1 after surgery.


Assuntos
Adenoidectomia/métodos , Curetagem/métodos , Endoscopia/métodos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , Pré-Escolar , Temperatura Baixa , Feminino , Humanos , Masculino , Duração da Cirurgia , Dor/etiologia , Medição da Dor , Estudos Prospectivos
18.
BMC Musculoskelet Disord ; 20(1): 134, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30922289

RESUMO

BACKGROUND: Sufficient data on outcome of patients with clinically and radiologically aggressive enchondromas and atypical cartilaginous tumors (ACT) is lacking. We therefore analyzed both conservatively and surgically treated patients with lesions, which were not distinguishable between benign enchondroma and low-grade malignant ACT based upon clinical and radiologic appearance. METHODS: The series included 228 consecutive cases with a follow-up > 24 months to assess radiological, histological, and clinical outcome including recurrences and complications. Pain, satisfaction, functional limitations, and the musculoskeletal tumor society (MSTS) score were evaluated to judge both function and emotional acceptance at final follow-up. RESULTS: Follow-up took place at a mean of 82 (median 75) months. The 228 patients all had comparable clinical and radiological findings. Of these, 153 patients were treated conservatively, while the other 75 patients underwent intralesional curettage. Besides clinical and radiological aggressiveness, most lesions were histologically judged as benign enchondromas. 9 cases were determined to be ACT, while the remaining 7 cases had indeterminate histology. After surgery, three patients developed a recurrence, and a further seven had complications of which six were related to osteosynthesis. Both groups had excellent and almost equal MSTS scores of 96 and 97%, respectively, but significantly less functional limitations were found in the non-surgery group. Further sub-analyses were performed to reduce selection bias. Sub-analysis of histologically diagnosed enchondromas in the surgery group found more pain, less function, and worse MSTS score compared to the non-surgery group. Sub-analysis of smaller lesions (< 4.4 cm) did not show significant differences. In contrast, larger lesions displayed significantly worse results after surgery compared to conservative treatment (enchondromas > 4.4 cm: MSTS score: 94.0% versus 97.3%, p = 0.007; pain 2.3 versus 0.8, p = 0.001). The majority of lesions treated surgically was filled with polymethylmethacrylate bone-cement, while the remainder was filled with cancellous-bone, without significant difference in clinical outcome. CONCLUSION: Feasibility of intralesional curettage strategies for symptomatic benign to low-grade malignant chondrogenic tumors was supported. Surgery, however, did not prove superior compared to conservative clinical and radiological observation. Due to the low risk of transformation into higher-grade tumors and better functional results, more lesions might just be observed if continuous follow-up is assured.


Assuntos
Neoplasias Ósseas/terapia , Condroma/terapia , Condrossarcoma/terapia , Tratamento Conservador/métodos , Curetagem/métodos , Ossos do Braço/diagnóstico por imagem , Ossos do Braço/patologia , Ossos do Braço/cirurgia , Cimentos para Ossos/uso terapêutico , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/patologia , Condroma/diagnóstico por imagem , Condroma/patologia , Condrossarcoma/epidemiologia , Condrossarcoma/patologia , Tomada de Decisão Clínica , Tratamento Conservador/efeitos adversos , Curetagem/efeitos adversos , Feminino , Seguimentos , Humanos , Ossos da Perna/diagnóstico por imagem , Ossos da Perna/patologia , Ossos da Perna/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Seleção de Pacientes , Polimetil Metacrilato/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
19.
Jpn J Clin Oncol ; 49(4): 379-382, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30796832

RESUMO

A randomized phase III trial was planned to commence in October 2017. Resectable giant cell tumor of bone (GCTB) without possible postoperative large bone defect has been treated by curettage with local adjuvant treatment, with the local recurrence rate found to be as high as 24.6-30.8%. The aim of this study is to confirm the superiority of preoperative denosumab for patients with GCTB without possible postoperative large bone defect. A total of 106 patients will be accrued from 34 Japanese institutions over 5 years. The primary endpoint is relapse-free survival (RFS). Secondary endpoints include overall survival, joint-preserved survival, local RFS, metastasis-free survival, adverse events, serious adverse events, surgical and postoperative complications, and discontinuation of denosumab. This trial is conducted by the Bone and Soft Tissue Tumor Study Group in the Japan Clinical Oncology Group and has been registered in the UMIN Clinical Trials Registry as UMIN000029451 [http://www.umin.ac.jp/ctr/index.htm].


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/cirurgia , Denosumab/uso terapêutico , Tumor de Células Gigantes do Osso/cirurgia , Adulto , Neoplasias Ósseas/tratamento farmacológico , Osso e Ossos/patologia , Osso e Ossos/cirurgia , Curetagem/métodos , Feminino , Tumor de Células Gigantes do Osso/tratamento farmacológico , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Projetos de Pesquisa
20.
J Surg Oncol ; 119(7): 864-872, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30734307

RESUMO

BACKGROUND: There are conflicting reports for the outcome of the patients with giant cell tumor of bone (GCTB) and pathological fracture at presentation treated with curettage or resection. This study compared local recurrence, complications, and function after curettage versus resection for these patients. MATERIALS AND METHODS: We retrospectively studied the files of 46 patients with histologically confirmed GCTB of the extremities admitted and treated from 1982 to 2015. The median follow-up was 79.5 months (57.0-125.5 months). We evaluated local recurrence and type of surgery-related complications with imaging and function with the Musculoskeletal Tumor Society (MSTS) score. RESULTS: Overall local recurrence was 6.5%. There were one patient with curettage and two patients with resection; local recurrence rate was similar between the two procedures but the time to local recurrence was shorter after curettage. MSTS score was significantly better after curettage. Complications occurred in two patients after curettage and in five patients after resection; because of the low number of patients with complications, a statistical comparison was not possible; however, by direct comparison of the numbers, complications were more common after resection compared with curettage. CONCLUSION: Curettage is recommended for GCTB and pathological fracture at presentation because of similar local recurrence but better function compared with resection. The treating physicians should be aware and inform their patients for a shorter time to local recurrence after curettage and for more complications after resection.


Assuntos
Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Fraturas Espontâneas/etiologia , Tumor de Células Gigantes do Osso/patologia , Tumor de Células Gigantes do Osso/cirurgia , Recidiva Local de Neoplasia/patologia , Adulto , Curetagem/efeitos adversos , Curetagem/métodos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Fraturas Espontâneas/patologia , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Adulto Jovem
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