RESUMEN
During diving, arterial Pco(2) (Pa(CO(2))) levels can increase and contribute to psychomotor impairment and unconsciousness. This study was designed to investigate the effects of the hypercapnic ventilatory response (HCVR), exercise, inspired Po(2), and externally applied transrespiratory pressure (P(tr)) on Pa(CO(2)) during immersed prone exercise in subjects breathing oxygen-nitrogen mixes at 4.7 ATA. Twenty-five subjects were studied at rest and during 6 min of exercise while dry and submersed at 1 ATA and during exercise submersed at 4.7 ATA. At 4.7 ATA, subsets of the 25 subjects (9-10 for each condition) exercised as P(tr) was varied between +10, 0, and -10 cmH(2)O; breathing gas Po(2) was 0.7, 1.0, and 1.3 ATA; and inspiratory and expiratory breathing resistances were varied using 14.9-, 11.6-, and 10.2-mm-diameter-aperture disks. During exercise, Pa(CO(2)) (Torr) increased from 31.5 +/- 4.1 (mean +/- SD for all subjects) dry to 34.2 +/- 4.8 (P = 0.02) submersed, to 46.1 +/- 5.9 (P < 0.001) at 4.7 ATA during air breathing and to 49.9 +/- 5.4 (P < 0.001 vs. 1 ATA) during breathing with high external resistance. There was no significant effect of inspired Po(2) or P(tr) on Pa(CO(2)) or minute ventilation (Ve). Ve (l/min) decreased from 89.2 +/- 22.9 dry to 76.3 +/- 20.5 (P = 0.02) submersed, to 61.6 +/- 13.9 (P < 0.001) at 4.7 ATA during air breathing and to 49.2 +/- 7.3 (P < 0.001) during breathing with resistance. We conclude that the major contributors to increased Pa(CO(2)) during exercise at 4.7 ATA are increased depth and external respiratory resistance. HCVR and maximal O(2) consumption were also weakly predictive. The effects of P(tr), inspired Po(2), and O(2) consumption during short-term exercise were not significant.
Asunto(s)
Dióxido de Carbono/sangre , Buceo/efectos adversos , Ejercicio Físico , Hipercapnia/etiología , Posición Prona , Fenómenos Fisiológicos Respiratorios , Adaptación Fisiológica , Adulto , Resistencia de las Vías Respiratorias , Presión Atmosférica , Espiración , Femenino , Humanos , Hipercapnia/sangre , Hipercapnia/fisiopatología , Inmersión , Inhalación , Masculino , Persona de Mediana Edad , Modelos Biológicos , Oxígeno/sangre , Consumo de Oxígeno , Presión Parcial , Ventilación Pulmonar , Espacio Muerto Respiratorio , Factores de Riesgo , Regulación hacia Arriba , Adulto JovenRESUMEN
Immersion pulmonary edema (IPE) is a condition with sudden onset in divers and swimmers suspected to be due to pulmonary arterial or venous hypertension induced by exercise in cold water, although it does occur even with adequate thermal protection. We tested the hypothesis that cold head immersion could facilitate IPE via a reflex rise in pulmonary vascular pressure due solely to cooling of the head. Ten volunteers were instrumented with ECG and radial and pulmonary artery catheters and studied at 1 atm absolute (ATA) during dry and immersed rest and exercise in thermoneutral (29-31 degrees C) and cold (18-20 degrees C) water. A head tent varied the temperature of the water surrounding the head independently of the trunk and limbs. Heart rate, Fick cardiac output (CO), mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), and central venous pressure (CVP) were measured. MPAP, PAWP, and CO were significantly higher in cold pool water (P < or = 0.004). Resting MPAP and PAWP values (means +/- SD) were 20 +/- 2.9/13 +/- 3.9 (cold body/cold head), 21 +/- 3.1/14 +/- 5.2 (cold/warm), 14 +/- 1.5/10 +/- 2.2 (warm/warm), and 15 +/- 1.6/10 +/- 2.6 mmHg (warm/cold). Exercise values were higher; cold body immersion augmented the rise in MPAP during exercise. MAP increased during immersion, especially in cold water (P < 0.0001). Except for a transient additive effect on MAP and MPAP during rapid head cooling, cold water on the head had no effect on vascular pressures. The results support a hemodynamic cause for IPE mediated in part by cooling of the trunk and extremities. This does not support the use of increased head insulation to prevent IPE.
Asunto(s)
Regulación de la Temperatura Corporal , Frío , Buceo/efectos adversos , Ejercicio Físico , Hemodinámica , Inmersión , Edema Pulmonar/etiología , Agua , Adulto , Presión Atmosférica , Dióxido de Carbono/sangre , Gasto Cardíaco , Presión Venosa Central , Extremidades , Femenino , Cabeza , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Circulación Pulmonar , Edema Pulmonar/sangre , Edema Pulmonar/fisiopatología , Presión Esfenoidal Pulmonar , Respiración , Adulto JovenRESUMEN
Findings reported in the literature on the sensation provided by intraorally applied innervated vs. non-innervated radial forearm free flaps differ. In an effort to understand these differences in sensory recovery, the authors carried out sensory evaluations in 12 patients who had undergone radial forearm free flaps. Seven patients had innervated flaps for defects of the tongue and floor of mouth; five had non-innervated flaps to various sites. Flap sensitivity to temperature, light touch, dull touch, and sharpness and two-point discrimination was assessed at the donor site and contralaterally, and at the recipient site and contralateral mirror-image oral mucosa. Patients subjectively rated post-reconstruction sensation and provided quality of life (QOOL) data. The innervated flaps demonstrated better sensory recovery than the non-innervated flaps, although the latter did restore reasonable sensation. This paper describes the results, compares the study to other similar studies, and discusses various factors in the sensory recovery of both innervated and non-innervated intraoral radial forearm free flaps. The authors conclude that, although the trend in this study is toward improved function with the innervated flaps, these flaps do not appear to offer major intraoral functional advantage over the non-innervated flaps, which attain reasonably effective sensory recovery from neural ingrowth, if the lingual nerve is intact.
Asunto(s)
Enfermedades de la Boca/cirugía , Procedimientos de Cirugía Plástica/métodos , Sensación/fisiología , Colgajos Quirúrgicos/inervación , Adolescente , Adulto , Anciano , Femenino , Antebrazo , Humanos , Masculino , Persona de Mediana Edad , Percepción , Valores de Referencia , Sensibilidad y Especificidad , Trasplante de Piel , Enfermedades de la Lengua/cirugía , Resultado del TratamientoRESUMEN
In an effort to evaluate quality-of-life benefits of ablative head and neck cancer surgery and microvascular reconstruction, a longitudinal study was undertaken in which patients with T3 or T4 oropharyngeal cancers without systemic metastases at presentation were administered both general and disease-specific quality-of-life instruments preoperatively and postoperatively. In an initial prospective pilot study, 17 cancer patients were evaluated both preoperatively and postoperatively using the Medical Outcomes Short-Form Health Survey questionnaire (SF-36) and the Performance Status Scale for Head and Neck Cancer Patients. In the second part of the study, the need was recognized for a different disease-specific measure, for more frequent intervals of longitudinal follow-up (rather than be limited by a single data collection point), and for a noncancer control group. Since then, 17 more cancer patients were evaluated in the second part of the study and were compared with patients who had similar reconstructions after suffering head and neck trauma and also with age-matched controls. Instead of the performance status scale, the University of Washington Head and Neck Quality of Life questionnaire was substituted. Interval assessments were done at 1, 3, 6, and 12 months and preoperatively. Whereas many of the general and disease-specific quality of life subclasses initially worsened following extensive surgery and radiation therapy, most returned to the preoperative baseline by 6 months following conclusion of treatment and surpassed pretreatment values at 1 year. It can be concluded, based on this study, that large resections and reconstructions for head and neck cancer patients are justified in terms of outcome; the resection controls the local disease, and the microvascular reconstruction restores quality of life and functional status.
Asunto(s)
Microcirugia/métodos , Neoplasias Orofaríngeas/cirugía , Calidad de Vida , Actividades Cotidianas/psicología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/psicología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/psicología , Estudios Prospectivos , Reoperación , Perfil de Impacto de Enfermedad , Colgajos QuirúrgicosRESUMEN
Typically the lateral antebrachial cutaneous nerve alone is used to innervate the radial forearm free flap when a sensate flap is required. The authors desired, by means of fresh cadaveric microdissections and by means of local anesthetic injections in living subjects, to map the sensory nerve territories of this flap. Eight radial forearm flaps were elevated and the medial antebrachial cutaneous nerve (MABC), lateral antebrachial cutaneous nerve (LABC), and superficial radial sensory nerve (SRSN) were dissected with the aid of an operating microscope (2.5-10x) and traced to their dermal insertions. In the injection study, the MABC, LABC, and SRSN in eight forearms of 4 subjects were blocked sequentially with 2% lidocaine injections. The resulting sensory deficit from each injection was mapped on the skin and superimposed on the marked radial forearm flap territory. Distribution of the three dissected nerve regions and the sensory deficit after injection were determined by digital images and computer analysis. During flap dissections, mean nerve distributions of total flap area were as follows: LABC, 61.8% (range, 48.3-71.6%); MABC, 33.8% (range, 30.5-38.9%); and SRSN, 34.6% (range, 26.8-44.1%). After nerve block the mapped sensory areas were as follows: LABC, 62.3% (range, 44.5-88.5%); MABC, 19.6% (range, 8.0-35.8%); and SRSN, 19.5% (range, 9.9-26.3%). At least 40% of the total flap area was not innervated by the LABC as identified both by nerve dissection and sensory local anesthetic blockade. By including the LABC, MABC, and SRSN in the radial forearm flap, both the theoretical and the clinically determined useful sensory innervation of the radial forearm flap potentially would be increased.
Asunto(s)
Antebrazo/inervación , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos/inervación , Antebrazo/cirugía , HumanosRESUMEN
Rehabilitation of the midface in chronic facial paralysis is one of the last frontiers in global facial reanimation. The suborbicularis oculi fat pad lift, or SOOF lift, also known as the midface lift, has been popularized in aesthetic surgery literature as a way to restore midface fullness with a youthful appearance while eliminating midface sag associated with aging. These techniques of midface aesthetic rejuvenation have recently been applied in cases of chronic facial paralysis. This article analyzes the role of the midface lift or SOOF lift in cases of facial reanimation and determines whether or not it is of benefit to patients affected by chronic facial paralysis.
Asunto(s)
Enfermedades de los Párpados/cirugía , Párpados/cirugía , Parálisis Facial/rehabilitación , Parálisis Facial/cirugía , Procedimientos de Cirugía Plástica/métodos , Tejido Adiposo/cirugía , Enfermedad Crónica , Ectropión/cirugía , Humanos , RejuvenecimientoRESUMEN
BACKGROUND: Although the microvascular transfer of the serratus/rib myo-osseous composite flap has been previously described, the indications for its use in head and neck reconstruction have not been fully explored. Slender and easily contoured, rib bone offers reconstructive advantages over other bone sources under certain circumstances. The serratus/rib myo-osseous flap can provide vascularized muscle, bone, and cartilage; in combination with the latissimus dorsi muscle, the serratus/rib flap provides additional soft-tissue bulk on a single thoracodorsal vascular pedicle unrestricted by orientation requirements of the bone. Many orientations of bone and soft tissue are possible. METHODS: We describe, through three illustrative cases, the indications for this flap, which might include bony, cartilaginous, and soft-tissue requirements in the retromolar trigone region, large calvarial defects, and large composite full-thickness cheek and mandibular defects. CONCLUSIONS: The serratus/rib composite myo-osseous flap reliably provides vascularized bone of relatively delicate composition which offers advantages in certain reconstructive circumstances. In addition, when combined with latissimus dorsi muscle on a single vascular pedicle, it supplies additional soft-tissue bulk which can be positioned without being constrained by the bone placement. Finally, this is a useful "backup" supply of vascularized bone when other sources cannot be used due to, for example, inability to use fibula in the face of severe peripheral vascular disease and inability to use iliac crest if this has been previously used as a donor site for nonvascularized free grafts (as in secondary reconstructions).
Asunto(s)
Trasplante Óseo/métodos , Músculo Esquelético/trasplante , Cuello/cirugía , Cráneo/cirugía , Colgajos Quirúrgicos , Adulto , Trasplante Óseo/patología , Carcinoma Adenoide Quístico/cirugía , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Cartílago/anatomía & histología , Cartílago/irrigación sanguínea , Cartílago/trasplante , Mejilla/cirugía , Músculos Faciales/cirugía , Peroné , Humanos , Ilion , Masculino , Mandíbula/cirugía , Enfermedades Mandibulares/cirugía , Neoplasias Mandibulares/radioterapia , Neoplasias Mandibulares/cirugía , Microcirugia , Persona de Mediana Edad , Músculo Esquelético/anatomía & histología , Músculo Esquelético/irrigación sanguínea , Osteorradionecrosis/cirugía , Neoplasias de la Parótida/cirugía , Enfermedades Vasculares Periféricas/complicaciones , Reproducibilidad de los Resultados , Costillas , Fracturas Craneales/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/patología , TóraxRESUMEN
BACKGROUND: It is a common perception that the overall health of patients with head and neck cancer (HNC) is likely to be poor compared with the general population. This project was undertaken to investigate the pre- and post-treatment, global health status of HNC patients in comparison with age-matched, U.S. population norms using a self-administered general health status survey. METHODS: Between July 1, 1993, and May 1, 1996, 180 patients underwent pretreatment and 6 month follow-up evaluation with the standard version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The SF-36 scale scores, means, standard deviations, and 95% confidence intervals were calculated for each SF-36 scale as well as for physical-health-component summary scores (PCS) and mental-health-component summary scores (MCS). Comparisons of these scores were made to U.S. population normative data. Pretreatment and 6-month follow-up SF-36 scores were compared. RESULTS: In the 45-54-year age group, all 8 SF-36 scale scores, the PCS, and MCS scores were significantly worse for the HNC patients in comparison with age-matched norms (p < .05). In the 55-64-year age group, the HNC patients were worse in 5 of the 8 SF-36 scale scores and the MCS score in comparison with age-matched norms (p < .05). In the 65-74-year age group, the HNC patients scored significantly worse in the mental health scale. In the comparison of pretreatment and 6-month follow-up scores, the HNC patients had significant decreases in the physical functioning scale (p = .003) and the PCS score (p = .047). The HNC patients showed significant improvement in the mental health scale (p = .049) and improvement in the bodily-pain scale, which approached significance (p = .053) at 6-month follow-up. The HNC patients showed a marked decrease in general health status with increasing stage of HNC. CONCLUSIONS: This work provides objective support for the perception that many HNC patients are initially seen for treatment with baseline health status functioning significantly below their age-matched contemporaries in the general population. An educated evaluation of global health outcomes following treatment in the HNC patient population must begin with an accurate pretreatment assessment of these parameters. Self-reported health-status assessment (HSA) is a useful means of evaluating global health status in this patient population.
Asunto(s)
Neoplasias de Cabeza y Cuello , Estado de Salud , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/terapia , Humanos , Persona de Mediana Edad , Valores de Referencia , Estados UnidosRESUMEN
BACKGROUND: Although allergic fungal sinusitis is a relatively common, noninvasive form of paranasal sinus mycosis, and despite frequent orbital involvement, there have been few reports of this condition in the ophthalmic literature. METHODS: Two cases of allergic fungal sinusitis having orbital symptoms are described. The current classification, typical presentation, and ideal management of fungal sinusitis are reviewed. RESULTS: Distinguishing radiologic and pathologic features were present in both patients. Aspergillus flavus was cultured in one case, and Bipolaris spicifera was cultured in the other. CONCLUSIONS: Allergic fungal sinusitis is a unique subset of sino-orbital disease with highly characteristic clinical, radiologic, and pathologic features. Unlike invasive forms of mycotic disease, allergic fungal sinusitis may be managed adequately with surgical debridement, aeration of the involved sinuses, and systemic and topical corticosteroids.
Asunto(s)
Infecciones Fúngicas del Ojo/etiología , Hipersensibilidad/microbiología , Micosis/etiología , Enfermedades Orbitales/microbiología , Sinusitis/microbiología , Adulto , Antifúngicos/uso terapéutico , Aspergillus flavus/aislamiento & purificación , Desbridamiento , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/terapia , Femenino , Glucocorticoides/uso terapéutico , Humanos , Hipersensibilidad/diagnóstico , Hipersensibilidad/terapia , Itraconazol/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Hongos Mitospóricos/aislamiento & purificación , Micosis/diagnóstico , Micosis/terapia , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/terapia , Senos Paranasales/microbiología , Senos Paranasales/patología , Sinusitis/diagnóstico , Sinusitis/terapia , Tomografía Computarizada por Rayos XRESUMEN
Intracranial suppurative complications of sinusitis remain a challenging and contemporary topic. To determine the prevalence of sinogenic sources in intracranial infectious complications, we reviewed the records at a large public hospital between 1985 and 1995. There were 203 patients with 212 suppurative intracranial infections. Sinogenic sources were identified in 12 patients with 19 infections. Most patients had ethmoid or frontal sinusitis. We discuss the presentation, microbiology, diagnosis, treatment, and clinical course of these 12 cases. The diagnosis of intracranial complications of sinusitis requires a high index of suspicion and radiographic imaging of the head and paranasal sinuses. The mean hospital stay was 31.4 days and all 12 patients survived, although three patients had significant neurologic sequelae.
Asunto(s)
Encefalopatías/microbiología , Infección Focal/complicaciones , Sinusitis/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Anciano , Absceso Encefálico/etiología , Niño , Enfermedad Crónica , Empiema Subdural/etiología , Sinusitis del Etmoides/complicaciones , Sinusitis del Etmoides/microbiología , Femenino , Sinusitis Frontal/complicaciones , Sinusitis Frontal/microbiología , Infecciones por Bacterias Gramnegativas , Humanos , Tiempo de Internación , Masculino , Meningitis Bacterianas/etiología , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Trombosis de los Senos Intracraneales/microbiología , Sinusitis/microbiología , Infecciones Estafilocócicas , Infecciones Estreptocócicas , Tasa de SupervivenciaRESUMEN
For the discussion of options in late reconstruction of residual posttraumatic calvarial defects in adults, the calvaria is divided into three reconstructive zones. Zone 1 comprises the frontal sinus region and the contour of the supraorbital brow; Zone 2 comprises the smooth, cosmetically visible prehairline forehead; Zone 3 comprises the posthairline area and the calvaria. The particular reconstructive requirements (autogenous bone versus alloplastic material) of each zone are described and illustrated with clinical cases. The merits of bone from various donor sites and those of alloplastic material are discussed. The authors present an algorithm of reconstructive choices for residual posttraumatic calvarial defects in adults based on the nature of the defect and the aesthetic reconstructive zone.
Asunto(s)
Algoritmos , Enfermedades Óseas/cirugía , Cráneo/lesiones , Adulto , Enfermedades Óseas/clasificación , Sustitutos de Huesos/uso terapéutico , Trasplante Óseo , Estética , Frente/lesiones , Frente/cirugía , Hueso Frontal/lesiones , Hueso Frontal/cirugía , Seno Frontal/lesiones , Seno Frontal/cirugía , Humanos , Masculino , Hueso Occipital/lesiones , Hueso Occipital/cirugía , Órbita/lesiones , Órbita/cirugía , Hueso Parietal/lesiones , Hueso Parietal/cirugía , Procedimientos de Cirugía Plástica/métodos , Cráneo/cirugía , Base del Cráneo/lesiones , Base del Cráneo/cirugía , Fracturas Craneales/cirugía , Infección de la Herida Quirúrgica/cirugía , Hueso Temporal/lesiones , Hueso Temporal/cirugíaRESUMEN
Surgical decompression of the optic canal is indicated in patients with traumatic optic neuropathy who fail to respond to corticosteroids. Traditional surgical approaches to the orbital apex have been effective in achieving optic nerve decompression but require either a craniotomy, provide limited exposure with late identification and protection of the optic nerve, or require external incisions. The combined transconjunctival/intranasal endoscopic approach to the optic canal offers sufficient exposure, allows early identification and protection of the optic nerve, provides space for the use of multiple surgical instruments, obviates a craniotomy and external incisions, and can be performed quickly with minimal morbidity. The technique of combined transconjunctival/intranasal endoscopic optic nerve decompression will be described and the experience with nine cases will be presented.
Asunto(s)
Conjuntiva/cirugía , Endoscopía , Nariz/cirugía , Traumatismos del Nervio Óptico , Órbita/cirugía , Hueso Esfenoides/cirugía , Adolescente , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Adulto , Pérdida de Sangre Quirúrgica , Craneotomía , Electrocoagulación/instrumentación , Electrocoagulación/métodos , Endoscopios , Endoscopía/métodos , Femenino , Humanos , Aparato Lagrimal/cirugía , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/cirugía , Nervio Óptico/cirugía , Enfermedades del Nervio Óptico/etiología , Enfermedades del Nervio Óptico/cirugía , Estudios Retrospectivos , Fracturas Craneales/complicaciones , Seno Esfenoidal/cirugía , Factores de Tiempo , Cornetes Nasales/cirugía , Trastornos de la Visión/cirugíaRESUMEN
We performed a fresh cadaver dissection study of the superficial venous system (cephalic vein and its branches) and the deep venous system (venae comitantes) of the radial forearm to assess the suitability of each system for venous anastomosis during free tissue transfer. We used methyl methacrylate to evaluate vessel diameters and anatomic variability of both venous systems. Colored radiopaque injectate allowed us to combine anatomic dissection with tissue radiographs. We discovered the cephalic vein to invariably be of larger caliber than the venae comitantes. Ensuring capture of the cephalic vein in the flap necessitated additional dorsoradial subcutaneous dissection beyond the boundaries of the skin flap in four of ten specimens. The vessel diameters of the venae comitantes in four cadavers were less than 2 mm. Proximal confluence of the two venae comitantes, and communication between the deep and superficial venous systems were encountered in only four cases. In these cases, had an anastomotic site been chosen proximal to such a communication to ensure greater vessel caliber, pedicle length probably would have made free tissue transfer unwieldy. We recommend mapping the course of the cephalic vein before flap elevation and maintaining a wide proximal subcutaneous pedicle to capture the best possible superficial drainage system. If the superficial venous system has been damaged (as by previous intravenous catheterization), one may not necessarily be able to rely on the vessel caliber of the deep venae comitantes for microvenous anastomosis.
Asunto(s)
Antebrazo/cirugía , Colgajos Quirúrgicos , Arteria Braquial/cirugía , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Basal cell carcinoma (BCC) is the most common malignancy in whites, but it rarely occurs in dark persons. OBJECTIVE: To report a BCC on the hairy scalp of an Asian Indian female with no obvious risk factors except previous scalp trauma. METHODS: We review the English literature concerning BCC in Indians, and compare this with data for North American blacks and whites; and reports of BCC arising in areas of prior trauma. RESULTS/CONCLUSION: Skin cancer accounts for 1-2% of malignancies in blacks and Indians, compared with one-third of neoplasms in whites. BCC comprises 75% of skin cancers in whites, but squamous cell carcinoma represents 60-65% of skin cancers in blacks and Indians. Although most BCCs occur in sun-exposed areas in whites, blacks, and Indians, a significant percentage also develop in photoprotected areas. Trauma may be a significant risk factor for BCC, either with actinic damage or alone, as in our case.
Asunto(s)
Carcinoma Basocelular/etnología , Cuero Cabelludo , Neoplasias Cutáneas/etnología , Población Negra , Carcinoma Basocelular/patología , Carcinoma de Células Escamosas/etnología , Femenino , Humanos , India/etnología , Persona de Mediana Edad , Neoplasias Cutáneas/patología , Pigmentación de la Piel , Estados Unidos , Población BlancaRESUMEN
BACKGROUND: Previously, the importance of providing skin for intraoral lining for full-thickness mucocutaneous defects has been emphasized. More recently, simple skin grafting of the intraoral portion of muscle flaps has been described. METHODS: Six patients were evaluated who had full-thickness mucocutaneous defects reconstructed by means of free muscle flaps with skin grafting of the intraoral muscle surface. An illustrative case is provided. A technique of preplacing the skin graft on the muscle prior to microvascular transfer is described. Mucosal biopsies were performed at the reconstruction site. RESULTS: All patients had complete take of the skin grafts. No fistulas occurred. Functional and esthetic results were satisfactory. CONCLUSIONS: The ideal candidate for this form of reconstruction is one in whom there is a large, full-thickness mucocutaneous defect. Preplacement of the skin graft reduces ischemia time, allows suturing of the skin graft to the muscle surface outside the narrow confines of the oral cavity, and enables placement of multiple quilting sutures that secure the graft against shear forces and so obviate the need for a stent dressing.
Asunto(s)
Boca/cirugía , Músculo Esquelético/trasplante , Trasplante de Piel/métodos , Colgajos Quirúrgicos/métodos , Anciano , Trasplante Óseo/métodos , Trasplante Óseo/patología , Carcinoma de Células Escamosas/rehabilitación , Carcinoma de Células Escamosas/cirugía , Epitelio/patología , Estudios de Seguimiento , Humanos , Isquemia/prevención & control , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Mucosa Bucal/patología , Neoplasias de la Boca/rehabilitación , Neoplasias de la Boca/cirugía , Músculo Esquelético/irrigación sanguínea , Trasplante de Piel/patología , Colgajos Quirúrgicos/patología , Técnicas de SuturaRESUMEN
Basal cell carcinoma (BCC), the most common skin cancer in the United States, is locally invasive but has a low risk of metastasis. BCC is rare in black patients but, regardless of racial origin, most BCC occurs on sun-exposed areas. We describe a 67-year-old black man with a large BCC on the hairy scalp, a relatively sun-protected area, that metastasized to the spine. To our knowledge, this is the first description of a black patient with development of metastatic BCC on an otherwise normal scalp.
Asunto(s)
Carcinoma Basocelular/secundario , Cuero Cabelludo , Neoplasias Cutáneas/patología , Neoplasias de la Médula Espinal/secundario , Anciano , Población Negra , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/etnología , Carcinoma Basocelular/terapia , Humanos , Masculino , Neoplasias Cutáneas/etnología , Neoplasias Cutáneas/terapia , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/etnología , Neoplasias de la Médula Espinal/terapiaRESUMEN
Giant fibrovascular polyps of the esophagus and hypopharynx are benign tumors of the upper digestive tract. Although a rare cause of asphyxiation, laryngeal impaction by a regurgitated polyp of the esophagus may be the initial symptom that brings the patient to request medical attention. Two new cases of giant fibrovascular polyps with dramatic and potentially life-threatening presentations illustrate the unpredictable behavior of these unusual tumors. Both patients presented to the emergency center with a history of coughing and eructation followed by temporary airway obstruction that was relieved by clenching a regurgitated fleshy mass between the teeth. Diagnostic and therapeutic intervention requires aggressive airway management, radiographic and endoscopic evaluation, and definitive surgical treatment. Tracheotomy was required in one patient, and successful endotracheal intubation provided satisfactory airway control in the second. Esophagoscopy revealed the origin of both tumors to be near the cricopharyngeal muscle. Complete surgical excision was curative in both cases.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Neoplasias Esofágicas/complicaciones , Hipofaringe , Neoplasias Faríngeas/complicaciones , Pólipos/complicaciones , Anciano , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Faríngeas/patología , Neoplasias Faríngeas/cirugía , Pólipos/patología , Pólipos/cirugíaRESUMEN
The torn earlobe is a common problem, yet no objective analysis of causation or management is found in the literature. We present a series of 68 patients with statistical data on earlobe characteristics and cleft-related historical factors. We describe three new methods of repair: two for full clefts and one for partial clefting (ie, elongation of the piercing site without penetration of the inferior rim). We report follow-up from 4 to 10 years, with a 91% success rate for lobe appearance and a 1.2% recurrence of clefting. We offer guidelines for repair and repiercing based on lobe thickness and shape. We make recommendations for earring use based on lobe characteristics and historical development of the defect.