RESUMEN
We report a case of cervical esophageal perforation caused by the Heimlich maneuver in a healthy 16-year-old boy. The patient reported a short coughing episode while eating rice, and his mother performed the Heimlich maneuver on him. Five days later, he presented to the emergency department with throat pain, odynophagia, secretion intolerance, muffled voice, and neck stiffness. He was admitted to the pediatric intensive care unit for conservative management. The next day he underwent transcervical incision and drainage of purulence, but the esophageal perforation could not be visualized at that time. The perforation was identified several days later and successfully repaired surgically. Esophageal perforation as a complication of the Heimlich maneuver is exceedingly rare, but the clinician should be aware of this entity in the differential diagnosis, as it is associated with a high mortality rate and warrants multidisciplinary care, including timely surgical intervention.
Asunto(s)
Perforación del Esófago/etiología , Maniobra de Heimlich/efectos adversos , Adolescente , Humanos , MasculinoRESUMEN
Mohs micrographic surgery has become the standard of care for the treatment of cutaneous malignancies. Reconstructing cutaneous defects of the nose can be challenging, as form and function must be respected to the greatest extent possible. A wide range of reconstructive techniques are used. Secondary intent, primary closure, skin grafts, local flaps, and the interpolated workhorse flaps represent the spectrum of options, each with specific advantages and disadvantages. Vigilant postoperative care, including judicious use of adjunctive procedures, can improve outcomes. A subunit approach to reconstruction aids with surgical planning in order to achieve the best possible results.
Asunto(s)
Procedimientos Quirúrgicos Dermatologicos/métodos , Deformidades Adquiridas Nasales/cirugía , Trasplante de Piel/métodos , Colgajos Quirúrgicos/trasplante , Femenino , Humanos , Masculino , Ilustración Médica , Cirugía de Mohs , Fotograbar , Técnicas de Cierre de HeridasRESUMEN
Aging of the midface is a complex aesthetic problem requiring an individualized and multifaceted surgical approach. The objective of harmonious rejuvenation of the entire face as well as increasing patient interest in midface rejuvenation mandates surgical familiarity with these techniques. Midface rejuvenation procedures have evolved from traditional laterally based rhytidectomy techniques with superolateral elevation to modern centrofacial approaches designed to achieve more vertical vectors of elevation. These approaches are informed by an evolving understanding of the multiple processes that contribute to the aged appearance of the midface and are based on lower blepharoplasty surgical techniques.
Asunto(s)
Ritidoplastia/métodos , Blefaroplastia , Cara/anatomía & histología , Cara/fisiopatología , Humanos , RejuvenecimientoRESUMEN
Anaplastic thyroid carcinoma (ATC) is an uncommon thyroid malignancy. Noninvasive ATC is a rare, surgically resectable variant with only four reported cases. We report a case of an 81-year-old man who presented with a 3.1 cm right thyroid lobe mass that on fine-needle aspiration biopsy was diagnosed as an ATC. Preoperative imaging revealed an encapsulated thyroid tumor without evidence of invasion of surrounding structures and no locoregional and distant metastases. A total thyroidectomy was performed that by histologic and immunohistochemical evaluation was diagnostic for a noninvasive ATC. Given the diagnosis of noninvasive ATC, adjuvant therapy was not administered. At 14 months following diagnosis, the patient remains disease free based on positron emission tomography/computed tomography imaging. A review of the outcomes of similar cases reported in the literature, as well as observations from our case, suggest a favorable prognosis for patients with noninvasive ATC. Noninvasive ATC may represent a distinct subset of resectable ATCs with an improved prognosis. The recently published American Thyroid Association (ATA) Guidelines for Management of Patients with ATC do not include this specific form of ATC. We encourage other authors to report similar cases in order to determine whether noninvasive ATC should be considered as a separate disease entity from the traditional highly lethal form of ATC.
Asunto(s)
Carcinoma Anaplásico de Tiroides/diagnóstico , Carcinoma Anaplásico de Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina , Humanos , Inmunohistoquímica , Masculino , Tomografía de Emisión de Positrones , Pronóstico , Glándula Tiroides/patología , Tiroidectomía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal human malignancies. To investigate the cellular origin(s) of this cancer, we determined the effect of PDAC-relevant gene mutations in distinct cell types of the adult pancreas. We show that a subpopulation of Pdx1-expressing cells is susceptible to oncogenic K-Ras-induced transformation without tissue injury, whereas insulin-expressing endocrine cells are completely refractory to transformation under these conditions. However, chronic pancreatic injury can alter their endocrine fate and allow them to serve as the cell of origin for exocrine neoplasia. These results suggest that one mechanism by which inflammation and/or tissue damage can promote neoplasia is by altering the fate of differentiated cells that are normally refractory to oncogenic stimulation.