RESUMEN
UNLABELLED: Postoperative pressure alopecia (PPA), defined as hair loss caused by prolonged pressure on the patient's scalp during surgery, is an uncommon condition after aesthetic surgery. Originally, it was described for patients who underwent lengthy cardiovascular and gynecologic operations. The authors present a rare case, in which hair loss occurred after secondary breast augmentation (replacement of breast implants). The PPA appeared in the occipitoparietal region of the patient's scalp approximately 2 weeks after surgery. The operation was completed in less than 3 hours, without any fluctuations in the patient's blood pressure or any unusual blood loss. There were no other precipitating factors such as anemia or coagulopathies. The probable cause of this unexpected result was the patient's braided hair coil, which had not been noted before the operation. The patient habitually, and on the day of her operation, combed her hair into a braided coil, which placed extra pressure on the occipitoparietal region. The hair loss was temporary, and hair regrowth was complete within 2 months. This incident may have been avoided if the braided hair coil had been noted by nursing or other medical staff preoperatively. Repositioning the head every 30 minutes and providing adequate head padding during surgery are advised to protect the patient and prevent such incidents. LEVEL OF EVIDENCE: 5.
Asunto(s)
Alopecia/etiología , Implantación de Mama/efectos adversos , Cabello/crecimiento & desarrollo , Adulto , Alopecia/diagnóstico , Alopecia/fisiopatología , Femenino , Humanos , Presión , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Recent research has evidenced that although investment in Continuing Medical Education (CME), both in terms of participation as well as financial resources allocated to it, has been steadily increasing to catch up with accelerating advances in health information and technology, effectiveness of CME is reported to be rather limited. Poor and disproportional returns can be attributed to failure of CME courses to address and stimulate an adult audience. METHODS: The present study initially drew on research findings and adult learning theories, providing the basis for comprehending adult learning, while entailing practical implications on fostering effectiveness in the design and delivery of CME. On a second level, a qualitative study was conducted with the aim to elucidate parameters accounting for effectiveness in educational interventions. Qualitative data was retrieved through 12 in-depth interviews, conducted with a random sample of participants in the 26th European Workshop of Advanced Plastic Surgery (EWAPS). The data underwent a three level qualitative analysis, following the "grounded theory" methodology, comprising 'open coding', 'axial coding' and 'selective coding'. RESULTS: Findings from the EWAPS study come in line with relevant literature, entailing significant implications for the necessity to apply a more effective and efficient paradigm in the design and delivery of educational interventions, advocating for implementing learner-centered schemata in CME and benefiting from a model that draws on the learning environment and social aspects of learning. CONCLUSIONS: What emerged as a pivotal parameter in designing educational interventions is to focus on small group educational events which could provide a supportive friendly context, enhance motivation through learner-centered approaches and allow interaction, experimentation and critical reflection. It should be outlined however that further research is required as the present study is limited in scope, having dealt with a limited sample.
Asunto(s)
Educación Médica Continua/métodos , Aprendizaje Basado en Problemas , Adulto , Procesos de Grupo , Humanos , Motivación , Investigación Cualitativa , Cirugía Plástica/educación , Cirugía Plástica/psicologíaRESUMEN
The maternally inherited 8344 A>G mutation in the mitochondrial Lys tRNA is classically associated with the myoclonic epilepsy, ragged-red muscle fiber (MERRF) syndrome. Multiple lipomatosis (Madelung's disease) is occasionally described. Here we report a large kindred with a statistically significant clustering of very unusual clinical manifestations. We have studied a Greek family that includes seven symptomatic cases of 8344 A>G. Clinical features, glucose tolerance and heteroplasmy in fat, muscle and blood were analyzed. The patients, aged 34-76 at the time of assessment, all suffer from progressive proximal limb-girdle myopathy and extensive lipomatosis. Four of the seven have either impaired glucose tolerance or diabetes but none has had epilepsy, a cardinal feature of MERRF. Heteroplasmy was not higher in adipose tissue than that found in the literature. Compared to literature reports, the familial clustering of this unusual combination of manifestations (lipomatosis in all, epilepsy in none) is statistically significant. The clustering of unusual manifestations in this large kindred strongly suggests that much of the phenotypic variability of 8344 A>G is determined by mitochondrially encoded modifiers in cis.
Asunto(s)
Mutación , ARN de Transferencia de Lisina/genética , ARN , Adulto , Anciano , Femenino , Intolerancia a la Glucosa/genética , Humanos , Lipomatosis/genética , Masculino , Persona de Mediana Edad , Enfermedades Musculares/genética , Linaje , ARN Mitocondrial , SíndromeRESUMEN
OBJECTIVES/HYPOTHESIS: The free jejunum transfer has become a widely used reconstruction option after total laryngopharyngectomy. The aim of this study was to evaluate the effectiveness of using an exteriorized jejunal segment for flap monitoring. STUDY DESIGN: Case series. METHODS: Twenty patients with tumors involving the pharynx, larynx, or cervical esophagus were subjected to total laryngopharyngectomy and neck dissection. The resulting esophageal defect was reconstructed with a free jejunal flap based on a major branch of the superior mesenteric artery and vein. After completion of anastomoses with the recipient vessels, the flap was divided into two segments of common vascular supply. The smaller segment was exteriorized in the cervical region for direct monitoring of serosal color, temperature, peristalsis, and bleeding during the postoperative period. This sentinel was resected once the viability of the flap was judged appropriate. RESULTS: Of the 20 patients who had free jejunum transfers for pharyngoesophageal reconstruction, 14 had an uneventful postoperative course, and six needed re-exploration due to signs of arterial insufficiency in the sentinel segment. On re-exploration, four flaps were found to have arterial thrombosis and two had no abnormality at the anastomotic site. One of the flaps that developed thrombosis was subsequently lost. CONCLUSIONS: Monitoring of buried free jejunal flap with a sentinel is an effective method of assessing flap viability after total laryngopharyngectomy and guides re-exploration in cases of anastomotic complications.
Asunto(s)
Colgajos Tisulares Libres/irrigación sanguínea , Supervivencia de Injerto/fisiología , Yeyuno/trasplante , Laringectomía , Microcirugia/métodos , Monitoreo Fisiológico/métodos , Faringectomía , Factores de Edad , Anciano , Anciano de 80 o más Años , Neoplasias Esofágicas/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Arterias Mesentéricas/cirugía , Venas Mesentéricas/cirugía , Persona de Mediana Edad , Neoplasias Faríngeas/cirugía , Flujo Sanguíneo Regional/fisiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Juvenile Hyaline Fibromatosis (JHF) is a rare autosomal recessive disorder, histologically characterized by the production and deposition of an unidentified hyaline material in the skin and other organs. Extracellular matrix molecules are implicated in the development of skin lesion which is debilitating and recurrent and, so far, no treatment is satisfactory. OBJECTIVE: To investigate the expression of matrix metalloproteinases (MMPs), their tissue inhibitors (TIMPs) and proteoglycans in lesional as compared to site-matched lesion-free skin tissue specimens of a JHF patient, aiming to elucidate the aetiopathological mechanisms involved in the development of JHF skin lesions. METHODS: Gelatinase activity of MMP-2 and MMP-9 was investigated by gelatine zymography. Protein levels of MMP-2, MMP-9, TIMP-1 and TIMP-2 in skin tissue extracts were measured by ELISA. Gene expression of MMPs, TIMPs and proteoglycans was examined by quantitative RT-PCR. RESULTS: JHF lesions exhibited significantly higher activity as well as elevated protein and gene expression of MMP-2 and MMP-9, as compared to lesion-free skin tissue specimens. Decorin was downregulated and aggrecan was upregulated in lesional skin, as compared to normal skin. CONCLUSION: The results presented in this study indicate that MMPs and proteoglycans may be involved in the pathogenesis of JHF and therefore these molecules may offer alternative targets for pharmacological intervention to achieve more radical and effective treatment.
Asunto(s)
Síndrome de Fibromatosis Hialina/enzimología , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 9 de la Matriz/metabolismo , Piel/enzimología , Inhibidor Tisular de Metaloproteinasa-1/metabolismo , Inhibidor Tisular de Metaloproteinasa-2/metabolismo , Agrecanos/genética , Agrecanos/metabolismo , Biglicano/genética , Biglicano/metabolismo , Niño , Decorina/genética , Decorina/metabolismo , Regulación hacia Abajo/genética , Precursores Enzimáticos/metabolismo , Matriz Extracelular , Femenino , Gelatinasas/metabolismo , Expresión Génica , Proteoglicanos de Heparán Sulfato/genética , Proteoglicanos de Heparán Sulfato/metabolismo , Humanos , Síndrome de Fibromatosis Hialina/genética , Síndrome de Fibromatosis Hialina/metabolismo , Metaloproteinasa 2 de la Matriz/genética , Metaloproteinasa 9 de la Matriz/genética , Piel/metabolismo , Estadísticas no Paramétricas , Regulación hacia Arriba/genéticaRESUMEN
Mucous cysts are very rare complications following rhinoplasty; less than 20 cases have been reported in literature. We present 2 new cases. The first case presented a cyst located beneath the glabella and above the articulation between the spina nasalis and the os nasale. The lesion first appeared 22 months following elective rhinoplasty. The treatment was complete surgical excision using a direct open approach. In the second case, a cyst was indentified between the right inner canthus and the sidewall of the nose. It appeared 6 months following elective rhinoplasty. The treatment was complete surgical excision through a transcartilaginous approach. Both patients had good postoperative results with no evidence of recurrence after a 7- and 8-year follow-up period, respectively. We believe that it is possible to prevent the appearance of mucous cysts after rhinoplasty, with careful dissection and avoidance of dispersion of mucosal material into a subcutaneous plane.
Asunto(s)
Quistes/etiología , Enfermedades Nasales/etiología , Rinoplastia/efectos adversos , Adulto , Quistes/prevención & control , Quistes/cirugía , Disección , Femenino , Estudios de Seguimiento , Humanos , Mucocele , Moco , Enfermedades Nasales/prevención & control , Enfermedades Nasales/cirugía , Factores de TiempoRESUMEN
Currently, in patients with malignant melanoma there is no clear cut-off point of Breslow thickness in order to avoid unnecessary lymph node excision surgery, without missing metastatic nodes. We retrospectively studied a cohort of 64 patients, with pathologically proven malignant melanoma, who underwent lymph node scintigraphy and surgical resection of the sentinel node, during the last two years. The patients were divided into 5 groups: Group 1: Ten patients, mean age 46 ± 6 years (range 40-55 years), with Breslow thickness of the lesion 0.51-0.75 mm. Group 2: Eleven patients, mean age 41 ± 9 years (range 31-61 years), with Breslow thickness 0.76-1mm. Group 3: Twelve patients, mean age 59 ± 12 (41-76 years), with Breslow thickness 1.01-1.25 mm. Group 4: Fourteen patients, mean age 61 ± 8 (38-74 years), with Breslow thickness 1.26-1.5mm. Group 5: Seventeen patients, mean age 56 ± 10 (32-71 years), with Breslow thickness >1.5mm. We found only seven infiltrated sentinel lymph nodes. From these, 3 patients belonged to the 5th group (Breslow>1.5mm), two patients to the 4th group (Breslow 1.26-1.5mm), one patient in the 3rd group (Breslow 1.01-1.25 mm) and one patient to the 2nd group (Breslow 0.76-1mm). Since there was no positive sentinel lymph node in any patient with Breslow thickness less than < 0.75 mm, we conclude that sentinel lymph node biopsy in patients with Breslow thickness less than < 0.75 mm may not be useful and might not be carried out, except in high risk cases such as melanomas with ulceration, high mitotic rate and vertical growth phase.
Asunto(s)
Melanoma/patología , Biopsia del Ganglio Linfático Centinela/normas , Adulto , Anciano , Humanos , Melanoma/diagnóstico , Melanoma/diagnóstico por imagen , Persona de Mediana Edad , Pronóstico , Cintigrafía , Estudios RetrospectivosRESUMEN
BACKGROUND: Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disease characterized histologically by deposition of hyaline material and clinically by multiple skin lesions. Clarification of the molecular and structural changes involved in JHF skin lesions may unravel targets for pharmacotherapy. OBJECTIVE: We sought to investigate the expression of glycosaminoglycans and their metabolizing enzymes in lesional as compared with lesion-free skin tissue specimens in JHF. METHODS: Glycosaminoglycans were isolated, purified, and fractionated by electrophoresis on cellulose acetate membranes and agarose gels. Hyaluronic acid (HA) was quantitated by enzyme-linked immunosorbent assay and the expression of HA metabolizing enzymes was investigated using reverse transcriptase-polypeptide chain reaction. RESULTS: JHF lesions exhibited significantly less HA and elevated amounts of dermatan sulfate and chondroitin sulfate, whereas gene expression of HA synthase-1 and HA synthase-3 was significantly down-regulated, as compared with lesion-free skin tissue specimens. LIMITATIONS: Because JHF is a rare disease, a limitation to our study was that we collected skin tissue specimens from only one patient. CONCLUSION: The significant alterations of HA homeostasis in JHF lesions provide further understanding of JHF pathogenesis and may offer a target for pharmacologic intervention to treat the skin lesions associated with JHF.
Asunto(s)
Sulfatos de Condroitina/metabolismo , Dermatán Sulfato/metabolismo , Fibroma/metabolismo , Homeostasis/fisiología , Ácido Hialurónico/metabolismo , Neoplasias Cutáneas/metabolismo , Biopsia , Niño , Regulación hacia Abajo/fisiología , Electroforesis en Gel de Agar , Proteínas de la Matriz Extracelular/genética , Femenino , Fibroma/patología , Glucuronosiltransferasa/genética , Humanos , Receptores de Hialuranos/genética , Hialuronano Sintasas , Piel/metabolismo , Piel/patología , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: Extramammary Paget's disease is a rare cutaneous malignancy, which occurring frequently in the elderly and affecting primarily the genital, perianal, and axillary regions. Unfortunately, surgical and ablative treatment modalities for extramammary Paget's disease have a high recurrence rate and are often associated with significant morbidity. METHODS: We present a case of a 51-year-old Caucasian man with Paget's disease of the right groin. The isolated localization of Paget's disease in the groin is extremely rare. Wide local excision of the tumor is currently the standard of care treatment. All publications found in the literature reporting this rare entity were reviewed for the purpose of further delineating a treatment regimen for this rare pathology. RESULTS: Six years after surgery, the patient remains disease free with a very acceptable aesthetic result. Currently, only 11 cases of Paget's disease have been reported with an isolated localization to the groin. CONCLUSIONS: Paget's disease of the groin has an extremely low incidence. Various treatments are described in the literature, early wide local excision may be the treatment of choice.
Asunto(s)
Ingle , Enfermedad de Paget Extramamaria/cirugía , Procedimientos de Cirugía Plástica , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Paget Extramamaria/patología , Resultado del TratamientoRESUMEN
Acne vulgaris is a skin disorder of the sebaceous follicles, involving hyperkeratinization and perifollicular inflammation. Matrix metalloproteinases (MMP) have a predominant role in inflammatory matrix remodeling and hyperproliferative skin disorders. We investigated the expression of MMP and tissue inhibitors of MMP (TIMP) in facial sebum specimens from acne patients, before and after treatment with isotretinoin. Gelatin zymography and Western-blot analysis revealed that sebum contains proMMP-9, which was decreased following per os or topical treatment with isotretinoin and in parallel to the clinical improvement of acne. Sebum also contains MMP-1, MMP-13, TIMP-1, and TIMP-2, as assessed by ELISA and western blot, but only MMP-13 was decreased following treatment with isotretinoin. The origin of MMP and TIMP in sebum is attributed to keratinocytes and sebocytes, since we found that HaCaT keratinocytes in culture secrete proMMP-2, proMMP-9, MMP-1, MMP-13, TIMP-1, and TIMP-2. SZ95 sebocytes in culture secreted proMMP-2 and proMMP-9, which was also confirmed by microarray analysis. Isotretinoin inhibited the arachidonic acid-induced secretion and mRNA expression of proMMP-2 and -9 in both cell types and of MMP-13 in HaCaT keratinocytes. These data indicate that MMP and TIMP of epithelial origin may be involved in acne pathogenesis, and that isotretinoin-induced reduction in MMP-9 and -13 may contribute to the therapeutic effects of the agent in acne.
Asunto(s)
Acné Vulgar/enzimología , Isotretinoína/farmacología , Metaloproteinasas de la Matriz/análisis , Sebo/enzimología , Acné Vulgar/tratamiento farmacológico , Acné Vulgar/etiología , Adolescente , Bacterias/aislamiento & purificación , Western Blotting , Células Cultivadas , Colagenasas/análisis , Ensayo de Inmunoadsorción Enzimática , Cara , Femenino , Gelatinasas/análisis , Humanos , Isotretinoína/uso terapéutico , Queratinocitos/enzimología , ARN Mensajero/análisis , Sebo/citología , Sebo/microbiología , Inhibidor Tisular de Metaloproteinasa-1/análisis , Inhibidor Tisular de Metaloproteinasa-1/genética , Inhibidor Tisular de Metaloproteinasa-2/análisisRESUMEN
BACKGROUND: Tuberous sclerosis complex lesions of the skin may be disfiguring to patients and can only be treated by laser or cosmetic surgery. Clarification of the molecular and structural changes involved in skin hamartomas may unravel targets for pharmacotherapy. OBJECTIVE: We investigated the expression of matrix metalloproteinase (MMP) and its tissue inhibitor (TIMP) in fibrous plaques, angiofibromas, and lesion-free skin specimens from patients with tuberous sclerosis complex. METHODS: Gene expression of MMPs and TIMP-1 was measured by reverse transcription polymerase chain reaction, gelatinase activity by gelatin zymography, and the content of collagenases and TIMPs by enzyme-linked immunosorbent assay. RESULTS: Compared with lesion-free specimens, hamartomas exhibited decreased levels of TIMPs and messenger RNA expression of TIMP-1, and increased content of MMP-1 and MMP-13 and activity of MMP-9, although gelatinase gene expression was diminished. Gene expression of MMP-15 and MMP-17 was not affected but was diminished for MMP-14. CONCLUSION: The significant variations of the above extracellular matrix molecules between lesion-free specimens and tuberous sclerosis complex hamartomas overall favors a collagenous protein-degrading microenvironment in affected skin, and argue in support of antiprotease treatment for disfiguring skin lesions.