RESUMEN
The appearance of patients seeking cosmetic surgery is changing to reflect our multicultural society. Integral to addressing the desires of a cross-cultural patient population is an understanding of one's perception of race, ethnicity, and culture. Race is an objective description, whereas ethnicity is a subjective description of a person's social group. Culture, on the other hand, defines the behaviors, beliefs, and values of a group. How a person perceives their place within these groups affects his or her self-image and approach to cosmetic surgery. These cultural perceptions are important, as patients of Asian, Hispanic, and African descent make up the fastest growing groups that desire cosmetic surgery. Factors contributing to this trend include population growth, especially within multicultural communities, improvements in social status, and increasing disposable income, combined with a positive perception of cosmetic surgery. Surgical philosophies have also changed, shifting from the perspective of racial transformation, defined as the use of a common set of surgical goals for all ethnicities, toward a view of racial preservation, with the goal of preserving one's racial and ethnic features.
Asunto(s)
Actitud/etnología , Belleza , Etnicidad , Cara/cirugía , Grupos Raciales , Actitud del Personal de Salud , Diversidad Cultural , Demografía , Cara/anatomía & histología , Humanos , Renta , Rejuvenecimiento , Clase Social , Estados UnidosRESUMEN
OBJECTIVES/HYPOTHESIS: To review the role of tonsillectomy in diagnosis and management of post-transplant lymphoproliferative disorder (PTLD). STUDY DESIGN: Case series using a retrospective chart review. METHODS: A retrospective review of post-transplant lymphoproliferative disease at a tertiary academic medical center from January 2004 to April 2008. Data extracted includes patients' gender, age at transplantation, year of transplantation and tonsillectomy, type of transplant, presenting symptoms, type of immunosuppression, and outcome. RESULTS: Six out of 25 (24%) patients who underwent tonsillectomy were found to have PTLD. The patient's characteristics, gender, age at transplantation, year of transplantation and tonsillectomy, type of transplant, presenting symptoms, type of immunosuppression, and outcomes are discussed. CONCLUSIONS: In our series, tonsillar hypertrophy, male gender, young age at transplantation, and liver transplantation were associated with higher rates of PTLD. Given the devastating nature of PTLD, early detection with tonsillectomy and institution of treatment is critical.
Asunto(s)
Trasplante de Corazón , Trasplante de Hígado , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/cirugía , Tonsilectomía , Adolescente , Niño , Preescolar , Femenino , Humanos , Terapia de Inmunosupresión , Lactante , Trastornos Linfoproliferativos/etiología , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the optimal utilization of histopathologic analysis of tonsil and adenoid specimens in the pediatric population. METHODS: A retrospective review was performed on 7837 tonsil and adenoid specimens submitted from January 2004 to April 2008. The records were reviewed for the patients' age, sex, and pathologic analysis. The time and cost per analysis of each specimen were determined. RESULTS: Histopathology was performed on 347 specimens based on clinical suspicion by the surgeon, a difference of 0.5 cm or more among tonsils, gross abnormalities, and history of malignancy, transplant, or immunocompromise. Malignancy was diagnosed in 0.026% of patients. Post-transplant lymphoproliferative disease was diagnosed in 6 of 24 immunocompromised patients. The use of these criteria resulted in a savings of $518,088.47 and 461 h of dedicated technician time per year. CONCLUSIONS: Histologic examinations in selected specimens should be based on specific criteria that should be determined by each hospital based on hospital size, finances and input from their pathologists and otolaryngogists. Storage of a representative specimen for possible retrospective review may be useful.
Asunto(s)
Tonsila Faríngea/patología , Tonsila Palatina/patología , Adenoidectomía , Adolescente , Biopsia , Niño , Preescolar , Femenino , Humanos , Hipertrofia/epidemiología , Hipertrofia/patología , Lactante , Masculino , Estudios Retrospectivos , Neoplasias Tonsilares/epidemiología , Neoplasias Tonsilares/patología , TonsilectomíaRESUMEN
OBJECTIVES/HYPOTHESIS: To review the presentation and management of cervical thymic cysts and ectopic thymic tissue at Texas Children's Hospital over the last 25 years. STUDY DESIGN: Case report and case series using retrospective chart review. METHODS: A case report is presented of a recently diagnosed thymic cyst highlighting diagnostic, management, and treatment strategies available for optimizing management of patients with significant mediastinal extension. We then present a retrospective review of cervical thymic anomalies at a tertiary academic medical center over a 25-year span (1983-present). Data extracted include patients' characteristics, clinical presentation, diagnostic workup, surgical management, and postoperative complications. RESULTS: Fifteen patients were found to have a pathological diagnosis of cervical thymic cyst, and 10 patients had a diagnosis of ectopic thymic tissue in the neck. This is the largest case series of cervical thymic anomalies presented in the literature to date. Patients' characteristics, diagnostic techniques, and treatment strategies are discussed. CONCLUSIONS: Cervical thymic anomalies are a rare but necessary part of the differential diagnosis of a cervical mass. Computed tomography scan can both narrow the preoperative differential diagnosis and aid in surgical planning for thymic cyst excision. A full discussion of the embryology, clinical presentation, and management of cervical thymic cysts and a review of the current literature is presented.