RESUMO
The absence of nipple-areola complex is a rare entity and is always associated with other anomalies. This paper described a case of bilateral athelia without other alterations. The atrophy of the dense mesenchyme due to absence of parathyroid hormone-related protein produced in epithelium may lead to nipple involution. Further cases should be studied to corroborate this theory.
Assuntos
Mamilos/anormalidades , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Atresia das Cóanas/etiologia , Cisto Dermoide/etiologia , Orelha/anormalidades , Feminino , Humanos , Mamilos/cirurgia , Síndrome de Poland/genética , Couro Cabeludo/anormalidades , Transplante de Pele/métodos , SíndromeRESUMO
Craniofaciostenosis is often associated with midfacial hypoplasia and has been treated traditionally using Le Fort advancement osteotomies and bone grafts. The surgical procedure requires a prolonged operating time, several osteotomies with a significant blood loss, and wide surgical exposure. According to the principles of bone lengthening, we performed midfacial advancement by bone distraction in 4 patients with midfacial hypoplasia to reduce the operative time and complication rate. In 2 patients with Crouzon's syndrome we performed a Le Fort III osteotomy and placed the distraction device behind the malar eminence and screwed it on the temporal bone bilaterally. In the other 2 children, with Apert's syndrome, we performed frontal advancement and remodeling before placing the device during the same surgery behind the malar bone without any midfacial osteotomy. It appears to us that patients with more severe deformities will need surgical procedures to offer more satisfactory results. In these patients, distraction is an initial therapy to reduce the severity of the deformity, making it possible to effect a better treatment afterward.
Assuntos
Acrocefalossindactilia/cirurgia , Disostose Craniofacial/cirurgia , Ossos Faciais/cirurgia , Osteogênese por Distração/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Osteogênese por Distração/instrumentação , Osteotomia de Le Fort/métodos , Período Pós-OperatórioRESUMO
PURPOSE: To study the short and long term clinical course of patients with severe aortic stenosis after surgical treatment of the valvular lesion. METHODS: Thirty survivors among 31 consecutive patients with severe left ventricular dysfunction (LVD) due to aortic stenosis (AS) were submitted to clinical and echocardiographic follow-up during a mean of 30 months after surgical treatment of the valvular lesion. Twenty five (83.3%) patients were male with a mean age of 50 years (25 to 74). Before operation the following parameters were obtained: diastolic left ventricular diameter (DLVD), shortening fraction (SF), left ventricular ejection fraction (LVEF), aortic valve area (AVA), left ventricular-aortic pressure gradient (PG) and NYHA functional class (FC). During the follow up, after the surgical procedure, FC, DLVD, LVEF and SF could be analysed and compared with previous data. RESULTS: A significant rise in SF (p = 0.001) and LVEF (p = 0.0001), as well as a decrease in DLVD (p = 0.001) were observed in the follow up. Symptoms lessened in severity in the majority of patients. Three of our patients died with progressive LVD and heart failure, after at least 36 months of follow-up. These results indicate that when operation is carried out in patients with AS and left ventricular failure, a significant improvement in left ventricular function and in symptoms takes place. Although the risk of surgical treatment is increased in this group of patients, LVD should not be considered a contraindication to the procedure. CONCLUSION: The left ventricular dysfunction is not a contraindiction for the surgical treatment of the aortic stenosis.