RESUMO
El dermatofibrosarcoma protuberans (DFSP) atrófico congénito es un tumor extremadamente poco frecuente, con contados reportes en la literatura mundial. Habitualmente el diagnóstico se demora años y se confunde con diversas marcas de nacimiento o con otras lesiones que cursan con atrofia cutánea. El comportamiento biológico sería, sin embargo, similar al de las otras formas de DFSP que se presentan en el niño y en el adulto, con alto riesgo de recurrencia tras la resección tumoral, por lo cual es importante conocer el aspecto para sospechar el diagnóstico. El estudio histopatológico se debe complementar con la inmunotinción con CD34, un marcador de utilidad no solo para aclarar el diagnóstico, sino también para guiar el tratamiento en la Cirugía de Mohs, que es en la actualidad el tratamiento de elección. La patogenia del DFSP se relacionaría con una mutación genética que provocaría una sobreproducción del factor de crecimiento derivado de las plaquetas que llevaría a un crecimiento celular maligno estimulado autocrinamente. El principal diagnóstico diferencial del DFSP atrófico congénito, tanto clínico como histopatológico, es el hamartoma dendrocítico dérmico tipo medallón, tumor congénito benigno descrito el año 2004. Presentamos el caso de un niño a quien se le diagnosticó un DFSP atrófico congénito a los 13 años de edad, después de haber sido reiteradamente interpretado como una lesión sin importancia. En este caso, se realizó resección con márgenes amplios, porque la ubicación anatómica lo permitía. En el control a los 18 meses después del tratamiento, el paciente no ha presentado recurrencias.
Congenital atrophic dermatofibrosarcoma protuberans is an extremely rare tumor, with few reports in world literature. Usually the diagnosis take a lot of years and get confused with many birthmarks or other lesions that present with cutaneous atrophy. However, the biological behavior would be similar to other forms of dermatofibrosarcoma protuberans (DFSP) shown in children and adults, with high risk of recurrence after surgical resection, that is why is so important to know the aspect to suspect the diagnosis. The histopathological study is complemented by the CD34 inmuno staining, used to clarify the diagnosis and to guide the treatment in Mohs micrographic surgery, which is currently the treatment of choice. The pathogenesis of DFSP would be related to a genetic mutation that induce an overproduction of platelet-derived growth factor that would lead to autocrine-stimulated malignant cell growth. The main differential diagnosis, clinical and histological, is the medallion-like dermal dendrocyte hamartoma, a congenital tumor first described in 2004. We report the case of a child who was diagnosed with a congenital atrophic dermatofibrosarcoma protuberans at the age of 13, after been repeatedly interpreted as a lesion without any importance. In this case, a resection with wide margins was made, because the anatomical location allowed it. The patient has not shown any recurrence of the tumor after 18 months of treatment.
Assuntos
Humanos , Masculino , Adolescente , Dermatofibrossarcoma/cirurgia , Dermatofibrossarcoma/diagnóstico , Cirurgia de Mohs , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/diagnóstico , Diagnóstico Diferencial , Dermatofibrossarcoma/congênito , Neoplasias Cutâneas/congênito , Resultado do TratamentoRESUMO
La población mundial y nacional está en proceso de envejecimiento. Las enfermedades dermatológicas son frecuentes en todos los grupos etarios y en el adulto mayor no es la excepción. Se realizó un estudio retrospectivo del principal motivo de consulta en los mayores de 60 años, atendidos en el periodo de 3 décadas (1984 a 2013) en una consulta privada de la ciudad de Antofagasta, Chile. Antofagasta exhibe un alto índice de radiación ultravioleta durante todo el año y hasta la década del 70 las aguas de consumo humano contenían arsénico. 4360 fichas de adultos mayores (60 años o más) ingresaron al estudio, 2.626 mujeres (60.2 por ciento) y 1734 hombres (39.8 por ciento). El 75,5 por ciento de los pacientes eran beneficiarios de Fonasa o fueron atendidos gratuitamente. Los diferentes motivos de consulta determinaron 191 diagnósticos diferentes, que fueron agrupados bajo 18 items. Los 3 items más frecuentes de consulta fueron tumores cutáneos (38,1 por ciento de los casos), dermatosis inflamatorias(26 por ciento) e infecciones cutáneas (15,3 por ciento). O sea, en esos 3 items se encasillaron casi el 80 por ciento de los pacientes. Los siete diagnósticos individuales más frecuentes fueron: queratosis seborreicas (9,6 por ciento de los casos), carcinomas basocelulares (6,7 por ciento), dermatitis aguda(5,7 por ciento), herpes zoster (4,3 por ciento), rosácea y condiciones afines (4,2 por ciento), enfermedad de Bowen (4 por ciento) y queratosis actínicas (3,9 por ciento). El alto porcentaje de tumores premalignos y malignos encontrados en los adultos mayores en el estudio, probablemente se relaciona con el daño provocado por la luz ultravioleta y el arsénico.
World and national population is in process of aging. Dermatological diseases are frequent in every age group and senior citizens are not an exception. We performed a retrospective study about the main reason of consultation in adults over the age of 60 in the period of 3 decades (1984 to 2013) in a private practice of the city of Antofagasta, Chile. Antofagasta exhibits a high UV index all the year round and until the 70s the water for human consumption contains arsenic. 4360 medical records of patients older than 60 years old were analyzed, 2626 female (60, 2 percent) and 1734 male (39, 8 percent). The different reasons of consultation determined 191 different diagnoses, which were grouped under 18 items. The 3 most frequent items of consultation were cutaneous tumors (38,1 percent of the cases), inflammatory dermatosis (26 percent) and cutaneous infections (15,3 percent), Almost an 80 percent of the patients were classified in these three items. The seven most frequent individual diagnoses were: seborrheic keratosis (9,6 percent of the cases), basal cell carcinoma (6,7 percent), acute dermatitis (5,7 percent), herpes zoster (4,3 percent), rosacea and related conditions (4,2 percent), Bowen disease (4 percent) and actinic keratosis (3,9 percent). The high percentage of premalignant and malignant tumors found among elders in this study is probably related with the damage induced by ultraviolet radiation and arsenic.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Envelhecimento , Dermatopatias/epidemiologia , Distribuição por Idade e Sexo , Chile , Neoplasias Cutâneas/epidemiologia , Estudos RetrospectivosRESUMO
Investigamos patologías dermatológicas de adultos mayores provocadas por RUV o arsénico en un periodo de treinta años en Antofagasta, ciudad con alto índice de RUV y que tuvo hidroarsenicismo. De 4360 adultos mayores, 20,5 por ciento presentaba una dermatosis relacionada con RUV o arsénico. RUV generó 13,1 por ciento de los diagnósticos, siendo más frecuente en mujeres que en hombres. Arsénico generó 5,9 por ciento de los diagnósticos, siendo más frecuente en hombres que en mujeres. El 1,5 por ciento restante se considera que fue por ambos. 43,8 por ciento de las patologías fueron cánceres de piel, 39 por ciento lesiones premalignas y solo 17,2 por ciento lesiones benignas. Además, el comportamiento epidemiológico del carcinoma basocelular y del espinocelular es diferente a lo descrito en estudios nacionales e internacionales.
We investigated dermatological pathologies in over 60 years old adults provoked by ultraviolet radiation (UVR) or arsenic in a thirty years period in Antofagasta, city with high index of UVR and that had hydroarsenicism. Of 4360 adults, 20,5 percent presented a dermatosis related to UVR or arsenic. UVR generated 13,1 percent of the diagnoses, being more frequent in women than in men. Arsenic generated 5,9 percent of the diagnoses, being more frequent in men than in women. It is considered that the 1,5 percent remaining was for both reasons. 43,8 percent of the pathologies were skin cancers , 39 percent premalignant lesions and only 17,2 percent benign lesions. In addition, the epidemiological behavior of basocellular carcinoma and squamous cell carcinoma, is different to the one described in other national and international studies.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Arsênio/efeitos adversos , Dermatopatias/epidemiologia , Raios Ultravioleta/efeitos adversos , Distribuição por Idade e Sexo , Chile , Neoplasias Cutâneas/epidemiologiaRESUMO
BACKGROUND: Problem based learning, integrating basic science with clinical problems, is one of the most recommended forms of teaching for medical schools. AIM: To compare a problem based learning program for physics with traditional teaching methods. MATERIAL AND METHODS: In the physics course, first year medical students were separated in groups with traditional learning and problem based teaching. Both groups were subjected to the same knowledge and qualitative evaluations. RESULTS: At the end of the course, cognitive performance in both groups was similar (60.8 and 61.3% among traditional teaching and problem based learning groups respectively). However, students assigned to the problem based learning group evaluated significantly better the teaching methodology and process. CONCLUSIONS: Physics education, using problem based learning, obtains the same cognitive results but a higher degree of satisfaction than traditional teaching among students.
Assuntos
Educação de Graduação em Medicina/métodos , Física/educação , Aprendizagem Baseada em Problemas/métodos , Ensino/métodos , Currículo , Educação de Graduação em Medicina/normas , Humanos , Aprendizagem Baseada em Problemas/normas , Avaliação de Programas e Projetos de SaúdeRESUMO
BACKGROUND: Modernization of medical teaching includes the use of new teaching methodologies and among these, computer assisted tutorials. Previous experience has shown that this type of methodology is associated with better student performances. AIM: To assess the cognitive performance of fourth year medical students using different teaching methodologies. MATERIAL AND METHODS: During the hypertension course, medical students were allowed to choose to receive a printed booklet (group A), to receive the booklet and attend lectures (group B), to receive the booklet and use a multimedial educational program (group C) and to use all three methodologies (group D). Cognitive performance was evaluated with a multiple choice test scored from 0 to 100. RESULTS: The mean scores obtained by students were 84.5 in group A, 82.4 in group B, 88.9 in group C and 84.4 in group D. This overall score of 83.6 in hypertension was significantly better than the mean score of 72.5 obtained in the cardiology test. CONCLUSIONS: Allowing students to choose the most suitable method to learn according to their personal preferences, results in a better cognitive performance.
Assuntos
Educação Médica , Avaliação Educacional/métodos , Estudantes de Medicina , Materiais de Ensino , Estudos de Avaliação como Assunto , Humanos , Hipertensão , Ensino/métodosRESUMO
BACKGROUND: When hypertension treatment does not achieve the expected reduction in blood pressure levels, experts recommended increasing the dose of the initially used drug or the addition of a new medication. AIM: To compare the efficacy of increasing doses of losartan or the addition of hydrochlorothiazide to achieve adequate blood pressure levels in patients with hypertension. PATIENTS AND METHODS: Seventy- three patients aged 64.4 +/- 5.3 years, with stage 1 or 2 essential hypertension were studied. If after four weeks of treatment with losartan 50 mg od, blood pressure levels were still high, the dose was increased to 100 mg od. After four weeks with this new schedule, the treatment was switched to losartan 50 mg and hydrochlorothiazide 12.5 mg for another four weeks. RESULTS: Thirty- seven patients normalized blood pressure with losartan 50 mg od. Of the 36 patients that did not respond, 69% achieved a normal blood pressure with losartan 100 mg od and 81% did so with the combination of losartan and hydrochlorothiazide. Combination therapy resulted in a better blood pressure lowering than monotherapy (33.2 +/- 3.2 and 29.5 +/- 3.4 mm Hg for systolic blood pressure respectively, 16.4 +/- 3.2 and 13.2 +/- 3.4 mm Hg for diastolic blood pressure, p < 0.05). No changes in blood glucose, total and HDL cholesterol, triglycerides, urea nitrogen and uric acid were observed with the combination therapy. CONCLUSIONS: In this group of patients, combination therapy achieved better blood pressure levels than monotherapy in high doses.