RESUMO
Although significant progress has been made in the understanding of melanoma pathophysiology and therapy, patients with metastatic melanoma still have a poor prognosis. The management of regional nodes remains a matter of debate. By replacing elective lymph node dissection, sentinel lymph node biopsy has revolutionized the treatment of malignant melanoma. In this paper, the history of the procedure is traced, and the indication for completion lymphadenectomy after positive sentinel node biopsy is discussed in light of the recent studies that addressed this issue. The role of adjuvant therapies in the management of patients with stage III melanoma is also discussed.
Assuntos
Dermatologia/métodos , Oncologia/métodos , Melanoma/patologia , Biópsia de Linfonodo Sentinela/história , Neoplasias Cutâneas/patologia , Quimioterapia Adjuvante/métodos , Dermatologia/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Metástase Linfática , Oncologia/história , Melanoma/diagnóstico , Melanoma/mortalidade , Melanoma/terapia , Procedimentos Cirúrgicos Minimamente Invasivos/história , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estadiamento de Neoplasias , Seleção de Pacientes , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/terapia , Taxa de Sobrevida , Resultado do Tratamento , Carga TumoralRESUMO
A review of the history of cardiac surgery around the world is made divided into three stages, the first since the beginning of humanity until 300 years BC; the second moment shows how comes the platform that would give the anatomical and functional bases of the cardiovascular system. This historic moment includes: 1. the description and analysis of the function of blood and its components; 2. the description of the normal and abnormal Anatomy of the human heart and its vessels; 3. the anatomic and functional correlation: Foundation of the deductive thinking, and 4. the anatomic and functional integration with the clinic. Finally, the third wave, which is living today, is the stage of the technological explosion that begins with procedures as thoracoscopic surgery with the concept of reducing surgical trauma through minimum approach surgery. Also the use of robotics to solve some of the alterations in the CC, another is hybrid procedures and finally the use of fetal cardiac surgery.
Se hace una revisión de la historia de la cirugía cardiaca a nivel mundial dividida en tres etapas; la primera desde los inicios de la humanidad hasta 300 años a.C, El segundo momento muestra cómo surge la plataforma que daría las bases anatómicas y funcionales del sistema cardiovascular. Este momento histórico comprende: 1. La descripción y el análisis de la función sanguínea y sus componentes; 2. La descripción de la anatomía normal y anormal del corazón humano y sus vasos; 3. La correlación anatomo-funcional: fundamento del pensamiento deductivo, y 4. La integración anatomo-funcional con la clínica. Por último, la tercera ola, que es la que se vive en la actualidad, es la etapa de la explosión tecnológica que inicia con los procedimientos toracoscópicos, con el concepto de reducir el trauma quirúrgico mediante la cirugía de mínimo abordaje. También está el uso de la robótica para solucionar algunos de las alteraciones en las Cardiopatías Congénitas, otro son los procedimientos hibridos y finalmente la cirugía fetal.