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1.
Rev. chil. dermatol ; 31(2): 151-154, 2015. ilus
Article in Spanish | LILACS | ID: biblio-836005

ABSTRACT

La granulomatosis eosinofílica con poliangeítis (Síndrome de Churg-Strauss) es una enfermedad vasculítica primaria poco frecuente. El diagnóstico actualmente se define a partir de la presencia de al menos cuatro de seis criterios propuestos por la Sociedad Americana de Reumatología, los cuales incluyen: asma bronquial, eosinofilia mayor que 10 por ciento, sinusitis paranasal, infiltración pulmonar, evidencia histológica de vasculitis y compromiso neurológico ya sea mono o polineuropático. En el presente artículo se reporta el caso de un paciente de 56 años con antecedentes de asma bronquial, rinitis alérgica y poliposis nasal operada, derivado a nuestro centro por cuadro de aumento de volumen doloroso en ambas extremidades inferiores, baja de peso, parestesias y debilidad muscular. Asociado a esto desarrolló lesiones purpúricas palpables cuya biopsia resultó compatible con granulomatosis eosinofílica con poliangeítis. El paciente posteriormente recibió tratamiento inmunosupresor con prednisona y un pulso de ciclofosfamida con buena respuesta clínica. Se presenta una revisión bibliográfica a propósito del caso.


Eosinophilic granulomatosis with polyangiitis (Churg-Strauss Syndrome) is an uncommon primary vasculitis. The diagnosis is currently defined by the presence of at least four of six criteria proposed by the American College of Rheumatology, which include: asthma, eosinophilia less than 10 percent, paranasal sinusitis, pulmonary infiltration, histologic evidence of vasculitis and neurologic compromise as mono or polyneuropathy. In the present article, we report the case of a 56 year-old man with history of asthma, allergic rhinitis and operated nasal polyposis, referred to our center with painful bulking in both lower extremities, weight loss, paresthesias and muscle weakness. It also developed palpable purpura. Biopsy of skin lesions was compatible with eosinophilic granulomatosis with polyangiitis. The patient subsequently received immunosuppressive therapy with prednisone and a cyclophosphamide bolus with good clinical response. A review on the subject is also presented.


Subject(s)
Humans , Male , Middle Aged , Granulomatosis with Polyangiitis/pathology , Granulomatosis with Polyangiitis/drug therapy , Churg-Strauss Syndrome/pathology , Churg-Strauss Syndrome/drug therapy , Granulomatosis with Polyangiitis/diagnosis , Immunosuppressive Agents/therapeutic use , Prednisone/therapeutic use , Churg-Strauss Syndrome/diagnosis
5.
Rev. chil. dermatol ; 30(3): 285-288, 2014. ilus
Article in Spanish | LILACS | ID: biblio-835962

ABSTRACT

La Anetoderma es una enfermedad elastolítica rara que se caracteriza por la pérdida focal de tejido elástico en la dermis. La patogénesis de esta enfermedad es desconocida y ha sido descrita en asociación con enfermedades autoinmunes, como lupus eritematoso y síndrome antifosfolípidos, y con enfermedades infecciosas, principalmente VIH, sífilis y borreliosis. Su diagnóstico diferencial es amplio e incluye otras enfermedades elastolíticas, liquen escleroatrófico extragenital y morfea, entre otros. Se reporta el caso de una paciente que consultó por un cuadro de larga data de múltiples parches blanquecinos atróficos, cuya biopsia cutánea fue compatible con Anetoderma. Se realiza una revisión de la literatura dada la necesidad de un adecuado estudio y seguimiento de estos pacientes en busca de una pesquisa temprana de enfermedades autoinmunes asociadas.


Anetoderma is a rare elastolytic disease characterized by focal loss of elastic tissue in the dermis. Pathogenesis is unknown and has been described in association with autoimmune diseases such as lupus erythematosus and antiphospholipid syndrome, and infectious diseases, especially HIV, syphilis and Lyme disease. Differential diagnosis is broad and includes other elastolytic disease, extragenital lichen sclerosus and morphea. We report the case of a patient with long-standing history of multiple atrophic white patches on the trunk and extremities, with diagnostic skin biopsy of Anetoderma. We conducted a literature review given the importance of good study and monitoring of these patients for an early investigation of associated autoimmune diseases.


Subject(s)
Humans , Adult , Female , Anetoderma/diagnosis , Anetoderma/pathology , Diagnosis, Differential
8.
Rev. chil. cir ; 64(1): 40-45, feb. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-627076

ABSTRACT

The pedicle transverse rectus abdominus myocutaneous flap (TRAM) is widely used for breast reconstruction, however is not exempt from complications. Between 2004 and 2010 the authors performed breast reconstruction after total mastectomy in 52 patients with pedicled TRAM flaps. Purpose: To describe the demography, outcomes and complications in patients operated for breast cancer and reconstructed with TRAM flap. To assess the influence of smoking, the laterality and timing of reconstruction. Material and Method: Retrospective, observational and comparative. We reviewed the medical records of 52 patients operated by the authors between 2004 and 2010. Four cases were excluded due to incomplete data. Results: In the 48 patients studied were 50 TRAM flaps. The most frequent comorbidity was smoking (27 percent). Regarding the timing of reconstruction, 74 percent (37) was performed immediately post-mastectomy and 26 percent (13) was deferred. Was used by 78 percent (39) ipsilateral TRAM, 18 percent (9) contralateral and 4 percent (2) bilateral. Only minor complications were observed and the cosmetic result evaluated by the surgeon's satisfaction was very good or excellent in 62 percent (31). Smoking, timing of reconstruction and laterality did not affect in complications or cosmetic outcome (p > 0.05). Conclusions: The pedicled TRAM flap is an excellent alternative for reconstruction in breast cancer patients. It is not exempt from complications, with a tendency to get better cosmetic results in the non-smoker group.


El colgajo de recto abdominal con isla transversal de piel infraumbilical (TRAM) pediculado es ampliamente utilizado para la reconstrucción mamaria, sin embargo, no está exento de complicaciones. Entre los años 2004 y 2010 los autores realizaron reconstrucción mamaria post-mastectomía total en 52 pacientes con colgajos TRAM pediculados. Objetivo: Describir la demografía, resultados y complicaciones de las pacientes operadas por cáncer de mama y reconstruidas con colgajo TRAM. Evaluar la influencia del tabaquismo, la lateralidad y el momento de la reconstrucción en dichos resultados. Material y Método: Diseño retrospectivo, observacional y comparativo. Se revisaron las historias clínicas de las 52 pacientes operadas por los autores entre los años 2004-2010. Se excluyeron 4 casos por datos incompletos. Resultados: En las 48 pacientes estudiadas se realizaron 50 colgajos TRAM. La comorbilidad más frecuente fue el tabaquismo (27 por ciento). La reconstrucción se realizó en un 74 por ciento (37) de manera inmediata postmastectomía y en un 26 por ciento (13) fue diferido. Se utilizó en un 78 por ciento (39) TRAM ipsilateral, 18 por ciento (9) contralateral y 4 por ciento (2) bilateral. Sólo se observaron complicaciones menores; el resultado estético evaluado por la satisfacción del cirujano fue muy bueno o excelente en un 62 por ciento (31). El tabaquismo, momento de la reconstrucción y la lateralidad no influyeron en las complicaciones ni en el resultado estético (p > 0,05). Conclusiones: El colgajo TRAM pediculado es una excelente alternativa de reconstrucción en pacientes mastectomizadas. No está exento de complicaciones, con una tendencia a obtener mejores resultados estéticos en el grupo no fumador.


Subject(s)
Humans , Female , Adult , Middle Aged , Breast Neoplasms/surgery , Reconstructive Surgical Procedures/methods , Surgical Flaps , Comorbidity , Esthetics , Smoking/adverse effects , Smoking/epidemiology , Mastectomy , Breast Neoplasms/epidemiology , Postoperative Complications , Retrospective Studies , Risk Factors , Rectus Abdominis/transplantation , Treatment Outcome
10.
Rev. Hosp. Clin. Univ. Chile ; 22(3): 187-194, 2011. tab
Article in Spanish | LILACS | ID: lil-647603

ABSTRACT

Negative effect of post-mastectomy radiotherapy in transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction remains unclear. The immediate post-mastectomy TRAM has shown better cosmetic results than delayed reconstruction, making it necessary to define the effects of radiation on this type of reconstruction. The aim of this study is to compare the effect of radiotherapy on immediate and delayed reconstruction with TRAM, analyzing aesthetic results and complications. We reviewed medical records of 23 patients undergoing mastectomy with TRAM reconstruction and radiation therapy between 2004-2009, distributed in those undergoing immediate reconstruction (n=12) and delayed post-radiotherapy (n=11). Cosmetic results and complications were compared between the groups. There were no differences in age, prevalence of comorbidities or clinical stage. Regarding the aesthetic result of immediate TRAM, 50 percent were classified as excellent, 20 percent very well, 20 percent good and 10 percent regular, while in delayed reconstructions, 64 percent was excellent, 18 percent very good and 18 percent good, no differences between both groups (p=0.51). There were no differences in local complications. Although the study population is insufficient to draw conclusions comparable, our results are comparable to those of other studies showing no deleterious effect of radiotherapy on immediate TRAM reconstructions. Additional studies are needed to recommend the treatment of choice.


Subject(s)
Humans , Adult , Female , Middle Aged , Mammaplasty/methods , Mammaplasty/trends , Breast Neoplasms/surgery , Breast Neoplasms/radiotherapy , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/trends
11.
Rev. chil. dermatol ; 26(4): 404-411, 2010. ilus, tab
Article in Spanish | LILACS | ID: lil-721804

ABSTRACT

Las metástasis cutáneas son infrecuentes, reportándose en la literatura rangos entre 0,6 por ciento y 10 por ciento. El cáncer de mama es la neoplasia más común en las mujeres con metástasis cutáneas. La presencia de éstas constituye un signo de enfermedad avanzada y es indicadora de mal pronóstico. Las lesiones pueden tener distintos patrones clínicos: tipo nodular, erisipeloide, alopecia y carcinoma telangiectásico. En el presente artículo se realiza un análisis retrospectivo de tres casos clínicos atendidos en nuestro centro y una revisión de la literatura.


Cutaneous metastases are unusual; their frequency in the literature ranges from 0.6 percent to 10 percent. Breast cancer is the most common cancer in women with cutaneous metastases. They are perceived as a sign of advanced disease and are regarded as a serious prognostic indicator. The lesions may present in distinct clinical forms: nodular pattern, erysipelas like presentations, alopecia and carcinoma telangiectaticum. In this article we analyzed three clinical cases that were seen in our center and a review of the literature.


Subject(s)
Humans , Female , Middle Aged , Adenocarcinoma/secondary , Skin Neoplasms/secondary , Skin Neoplasms/therapy , Breast Neoplasms/pathology , Breast Neoplasms/therapy
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