RESUMEN
BACKGROUND: One of the main concerns in orbital blowout fracture repair is a narrow operation field, due mainly to the innate complex three dimensions of the orbit; however, a deep location and extensive area of the fracture and soft tissue edema can also cause concern. Swelling of the orbital contents progresses as the operation continues. Mannitol has been used empirically in glaucoma, cerebral hemorrhage, and orbital compartment syndrome for decompression. The authors adopted mannitol for the control of intraorbital edema and pressure in orbital blowout fracture repair. METHODS: This prospective study included 108 consecutive patients who were treated for a pure blowout fracture from January 2007 to October 2012. For group I, mannitol was administered during the operation. Under general anesthesia, all patients underwent surgery by open reduction and insertion of an absorbable mesh implant. The authors compared postoperative complications, the reoperation rate, operation time, and surgical field improvement between the two groups. RESULTS: In patients who received intraoperative administration of mannitol, the reoperation rate and operation time were decreased; however, the difference was not statistically significant. The total postoperative complication rates did not differ. Panel assessment for the intraoperative surgical field video recordings showed significantly improved vision in group I. CONCLUSIONS: For six years, mannitol proved itself an effective, reliable, and safe adjunctive drug in the repair of orbital blowout fractures. With its rapid onset and short duration of action, mannitol could be one of the best methods for obtaining a wider surgical field in blowout fracture defects.
Asunto(s)
Humanos , Anestesia General , Hemorragia Cerebral , Síndromes Compartimentales , Descompresión , Edema , Cirugía General , Glaucoma , Complicaciones Intraoperatorias , Manitol , Métodos , Órbita , Fracturas Orbitales , Complicaciones Posoperatorias , Estudios Prospectivos , Reoperación , Grabación en Video , Visión OcularRESUMEN
Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity, and the standard treatment is extensive surgical excision. Cesarean scar endometriosis is a type of cutaneous endometriosis arising on or near a Cesarean section scar. A 44-year-old woman presented with a 9x6 cm sized dark-brown, stony-hard, irregular, lower abdominal mass of four years duration. The patient had a history of two Cesarean deliveries, 14 and 16 years ago. Suspecting endometriosis, we excised the tumor conservatively rather than extensively to prevent incisional hernia considering the benign nature of the tumor and the low possibility of recurrence because the patient's age was near menopause, along with simultaneous bilateral salpingo-oophorectomy that was performed in this case. On reconstruction, mini-abdominoplasty was adopted to avoid possible wound complications and cosmetic deformities. The patient was satisfied with the cosmetic results, and neither recurrence nor functional problems occurred during the 1-year follow-up period. Plastic surgeons should keep in mind the possibility of cutaneous endometriosis in an abdominal mass of a female of reproductive age with a previous history of pelvic or intra-abdominal surgery. An optimal result from oncological, functional, and cosmetic standpoints can be achieved with conservative excision followed by mini-abdominoplasty of extensive Cesarean scar endometriosis.
Asunto(s)
Adulto , Femenino , Humanos , Embarazo , Técnicas de Cierre de Herida Abdominal , Cesárea , Cicatriz , Anomalías Congénitas , Cosméticos , Endometriosis , Estudios de Seguimiento , Hernia , Menopausia , RecurrenciaRESUMEN
PURPOSE: Nevus sebaceus is a congenital hamartomatous lesion, typically involving head and neck. Various benign and malignant neoplasms can develop in association with nevus sebaceus. We report a case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma in nevus sebaceus. METHODS: A 73-year-old man presented with erythematous to black verrucous nodules on the right subauricular area. The upper part was accompanied with inflammation and ulceration, and no specific findings suspicious for malignant degeneration were found in the lower part preoperatively. The mass was totally excised and the defect was directly closed. Lymph nodes were not involved on concomitant neck dissection. RESULTS: Histopathologic examination confirmed the presence of squamous cell carcinoma in the upper part and basal cell carcinoma in the lower part of a nevus sebaceus. Negative margins were achieved on resection. No clinical problems were found during the 3-month follow-up period. CONCLUSION: We experienced a rare case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma within the same nevus sebaceus. Because patients with nevus sebaceus have risk of malignant changes, surgical excision and work-up for recurrence and metastasis should be considered in suspicious cases. And even in a totally asymptomatic case, the possibility of occult secondary cancer should be informed before surgery in aged patients.
Asunto(s)
Anciano , Humanos , Carcinoma Basocelular , Carcinoma de Células Escamosas , Estudios de Seguimiento , Cabeza , Inflamación , Ganglios Linfáticos , Cuello , Metástasis de la Neoplasia , Nevo , Recurrencia , ÚlceraRESUMEN
We evaluated tetanus specific IgG, IgM, IgG subclasses after DPT vaccination in infants and children. Tetanus toxoid specific IgG, IgM IgG subclasses were measured to characterize the isotope profile of antibody against tetanus toxoid. The values of the tetanus specific IgG in the positive group were significantly increased compared to those of the control group, and were significantly increased after two inoculation. Tetanus specific IgG was very low in adults and neonates. In our tetanus specific IgG subclasses study, forty-five of 56 cases (80%) showed predominantly IgG1 antibody responses to tetanus toxoid, while twenty-five of 56 cases (45%) showed IgG4 responses. Both IgG1 and IgG4 responses were demonstrated in 17 cases (30%). So we suggest that IgG was mainly involved in humoral immune response after DPT vaccination, and IgG1 may play an important role among IgG subclasses. IgG4, alone or together with IgG1, can also play a role in immune response to tetanus toxoid.