RESUMEN
BACKGROUND: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, Non-Hodgkin lymphoma arising in the capsule of breast implants. BIA-ALCL presents as a recurrent effusion and/or mass. Tumours exhibit CD30 expression and are negative for Anaplastic Lymphoma Kinase (ALK). We report the multi-disciplinary management of the UK series and how the stage of disease may be used to stratify treatment. METHODS: Between 2012 and 2016, 23 cases of BIA-ALCL were diagnosed in 15 regional centres throughout the UK. Data on breast implant surgeries, clinical features, treatment and follow-up were available for 18 patients. RESULTS: The mean lead-time from initial implant insertion to diagnosis was 10 years (range: 3-16). All cases were observed in patients with textured breast implants or expanders. Fifteen patients with breast implants presented with stage I disease (capsule confined), and were treated with implant removal and capsulectomy. One patient received adjuvant chest-wall radiotherapy. Three patients presented with extra-capsular masses (stage IIA). In addition to explantation, capsulectomy and excision of the mass, all patients received neo-/adjuvant chemotherapy with CHOP as first line. One patient progressed on CHOP but achieved pathological complete response (pCR) with Brentuximab Vedotin. After a mean follow-up of 23 months (range: 1-56) all patients reported here remain disease-free. DISCUSSION: BIA-ALCL is a rare neoplasm with a good prognosis. Our data support the recommendation that stage I disease be managed with surgery alone. Adjuvant chemotherapy may be required for more invasive disease and our experience has shown the efficacy of Brentuximab as a second line treatment.
Asunto(s)
Implantes de Mama/efectos adversos , Neoplasias de la Mama/etiología , Neoplasias de la Mama/terapia , Consentimiento Informado , Linfoma Anaplásico de Células Grandes/etiología , Linfoma Anaplásico de Células Grandes/terapia , Adulto , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Terapia Combinada , Remoción de Dispositivos , Femenino , Humanos , Linfoma Anaplásico de Células Grandes/epidemiología , Linfoma Anaplásico de Células Grandes/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Resultado del Tratamiento , Reino Unido/epidemiologíaRESUMEN
The upper outer quadrant of the breast is the most common site for the incidence of breast cancer, and the upper inner quadrant the most cosmetically sensitive area. If an oncoplastic approach is considered however, these quadrants do not fall within the classical Wise pattern for oncological mammoplasty. We use a simple modification of the Wise pattern that facilitates oncological mammoplasty of tumours in these quadrants without the need for secondary or extended pedicles. In planning this modification excision of skin overlying the tumour is usually also possible. The modification of the Wise pattern technique that we use is described as a technical note, and a case series of 11 patients who underwent this procedure is presented. To date there have been no recurrences. This is a simple cosmetically acceptable modification of the Wise pattern breast reduction for oncological mammoplasty.
Asunto(s)
Neoplasias de la Mama/cirugía , Mama/anatomía & histología , Mama/cirugía , Mamoplastia/métodos , Adulto , Anciano , Neoplasias de la Mama/patología , Estética , Femenino , Estudios de Seguimiento , Humanos , Mastectomía Segmentaria/métodos , Persona de Mediana Edad , Medición de Riesgo , Resultado del TratamientoRESUMEN
Cutaneous melanoma is highly immunogenic, yet primary melanomas and metastases develop successfully in otherwise immunocompetent patients. To investigate the local immunosuppressive microenvironment, we examined the presence of suppressor T lymphocytes and tolerising dendritic cells (DCs), the expression of immunosuppressive cytokines (IL-10, TGFbeta1 and TGFbeta2) and the enzyme indoleamine 2,3-dioxygenase (IDO) using qRT-PCR and immunohistochemistry in primary skin melanomas, negative and positive sentinel lymph nodes (SLN), and lymph nodes with advanced metastases. Our results indicate that tolerogenic DCs and suppressor T lymphocytes are present in melanoma at all stages of disease progression. They express transforming growth factor beta receptor 1 (TGFbetaR1), and are therefore susceptible to TGFbeta1 and TGFbeta2 specifically expressed by primary melanoma. We found that expression of IDO and interleukin 10 (IL-10) increased with melanoma progression, with the highest concentration in positive SLN. We suggest that negative SLN contain immunosuppressive cells and cytokines, due to preconditioning by tolerogenic DCs migrating from the primary melanoma site to the SLN. In primary melanoma, TGFbeta2 is likely to render peripheral DCs tolerogenic, while in lymph nodes IDO and TGFbeta1 may have a major effect. This mechanism of tumour-associated immunosuppression may inhibit the immune response to the tumour and may explain the discrepancy between the induction of systemic immunity by anti-melanoma vaccines and their poor performance in the clinic.
Asunto(s)
Melanoma/inmunología , Neoplasias Cutáneas/inmunología , Citocinas/genética , Citocinas/inmunología , Células Dendríticas/inmunología , Humanos , Terapia de Inmunosupresión , Indolamina-Pirrol 2,3,-Dioxigenasa/genética , Indolamina-Pirrol 2,3,-Dioxigenasa/inmunología , Metástasis Linfática/inmunología , Reacción en Cadena de la Polimerasa , ARN Neoplásico/genética , ARN Neoplásico/aislamiento & purificaciónRESUMEN
This report describes a case of venous dissecting aneurysm presenting as a popliteal mass, in a 33 year old woman. A 1 x 1 x 0.5 cm lump developed early in the course of a second pregnancy. Primary venous aneurysms are rare vascular abnormalities that can affect either the superficial or deep veins, and have been described throughout the venous system. Most commonly found in the neck and central thoracic veins, they have also been found in visceral veins and extremities. There is a tendency for vascular disturbances to occur during pregnancy. The haemodynamic changes and hormonal milieu may be the cause of vascular alterations, which can lead to new aneurysm formation, or weakening of pre-existing aneurysms. This is the first reported case of a dissecting venous aneurysm, and has the added interest that it occurred during pregnancy.
Asunto(s)
Disección Aórtica/cirugía , Complicaciones Cardiovasculares del Embarazo/cirugía , Vena Safena/cirugía , Adulto , Disección Aórtica/patología , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/patologíaRESUMEN
The recent discovery of activating mutations in the BRAF gene in many cutaneous melanomas led us to screen the genomic sequence of BRAF exons 11 and 15 in a series of 48 intraocular (uveal) melanomas, together with control samples from three cutaneous melanomas and the SK-Mel-28 cell line, which has a BRAF mutation. The same mutation was detected in two-thirds of our cutaneous melanoma samples, but was not present in any uveal melanomas. This finding further underlines the distinction between uveal and cutaneous melanomas, and suggests that BRAF inhibitors are unlikely to benefit patients with uveal melanoma.
Asunto(s)
Proteínas de Unión al ADN/genética , Exones , Melanoma/genética , Mutación , Proteínas Oncogénicas/genética , Neoplasias Cutáneas/genética , Neoplasias de la Úvea/genética , Secuencia de Bases , Cartilla de ADN , Proteínas del Grupo de Alta Movilidad , Humanos , Melanoma/patología , Reacción en Cadena de la Polimerasa , Proteínas Proto-Oncogénicas B-raf , Neoplasias Cutáneas/patología , Células Tumorales Cultivadas , Neoplasias de la Úvea/patologíaRESUMEN
Intraosseous infusion is increasingly finding application for venous access to infuse drugs and fluids in paediatric resuscitation including burns. The aim of this study was to determine the feasibility of using blood samples taken from the bone marrow cavity for routine blood analysis. In paediatric resuscitation where alternative venous access is not available this could prove valuable. Peripheral venous blood samples were compared with blood obtained from the bone marrow cavity in patients undergoing bone marrow aspiration for the investigation of possible medical pathology. Haemoglobin, haematocrit, sodium, urea, creatinine, and calcium levels values were sufficiently similar to be clinically useful. The potassium level was elevated in most bone marrow samples and the difference from peripheral venous samples variable. Great caution should be exercised in their interpretation. Glucose levels should also be interpreted with care. In conclusion, blood samples obtained intraosseously may give a useful guide to peripheral blood levels of some haematological and biochemical variables. This is potentially useful where a peripheral venous sample cannot be obtained. The values must be interpreted with care. Whether these findings can be extended to paediatric patients who are not haemodynamically stable has not been assessed.
Asunto(s)
Médula Ósea/química , Cateterismo Venoso Central , Inyecciones Intralesiones , Manejo de Especímenes/métodos , Análisis Químico de la Sangre/métodos , Catéteres de Permanencia , Femenino , Humanos , Masculino , Sensibilidad y EspecificidadRESUMEN
We have described the application of the rotation flap to the dorsum of the hand. This has proved useful for closing certain defects on the dorsum of the hand. The flap is designed as a rotation flap and the secondary defect is then closed by advancement using the laxity at the dorsal wrist crease. We have reported on 10 cases. These adhere to the principle of repairing like with like and yield results which are both aesthetically and functionally excellent. The preservation of the axial elements of the flap theoretically makes it more robust and more resistant to infection.
Asunto(s)
Mano/cirugía , Procedimientos de Cirugía Plástica/métodos , Neoplasias Cutáneas/cirugía , Colgajos Quirúrgicos , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Dupuytren's disease may present with well-defined subcutaneous cords or as more diffuse disease with involvement of the skin. Fasciectomy is the procedure commonly carried out for the full range of disease, but is associated with rates of recurrence of up to 66%. We reviewed 143 rays in 103 patients undergoing dermofasciectomy for diffuse disease with involvement of the skin. We found recurrence in 12 rays (8.4% of rays; 11.6% of patients) during a mean follow-up of 5.8 years, eight as cords and four as nodules. We suggest that dermofasciectomy is a better method of disease control than fasciectomy for the more diffuse type of disease with involvement of the skin.
Asunto(s)
Procedimientos Quirúrgicos Dermatologicos , Contractura de Dupuytren/cirugía , Fasciotomía , Trasplante de Piel , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , RecurrenciaRESUMEN
The use of a V-Y advancement flap for reconstruction of a volar/lateral soft tissue defect in a digit involving segmental loss of the neurovascular bundle of up to 10 mm at middle phalangeal level is described. This flap allows immediate reconstruction with primary repair of the nerve and gives good functional results. Two cases are presented.
Asunto(s)
Dedos/inervación , Nervio Radial/lesiones , Nervio Cubital/lesiones , Adulto , Anciano , Arterias/trasplante , Dedos/irrigación sanguínea , Humanos , Masculino , Nervio Radial/trasplante , Trasplante de Piel/métodos , Colgajos Quirúrgicos , Nervio Cubital/trasplanteRESUMEN
Two examples of resuscitation of a scalded child by intraosseous infusion, following failed peripheral venous cannulation, are presented. The technique of intraosseous infusion is reviewed and it is concluded that this technique provides a valuable second-line technique for establishing emergency venous access in children. It is quick, reliable and enables the rapid infusion of intravenous fluids and drugs into the systemic venous system. Complications are rare but can be serious and close observation of the infusion site is advisable.
Asunto(s)
Quemaduras/terapia , Fluidoterapia/métodos , Infusiones Intraóseas/métodos , Humanos , Lactante , Recién Nacido , MasculinoAsunto(s)
Quemaduras/rehabilitación , Cicatriz/prevención & control , Estrés Psicológico/terapia , Colgajos Quirúrgicos/métodos , Vendajes , Quemaduras/complicaciones , Quemaduras/fisiopatología , Cicatriz/etiología , Terapia Combinada , Consejo , Humanos , Terapia por Láser , Psicoterapia , Siliconas/uso terapéutico , Ajuste Social , Esteroides/uso terapéutico , Estrés Psicológico/etiología , Cirugía Plástica , Expansión de Tejido , Trasplante de Tejidos , Cicatrización de HeridasRESUMEN
We report a case of a spontaneous pneumothorax in association with a major burn. The pneumothorax remained undetected for 4 days and the patient underwent a 2 h aeromedical transfer which could potentially have been hazardous. We strongly recommend that arterial blood gas analysis is performed before air transport of moderate or severely burned patients. If blood gases are abnormal a chest X-ray should also be performed. In practice a strong case can be made for routinely obtaining a chest X-ray in these patients. In-flight monitoring should include pulse oximetry.
Asunto(s)
Quemaduras/complicaciones , Neumotórax/etiología , Adulto , Ambulancias Aéreas , Femenino , Humanos , Neumotórax/diagnóstico , Transporte de PacientesRESUMEN
Five cases of burns caused by residents of nursing homes falling out of bed and becoming trapped against radiators or hot pipes are reported. The current guidelines for nursing homes in relation to heating surfaces are reviewed and recommendations are made on how this hazard can be avoided.