Primary cutaneous melanoma: an 18-year study.

BACKGROUND: Primary cutaneous melanoma still constitutes the main cause of skin cancer death in developed countries, and its incidence in recent years has been increasing in a steady, worrisome manner. OBJECTIVES: This study evaluated the clinical, epidemiological and demographic aspects of this disease, and correlated them with patient prognosis. METHODS: Using epidemiologic and clinical data, we analyzed 84 patients with mild to severe primary cutaneous melanoma treated between 1990 and 2007. Slides containing surgical specimens were analyzed, and new slides were made from archived paraffin sections when necessary. RESULTS: The melanoma incidence was higher in areas of sun exposure, with lesions commonly observed in the trunk for males, and lower limbs for females. In addition to Breslow's thickness and ulceration (p = 0.043 and p < 0.001, respectively), the mitotic rate per mm(2) also correlated with worse patient outcome (p = 0.0007). The sum of ulceration (0 when absent or 1 when present), the Breslow index (1 when <1 mm, 2 when >1 mm and <4 mm, 3 when >4 mm) and the mitotic index (0 when absent or 1 when > or =1 per mm(2)) allowed the establishment of a prognostic score: if the sum was equal to or over three, nearly all (91.7%) patients had systemic disease. The 5-year survival was approximately seventy percent. CONCLUSION: Because American Join Committee of Cancer Staging will update the classification of malignant tumors (TNM) staging in the near future, and introduce mitosis as a prognostic factor, our results show the importance of such a feature. Additional studies are necessary to confirm the importance of a prognostic score as proposed herein.

Primary cutaneous melanoma: an 18-year study

BACKGROUND: Primary cutaneous melanoma still constitutes the main cause of skin cancer death in developed countries, and its incidence in recent years has been increasing in a steady, worrisome manner. OBJECTIVES: This study evaluated the clinical, epidemiological and demographic aspects of this disease, and correlated them with patient prognosis. METHODS: Using epidemiologic and clinical data, we analyzed 84 patients with mild to severe primary cutaneous melanoma treated between 1990 and 2007. Slides containing surgical specimens were analyzed, and new slides were made from archived paraffin sections when necessary. RESULTS: The melanoma incidence was higher in areas of sun exposure, with lesions commonly observed in the trunk for males, and lower limbs for females. In addition to Breslow's thickness and ulceration (p = 0.043 and p < 0.001, respectively), the mitotic rate per mm² also correlated with worse patient outcome (p = 0.0007). The sum of ulceration (0 when absent or 1 when present), the Breslow index (1 when <1 mm, 2 when >1 mm and <4 mm, 3 when >4 mm) and the mitotic index (0 when absent or 1 when >1 per mm²) allowed the establishment of a prognostic score: if the sum was equal to or over three, nearly all (91.7 percent) patients had systemic disease. The 5-year survival was approximately seventy percent. CONCLUSION: Because American Join Committee of Cancer Staging will update the classification of malignant tumors (TNM) staging in the near future, and introduce mitosis as a prognostic factor, our results show the importance of such a feature. Additional studies are necessary to confirm the importance of a prognostic score as proposed herein.

Lymphoscintigraphic appraisal of the lower limbs after liposuction.

BACKGROUND: The trauma resulting from liposuction damages the subcutaneous cellular tissue and subsequently the lymphatic structures. In turn, this damage can reduce lymphatic drainage, which may or may not appear clinically as some degree of edema. OBJECTIVE: It is possible to evaluate the function of the lymphatic system using lymphoscintigraphy. We conducted a study to evaluate the lymphatic system using this technique both before and after liposuction of the lower limbs. METHODS: The study included seven women ranging from 18 to 42 years of age, all of whom were diagnosed with lipodystrophy solely in the lateral and medial regions of the upper third of the thighs. This study was conducted in three stages: preoperative lymphoscintigraphy, liposuction, and postoperative lymphoscintigraphy three months postoperatively. The Wilcoxon signed-rank test was used for the statistical analysis of the results. RESULTS: A comparison of values for the average time of the radiopharmaceutical acquisition curve and clearance in the areas of lymphoscintigraphic interest both before and three months after liposuction did not reveal significant results. CONCLUSIONS: A comparison of preoperative and postoperative lymphoscintigraphic findings showed no significant damage to the lymphatic system associated with liposuction of the lower limbs.

Mamoplastia redutora de pedículo inferior: sensibilidade aréolo-mamilar, indicações e resultados / Reducing mammoplasty of inferior pedicle: aréolo-mamilar sensitivity, indications and results

A mamoplastia redutora com pedículo inferior apresenta vantagens em relação à manutenção da sensibilidade aréolo-mamilar, quando comparada com o uso de outras técnicas de redução do volume mamário, principalmente quando indicada em pacientes com gigantomastia. Nas últimas décadas, esta técnica foi aperfeiçoada, com pedículo mais estreito e sem descolamento de sua face posterior, com a finalidade de preservar o ramo anterior do 4°. nervo cutâneo lateral, obtendo melhores resultados.Método: foram selecionadas dez pacientes submetidas a este procedimento, e dez pacientes à mamoplastia redutora, por técnicas em que o complexo aréolo-mamilar tem sua nutrição por pedículo superior, de modo a formar pares de casos com idades próximas e volume final de ressecção semelhante, todas submetidas a testes de sensibilidade térmica, dolorosa e de discriminação táctil, com acompanhamento semanal no 1°. mês, e mensal, até o 7°. mês. Resultado: a comparação de ambos os grupos mostrou manutenção integral da sensibilidade dolorosa no CAM daquelas operadas pela técnica do pedículo inferior, perda inicial no 2°. grupo com retorno gradual e apenas parcial após três meses. A diferença da sensibilidade térmica e de discriminação táctil foi mais acentuada ainda em todo o seguimento. Conclusões: obedecidos alguns preceitos básicos, esta técnica oferece diversas vantagens: manutenção da sensibilidade aréolo-mamilar, fácil execução e adequado aspecto pós-operatório, além da possibilidade de grandes ressecções mamarias.

Cuidados de rotina em pacientes traqueostomizados / Routine cares for tracheostomized patients

Com a finalidade de prevenir as principais complicaçöes que podem ocorrer em pacientes traqueostomizados, säo apresentadas e discutidas algumas medidas práticas na manipulaçäo destes doentes e realçada a importância de sua observaçäo e cuidado constantes.

Infecçäo do paciente cirúrgico: cuidados para sua prevençäo / Infection in sugical patient: care to its prevention

Neste estudo, os autores apresentam uma sequência objetiva de medidas que, colocadas em prática, desde o preparo do paciente até sua recuperaçäo, abrangendo o próprio paciente e o ambiente que o cerca na enfermaria e sala cirúrgica, visam diminuir a incidência de infecçäo no pós-operatório.