El ganglio centinela en el melanoma: nuestra experiencia / The sentinel lymph node biopsy for melanoma: our experience

El ganglio centinela ha sido recientemente aceptado como uno de los factores pronósticos más importantes en el melanoma maligno según la AJCC (American Joint Committee on Cancer), a pesar de que su uso sistemático no está aún extendido a todas la unidades de melanoma y su empleo no está exento de controversias. Entre otros aspectos, se discute si la realización de la ampliación de márgenes debe ser realizada en el mismo tiempo quirúrgico que el ganglio centinela para la eficacia del mismo. Se realiza un estudio retrospectivo sobre 78 pacientes intervenidos de ganglio centinela por melanoma entre Mayo 99 y Enero 04, todos ellos remitidos por Dermatología con diagnóstico de melanoma maligno >1mm de espesor de Breslow y adenopatías no palpables (estadio I y II de la AJCC). De ellos,42 son mujeres y 36 varones, con una edad media de 53.5 años. El espesor de Breslow medio es de 2.78mm. La ampliación de márgenes se hizo en un tiempo quirúrgico anterior por parte de Dermatología en 59 casos(76.62%), mientras que en 18 se realizó en el mismo tiempo que el ganglio centinela. La demora media entre la ampliación de márgenes y la realización del ganglio centinela fue de 5.87 meses. En el 19.23% (15 pacientes)no se observó captación gama gráfica, por lo que el estudio del ganglio centinela no pudo llevarse a cabo. De ellos, en 12, la ampliación de márgenes había sido anterior al tiempo del ganglio centinela, con una demora media de 5.06meses.El 50% (39) de los ganglios enviados a Anatomía Patológica fueron negativos para células malignas. El 25.74% (20pacientes) fueron positivos. El seguimiento medio es de 23.12 meses; 18 pacientes presentan en la actualidad metástasis o han fallecido; 47 casos (60%) se encuentran libres de (..) (AU)

The sentinel lymph node biopsy (SLNB) has recently been accepted as one of the most important prognostic factors of the cutaneous primary melanoma by the AJCC (American Joint Committee on Cancer), even its overall use is still not extended to all the melanoma units and there are many controversies about its use. Among other aspects, there is no consensus about if the previous wide local excision can alter the results of the biopsy. This is a retrospective study done over 78 consecutive cases of SLNB for melanoma between May´99 and Jan´04. All of them were remitted from Dermatology with the diagnose of melanoma, tumor thickness >1.0mm and no clinical nodes (AJCC est. I and II). Out of the 78 cases, 42 were women and 36 men, with an average age of 53.5. The average Breslow thickness was of 2.78mm. The wide local excision(WLE) was done by Dermatology at a previous time in 59 cases (76.62%), while 18 patients had the WLE at the time of the SLNB. The delay between the WLE and the SLNB was of 5.87 months. In the 19.23% (15patients) the SLNB was not feasible because there was not found colloid captation by any node; 12 of them had de WLE previous to the SLNB, with a delay of 5.06months; 50% (39) of the nodes were negative for melanoma cells ;25.74% (20patients) were positive. The follow up time was of 23.12months; 18 patients presented metastasis or died, while 47 cases (60%) are actually free of disease. We corroborate that the SLNB is a low morbility technique with an important staging function for the primary cutaneous melanoma. We don´t find any difference in the survival of patients with previous WLE compared with those whom the WLE was done concurrently (AU)

Manejo de la ptosis palpebral miogénica congénita / Congenital Myogenic Palpebral ptosis management

La ptosis palpebral congénita es una malformación relativamente frecuente con implicaciones estéticas y, en los casos más graves, funcionales, que pueden conducir a una importante merma en la agudeza visual del paciente. La ptosis palpebral miogénica es con mucho la más frecuente y la de mayor incidencia infantil. La evaluación correcta de cada caso, el aná- lisis de su etiología, de su evolución y de su grado de severidad nos permitirá realizar una selección adecuada de la técnica quirúrgica que debemos emplear. A continuación presentamos nuestra experiencia de los últimos cinco años (AU)

Upper eyelid congenital ptosis is a relatively frequent malformation which not only has aesthetic consequences but often, in more severe cases, may have a functional significance with a considerable loss of eyesight. Myogenic upper eyelid ptosis is by far the most frequent type and the one with the highest incidence in children. An adequate preoperative assessment, including an analysis of the cause, clinical progress and degree of severity will allow us to select the most appropriate surgical technique for each case. Following is our experience from the past five years (AU)

[Response of micropenis to topical testosterone and gonadotrophines. A comparative study (author's transl)]. / Estudio comparativo del desarrollo del pene en niños portadores de hipospadias por medio de testosterona y gonadotropina coriónica.

Hypoplasia of penis which is frequently associated with hipospadias is important when a surgical treatment of this malformation is to undertaken. The decision to increase the dimensions of the penis before surgery by means of hormone treatments is based on good surgical results obtained in very young patients with hypoplasia. The authors have conducted a study involving 76 boys with hipospadias over a period of four years. One group of 37 boys was treated with corionic gonadotrophines by injection during a period of eight weeks. The second group of 39 boys was treated with testosterone cream (2%) topically during one month. Measurements were taken before and after the treatments using four parameters, and the boys were separated according to age. The results showed a more favorable response to testosterone cream in comparison to the injections of corionic gonadotrophines.