RESUMO
Varón de 68 años que acude para valoración de un carcinoma basocelular con diferenciación escamosa en el párpado inferior izquierdo. Se realizó una resección con control de margen de sección congelada y el defecto (canto interno, dos tercios del párpado inferior y 2,5cm de la mejilla) fue reconstruido 2 días después de la cirugía en un solo acto quirúrgico: la lamela posterior con injerto de pericráneo y la anterior con un flap de Mustardé. Después de un año de seguimiento, el paciente tiene un aspecto aceptable, un buen soporte y posición palpebral, tejido vascularizado como el nativo en el párpado, sin recurrencia del tumor
We report the case of a 68-year-old man with a left lower eyelid basal cell carcinoma with squamous differentiation. Resection was performed under frozen section technique and the defect (inner canthus, two thirds of the lower eyelid and 2.5cm of the cheek) reconstructed 2 days after surgery in a single surgical operation: posterior lamella with pericranial graft and anterior lamella with Mustarde flap. After one year of follow-up, the patient has an adequate appearance, good eyelid support and position, vascularized tissue like the native eyelid and no tumor recurrence
Assuntos
Humanos , Masculino , Idoso , Blefaroplastia/métodos , Carcinoma Basocelular/cirurgia , Neoplasias Palpebrais/cirurgia , Periósteo/transplante , Retalhos Cirúrgicos , CrânioRESUMO
We report the case of a 68-year-old man with a left lower eyelid basal cell carcinoma with squamous differentiation. Resection was performed under frozen section technique and the defect (inner canthus, two thirds of the lower eyelid and 2.5cm of the cheek) reconstructed 2 days after surgery in a single surgical operation: posterior lamella with pericranial graft and anterior lamella with Mustarde flap. After one year of follow-up, the patient has an adequate appearance, good eyelid support and position, vascularized tissue like the native eyelid and no tumor recurrence.
Assuntos
Blefaroplastia/métodos , Carcinoma Basocelular/cirurgia , Neoplasias Palpebrais/cirurgia , Periósteo/transplante , Retalhos Cirúrgicos , Idoso , Humanos , Masculino , CrânioAssuntos
Traumatismos por Explosões/cirurgia , Desbridamento/instrumentação , Desbridamento/métodos , Ferimentos Oculares Penetrantes/cirurgia , Armas de Fogo , Balística Forense , Túnica Conjuntiva/lesões , Túnica Conjuntiva/cirurgia , Lesões da Córnea/cirurgia , Diamante , Explosões , Traumatismos Faciais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pós , TatuagemAssuntos
Corpos Estranhos no Olho/complicações , Corpos Estranhos no Olho/diagnóstico , Ferimentos Oculares Penetrantes , Miosite/diagnóstico , Miosite/etiologia , Órbita/lesões , Madeira , Adulto , Diplopia/diagnóstico , Diplopia/etiologia , Diplopia/cirurgia , Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/complicações , Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/cirurgia , Humanos , Masculino , Órbita/cirurgia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/etiologia , Doenças Orbitárias/cirurgia , Plantas , Torcicolo/diagnóstico , Torcicolo/etiologiaRESUMO
Mechanisms leading to liver damage in chronic hepatitis C (CHC) are being discussed, but both the immune system and the virus are involved. The aim of this study was to evaluate intrahepatic viral infection, apoptosis and portal and periportal/interface infiltrate in paediatric and adult patients to elucidate the pathogenesis of chronic hepatitis C. HCV-infected, activated caspase-3(+) and TUNEL(+) hepatocytes, as well as total, CD4(+), CD8(+), Foxp3(+) and CD20(+) lymphocytes infiltrating portal and periportal/interface tracts were evaluated in 27 paediatric and 32 adult liver samples by immunohistochemistry or immunofluorescence. The number of infected hepatocytes was higher in paediatric than in adult samples (p 0.0078). In children, they correlated with apoptotic hepatocytes (activated caspase-3(+) r = 0.74, p < 0.0001; TUNEL(+) r = 0.606, p 0.0017). Also, infected (p = 0.026) and apoptotic hepatocytes (p = 0.03) were associated with the severity of fibrosis. In adults, activated caspase-3(+) cell count was increased in severe hepatitis (p = 0.009). Total, CD4(+), CD8(+) and Foxp3(+) lymphocyte count was higher in adult samples (p < 0.05). Paediatric CD8(+) cells correlated with infected (r = 0.495, p 0.04) and TUNEL(+) hepatocytes (r = 0.474, p = 0.047), while adult ones correlated with activated caspase-3(+) hepatocytes (r = 0.387, p 0.04). In adults, CD8(+) was associated with hepatitis severity (p < 0.0001) and correlated with inflammatory activity (CD8(+) r = 0.639, p 0.0003). HCV, apoptosis and immune response proved to be involved in CHC pathogenesis of both paediatric and adult patients. However, liver injury in paediatric CHC would be largely associated with a viral cytopathic effect mediated by apoptosis, while in adults it would be mainly associated with an exacerbated immune response.