RESUMO
The case of a 38-year-old white man with digital papillary adenocarcinoma is presented. It is a lesion of the skin often occurring in the digits of the hand or of the feet. This disease is rare and has not been reported in the plastic surgical or orthopedic literature to date. A case report is presented here along with our rationale for aggressive surgical treatment consisting of amputation.
Assuntos
Adenocarcinoma Papilar/cirurgia , Amputação Cirúrgica , Dedos/cirurgia , Neoplasias Cutâneas/cirurgia , Adenocarcinoma Papilar/patologia , Adulto , Glândulas Apócrinas/patologia , Núcleo Celular/ultraestrutura , Citoplasma/ultraestrutura , Epitélio/patologia , Seguimentos , Humanos , Masculino , Neoplasias Cutâneas/patologiaRESUMO
The "tumoral" calcifications seen with polymyositis and dermatomyositis are frequently large and painful. Many surgeons believe such calcifications should not be removed surgically, arguing that the surgical trauma induces further calcification that is probably ever more severe. However, we believe that surgical removal of these large masses is less traumatic than cyclical, spontaneous extrusion of the calcium with secondary healing. We present 2 patients in whom chronically draining and painful dystrophic calcifications were treated surgically without recurrence.
Assuntos
Calcinose/cirurgia , Miosite/complicações , Dermatopatias/cirurgia , Nádegas , Criança , Dermatomiosite/complicações , Cotovelo , Feminino , Seguimentos , Humanos , Pessoa de Meia-IdadeRESUMO
A posterior approach is proposed for correction of the webbed-neck deformity of Turner's syndrome. In this approach, a butterfly-shaped portion of redundant skin is excised posteriorly and the lateral, superior and inferior flaps joined in a double Y midline suture line. This approach avoids the unnatural hairline and noticeable scars characteristic of a lateral approach. We believe that the revision required in the case reported here can be avoided by employing an X-shaped, rather than a double inverted Y-shaped, suture line.
Assuntos
Procedimentos Cirúrgicos Dermatológicos , Pescoço/cirurgia , Síndrome de Turner/cirurgia , Coartação Aórtica/complicações , Coartação Aórtica/cirurgia , Criança , Pré-Escolar , Orelha/anormalidades , Feminino , Seguimentos , Hérnia Inguinal/complicações , Humanos , Hipertensão/complicações , Lactente , Recém-Nascido , Couro Cabeludo/cirurgia , Síndrome de Turner/diagnósticoRESUMO
Cadaver dissection indicated that a large amount of tissue could be transferred in one stage to the head and neck by a latissimus dorsi myocutaneous island flap tunneled beneath a pectoral skin bridge. A clinical trial of this flap (for one-stage reconstruction of a patient after excision of a recurrent mandibular carcinoma and a neck dissection) was successful. Previous investigators have found the myocutaneous latissimus dorsi flap to be dependable and adaptable in reconstructions of the chest wall, breast, and shoulder. It is evident now that the flap also has value in reconstructions of the head and neck.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Mandibulares/cirurgia , Músculos/transplante , Transplante de Pele , Cirurgia Plástica , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de NeoplasiaRESUMO
Using the rabbit ear as an experimental model, a composite flap based on an anastomosed central artery and vein can be created and its viability determined. This inexpensive model can be used to train plastic surgical residents in microsurgery and in further investigations of the microcirculation of flaps and their survival.
Assuntos
Orelha Externa/irrigação sanguínea , Microcirculação/cirurgia , Modelos Biológicos , Animais , Métodos , CoelhosRESUMO
Malignant pleural mesothelioma may be composed of sarcomatous, epitheliomatous or mixed cell types. They can be differentiated from localized, benign mesothelioma. Malignant pleural mesothelioma is a rapidly fatal tumor that poses serious diagnostic and therapeutic problems. A series of 19 cases was compiled at the North Carolina Baptist Hospital, and data from these cases were compared to those of other series. The average survival time was 10 months. The most common symptoms were dyspnea, chest pain, pleural effusion, and weight loss. Three patients had a definite history of exposure to asbestos; in 6 more there was a questionable exposure. The most helpful investigative screening tool was the chest roentgenogram, in that it demonstrated an intrathoracic abnormality; however, mesothelioma could not be differentiated from inflammatory reaction or bronchogenic carcinoma with pleural effusion. Sputum cytology as well as pleural effusion cytology was only suggestive of malignancy. Bronchoscopy was not helpful. Needle biopsy yielded malignant cells in 3 of 8 patients. Exploratory thoracotomy was the most accurate means of diagnosis but was frequently followed by seeding into the incision and severe, intractable incisional pain. Therapy proved to be palliative at best. Thoracotomy did not alter the course of the disease; in fact, the production of severe incisional pain was deleterious to the patient's well-being. Cordotomy done in 3 patients brought no relief. Neither radiation therapy nor chemotherapy had a significant effect on survival time or palliation.
