RESUMO
BACKGROUND: Basal cell carcinomas are rare in non-sun-exposed skin, and are even rarer in the perianal region. Alertness to the unusual occurrence of this tumor at perianal site, with understanding of its clinical course, can prevent delay in its diagnosis and morbid aggressiveness in the management of the disease. PRESENTATION OF CASE: A 93 year old female, referred to our hospital because of a three month bleeding ulcerative lesion, with a diameter approximately of 4.5×3.2cm, located in the perianal region. DISCUSSION: Tumors of the anus and perianal are infrequent neoplasms of the digestive tract. There are many diseases that can be confused with this diagnosis and it is commonly delayed because the tumor is rarely thought of in this particular cutaneous topography. Suspicion and early diagnosis, give the opportunity for a timely and appropriate treatment and also prevent tumor extension. CONCLUSION: Treatment modalities include early wide local excision to clear margins, ensuring further local recurrence and distant metastasis. The use of local V-Y advancement fasciocutaneous flaps may be another valid option for the reconstruction of perianal skin defects, with less morbidity than other flaps described in the literature.
RESUMO
La glándula mamaria es una parte importante de la morfología femenina y su desarrollo constituye una de las características más destacadas de la diferenciación sexual. Cada día aumenta el número de pacientes sometidas a mastectomía por un diagnóstico cada vez más temprano de cáncer de mama y aunque el porcentaje es bajo, ahora son más las pacientes que deciden optar por el procedimiento, incrementándose nuestra experiencia en la técnica practicada en el Servicio de Cirugía Plástica y Unidad Nacional de Quemados del Hospital San Juan de Dios, con un agresivo programa de reconstrucción mamaria, específicamente con el colgajo músculo-cutáneo de Latísimo Dorsal, dorsal ancho, y prótesis de silicón. Hubo 78 pacientes que se sometieron a reconstrucción mamaria con la técnica de colgajo músculo-cutáneo de dorsal ancho, más prótesis de silicón. Estos casos fueron aportados por los médicos del servicio, las pacientes mismas y posteriormente, en su gran mayoría por la CCSS, la cual asumió el programa en su totalidad. Todas las prótesis fueron rellenas con silicón cohesivo o altamente cohesivo y de perfil alto o muy alto. Se reconstruyeron 78 mamas entre enero de 1999 y julio del 2003, por la técnica acá descrita en igual número de pacientes, quienes habían sido sometidas a mastectomía a causa de cáncer del seno...
The female breast is an important part of the woman and its development is one of the most remarkable characteristics on the sex differential. Every day more patients are mastectomized due to a good and early diagnosis of breast cancer. Eventhough the percentage is low, there are more patients looking for a breast reconstruction. This situation increment the experience of the plastic surgery department and the national burn unit of the Hospital San Juan de Dios, with a very aggressive program of breast reconstruction,specifically, using the technic of the Latissimus Dorsi Moycutaneos Flap and Silastic Gell Filled rosthesis. A total of 78 patients underwent breast reconstruction with the Latissimus Dorsi Flap and Silastic Gel Filled Prosthesis. The staff physician performed all of these and all the patients are from the Caja Costarricense de Seguro Social (CCSS). All of the 78 patients underwent breast reconstruction with the method described here between january of 1999 and july 2003. The medium age was 48.55 years. The surgical time was about 2 hours with 30 minutes in the patients were discharged in the first 24 hours in the 95% of the cases. The mastectomy affected the couple relationship; more than 50% of the woman lost her partner. No evidence of cancer recurrence was found on the chest wall. Patients and physicians are very satisfied with the reconstruction technic. The results and our experience are increasing every year. In our country breast cancer is early diagnosed, treated and reconstruction is following mastectomy. The prime interest of plastic surgeons is to developed a good program for reconstruction eventhough only 10% resort to this operation. We are sure that in the near future more patients will undergo this procedure (breast reconstruction) due to our excellent results, and for the anatomical and personal satisfaction obtained y the patient.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Mama , Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mastectomia , Costa RicaRESUMO
El síndrome del túnel carpal es la más frecuente neuropatía por atrapamiento que se reporta. En nuestro medio su incidencia es elevada y fácilmente se puede detectar que va en aumento. Desde que Phalen en 1966 describió por primera vez el síndrome y sugirió la liberación del retináculo de los flexores como tratamiento, se han descrito varias técnicas quirúrgicas que en mayor o menor grado pueden retardar la reinserción a la actividad diaria de los pacientes. La importante casuística que existe ha permitido desarrollar gran experiencia quirúrgica e implementar un procedimiento de ésta índole para el tratamiento del síndrome. Con ésta técnica los pacientes se reincorporan rápidamente a sus actividades y las secuelas postoperatorias son casi nulas, el tiempo quirúrgico y, por ende, de isquemia de la extremidad es muy corto y no requiere de ningún equipo especial en sala de operaciones, más que el equipo de isquemia. Entre agosto del 2000 y julio del 2002 se intervinieron quirúrgicamente en el Servicio de Cirugía Plástica y Unidad de Quemados del Hospital San Juan de Dios, 118 pacientes con el diagnóstico de síndrome túnel carpal. Todos los diagnósticos fueron comprobados electrofisiológicamente La edad promedio fue de 47 años y la enfermedad predominó en el sexo femenino (11 pacientes). La sintomatología se presentó entre 6 y 60 meses, con un promedio de 12 meses...
The carpal tunnel syndrome is the most common of the peripheral nerve entrapment syndromes encountered by hand surgeons. There is a lot of morbidity related with the operation technic release. We present a "short-incision " operative technique in and effort to decrease the post-operative morbidity of open release. The goal of this study was to evaluate the safety and functional outcomes o minimal incision open carpal tunnel release. We present and introduced two cm carpal tunnel incision technic that does not require the use of special devices. Between August 2000 and July 2002 a total of 118 patients underwent carpal tunnel syndrome release in the Hospital San Juan de Dios. All the patients were evaluated with clinic and electro diagnostic studies, and with a detailed symptoms history. All these 118 underwent a carpal tunnel syndrome release after a well documented treatment with rheumatology that was unsuccessful or failed. Patients were between 27 and 73 years old and history ranged from 6 to 60 months. The median nerve was affected unilaterally in 65% and 53% bilaterally. The most common symptom was paresthesia in 95%, follow by pain (85%), and weakness (85%). The tinel sign was positive in 85% patients; motor deficit and muscle atrophy were also present in 24% of the patients. All patients had varying increases latencies and decreases in conduction velocities across the wrist. Postoperative electro physiologic studies were performed in only 3 patients with residual symptoms and still indicated varying degrees of median nerve compression at the wrist level. All patients were treated on an out-patient basis and operations were performed under local anesthesia.
