Hemangioma hepático gigante único: serie de casos con seguimiento de pacientes tratados quirúrgicamente / Single giant liver hemangioma: case series with follow-up of patients treated surgically

El tratamiento del hemangioma hepático gigante (HHG), sigue siendo motivo de controversia. El objetivo de este estudio fue reportar los resultados de pacientes con HHG resecados quirúrgicamente en términos de morbilidad postoperatoria (MPO). Serie de casos con seguimiento. Se incluyeron pacientes con HHG, sometidos a cirugía de forma consecutiva, en Clínica RedSalud Mayor, entre 2011 y 2020. La variable resultado fue MPO. Otras variables de interés fueron: tiempo quirúrgico, estancia hospitalaria y mortalidad. Las pacientes fueron seguidas de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión. Se intervinieron 5 pacientes, con una mediana de edad de 38 años. La medianas del tiempo quirúrgico y estancia hospitalaria; fueron 75 min y 4 días respectivamente. La MPO fue 20 % (1 caso de seroma). Con una mediana de seguimiento de 41 meses, los pacientes se encuentran asintomáticos y no se ha verificado morbilidad alejada. La resección quirúrgica de un HHG se puede realizar con escasa morbilidad, tanto en términos numéricos como de gravedad de la complicación observada.

SUMMARY: Treatment of giant hepatic hemangioma (GHH) remains controversial. The aim of this study was to report the outcomes of surgically resected GHH patients in terms of postoperative morbidity (POM). Case series with follow-up. Patients with GHH who underwent surgery consecutively at the RedSalud Mayor Clinic between 2011 and 2020 were included. The outcome variable was POM. Other variables of interest were surgical time, hospital stay and mortality. The patients were followed up clinically. Descriptive statistics were used, with measures of central tendency and dispersion. Five patients underwent surgery, with a median age of 38 years. The median surgical time and hospital stay; were 75 min and 4 days respectively. The MPO was 20 % (1 case of seroma). With a median follow-up of 41 months, the patients are asymptomatic, and no distant morbidity has been verified. Surgical resection of GHH can be performed with low morbidity, both in terms of numbers and the severity of the complication observed.

Scanning electron microscopy of dermatofibroma.

Dermatofibroma is a proliferation of spindle cells located in the dermis. We used scanning electron microscopy to examine two histologically confirmed lesions and observed preserved collagen bundles in the perilesional area. In the lesional area, the collagen was denser, without formation of bundles. Higher magnification showed collagen with mesh-like appearance similar to stretched tufts of cotton. Very high magnification evidenced the tufts of cotton and spindle cells measuring 2 to 12 microns.

Scanning electron microscopy of dermatofibroma

Abstract: Dermatofibroma is a proliferation of spindle cells located in the dermis. We used scanning electron microscopy to examine two histologically confirmed lesions and observed preserved collagen bundles in the perilesional area. In the lesional area, the collagen was denser, without formation of bundles. Higher magnification showed collagen with mesh-like appearance similar to stretched tufts of cotton. Very high magnification evidenced the tufts of cotton and spindle cells measuring 2 to 12 microns.

Síndrome de Millard-Gubler secundario a angioma cavernoso: reporte de un caso / Millard-Gubler syndrome secondary to cavernous angioma: report of a case

RESUMEN El síndrome de Millard-Gubler es considerado un síndrome protuberancial debido a una lesión pontina inferior y caracterizado, desde el punto de vista clínico, por parálisis facial y del VI par, ipsilateral a la lesión y parálisis braquiocrural contralateral; frecuentemente es de causa vascular, menos frecuente de causa traumática o por efecto de masa secundario a un tumor. Se realiza reporte de un caso de un paciente de 45 años de edad que acude al servicio hospitalario de la Fundación Centro Colombiano y Enfermedades Neurológicas FIRE con cuadro clínico caracterizado en pérdida de la fuerza muscular en hemicuerpo izquierdo, y déficit motor de la hemicara derecha, disartria y deterioro del estado de consciencia. La TAC de cráneo simple al ingreso evidenció sangrado extenso del tallo cerebral. De acuerdo con los hallazgos clínicos se concluye que el paciente presentó un síndrome de Millard-Gubler.

SUMMARY The Millard Gubler syndrome is considered a protuberant syndrome due to a lower pontine lesion and characterized, from the clinical point of view, by facial paralysis and VI pares, ipsilateral to the lesion and contralateral brachiocrural palsy; frequently it is of vascular cause, less frequent of traumatic cause or by effect of mass secondary to a tumor. A case report is presented of a 45-year-old patient who attends the hospital service of the Fundación Centro Colombiano y Neurológicas FIRE with a clinical picture characterized by loss of muscle strength in the left side of the body, and motor deficit of the right side of the face, dysarthria and deterioration of the state of consciousness. The simple skull CT on admission showed extensive brainstem bleeding. According to the clinical findings, it is concluded that the patient presented a Millard Gubler syndrome.

Anomalias venosas nos cavernomas / Venous anomalies in cavernomas

As anomalias do desenvolvimento venoso (DVA) são as malformações vasculares cerebrais mais frequentes, tendo geralmente um curso benigno, e podem estar acompanhando os cavernomas. Atualmente, são mais diagnosticadas por causa dos métodos de diagnósticos por imagem que existem, como a tomografia computadorizada e, sobretudo, a ressonância magnética nuclear. Este artigo revisa as DAV em geral e as relacionadas com os cavernomas. Os artigos foram buscados na base de dados PubMed, em publicações desde 1995 a junho de 2012, usando como filtros as expressões ?anomalias do desenvolvimento venoso e malformações cavernosas? e ?anomalias venosas cerebrais e malformações cavernosas?; a pesquisa foi limitada a artigos em idioma inglês e relacionados a humanos. As sessões de referência de artigos e revisões recentes foram revisadas e os artigos pertinentes foram recuperados no formato resumo; os manuscritos em texto completo foram obtidos subsequentemente para todos os artigos originais aplicados à revisão em curso...

Developmental venous anomalies (DAV) are the most common brain vascular malformations usually, having a benign course and may be following the cavernomas. They are more diagnosed recently due to diagnostic imaging methods that exist, such as computed tomography and nuclear magnetic resonance. This article reviews the DAV in general and those relating to cavernomas. The PubMed database was searched for publications from 1995 through June 2012 using the mesh terms ?anomalies venous cerebral, development venous and cavernous malformation?, ?anomaly venous cerebral and cavernous malformation?. The search was limited to articles in the English language and related to humans subjects. Reference sections of recent articles and reviews were reviewed and pertinent articles were retrieved in the abstract format, full text manuscripts were subsequently obtained for all original articles applicable to the current review...

Sternal cleft: a surgical opportunity.

PURPOSE: The aim of this study was to evaluate the results from the surgical techniques utilized to repair congenital sternal cleft. METHODS: From January, 1987 to January, 2001, 5,182 patients were seen for chest wall malformations. Eight (0.15%) had sternal cleft. The age at presentation ranged from 15 days to 5 years. Six were girls (75%). The associated malformations were congenital cardiac malformations (2 patients), maxillofacial hemangioma (1 patient). All of them underwent a surgical repair, which could be classified into 3 methods: group 1 had primary closure of the defect (3 patients); group 2 underwent partial resection of the first, second, and third costal cartilages, disruption of the sternoclavicular junction, and closure of the sternal bars with stainless steel wire (3 patients); and group 3 had mobilization and approximation of the sternocleidomastoid muscles with closure achieved with costal homograft and prosthetic mesh (2 patients). The interval for postoperative follow-up was 1 to 8 years. RESULTS: Group 1 patients developed well, although 2 of them had a slight degree of pectus excavatum in the long term not requiring surgical correction. Group 2 Patients developed without problems in all cases. One of the patients from group 3 had unsatisfactory aesthetic and functional results. He underwent reoperation with the second technique, achieving an improved result. CONCLUSIONS: Primary closure of the sternal cleft is the easiest technique. It should be performed in young infants. In the long term it can lead to a mild degree of pectus excavatum. The costal cartilage resection with mobilization of the clavicle achieved excellent results and allowed ready approximation of both sternal halves avoiding the use of costal grafts and prosthetic material.

Reconstrucción de la pared torácica mediante prótesis sintética moldeada durante el acto operatorio / Abdominal wall of the reconstruction intervening synthetical prothesis during surgery acto

La reparación de la pared torácica consecutiva a resecciones extensas de esqueleto debidas por lo general a neoplasias, debe ser cuidadosamente efectuada con la finalidad de restaurar la rigidez y la estabilidad del torax, previniendo trastornos ventilatorios que de otro modo inevitablemente ocurrirían. A 4 pacientes que habían sido sometidos a la exéresis parcial de varias costillas, 3 de ellos con parte de esternón, se les colocó una prótesis fabricada con malla de marlex y metilmetacrilato. Para confeccionar esa prótesis fue utilizado un molde o matriz de aluminio con la forma y el tamaño de una sección de la pieza operatoria; por consiguiente aquélla se adaptó con bastante precisión a la brecha parietal. Se describe el procedimiento. El resultado funcional fue muy satisfactorio.

Reconstrucción de la pared torácica mediante prótesis sintética moldeada durante el acto operatorio / Abdominal wall of the reconstruction intervening synthetical prothesis during surgery acto

La reparación de la pared torácica consecutiva a resecciones extensas de esqueleto debidas por lo general a neoplasias, debe ser cuidadosamente efectuada con la finalidad de restaurar la rigidez y la estabilidad del torax, previniendo trastornos ventilatorios que de otro modo inevitablemente ocurrirían. A 4 pacientes que habían sido sometidos a la exéresis parcial de varias costillas, 3 de ellos con parte de esternón, se les colocó una prótesis fabricada con malla de marlex y metilmetacrilato. Para confeccionar esa prótesis fue utilizado un molde o matriz de aluminio con la forma y el tamaño de una sección de la pieza operatoria; por consiguiente aquélla se adaptó con bastante precisión a la brecha parietal. Se describe el procedimiento. El resultado funcional fue muy satisfactorio. (AU)