Código numérico 2001-2420Palabras clave Cuero cabelludo. Colgajos. Código numérico 2001-2420Presentamos una serie de casos realizados en el Servicio de Cirugía del Hospital Clínico San Pablo en Coquimbo, Chile, entre Abril de 1998 y Abril de2005. Se trata de un grupo de estudio de 22 pacientes consecutivos con pérdida traumática o quirúrgica del cuero cabelludo, mayor de 3cm de diámetro. Se empleó para la reconstrucción colgajo semilunar, en espejo o en remolino vascularizados a partir de las ramas principales del cuero cabelludo. Analizamos en cada caso el tamaño del defecto, pérdida de hueso asociada, tipo de cirugía, resultados de la cobertura y complicaciones.La edad media de los pacientes fue de 40.6 años con un rango entre 3 y 71 años. El área anatómica comprometida fue parietal en 11 pacientes (50%), temporal en 7 (31,8%), occipital en 3 (13,6%) y frontal en 1 caso (4,5%). La causa de la pérdida de sustancia fue resección de tumores malignos o benignos en 10 casos, postraumática en 5, postquirúrgica en 4, y por alopecia en 3. El tamaño medio del defecto fue de 147 cm 2 con un rango entre 28 y 615 cm 2 .El colgajo empleado fue doble en espejo en 10 casos (50%), semilunar de deslizamiento en 9 (36,4%) y en remolino en 3 (13,6%). En 6 pacientes se utilizó un injerto dermo-epidérmico para cerrar un defecto residual del área dadora del colgajo (dos semilunares y dos en espejo). Veintiun pacientes (45%) evolucionaron sin incidencias, con cicatrización del colgajo en un plazo máximo de 21 días. Un paciente con pérdida ósea tras dos craneotomías, presentó necrosis parcial distal del colgajo y falleció por neumonía aspirativa.Comparamos los tres tipos de reparación de acuerdo al tamaño del defecto y a la superficie del mismo. La elección de colgajo doble en espejo, remolino o semilunar, al aplicar la prueba de Kruskal Wallis, no se relacionó con la superficie del defecto, y la elección del colgajo fue atribuible al azar, p > 0.05. La principal razón para escoger uno u otro fue la ubicación del defecto.En conclusión, la estrategia de reconstrucción del cuero cabelludo mediante colgajos arterializados permite el cierre de grandes defectos en una operación fácil y con cicatrices inaparentes que quedan ocultas bajo el cabello. Es por ello que creemos que estos procedimientos son la mejor alternativa de tratamiento y recomendamos su uso por sus resultados fiables cuando se siguen los principios técnicos del manejo de colgajos. We present sucessive cases performed at Surgery Department of Hospital San Pablo, Coquimbo, Chile, between April1998, and April 2005: Twenty two consecutive patients suffering surgical or postinjury scalp defects, greater than 3 cm of diameter. Semilunar flap, mirror flap, or multiple pinwheel flap arterialized from the main scalp arteries were used for reconstruction. We determinate in every case the large of the defect, asociated bone loss, kind of surgery, end result and complications. Reconstrucción inmediata de cuero cabelludoPatients' mean age was 40.6 years with rank between 3 and 71 years...
Angle closure is usually associated with older patients, as it typically manifests in middle to later life, being associated with an age-related increased lens volume. However, angle closure can occur in any age group if there is an anatomical predisposition that promotes pupillary block or an anterior pulling of the iris. During an acute angle closure, patients generally experience ocular pain, headache, nausea, vomiting and conjunctival hyperaemia. These attacks can be misinterpreted as migraine, particularly if subacute or chronic and the demographic characteristics of the patient do not suggest a primary angle closure event. Diagnosing a headache as ocular related is of paramount importance, since there is an effective treatment. We report a case of a child with intermittent headache which revealed a subacute angle closure in both eyes.
466 Background: Sunitinib, a multitarget tyrosine-kinase inhibitor, has become a standard of care for first-line low and intermediate risk metastatic renal cell carcinoma (mRCC). Sunitinib-induced hypothyroidism and hypertension have been correlated with better outcomes in those patients. Methods: Fifty patients with mRCC, treated in the first-line with sunitinib, were retrospective analyzed at one brazilian institution, for overall survival (OS), progression free survival (PFS), overall response rate (ORR) and toxicity. We evaluated clinical and laboratory parameters, such as hypothyroidism (TSH level > 5,5 mIU/L) and hypertension, to identify prognostic factors. Results: The median age of patients was 58 years (range: 37-73 years), 82% were male, 54% were ECOG 0 or 1, and 76% were classified in low or intermediate risk. Nefrectomy was performed in 96% of cases. Lung and bone were the most common sites of metastases. The incidence of hypothyroidism and hypertension during treatment were 40% and 34%, respectively. ORR for the entire population was 40% and it was statistically superior in patients that developed hypothyroidism during treatment (90% vs. 20%; p<0,0001). Median survival and PFS were 21.7 months (10.65-17.70 months, 95% CI) and 14.2 months (15.77-27.58 months, 95% CI), respectively. In univariate analysis, ECOG (p<0,0001), MSKCC criteria (p<0,0001), hypothyroidism (p<00001) and hypertension (p=0,001) were associated with OS. In multivariate analysis, ECOG (p<0,0001), MSKCC criteria (p<0,0001) and hypothyroidism (p<00001) were independent prognostic factors for OS. The most common severe adverse events (G3-4) were asthenia (14%), diarrhoea (6%), neutropenia (14%), thrombocytopenia (10%), hand-foot syndrome (6%) and hypertension (8%). Conclusions: Efficacy in survival and toxicity profile of sunitinib in first-line treatment of mRCC in patients out of clinical trials were comparable to prior studies. Hypothyroidism, MSKCC criteria and ECOG were independent prognostic factors for survival.
11038 Background: There are no validated biomarkers for clinical response or survival benefit in patients treated with bevacizumab (Bv) in advanced metastatic colorectal cancer (mCRC). The aim of this study was to evaluate the predictive value of putative biomarkers in mCRC. Methods: One hundred and five mCRC patients who received Bv combined with FOLFOX or FOLFIRI were retrospectively evaluated for clinical and pathological characteristics. VEGFR1, VEGFR2, VEGFR3, PlGF, DLL4 and NOTCH1 expression were assessed by immunohistochemistry on formalin-fixed, paraffin-embedded neoplastic tissue of either primary or metastatic tissue in a tissue microarray. High levels of expression were defined as less than or equal to or more than the median. Survival curves were calculated by the Kaplan-Meier method and compared by the log-rank test. For multivariate analysis the Cox proportional hazards model was used. Results: Grade 1 or 2 (p=0.01), non-mucin-producing histology (p=0.04) and presence of liver metastasis (p=0.001) were associated with a higher response rate. There was no difference between the expression of markers and the response rate. ECOG 0 or 1 (p=0.002), grade 1 or 2 (p=0.02), liver metastasis (p=0.003), no lymph node metastasis (p=0.01) no peritoneal metastasis (p=0.02) and resection of metastasis (p<0.001) were correlated with higher progression-free survival (PFS). There was also a strong correlation between ECOG 0 or 1 (p=0.001), grade 1 or 2 (p=0.006), no lymph node metastasis (p=0.004), liver metastasis (p<0.001) and resection of metastasis (p<0.0001) with better overall survival. There was a trend between high expression of NOTCH1 (p=0.06) and worst PFS.High expression of VEGFR2 (p=0.07) was slightly associated with a better overall survival, while high expression of NOTCH1 was associated with a worse overall survival (p=0.01). Using multivariate analysis, NOTCH1 proved to be an independent variable for adverse overall survival (HR 2.01, IC 1.07 – 3.77, p=0.02). Conclusions: High NOTCH1 expression assessed by immunohistochemistry is capable of predicting poor survival in advanced colorectal cancer patients treated with bevacizumab.
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