Objective: Arteriovenous malformations (AVM) of the ear show unique features. Progressive growth or inadequate management of AVMs may lead to bleeding, infection, cartilage exposure, and ultimately loss of structure. Total ear amputation is an alternative; however, due to the structural complexity of the ear, reconstruction is technically challenging. This study presents a treatment algorithm based on a clinical series, with treatment options including resection and immediate and late reconstruction.Methods: Between 2004 and 2018, 12 patients with auricular AVMs were treated with AVM resection and ear reconstruction at our hospital. Among these 12 patients, seven were women, and patients' ages ranged between 4 and 34 years. Parameters considered before resection and reconstruction were compromised ear extension (partial, total, or extra-auricular involvement), thickness (cutaneous and cartilaginous), symptoms (bleeding, infection, ulceration, and/or cartilage exposure), and preoperative embolization. Total resection of AVMs was planned as the first step in all cases, followed by primary closure. AVM resection was categorized into a partial or total procedure, resulting in partial or total ear defects. Reconstruction was categorized as immediate or delayed.Results: Preoperative embolization was performed in 10 patients. AVMs were totally removed, resulting in seven total ear amputations. In six of these patients, total ear reconstruction was performed 6 months later, and all patients were recurrence-free. Only one patient did not undergo ear reconstruction. Regrowth was not observed in any reconstructed ear.Conclusion: Treatment of ear AVMs requires a planned approach to achieve favorable clinical outcomes and for concomitant safe and definitive reconstruction.
-Context -Orthotopic liver transplantation is an excellent treatment approach for hepatocellular carcinoma in well-selected candidates. Nowadays some institutions tend to Expand the Milan Criteria including tumor with more than 5 cm and also associate with multiple tumors none larger than 3 cm in order to benefit more patients with the orthotopic liver transplantation. Methods -The data collected were based on the online database PubMED. The key words applied on the search were "expanded Milan criteria" limited to the period from 2000 to 2009. We excluded 19 papers due to: irrelevance of the subject, lack of information and incompatibility of the language (English only). We compiled patient survival and tumor recurrence free rate from 1 to 5-years in patients with hepatocellular carcinoma submitted to orthotopic liver transplantation according to expanded the Milan criteria from different centers. Results -Review compiled data from 23 articles. Fourteen different criteria were found and they are also described in detail, however the University of California -San Francisco was the most studied one among them. Conclusion -Expanded the Milan criteria is a useful attempt for widening the preexistent protocol for patients with hepatocellular carcinoma in waiting-list for orthotopic liver transplantation. However there is no significant difference in patient survival rate and tumor recurrence free rate from those patients that followed the Milan criteria.
RESUMO:Há oitenta anos, Alexander Fleming descobriu a penicilina. O trabalho enfatiza o contexto no qual foi descoberto a penicilina e suas repercussões na prática clínica e na epidemiologia. DESCRITORES:História da medicina. Microbiologia. Penicilinas/história. O tratamento de infecções na antiguidadeD esde o início dos tempos o homem tentou controlar as doenças a fi m de manter sua sobrevivência. As primeiras informações que concernem a prática da medicina datam do 5º milênio a.C., com os egípcios. Os sacerdotes egípcios uniam a medicina e a teleologia supersticiosa de maneira muito íntima; usavam ervas medicinais e outros produtos como leite, mel, sal ou cerveja, mas nenhum deles era considerado efi caz no tratamento de infecções sem o uso de invocações mágicas 3 .N o e n t a n t o , n ã o p o d e m o s a f i r m a r inexoravelmente que todos os componentes eram inefetivos. O efeito bactericida do açúcar para Staphylococcus aureus e Escherichia coli, entre outros, foi comprovado por Rahal et al., em 1983 6 . Obviamente, os povos antigos não tinham o conhecimento da existência dos microorganismos, e seus tratamentos eram conduzidos de forma bastante empírica. Somente a partir de Robert Koch, que comprovou o papel patogênico dos microorganismos no século XIX a partir da elaboração dos quatro Postulados de Koch (usados até hoje na descoberta de patógenos, como a relação entre a Helicobacter pylori e as úlceras pépticas), cientistas começaram a realizar pesquisas relacionadas à antibiose. O conceito de antibiose em medicina e o isolamento da penicilinaEm meados do século XIX, sabia-se que medidas sanitárias, adotadas previamente a procedimentos cirúrgicos e obstétricos, eram capazes de reduzir significativamente as infecções pós-operatórias. Os exemplos mais claros disso foram a adoção da lavagem das mãos por Semmelweis e a esterilização, introduzida por Joseph Lister nesta mesma época, por meio de uma solução de fenol (ácido carbólico) 5 . No entanto, o fenol possui um efeito tóxico importante, sendo o seu uso em
The agreement between ultrasound and maternal perception of fetal movement is good, allowing the use of fetal movement counting in the assessment of fetal wellbeing.
In Brazil, there is no published article that measures the expense of this condition for the health system. There are international studies that show that treating a pressure ulcer is significantly more expensive than preventing it. The purpose of this article is to describe the incidence of patients with hospitalization related to pressure ulcers, in the city of São Paulo, in the period of the 1st increase in cases of COVID - 19 (March 2020 to December 2020), as well as the related expense with these hospitalizations.
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