Evaluation of cases of mammoplasty with the areolar inferior pedicle technique

INTRODUCTION: Mammoplasty is one of the most common plastic surgeries in Brazil. Among the surgical techniques described in the literature, the areolar inferior pedicle technique is the most significant because of its versatility, safety, and satisfactory aesthetic results. This study avaluated cases of mammoplasty with the areolar inferior pedicle technique performed by the author, and to propose a small change in the attachment of the pedicle to the pectoralis major muscle. METHODS: A total of 74 patients underwent the surgery from June 2007 to December 2014. RESULTS: The average patient age was 35.63 years; the mean body mass index was 25.8; and the mean follow-up duration was 28 months. Complications occurred in 33.76% of the cases, and the average amount of resected tissue was 585 g. The degree of satisfaction was excellent or good in 93% of the cases. The sensitivity of the areolar-papillary complex (APC) was maintained in 72% of left-breast reconstructions and 77% of right-breast reconstructions. Moreover, there was a complete loss of sensitivity in 3% of left-breast cases. CONCLUSION: The use of mammoplasty with the areolar inferior pedicle was versatile and safe, and produced favorable outcomes. In addition, the sensitivity of the APC was adequately maintained. Further studies might confirm the importance of the change in fixation of the pedicle suggested in this study

V-Y flap of advancement after the recurrence of perineal cancer: case report and literature review

INTRODUCTION: Anal cancer is a rare disease, with an increasing incidence. Flaps are complex options for closing large areas. The perineal region may be affected by extensive lesions that require the use of flaps for repair. CASE REPORT: A 56-year-old female patient with anal adenocarcinoma underwent abdominoperineal amputation surgery of the rectum with postoperative radiotherapy for 2 years. She had cutaneous recurrence of the neoplastic lesion with indication of surgical margin expansion to control the local recurrence. After extensive resection with safety margins of the skin defect, we selected double V-Y flap of length 15 cm each and a total thickness of the gluteal subcutaneous tissue (ST) to fill up the dead space caused by resection and advancement of the defect. Intravenous antibiotic prophylaxis and deep venous thrombosis prophylaxis were administered. The patient progressed well from the procedure, with no problems. DISCUSSION: A flap is a tissue that is mobilized based on vascular anatomy. Flaps based on the subdermal plexus include bipedicle, advancement (V-Y), rotation, and transposition flaps. Perineum reconstructions are often indicated for tumors, trauma, infections, burns, or pressure sores. The anal region is divided into the anal canal and the anal margin. Among the histological types of anal cancer, the most prevalent are squamous cell carcinoma (most common histology), adenocarcinoma, melanoma, small cell carcinoma, and sarcomas. The risk of regional recurrence after treatment can reach approximately 30% of cases and is the most frequent recurrence pattern

Fatores associados à readmissão hospitalar de pacientes com insuficiência cardíaca atendidos em um hospital na cidade de Criciúma- SC

Artigo apresentado como requisito parcial para obtenção do grau de Bacharel, no Curso de Medicina, da Universidade do Extremo Sul Catarinense- UNESCObjetivo: Investigar os fatores associados com a readmissão hospitalar em um período de 30 dias de pacientes com insuficiência cardíaca. Métodos: Estudo coorte retrospectivo em que se analisou prontuários eletrônicos de pacientes com insuficiência cardíaca. Os pacientes foram divididos em 2 grupos, um grupo que não sofreu readmissão hospitalar em 30 dias e outro grupo que teve readmissão, ambos utilizaram uma ficha padronizada para coleta dos dados. Nos dois grupos, através de uma ficha padronizada, foram coletados dados sociodemográficos, clínicos, laboratoriais e de imagem. A amostra foi composta por 75 prontuários. Resultados: Os pacientes do grupo com readmissão hospitalar apresentaram o ensino fundamental incompleto (p = 0,026), classe funcional III (p = 0,010) e antiagregantes plaquetários (p = 0,006) com maior frequência. Este modelo foi estatisticamente significativo (p <0,001), e explicou em 61,4% (R2 Nagelkerke) da variação na readmissão hospitalar em 30 dias. Conclusão: Há evidências de que o ensino fundamental incompleto, a classe funcional III e o uso de antiagregante plaquetário estão associados a maior readmissão hospitalar, com a importância de serem fatores de risco modificáveis. Embora o estudo esteja limitado quanto ao número amostral, pode-se ratificar a importância destas variáveis na readmissão hospitala

Reação a drogas com eosinofilia e sintomas sistêmicos associada a alopecia universal e vitiligo

A reação a drogas com eosinofilia e sintomas sistêmicos (DRESS) é uma rara e potencialmente fatal reação adversa de hipersensibilidade, decorrente de alguns medicamentos, principalmente os anticonvulsivantes. A síndrome não afeta apenas a pele, mas também outros órgãos, principalmente o fígado. A incidência pode variar de 1 a 5 casos por 10.000 pacientes expostos aos anticonvulsivantes. O reconhecimento da síndrome é de fundamental importância devido a taxa de mortalidade entre 10-40%. Uma vez estabelecido o diagnóstico, deve-se identificar o medicamento desencadeante e suspendê-lo. O corticosteróide geralmente é associado na terapia. Sequelas autoimunes foram relatadas, incluindo vitiligo e raramente alopecia. A alopecia universal é uma variante da alopecia areata, caracterizada pela perda de pelos em todo o corpo. Relatamos um caso de DRESS, associado a duas doenças autoimunes dermatológicas: alopecia universal e vitiligo.Drug reactions with eosinophilia and systemic symptoms (DRESS) are rare and potentially fatal adverse hypersensitivity reaction to some drugs, especially anticonvulsants. The syndrome affects not only the skin but also other organs, especially the liver. The incidence can vary from 1 to 5 cases per 10.000 patients exposed to anticonvulsants.The recognition of the syndrome is of fundamental importance since the mortality rate is between 10 and 40%. Once the diagnosis is established, the triggering drug must be identified and discontinued. Corticosteroids are usually associated with therapy. Autoimmune sequelae have been reported, including vitiligo and rarely alopecia. Alopecia universalis is a variant of alopecia areata, characterized by hair loss throughout the body. We report a case of DRESS, associated with two autoimmune dermatological diseases: alopecia universalis and vitiligo