1/108. Squamous cell carcinoma in chronic ulcerative lesions: a case report and literature review.A case report and literature review are presented involving a fatal case of squamous cell carcinoma of the lower extremity. The unique aspects of this patient include the young age at presentation (35 years old), and the association with both a burn scar (Marjolin's) ulcer and a draining osteomyelitis fistulus tract. Epidemiologic data for Marjolin's ulcers as well as squamous cell carcinoma associated with draining sinus tracts of osteomyelitis are reviewed, in addition to the recommended management of such patients. The case presented is a reminder of the need to maintain a high index of suspicion for malignant transformation within ulcerative lesions.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
2/108. Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar.A case of laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar is reported. A 30 year old woman was admitted to our hospital for profuse vaginal bleeding 2 weeks after an abortion had been performed. A urine pregnancy test was positive. Abdominal ultrasound revealed a well-encapsulated bulging mass over the lower anterior uterine wall measuring 7x5 cm. hysteroscopy revealed retained gestational tissue in the lower corpus despite a normal uterine cavity. An incision was made over the most prominent area of the mass by operative laparoscopy. Dark reddish tissue suggestive of the products of conception was removed using grasping forceps. One-layer of continuous endoscopic sutures along the affected uterine wall was made with 1-0 Prolene. laparoscopy enabled the successful treatment of an unruptured ectopic pregnancy in a previous Caesarean scar and made it possible to preserve the patient's reproductive capability.- - - - - - - - - - ranking = 2keywords = lower (Clic here for more details about this article) |
3/108. Sigmoidofiberscopic incision plus balloon dilatation for anastomotic cicatricial stricture after anterior resection of the rectum.We describe the procedure and examine the therapeutic efficacy of a combination of sigmoidofiberscopic incision plus balloon dilatation for tubular stricture by thick, long scar tissue at the colorectal anastomosis after anterior resection for rectal cancer. Balloon dilatation alone does not always relieve the strictures, although this method is the usual therapy for this condition. Five patients were identified in whom the stricture was not improved with balloon dilatation alone. Of these five patients, three complained of difficulty defecating, a feeling of incomplete evacuation, residual feces, and lower abdominal fullness. The remaining two patients, who had transverse colostomy to treat major leakage at the anastomosis, showed no symptoms. All five patients underwent the combination therapy described below. Two or three small radial incisions were made in the scar of the stricture with electrocautery under fiberscopic vision. Then the strictural scar was split and loosened bluntly along the incisions over a 15- to 20-minute period with a balloon dilator. This procedure was performed once or twice at a 2-week interval. In all five patients the stricture was improved according to objective criteria. There was also an improvement in the subjective symptoms suffered by three patients. The improvements were maintained over observation periods of 9 to 15 months. No complications were observed. Sigmoidofiberscopic incision plus balloon dilatation is an effective, safe therapy for cicatricial strictures after anterior resection for rectal cancer when the strictures have failed to improve following balloon dilatation alone.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
4/108. Distraction of scarred soft tissue before secondary bone grafting. A case report.Mandibular distraction was performed to restore oral function in a 52-year-old man with tongue cancer, in whom a mandibular fracture developed after marginal resection of the mandible. The fracture caused the mandibular dental arch to be shorter than the maxillary arch. An external fixation device was attached to the collapsed mandible. The mandibular soft tissue was expanded by 32 mm. After gradual distraction, a vascularized iliac bone graft was transferred to the lengthened space. Subsequently, vestibuloplasty was performed and implants were inserted. A normal appearance, acceptable occlusion and satisfactory oral function were achieved.- - - - - - - - - - ranking = 2.1988977713737keywords = mandible (Clic here for more details about this article) |
5/108. An endoscopic technique for decompressive fasciotomy.A guiding principle of minimally invasive techniques in plastic surgery is improvement of the aesthetic outcome, usually by reducing morbidity from postsurgical scarring. The elimination or reduction of scars has already been so achieved during elevation of fascial flaps and for the harvest of fascial grafts. A natural extension of this endoscopic experience is decompressive fasciotomy, which has now been performed successfully in the upper extremity. Using endoscopic guidance, this is actually a simple, rapid, and safe procedure with minimal morbidity, and should also be apropos for the lower extremity, where compartment syndromes are a more common malady.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
6/108. Squamous cell carcinoma secondary to recessive dystrophic epidermolysis bullosa: report of eight tumours in four patients.BACKGROUND: The development of squamous cell carcinomas is the main cause of death of patients with Dystrophic epidermolysis bullosa. We think it is of interest to know their clinical characteristics and the treatment difficulties they cause. methods: We followed the clinical evolutions and carried out histopathological studies of eight primary cutaneous squamous cell carcinomas on three males and one female with recessive dystrophic epidermolysis bullosa. Patient ages ranged from 16 to 34 years (mean 27). RESULTS: Two patients had two tumours and one three, all were in characteristically scarred skin; four on upper limbs; four on lower. Maximum tumour dimensions ranged from 2 to 28 cm (mean 13), and represented 6 or more months of evolution. In three cases the affected limb must be amputated. Five tumours were well differentiated, three were moderately differentiated. CONCLUSIONS: The patients consulted too late and their large lesions needed aggressive treatment. Appropriate information and regular examination of patients with RDEB helps early diagnosis of tumours and may avoid disabling operations.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
7/108. methotrexate for cesarean scar pregnancy after in vitro fertilization and embryo transfer. A case report.BACKGROUND: Cesarean scar pregnancy is an exceedingly rare occurrence. We present the first case of cesarean scar pregnancy following in vitro fertilization-embryo transfer (IVF-ET). CASE: A 40-year-old woman with a history of a previous cesarean section presented with five years of unexplained infertility. The patient complained of abdominal pain 16 days after embryo transfer. ultrasonography revealed a gestational sac with cardiac activity located outside the lower segment of the uterus. dilatation and curettage was performed due to misdiagnosis of inevitable abortion. Two weeks later, repeated sonography demonstrated a sacculus, 4.07 x 4.07 cm, within the uterine isthmus with only 7.1 mm of thickness separating the sac from the urinary bladder. Normal cervical length without ballooning was noted. Cesarean scar pregnancy was diagnosed. Local injection of methotrexate (MTX) under ultrasound guidance was performed. plasma beta-hCG levels declined from 23,328 to 8 mlU/mL within two months. CONCLUSION: For women with cesarean scar pregnancy who desire fertility, conservative treatment using MTX is an excellent choice.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
8/108. necrobiosis lipoidica associated with Kobner's phenomenon in a patient with diabetes.necrobiosis lipoidica (NL) is a granulomatous disease that usually presents on the lower extremities of patients with diabetes mellitus. We present a rare case of NL kobnerizing in a surgical scar on the upper extremity of a patient with diabetes. NL is generally refractory to treatment.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
9/108. Destructive eyelid lesions in sarcoidosis.PURPOSE: To report the clinical and histopathologic findings of a patient with sarcoidosis causing bilateral destruction of the lower eyelids. methods: Case report. RESULTS: Bilateral destructive lower eyelid lesions and cicatricial entropion developed in a 43-year-old man with systemic sarcoidosis. Histopathology was consistent with sarcoid granulomas. disease progression was arrested with systemic prednisone and methotrexate before eyelid reconstruction was performed. CONCLUSIONS: sarcoidosis very rarely can cause destruction of full-thickness eyelid architecture. Active inflammation should be controlled before reconstruction.- - - - - - - - - - ranking = 2keywords = lower (Clic here for more details about this article) |
10/108. anthrax as the cause of preseptal cellulitis and cicatricial ectropion.A 54-year-old female farmer with anthrax infection of the eyelids is presented. She was initially managed with high dose intravenous penicillin g treatment. Following complete healing of the eyelid lesions, significant cicatricial ectropion resulted. Her right lower eyelid ectropion was corrected by surgical reconstruction using full thickness skin graft after a period of 6 months during which the cicatrization process stabilized. Satisfactory cosmetic and functional improvement was achieved. anthrax of the eyelid must be considered in the differential diagnosis of preseptal or orbital cellulitis and any reconstructive procedure should be attempted only after the cessation of the healing process.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
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