1,720,996 research outputs found
Burns: Classification and Treatment
No full textBurns are the most devastating form of trauma that has afflicted mankind since ancient times, and their short- and long-term consequences leave severe sequelae in the patients involved. The costs they generate to health systems are very high, and at present there are only few hospital centers specialized in the treatment of these affections. A burn is defined as an injury to the skin or other organic tissue primarily caused by heat or flame (>90%) or due to radiation, radioactivity, electricity, friction, or contact with chemicals (10%). Burn severity classification is determined by the patient’s age; the percentage of total body surface area burned; depth of burn; type of burn; whether it is associated with gas inhalation; or specific body parts involved. The majority of burn injuries are minor and either do not require treatment or can be treated by any caregiver. On the other side, severe burns (>20% TBSA) can result in clinically significant morbidity as they cause not only significant injury at the local burn site but also a systemic response throughout the body. Inflammatory and vasoactive mediators such as histamines, prostaglandins, and cytokines are released causing a systemic capillary leak, intravascular fluid loss, and large fluid shifts. Failure to properly treat these injuries will lead to rapid development of organ failure and death. The initial approach of the severely burned patient in the shock phase is critical for patients’ survival; the main pillars of the treatment are fluid resuscitation, airway distress management, and surgical debridement. A multidisciplinary team is essential for a proper management
Cutaneous metastases of melanoma affecting exclusively skin graft donorand receiving sites: A novel clinical presentation
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Reply to comments on “Microvascular coupler device versus handsewn venous anastomosis: A systematic review of the literature and data meta‐analysis”
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Prepectoral breast reconstruction: an ideal approach to bilateral risk-reducing mastectomy
Full text linkBackground: Bilateral risk-reducing mastectomy (BRRM) has increased its popularity in the last years
because of its aim to minimise the chances of developing breast cancer in high-risk patients. Women
undergoing this procedure must be considered highly demanding patients given the need to combine
aesthetical, functional and preventive desires. This study aims to present the authors’ experience in
performing BRRM followed by single-stage prepectoral reconstruction (PPBR) with implant completely
covered by acellular dermal matrix (ADM) and to report indications, surgical techniques, functional and
aesthetic results.
Methods: A single-centre prospective data collection was carried out from January 2017 to January
2021 of patients at high risk of developing breast cancer undergoing BRRM and immediate PPBR with
ADM. Patients were subdivided into two groups according to the breast shape: Group A had small and
medium size breasts and Group B had large and ptotic breasts. Oncological and surgical outcomes were
collected. Satisfaction with reconstruction and related quality of life were evaluated through the BREAST-Q
questionnaire.
Results: A total of twenty-three patients met the inclusion criteria. Seventeen patients were included in
group A and six patients in group B. Average follow-up was 18.4 months. Minor complications occurred
in four breasts: one seroma, one hematoma and two cases of wound dehiscence. Capsular contracture was
not observed. All patients were satisfed with the fnal result according to the post-operative BREAST-Q
questionnaire.
Conclusions: Immediate prepectoral breast reconstruction could represent the ideal reconstruction option
after BRRM and should be offered to all women that fulfl the inclusion criteria
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Correction: "No-back-scar" Latissimus Dorsi Muscle Flap and Tissue Expander: A Valuable Strategy for Secondary Breast Reconstructions
No full textAn overall complication rates for implant-based breast reconstruction (IBBR) have been reported from 29 to 46%, particularly in the setting of adjuvant radiotherapy. Although the majority of the literature describes autologous conversion in such scenario, a microsurgical flap is not always feasible. The aim of the paper is to assess surgical and patient-reported outcomes of breast reconstruction using a Latissimus Dorsi muscle Flap (LDMF), harvested without a back scar, in combination with a tissue expander for a two-staged reconstruction in the setting of a previously failed IBBR. All consecutive patients undergoing a two-stages LDMF IBBR between January 2016 and June 2020 were retrospectively identified. A minimal length vertical incision along the posterior axillary line was used for LD flap harvest. Demographic, clinical and surgical data were collected. Aesthetic outcome was evaluated with the Aesthetic Item Scale, and BREAST-Q was used to assess patients’ reported outcomes. Twenty-one patients met the inclusion criteria. Mean age was 45.6 years, and the average follow-up was 41.2 months after tissue expander replacement with definitive implant. All patients completed the secondary reconstructive procedure, without major complications both at reconstructive and donor flap site. All women reported to be very satisfied with the final breast reconstruction. Second-attempt implant-based breast reconstruction for patients with a previously failed IBBR is challenging. A conversion from prosthetic to a mixed breast reconstruction with a “no-back scar” LD flap and tissue expander can be considered as a valuable strategy, especially when an abdominal-based autologous breast reconstruction is not feasible or refused by the patients
A large metastatic intramammary lesion of an occult melanoma
No full textOBJECTIVE: Malignant melanomas presenting with unknown primaries are uncommon. In the majority of cases metastases of occult melanoma were detected in skin or in lymph nodes. Melanoma can rarely occur as a primary or metastatic intramammary tumor. CASE REPORT: We report the case of a 58-year-old Caucasian woman who came to our department with a voluminous mass in her right breast. Histopathological examination found metastasis of epithelioid melanoma with unknown primary lesion. Our patient underwent a radical enlarged mastectomy, but due to the extension a radical removal was not possible. DISCUSSION: In 2.2% of cases, melanoma may present with a metastasis without an identifiable primary lesion; this case should be considered a stage IV melanoma (Tx; Nl; Ml) due to the extension of the lesion and the infiltration of adjacent structures. CONCLUSIONS: In literature, the presence of a breast metastasis of melanoma with unknown primary origin was reported just in one case. The execution of histopathological analysis is mandatory for a correct differential diagnosis with primary carcinoma of the breast. Palliative metastasectomy should be discussed with multidisciplinary melanoma board
Free vascularized osteoseptocutaneous fibular flap for radius shaft nonunion: The final solution when the iliac crest autograft fails. A case report
No full text: Treatment of forearm nonunion associated with bone defects can be challenging. Restoring the correct length and rotation are two main principles for the management of these patients. Herein, we describe a patient with isolated radius nonunion already treated with an iliac crest autograft with no success. A free vascularized osteoseptocutaneous fibular autogenous graft was harvested as the final solution to managed long bone defect after previous multiple surgeries. At the 1- year follow-up, the patient gained full range of motion and was functioning well.Treatment of forearm nonunion associated with bone defects can be challenging. Restoring the correct length and rotation are two main principles for the management of these patients. Herein, we describe a patient with isolated radius nonunion already treated with an iliac crest autograft with no success. A free vascularized osteoseptocutaneous fibular autogenous graft was harvested as the final solution to managed long bone defect after previous multiple surgeries. At the 1- year follow-up, the patient gained full range of motion and was functioning well
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