Search

Background Schwannomas, also known as neurilemomas, represent the prevailing non-malignant neoplasms affecting the peripheral nervous system. Benign neoplasms affecting the peripheral nerves of the upper extremity are infrequent in occurrence. Typically, these neoplasms arise from Schwann cells situated within the peripheral nerve sheaths. Schwannomas, which are benign tumors found in peripheral nerves, are observed to be the prevailing type, accounting for approximately 5% of all tumors occurring in the upper extremity. Schwannomas involving the median nerve are observed at a frequency ranging from 0.1% to 0.2% among the entirety of hand tumors. Schwannomas typically manifest as a source of patient discomfort. The observed edema has the potential to be erroneously identified as a ganglion, lipoma, or lymph node. Neuromas manifest as a hyperplastic and disorganized growth of cells, which arises as a response to nerve injury, signifying an endeavor towards nerve regeneration. These neuromas can be categorized into two types: terminal neuromas and in-continuity neuromas. Magnetic resonance imaging (MRI) and ultrasound imaging techniques have proven to be valuable tools in the diagnostic process. The curative approach typically involves the implementation of surgical removal.

After a mastectomy, the breast may be managed in a number of ways, including with implants or autologous tissue flaps taken from a variety of donor locations. About 7.5% of women who have had a mastectomy choose for breast reconstruction. However, that worth is growing as surgical oncologists are increasingly teaming together with reconstructive surgeons to improve outcomes in both areas (patient satisfaction and psychological effects). The transverse rectus abdominis musculocutaneous (TRAM) flap and the deep inferior epigastric perforator (DIEP) flap are the two most common autogenous reconstructive procedures used today. Despite being a significant improvement in breast reconstruction, the deep inferior epigastric perforator (DIEP) flap is often avoided by surgeons because of fears of a greater flap loss rate compared to free or muscle-sparing transverse rectus abdominis myocutaneous (TRAM) flaps. Smoking, chemotherapy, prereconstruction radiation, postreconstruction radiotherapy, hypertension, diabetes mellitus, abdominal scarring, obesity, age, flap size, number of venous anastomoses, and number of perforators were all factors associated with greater flap morbidity. Fat necrosis, partial flap loss, complete flap loss, arterial thrombosis, venous congestion, postoperative hernia, infection, seroma, and hematoma are some of the issues associated with breast reconstruction. The tricarbocyanine dye indocyanine green (ICG) fluoresces upon near-infrared stimulation and strongly binds to plasma proteins that have not left the intravascular space. It has been utilized for some time now in the examination of vascularization; it tells us about the perfusion of the flap's cutaneous island.

The two most frequent congenital abnormalities of the front abdominal wall are omphalocele and gastroschisis. An omphalocele is a defect in the midline of the abdominal wall that allows abdominal viscera to protrude into the umbilical cord sac. Right-sided abdominal wall defects (gastroschisis) are defects in the anterior abdominal wall, leading to an unprotected herniation of the gastrointestinal system and, rarely, the urogenital tract into the fetal amnion. There are no established management plans or treatment regimens for this uncommon congenital abnormality. Surgeons face a significant hurdle when attempting to treat omphalocele with a single operation. Wound infections, face separation, and abdominal domain loss are common side effects of current treatment methods. Significant increases in intra-abdominal pressures, disruption of interior venous blood flow, and hemodynamic and respiratory instability due to diaphragmatic elevation are the most common causes of postoperative problems following a single-stage surgery. The primary benefit of delayed phased closure is the avoidance of additional newborn surgical procedures. In the treatment of omphalocele, both synthetic and natural biomaterials have shown useful as substitutes. This case report details the non-surgical closure of an omphalocele in an infant who presented with a huge omphalocele.

Background Takotsubo cardiomyopathy is a rare temporary and reversible systolic alteration of the apical area of the left ventricle that resembles an acute myocardial infarction in the absence of coronary artery disease, caused by stress. It is characterized by temporary hypokinesia, dyskinesia, or akinesia in left ventricular segments with or without apical involvement and regional wall motion aberration. We present a case of a 71-year-old woman with medical history of hypertension and paroxysmal atrial fibrillation who underwent cryoablation of pulmonary veins foci; during the procedure, when transseptal puncture was performed, elevation of the segment ST was observed on the upper lateral face with reciprocal changes on the lower face. Coronary angiography was carried out, where epicardial arteries are observed without lesions, left ventricle not dilated, however hypokinesia of the middle and apical segments and hyperkinesia of the basal segments was noted; showing an apical bulge simulating an image in Takotsubo, making the diagnosis. There are only few reports of Takotsubo related to cryoablation of atrial fibrillation in medical literature, therefore reporting cases is important in order to study more this particular trigger of Takotsubo.

Background Incomplete obliteration of the omphalomesenteric duct causes Meckel's diverticulum, the most common congenital anomaly of the gastrointestinal tract. (1,2,6). It is known as "the disease of the 2", affecting 2% of the general population, located two feet proximal to the ileocecal valve, is twice as common in men, measuring 2 inches long and commonly containing gastric and pancreatic heterotopic tissue. (14) Clinical manifestations occur in 20% of cases (3). During the first few years of life, hemorrhage is the most common clinical presentation in pediatrics. (2). Approximately 80% of cases are discovered incidentally during imaging studies or during surgery. (1, 4). Diverticulitis, intussusception, hemorrhage, perforation, ulceration, herniation, malignancy, volvulation, and occlusion are the most common complications in adults. (1, 2, 9) There are many clinical presentations of Meckel's diverticulum, but volvulation is a rare complication, especially if a flange to the mesentery is also present. (14). Surgical resection is the preferred treatment for symptomatic Meckel's diverticulums, including diverticulectomy, wedge resection, or segmental bowel resection (2). In this case, a 51-year-old female with acute abdominal symptoms was diagnosed with sigmoid colon volvulus with herniation of the mesodiverticular band of a Meckel's diverticulum. In the existing literature, only a few cases similar to this have been described in adult patients. Keywords: Meckel's diverticulum, intestinal occlusion, volvulus, internal hernia, mesodiverticular band.

Background Scalp lesions have been increasing in recent decades due to their association to head trauma. Treatment is a challenge for the reconstructive surgeon, as there are different surgical alternatives such as: primary closure, grafts, local, regional and remote flaps depending on the lesion. In this work we present a 29-year-old female patient with a scalp lesion on frontotemporal region of approximately 7 cm in diameter, with devitalized perilesional tissue and bone exposure. It was handled with flap of advance and rotation with favorable clinical evolution. Keywords: Scalp, scalp reconstruction, rotational flap.

Objective: To describe the case of a patient with modeling disease and overview the literature. Case description: 62-year-old female patient with a history of injection with modeling substances 20 years ago presenting late onset reaction to these and ASIA syndrome, managed with surgical debridement, negative pressure system and skin graft placement. Conclusion: Complications due to the use of biopolymers can be severe and their management must be multidisciplinary. Keywords: modeling disease, biopolymers, skin grafting.

Introduction: The carpal tunnel syndrome (CTS) is the most common of the entrapment neuropathies in which the body´s peripheral nerves are compressed. It is caused by excessive pressure on the median nerve. Gouty tophi is a rare cause of CTS, with an incidence of 0.6%. Gouty may lead to CTS due to: synovial hypertrophy, tenosynovitis, tophaceous nodules and crystal deposits in nerves, muscles or tendons. Case report: 80 years old male with a history of a mass in the wrist of the right hand, of 5 years of evolution, which 2 years prior intervention debuts with carpal tunnel syndrome, treated with surgical removal of the mass, with preservation of flexor tendons and medial nerve. Histopathological reported xanthogranulomatous reaction foreign body type and tophaceous gout, 2 years after treatment with good evolution and no symptom recurrence. Discussion: Gout it’s a type of crystal- induced arthritis. Sodium urate crystals with localized inflammation and neutrophil activation that further activate macrophages forming an inflammatory loop. Gout is an uncommon cause of carpal tunnel syndrome. One of the firsts reported cases dated to 1966 by Phalen et al. reported 15 hands with gout in 2469 cases of carpel tunnel syndrome (0.6%). Patil el al. reported three cases of gout among 3216 cases of carpal syndrome (0.9%). Surgical treatment is considered effective for chronic patients. Conclusions: Gouty tophus is a rare cause of carpal tunnel syndrome; an early diagnosis and control of the gout are necessary to avoid irreversible nerve injury. Delays in the diagnosis and treatment can lead to functional damage and residual deformity. Surgical treatment combined with medical treatment can improve the treatment outcome of gouty tophus. Key words: Tophaceus gout, median nerve, carpal tunnel syndrome, hand surgery.

Introduction: Soft tissue sarcomas are rare forms of cancer, about 15% of sarcomas grow in the upper extremities, of which liposarcoma has been linked to members of the p53 and MDM2 gene. Treatment strategies are based on wide surgical excision with a focus on limb salvage, reserving amputation for advanced cases. Reconstruction of upper extremity defects is a challenging task for the plastic surgeon. Random pattern local flaps are reconstructive options, lateral thoracic and thoracodorsal artery perforator flap contains skin without muscle and is based on its perforators, is used in defects of the trunk, axilla, proximal arm and locoregional reconstruction without injury no muscle. Case presentation: A 47-year-old male with a 14 x 10 cm tumor lesion in the left arm, who underwent oncological resection and reconstruction with a random pattern local faciocutaneous flap dependent on thoracodorsal and thoracolateral artery perforators, with Histological diagnosis of liposarcoma, postoperative evolution was satisfactory, no recurrence was observed during the follow-up period and the range of motion returned to normal. Conclusion: Reconstructive surgery of the upper extremity is very challenging due to the poor viability of local tissues. The random pattern local flap based on thoracodorsal and thoracolateral artery perforators is versatile, useful for soft tissue sarcomas of the upper extremity, with a multidisciplinary approach it is possible to save the extremity. The random pattern local flap can be an option and a weapon in the reconstructive arsenal. Keywords: Random pattern flap, liposarcoma, upper limb.

INTRODUCTION: The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable.; MATERIAL AND METHODS: A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic.; RESULTS: Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination.; CONCLUSION: The key informant survey identified the foreseeable changes in neurological care after the pandemic. Copyright © 2020 Sociedad Espanola de Neurologia. Publicado por Elsevier Espana, S.L.U. All rights reserved.