Giant congenital melanocytic nevi: long-term results of treatment modalities

We present our long-term results of 44 children treated for giant congenital melanocytic nevus (GCMN). Although controversial, their potential malignancy enforces their removal. The choice of the technique is a real challenge but should attempt to remove all of the involved tissue with minor cosmetic deformity. Our present approach favours the use of multimodality therapy, and different surgical procedures being used for each region.     

Results of early curettage of giant congenital melanocytic nevi; a report of eight cases and review of the literature

The aim of this study was to investigate the long-term cosmetic and oncologic results following early curettage of giant congenital melanocytic nevi (GCMN). Neonates with GCMN treated with curettage within 4 weeks of age and with a minimum follow-up of 2 years were evaluated at the outpatient department. Scar formation was evaluated by means of the patient and observer scar assessment scale (POSAS). Biopsy specimens were analysed. In 9 years, eight neonates were treated. The mean follow-up period was 5.6 years. Six (75%) patients developed re-pigmentation of the curetted skin, hypertrichosis returned in five cases. One patient developed hypertrophic scars, all others formed good scars. None of the patients developed a melanoma. Biopsy specimens showed nevus cells in the skin after curettage. In 50% of the patients curettage is followed by severe re-pigmentation. Since this treatment does not remove all nevus cells, long-term follow-up is essential to detect malignant transformation.     

断层皮片切削法在巨痣治疗中的应用

目的:探讨断层皮片切削法治疗巨痣的临床疗效。方法:采用滚轴式取皮刀切削巨痣达真皮浅层,创面不需植皮,待其自行愈合后配合预防瘢痕增生治疗。结果:6例患儿取得满意效果,3例患儿有少部分色素残留。所有患儿术前术后毛发无明显改变。平均治疗时间为18天。结论:断层皮片切削法治疗巨痣临床效果明显:术后恢复快,色素残留少,皮肤无明显瘢痕形成,可明显改善患者外观。     

应用削除及磨削法治疗体表先天性巨痣疗效分析

目的探索应用削除或磨削法治疗成人体表先天性巨痣的操作与效果。方法综合先期进行的病理学检查结果、病变具体位置及患者的治疗心理预期等相关因素后,使用滚轴取皮刀切取刃厚或中厚皮片,或者使用高速的“西瓜”磨头磨削肿物浅层病变的方法治疗巨痣,治疗区保持在湿润状态下愈合,治疗按部位分1～2次进行,共治疗10例。结果10例中5例患者取得较为理想的效果,肤色接近正常,病理学检查未发现痣细胞明显残留,4例明显改善,1例有所复发,多数治疗效果均达到患者的心理预期。结论削除或磨削法对曾用其他方法治疗效果不佳或须付出较大代价的体表先天性巨痣有明显的实用效果,特别是由于综合考虑了多种相关因素,有利于在治疗效果与治疗代价之间取得较好的平衡,值得在临床上加以推广。     

Nonprogessive size reduction of limbs involved in giant congenital nevi: A magnetic resonance imaging study

Giant congenital nevi are hamartomas of neuroectodermal origin predominantly involving the trunk; two or more body segments are also commonly involved. A feature observed when giant congenital nevi are involved in a limb is a nonprogressive reduction in limb size. This feature has been evaluated, and demonstrates alterations only in the skin and subcutaneous tissue of the affected limb, with all other structures normal compared with the unaffected contralateral limb. The present magnetic resonance imaging study clearly demonstrates the substitution of subcutaneous tissue and fat cells by nevus cells, leading to a dramatic volume reduction in these tissues. The volumes of the deeper structures were not affected.     

Cutaneous lasers and skin camouflage make-up: A useful alternative intervention for periorbital hairy congenital melanocytic naevus

Abstract

Periorbital congenital melanocytic naevi can be very disfiguring and difficult to treat effectively. Although surgical excision and reconstruction is the most widely accepted treatment strategy, we describe a case in which cutaneous lasers treatment followed by the application of cosmetic skin camouflage make-up provided an alternative solution delivering a good cosmetic improvement.     

Expanded scalping forehead flap for coverage of giant congenital nevi of the face: A report of three cases

Summary We present a technique using expanded forehead skin to allow excision and resurfacing of giant hairy nevi of the face. In each of three young patients an expanded scalping forehead flap provided pleasing coverage and permitted primary closure of the donor site. We believe that the superiority of this technique compared to other reconstructive options justifies the multiplicity of operative stages.     

先天性巨指畸形的手术治疗(附21例报告)

目的探讨先天性巨指畸形的手术治疗方法与疗效。方法对21例先天性巨指畸形病人分别采用巨指矫形术、病变神经切除术、巨指部分切除术、截指术。结果手术年龄平均为9岁，术后随访1—9年(平均4年3个月)，2例巨指术后外形仍显臃肿，功能不理想，其余19例术后功能与外形均较满意。结论巨指畸形应根据患者年龄大小、病变程度和畸形状况，选择适宜的手术方式。早期手术以阻止畸形的发展为主，晚期手术则以矫正畸形为主。     

机械磨削联合铒激光磨削治疗泛发性表皮痣临床观察

目的：观察机械磨削联合铒激光磨削治疗泛发性表皮痣的疗效与安全性。方法：2008年3月～2010年3月,笔者对19例泛发性表皮痣患者先采用不锈钢磨头行真皮网状层浅层磨削治疗,2～3个月后对复发的表皮痣再联合铒（Er：YAG）激光磨削治疗,末次治疗后6个月复诊;根据表皮痣复发程度,分别评定为＂无效、轻度改善、中度改善、显著改善＂四级;有效率以轻度改善＋中度改善＋显著改善计,满意率以中度改善＋显著改善计。结果：19例患者均有疗效,其中轻度改善2例（10.53%）,中度改善6例（31.58%）,显著改善11例（57.89%）,有效率为100%,满意率为89.47%;继发并发症中色素沉着19例（100%）、色素减退4例（21.05%）、瘢痕增生1例（5.26%）。结论：机械磨削联合铒激光磨削是一种目前治疗泛发性表皮痣安全、有效的方法。     

Evidence-based review of treatment options for patients with glottic cancer

Evidence-based medicine integrates the best available data in decision making, with the goal of minimizing physicians' and patients' subjectivity. In 2006, the American Society of Clinical Oncology edited clinical practice guidelines for the use of larynx preservation strategies. The objective of this review was to evaluate the current levels of evidence for glottic squamous cell carcinoma. Current guidelines for early stage glottic cancer are based on low-level evidence. Conservation surgery (open or transoral) and radiation therapy are all valid options for T1 and selected T2 lesions. For advanced lesions, surgery and combined chemotherapy and radiation are options. High-level evidence favors combined chemotherapy and radiation therapy or altered fractionation radiation therapy as nonsurgical strategies for organ preservation, compared with radiation therapy alone. The optimal combination of chemotherapy, targeted therapy, and radiation therapy remains to be demonstrated, however, and for high-volume tumors, total laryngectomy may still be warranted.     

梭形切除与激光治疗腋臭疗效比较

目的:探讨梭形切除与激光治疗腋臭的效果。方法:观察对象按方法分为2组,A组为梭形切除术组共64例,B组为激光治疗组共31例,通过随访患者的疗效比较两种方法近期(1年内)及远期效果。结果:1年内,A组总有效率为100%,B组总有效率为81%,近期疗效A、B两组有显著统计学差异(P<0.01)。1年后,A组治愈62例,另2例边缘残留,再次手术后治愈;B组31例气味均恢复同术前。结论:梭形切除可根治腋臭,激光治疗仅有近期疗效,远期无效。     

A tale of two tibias: a review of treatment options for congenital pseudarthrosis of the tibia

Purpose Two common treatment options for congenital pseudarthrosis of the tibia (CPT) are intramedullary fixation following resection/shortening of the pseudarthrosis site and reconstruction with an Ilizarov external fixator following resection. We present in detail a narrative of two cases with similar degrees of tibial dysplasia associated with NF-1 treated using these different methods and followed to completion. Methods Technical issues and details of the treatment methods from case reports are discussed in depth. The eventual profoundly different outcomes are correlated to the technical variations used. Results Treatment with the Charnley–Williams rodding method and aggressive bone grafting supplemented by rh-BMP2 resulted in a normal functioning limb at maturity, while treatment with first, an ineffective version of IM rodding, followed by two sessions of bone transport using an Ilizarov fixator failed to gain useful union and eventually resulted in amputation. Conclusions Technical details, heretofore inadequately reviewed in the literature, are crucial to the success of either of these commonly utilized treatment methods for CPT.     

Results of laparoscopic anterior resection for rectal adenocarcinoma: retrospective analysis of 157 cases

BACKGROUND: Laparoscopic excision of rectal tumors has gained favor in the last decade and several issues have reported encouraging results: still, the use of laparoscopy remains open to debate. The aim of the current study is to assess the reliability of laparoscopic anterior resection (LAR) for rectal cancer analyzing short-term outcomes and long-term survival. METHODS: The charts of 157 patients were reviewed retrospectively after anterior resection for rectal adenocarcinoma performed by minimal access. Patients undergoing emergency surgery were excluded. LAR was excluded in presence of preoperative features at computed tomography (CT) scan suggesting bulky tumors unresectable by laparoscopy or in case of anesthesiologic contraindications. Conversion rate and functional and oncologic outcomes were analyzed. Data on long-term results and survival were evaluated. RESULTS: LAR was performed in 157 patients, and conversion to laparotomy was required in 12 cases. Mean operation time for nonconverted patients was 229 minutes (overall 238 minutes). Total mesorectal excision (TME) was performed in tumors of the mid and low rectum and a temporary ileostomy was performed in 56 patients. The mean length of hospital stay (LOS) was 10.5 days. Morbidity of anterior resection included 17 anastomotic leaks after laparoscopic surgery (LS; 5 in the converted patients). Conversion increased significantly the risk of leak (P < .005). Two leaks caused death. The mean number of nodes collected was 12. The incidence of local relapse was 4%, and the rate of anastomotic recurrence was nil. Survival probability with LS was .73 at 5 years. Patients in stage III took advantage of adjuvant treatment and had a better survival than patients in stage II (P = not significant [NS]). CONCLUSIONS: The outcomes of this study suggest that LAR for rectal cancer is a reliable procedure. Oncologic requirements were respected; parameters such as length of specimen, distal margin, and number of nodes retrieved were quite acceptable. Incidences of local recurrence and long-term survival were comparable with those of other series.     

成人先天性胆管扩张症手术治疗39例分析

目的探讨成人先天性胆管扩张症手术治疗的经验体会。方法1992年10月至2006年2月我院收治的成人先天性胆管扩张症39例患者均行囊肿切除。结果术后短期胆汁漏6例,无胰漏,急性胰腺炎1例,无死亡。39例经1～15年随访,随访率94．6％,2例表现轻度胆管炎,余均痊愈,无胆管炎及胆管狭窄表现。结论囊肿切除、胆管空肠Roux-Y吻合是成人先天性胆管扩张症的首选治疗。切除囊肿时,囊肿近端在尽量切净囊肿的基础上行大口吻合,可吸收线单层吻合,防止术后吻合口狭窄;囊肿远端在保证胰液引流通畅、不损伤胰管开口的基础上,尽量切净囊肿内膜。     

成人先天性胆管扩张症33例诊治体会

目的 探讨成人先天性胆管扩张症的诊治方法。方法 回顾分析2005年1月至2016年5月我科收治的先天性胆管扩张症33例患者的临床资料。结果 33例患者根据Todani分型:Ⅰ型26例,Ⅳ型3例,Ⅴ型4例。有2例因病情危重分二期手术完成治疗,其余31例均一期手术完成治疗。结论 上腹部MR+MRCP具有高的诊断率,应作为临床检查诊断首选;先天性胆管扩张症的治疗应结合Todani分型,病人的整体情况及病情缓急等决定的治疗方式,术中应结合MRCP或胆道造影尽可能完整切除囊性扩张的胆管。     

上臂皮管移植联合Q开关及CO2激光治疗鼻面部复杂性黑色素痣

目的：探讨皮管移植联合Q开关及CO2激光技术治疗鼻面部复杂性黑色素痣的效果,总结手术及激光治疗的技巧。方法：6例鼻面部复杂性黑色素痣采用手术切除后上臂皮管移植联合Q开关及CO2激光治疗,观察治疗效果。结果：本组6例患者经过皮管移植联合Q开关及CO2激光治疗后,皮瓣存活良好,存活后皮瓣颜色与邻近部位无明显差异,术后激光治疗1个疗程后鼻面部黑色素痣区域色素基本消失,手术切口瘢痕淡化,外观改善满意,随访1年无复发。结论：采用皮管移植联合Q开关及CO2激光治疗鼻面部复杂性黑色素痣临床疗效显著,是目前较为理想的方法。     

Surgical treatment options in proximal hypospadias: retrospective analysis of 171 cases at a single institution

Aim So far, various techniques have been used in the surgical treatment of proximal hypospadias. The aim of all techniques is to form a near to normal penis functionally and cosmetically. In the present study, proximal hypospadias cases operated in our clinic were evaluated. Material method Overall 171 cases with proximal penile, penoscrotal and scrotal meatus, aged between 3 and 28 were included in the study. Early and late postoperative complication rates and factors affecting success were investigated retrospectively. Results Sixteen cases underwent Duckett, 20 Onlay, 28 free tube, 56 Belt-Fuqua and 51 Thiersch operations. Success rate at early postoperative period was 60.8%, while it became 81.2% following secondary interventions. Conclusion No effect of operation technique and meatus levels were observed on complication rates whilst previous operation increased complication rates significantly.     

改良莎氏手术治疗儿童先天性髋关节脱位疗效分析

目的：评价先天性髋关节脱位改良莎氏手术后的疗效。方法：182例儿童先天性髋脱位行切开复位,髋臼扩大加深、骨膜植入,股骨上端旋转截骨术,结果：随访94例,时间3－14年,平均6年,临床功能及X线形态优良率为85％。结论：改良莎氏手术虽然不是儿童先天性髋脱位的首选术式,但对于年龄较大或行其他手术再脱位不失为一种较好的补救手术。