[Delay in diagnosing melanoma. A prospective study in 102 patients].
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Abstract A prospective study of 200 consecutive patients with suspected acute appendicitis was performed to compare open and laparoscopic appendicectomy. Formal randomization was precluded by instrument availability. Some 100 patients underwent laparoscopic appendicectomy (conversion to laparotomy was carried out in five) and 100 had conventional surgery. The groups were similar in sex ratio, age, degree of appendiceal inflammation and antibiotic treatment. The mean duration of open appendicectomy was 46 min and of the laparoscopic procedure 51 min (P not significant). Postoperative complications in patients who underwent laparoscopic appendicectomy included: intraabdominal abscess (two patients), wound infection (one), early bowel obstruction (four all resolved with medical treatment) and umbilical haematoma (two). There were no reoperations in the immediate or late postoperative period. Complications after open operation were: wound infection (seven patients) (P < 0·05), early bowel obstruction (five; three resolved with medical treatment, two required surgery) and haematoma of the Surgical wound (one). The mean hospital stay was 4·8 days for laparoscopic appendicectomy and 6·0 days for the open operation (P < 0·05). There were no deaths.
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Fifty-two patients with a haematoma or abscess of the nasal septum underwent surgical treatment during a period of 10 years in the ENT Department at Aalborg Hospital. Of these, 27 patients with a haematoma and 12 patients with an abscess were re-examined. In all the patients except 1, trauma was the cause of the lesion. The average delay of treatment was 48 hours for patients with a haematoma and 11 days for patients with abscesses. All these lesions were incised under general anaesthesia and treated with drainage and nasal packing. Eight patients showed cartilage resorption; none had initial cartilage implantation. Follow-up showed that 7 patients had received further surgical treatment during the observation period (mean 44 months). The frequency of nasal deformities is comparable with that of previous reports. The patients with abscesses in particular showed severe external nasal deformities; this is mainly attributable to the delay in treatment.
Incision and drainage
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Background: Although the fibula free flap is preferred for bony head and neck reconstruction, donor-site morbidity remains a concern. The authors' goal was to evaluate potential risk factors for complications and whether the type of wound closure and timing of postoperative ambulation had an effect on the development of short- and long-term morbidities. Methods: A prospective cohort study of donor-site morbidity was performed in 157 consecutive patients who underwent fibula free flap reconstruction for head and neck defects. Results: Perioperative donor-site complications occurred in 31.2 percent of patients, including skin graft loss (15 percent), cellulitis (10 percent), wound dehiscence (8 percent), and abscess (1 percent). Preoperative chemotherapy (p = 0.02) was associated with increased complications. No significant difference in complication rates was observed between primary and skin graft wound closure (p = 0.59). The timing of ambulation was not related to the development of complications (p = 0.41). Long-term morbidities occurred in 17 percent of patients and included leg weakness (8 percent), ankle instability (4 percent), great toe contracture (9 percent), and decreased ankle mobility (12 percent). The occurrence of perioperative complications, flap type, and closure technique were not significantly associated with long-term morbidities. Functionally, 96 percent of patients returned to their preoperative level of ambulatory activity. Decreases in ambulatory status could all be ascribed to causes other than donor-site morbidity. Conclusion: Fibula free flap harvest is associated with a high rate of complications, but the majority of patients have no long-term functional limitations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.
Wound dehiscence
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Rationale: Acral lentiginous melanoma (AML) does not exhibit the classic signs of malignant melanoma. ALM is frequently misdiagnosed because of its unusual sites and atypical clinical morphologies, which lead to poor prognosis. Patient concerns: A female patient aged 78 years was presented to our center with two ulcers on her right foot. Diabetic foot ulcer was considered as the primary diagnosis. The ulcers failed to improve after 2 weeks’ therapy. Diagnoses: An incisional biopsy of the lesion revealed malignant melanoma. Interventions: The patient received wide excision, skin grafting as well as biotherapy. Outcomes: The lesion was healed and no other metastasis has been founded until now. Lessons: Clinicians must maintain a high level of suspicion in distinguishing malignant melanoma from other more benign skin lesions of the foot. The need for early biopsy of ulcer, even when clinical suspicion is low, can not be overemphasized. Only in this way can we reduce misdiagnosis rate and improve survival rate in patients with foot ulcer.
Foot (prosody)
Acral lentiginous melanoma
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Melanoma diagnosis
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Pleurodesis
Video-assisted thoracoscopic surgery
Chest tube
Thoracoscopy
Cardiothoracic surgery
Bleb (medicine)
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As Dr Whitmore notes, for any individual pigmented lesion on the skin, the final diagnosis can only be made after biopsy of the lesion. Clinically diagnosed dysplastic nevi span a continuum from minimally abnormal nevi that barely fulfill criteria for diagnosis of dysplastic nevi to markedly abnormal nevi that cannot clinically be distinguished from early melanoma and need to be biopsied to rule out either in situ or invasive melanoma. At either end of the spectrum, the clinical diagnosis is difficult. In selecting the photographs, we chose representative samples of all of the types of nevi (in the middle of the spectrum clinically). Patients with florid dysplastic nevi may have many, sometimes hundreds, of abnormal-appearing nevi. At the time of initial examination, of course, any lesion that is suspicious for melanoma should be removed. Removal of all unusual-appearing nevi is not recommended, however, because (1) the chance of any 1
Dysplastic nevus
Melanoma diagnosis
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The incidence of cutaneous melanoma is increasing worldwide and early diagnosis is essential since the prognosis is poor in advanced stages of disease. Dermoscopy emerged as an additional and important diagnostic procedure for the early diagnosis of cutaneous melanoma.We report a case of a 52-year-old man, who developed a pigmented lesion in the right pretibial region. Dermoscopy highly suggestive of melanoma. The initial histopathological evaluation suggested a benign lesion. Since dermoscopy was very suspicious, a more extensive histopathological study of the excised skin fragment was performed. This led to a change of diagnosis to a melanoma with partial regression.The present case shows that occasionally dermoscopy may be more informative for diagnosis of melanoma than an initial histopathology result.
Histopathology
Dermatoscopy
Histopathological examination
Skin lesion
Melanoma diagnosis
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