tailieunhanh - Báo cáo khoa học: "Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Marjolin's ulcers: theories, prognostic factors and their peculiarities in spina bifida patients | Nthumba World Journal of Surgical Oncology 2010 8 108 http content 8 1 108 WORLD JOURNAL OF SURGICAL ONCOLOGY RESEARCH Open Access Marjolin s ulcers theories prognostic factors and their peculiarities in spina bifida patients Peter M Nthumba Abstract Background Due to improved care more and more children born with spina bifida in rural Kenya are surviving into adulthood. This improved survival has led to significant challenges in their lifestyles especially the need to ensure pressure ulcer prevention and treatment. Malignant degeneration of pressure ulcers in spina bifida patients is very rare. The author describes the clinical presentation of two pressure ulcer carcinomas that are at variance from classical descriptions. Materials and methods An internet Medline PubMed search of English literature for theories on Marjolin s ulcer evolution and prognostic features of Marjolin s ulcers was performed. A chart review of two young adults with spina bifida who had presented to the author s hospital between 2004 and August 2010 with chronic pressure ulcers found to be Marjolin s ulcers on histo-pathological examination was performed and the clinical features are reported. Results The two ulcers appeared clinically benign one was a deep ulcer while the other was shallow both had normal benign-appearing edges and a foul smelling discharge. The two ulcers were surrounded by induration and multiple communicating sinuses with no evidence of chronic osteomyelitis. The internet search revealed a total of nine theories on Marjolin s ulcer development as well as seven clinical and four histological prognostic features. Discussion The multifactorial theory a coalescence of a number of proposed theories best explains the evolution of Marjolin s ulcers. Poor prognostic features include pressure ulcer carcinomas lesions and location in the lower limbs trunks all present in the two patients making their prognosis dim this is despite the surgical margins being clear of .