Fibrohistiocitoma maligno / Malignant fibrohystiocytoma

RESUMEN El fibrohistiocitoma maligno es el sarcoma de partes blandas más frecuente en adultos; es poco frecuente como tumor primario cutáneo. Presenta predilección por el sexo masculino con una mayor incidencia entre la quinta y sexta década de la vida. Se localiza predominantemente en las extremidades. Presentamos a continuación el caso clínico de un paciente con diagnóstico de fibrohistiocitoma maligno localizado en hallux de pie derecho y realizaremos una revisión de la literatura.

ABSTRACT Malignant fibrohistiocytoma is the most frequent soft tissue tumor in adults; it is rare as a primary cutaneous tumor. It presents a predilection for males with the highest incidence between the fifth and sixth decade of life. It is located predominantly on the extremities. We will perform a literature review. We present below the clinical case of a patient diagnosed with malignant fibrohistiocytoma located in hallux of the right foot.

Conceptos para la identificación y abordaje dela gangrena de Fournier / Concepts for the identification and approach of Fournier's gangrene

Introducción. La gangrena de Fournier es una fasciitis necrosante fulminante y progresiva, de origen infeccioso sinérgico polimicrobiano, que afecta las regiones perianal, perineal, genital y abdominal. Su incidencia es mayor en hombres, la edad promedio de presentación reportada está en los 54,7 ± 15,6 años, su mortalidad es del 3-67 %, aunque hay estudios que informan una mortalidad en hombres del 7,5 % y en las mujeres del 12,8 %. Métodos. Se hizo una revisión de la literatura en las bases de datos y fuentes de información PubMed, Scielo y Google Scholar, publicados entre 1950 y 2018, utilizando términos como "fournier gangrene", "fasciitis, necrotizing", "wound infection", "therapy"[subheading] y "GRADE approach". Se realizó una segunda revisión para artículos latinoamericanos en español hasta 2020 usando las mismas fuentes y palabras claves. Resultados. Se seleccionaron artículos que reportaron definiciones, datos históricos, actualizaciones en diagnóstico y terapéutica para hacer una revisión actualizada. Para el uso de las imágenes se solicitó consentimiento informado. Conclusión. La gangrena de Fournier continúa siendo una emergencia quirúrgica potencialmente letal. Gracias a las investigaciones realizadas se ha avanzado en su tratamiento, mejorando los resultados. Es importante analizar los factores de riesgo en cada paciente y su etiología para establecer el tratamiento más adecuado.

Introduction. Fournier's gangrene is a fulminant and progressive necrotizing fasciitis of synergistic polymicrobial infectious origin that affects the perianal, perineal, genital and abdominal regions. Its incidence is greater in men, the average age of reported presentation is 54.7 ± 15.6 years; its mortality is 3-67%, although there are studies that report a mortality of 7.5% in men and 12.8% in women. Methodology. A review of the literature was carried out in the databases and information sources: PubMed, Scielo, and Google Scholar, published between 1950 and 2018 using terms such as "Fournier Gangrene", "Fasciitis, Necrotizing", Wound Infection, "therapy"[Subheading] and "GRADE Approach". A second review was performed for articles in Latin American Spanish up to 2020 using the same sources and keywords. Results. Articles that reported definitions, historical data, diagnostic and therapeutic updates were selected, performing an updated review. Informed consent was requested for the use of images.Conclusion. Fournier's gangrene continues to be a potentially lethal surgical emergency, thanks to the research carried out, progress has been made in its treatment, improving results. It is important to analyze the risk factors for each patient and its etiology to establish the most appropriate treatment

Hibernoma intramuscular en el muslo izquierdo de una fémina / Intramuscular lipoma in the left thigh of a woman

Se describe el caso clínico de una paciente de 32 años de edad, con antecedentes de esquizofrenia paranoide, atendida en la consulta de Ortopedia y Traumatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, por presentar aumento de volumen en la cara interna del muslo izquierdo que le dificultaba la marcha. Al examen físico se observó un tumor de aproximadamente 20 cm, no doloroso a la palpación, así como blando y pastoso, con límites imprecisos y adherido a planos profundos. Según los estudios imagenológicos efectuados se trataba de tejido graso, por lo que no existía correlación con los elementos aportados al examen físico. Teniendo en cuenta lo anterior se discutió el caso con los imagenólogos y se decidió realizar la exéresis del tumor. Se tomó muestra para biopsia cuyo resultado informó la presencia de un hibernoma. La fémina evolucionó satisfactoriamente y se reincorporó a sus actividades habituales a los 2 meses.

The case report of a 32 years patient with history of paranoid schizophrenia is described. She was assisted in the Orthopedics and Traumatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, due to an increase of volume in the internal face of the left thigh that difficulted her from walking. A tumor of approximately 20 cm was observed with the physical exam, that was not painful to the palpation, but soft and doughy, with imprecise limits and adhered to deep planes. According to the imaging studies it was an adipose tissue, reason why there was no correlation with the elements obtained with the physical exam. Taking into account the above-mentioned the case was discussed with the imaging specialists and the decision was removing the tumor. A sample for biopsy was taken whose result informed the presence of a lipoma. The woman had a favorable clinical course and she returned to her usual activities 2 months later.

Efecto de la Fibrina Rica en Plaquetas en la Curación de los Tejidos Blandos de Alveolos Post Exodoncia Atraumática. Un Ensayo Clínico Controlado Aleatorizado Cruzado a Ciego Simple

RESUMEN: El objetivo de este estudio fue determinarel efecto de la fibrina rica en plaquetas (FRP) en la curación de los tejidos blandos de alveolos post exodoncia atraumática. El presente es un ensayo clínico controlado aleatorizado a ciego simple y de diseño cruzado. Se llevó a cabo en el Servicio de Odontología del Hospital Distrital Santa Isabel del Porvenir - Perú, durante los años 2016 y 2017. La muestra estuvo conformada por 51 pacientes cuyos alveolos post exodoncia fueron divididos de forma aleatoria en 2 grupos, cada paciente firmó un consentimiento informado. Al grupo A (control) se le dejó con un coágulo de sangre para su curación normal y al grupo B (experimental) se le administró FRP (como tapón y membrana), obtenido según el protocolo de Choukroun. Para determinar el efecto del FRP en la curación de los tejidos blandos de los alveolos post exodoncia atraumática se utilizó el índice de Landry. Las medidas se realizaron a los 7 y 14días después de la cirugía.Para la comparación de cada una de las variables del estudio se utilizó el Test de Mc Nemar y el Test exacto de Fisher. La significación estadística fue del 5 %. Al comparar ambos grupos en la curación de los tejidos blandos de alveolos post exodoncia atraumática se encontró que existe una diferencia estadísticamente significativa a los 7 y 14 días después de la cirugía (p0.05). La FRP presenta un efecto positivo en la curación de los tejidos blandos de alveolos post exodoncia atraumática de forma independiente del sexo y la edad.

ABSTRACT: The objective of the study was to determine the effect of platelet-rich fibrin (PRF) on the healing of soft tissues of socket after atraumatic exodontia. The present is a single-blind, cross-sectional randomized controlled trial. It was carried out in the Dental Service of the Santa Isabel District Hospital of Porvenir - Peru, during the years 2016 and 2017. The sample consisted of 51 patients whose alveoli post exodontia were randomly divided into 2 groups, each patient signed an informed consent. Group A (control) was left with a blood clot for normal healing and group B (experi- mental) was given PRF (as a plug and membrane), obtained according to the Choukroun protocol. The effect of PRF on the healing of the soft tissues of the alveoli after atraumatic exodontia was used the Landry index. The measurements were made at 7 and 14 days after surgery. For the comparison of each one of the variables of the study, the Mc Nemar test and the Fisher exact test were used. The statistical significance was 5 %. When comparing both groups in the healing of the soft tissues of alveoli after atraumatic exodontia, a statistically significant difference was found at 7 and 14 days after surgery (p 0.05). The PRF has a positive effect on the healing of the soft tissues of the alveoli after atraumatic exodontia independently of sex and age.

Soft tissue myoepithelial carcinoma: is it a low-grade cancer? / Carcinoma mioepitelial de partes moles: um tumor de baixo grau de malignidade?

ABSTRACT Myoepithelial carcinoma is a rare neoplasm of very heterogeneous manifestation that represents a major challenge to the adoption of categorical prognostic criteria since, despite being classified as a low-grade cancer, it behaves very aggressively. While several studies have indicated complete surgical resection as the best treatment for myoepithelial carcinoma, adjuvant therapies have proven effective in preventing relapse. This study describes the case of a patient who developed myoepithelial carcinoma in the right thigh, affecting deep tissues, which were conducted as indicated in the current literature, however, presenting an unfavorable outcome. The available information comes from few studies; therefore, we emphasize the importance of gathering data on the subject, which are still scarce.

RESUMEN El carcinoma mioepitelial es una neoplasia rara, de manifestación muy heterogénea, que encierra un gran desafío para la adopción de criterios pronósticos categóricos, puesto que, a pesar de ser clasificado como tumor de bajo grado de malignidad, muestra comportamientos muy agresivos. Mientras varios estudios indican la resección quirúrgica completa como el mejor tratamiento para el carcinoma mioepitelial, terapias adyuvantes se han revelado efectivas para prevenir la recidiva. Este estudio describe el caso de una mujer que presentó carcinoma mioepitelial en muslo derecho, afectando partes profundas, lo cual fue conducido como indica la literatura actual, sin embargo, con un resultado desfavorable. Las informaciones disponibles son producto de pocos estudios, por ello, destacamos la importancia de reunir datos acerca del tema, que aún son escasos.

RESUMO O carcinoma mioepitelial é uma neoplasia rara, de manifestação muito heterogênea, que encerra um grande desafio na adoção de critérios prognósticos categóricos, uma vez que, apesar de ser classificado como tumor de baixo grau de malignidade, apresenta comportamentos muito agressivos. Enquanto vários estudos indicam a ressecção cirúrgica completa como o melhor tratamento para carcinoma mioepitelial, terapias adjuvantes têm-se revelado efetivas na prevenção da recidiva. Este estudo descreve o caso de uma paciente que desenvolveu carcinoma mioepitelial em coxa direita, acometendo partes profundas, o qual foi conduzido como indica a literatura atual, contudo, apresentando desfecho desfavorável. As informações disponíveis provêm de poucos estudos, logo, ressaltamos a importância de reunir dados a respeito do tema, que ainda são escassos.

Desenlaces clínicos y radiológicos de las fracturas de maléolo lateral manejadas de forma percutánea. Serie de casos / Clinical and radiological outcomes of percutaneously managed lateral malleolar ankle fractures. Case series

Introducción El estándar de manejo para las fracturas del peroné distal es la reducción abierta más fijación interna con placa y tornillos (bloqueados o no), sin embargo, existen complicaciones asociadas a este tipo de intervención. En pacientes ancianos con mala calidad de tejidos blandos o en quienes presentan traumas de alta energía como etiología de las fracturas en el tobillo, la tasa de complicaciones previamente mencionadas aumenta, por lo que el manejo de las fracturas de peroné distal con tornillos percutáneos representa una alternativa con menor riesgo de complicaciones y con desenlaces similares al manejo convencional. Materiales y métodos Se realiza una serie de casos de pacientes con fractura de peroné manejados de forma percutánea. Se obtuvo una muestra de 17 pacientes por un año, a quienes se les realizó seguimiento sobre tasa de consolidación, funcionalidad y complicaciones postoperatorias. Resultados Diez (62,5%) fueron hombres, con una media de edad de 59 años (rango entre 24 y 90). El 100% fueron secundarios a traumas de alta energía, 10 (62,5%) fueron izquierdas, 14 (87,5%) se clasificaron como Weber B y 7 casos (56,25%) se presentaron concomitantemente con fracturas abiertas. Conclusiones Con el fin de evitar complicaciones, se debe considerar este abordaje en pacientes con comorbilidades, de edad avanzada o con tejidos blandos lesionados severamente o de mala calidad

Background The standard management for distal fibula fractures is open reduction plus internal fixation with plate and screws (blocked or not), however, there are complications associated with this type of intervention. In elderly patients with poor soft tissue quality or in those with high-energy trauma as the etiology of ankle fractures, the rate of previously mentioned complications increases, so that the management of distal fibula fractures with percutaneous screws represents a alternative with lower risk of complications and similar outcomes to conventional management. Methods A series of cases of patients with fibula fracture managed percutaneously was carried out. A sample of 17 patients was obtained for one year, who were followed up on consolidation rate, functionality, and postoperative complications. Results 10 (62.5%) were men, with a mean age of 59 years (range between 24 and 90). 100% were secondary to high-energy trauma, 10 (62.5%) were left, 14 (87.5%) were classified as Weber B and 7 cases (56.25%) presented concomitantly with open fractures. Discussion In order to avoid complications, this approach should be considered in patients with comorbidities, the elderly, or those with severely injured or poor-quality soft tissues.

Rabdomiossarcoma embrionário de colo uterino: relato de caso em adolescente / Embryonic rabdomyosarcoma of the cervix: case report in a teenager

O rabdomiossarcoma embrionário, variante botrioide, é uma neoplasia maligna dos tecidos moles que deriva de células musculares mesenquimais embrionárias. Alguns fatores de risco genéticos são conhecidos, mas a doença geralmente se apresenta de forma esporádica. É raro manifestar-se em adolescentes, assim como é raro ser primário do colo uterino. Cursa com a presença de pólipos e até massas que se sobressaem na vagina com casos de sangramento vaginal anormal. O diagnóstico é realizado essencialmente pela história e exame anatomopatológico. Quanto maior o tempo para confirmação do diagnóstico, pior o prognóstico. Há várias modalidades de tratamento ­ que deve ser individualizado e envolver uma equipe multidisciplinar ­, que, basicamente, incluem quimioterapia, radioterapia e cirurgia. Os resultados geralmente são menos favoráveis em adolescentes, quando comparados com os de crianças com a mesma neoplasia.(AU)

Embryonic rhabdomyosarcoma, a botryoid variant, is a malignant neoplasm of soft tissues that derives from embryonic mesenchymal muscle cells. Some genetic risk factors are known, but the disease usually presents itself sporadically. It's rarely manifested in adolescents, just as it is rare to be primary in the cervix. It occurs with the presence of polyps and even masses that protrude in the vagina with cases of abnormal vaginal bleeding. The diagnosis is made essentially by history and anatomopathological examination. The longer the time to confirm the diagnosis, the worse the prognosis. There are several treatment modalities ­ involving a multidisciplinary team ­ that must be individualized and basically include chemotherapy, radiotherapy and surgery. The results are generally less favorable in adolescents, when compared with those of children with the same neoplasia.(AU)

The Influence of Bending Parameters on Mechanical Properties of Soft Tissue Suture Passer Hook / 医用生物力学

Objective To explore the influence of hook deflection angle and inclination angle on mechanical properties of the soft tissue suture passer hook. Methods Taking the end face far away from the tip of the needle (end face 1) as the study object, a mathematical model was established with the moment as dependent variable and the hook deflection angle and inclination angle as the independent variable. The moment was solved by the mathematical model with the deflection angle and inclination angle of 0°, 10°, 20° and 30°. Based on the finite element analysis method, 16 three-dimensional geometric hook models with deflection angle and inclination angle of 0°, 10°, 20° and 30° were established by SolidWorks. The stress analysis was carried out by ANSYS Workbench. Under the same puncture force, the maximum von Mises stress of each hook and the reaction moment of end face far away from the tip of the needle were calculated. Results The results from theoretical analysis and numerical simulation showed that the reaction moment of end face 1 increased with the increase of deflection angle, and increased with the decrease of inclination angle. The hook with deflection angle of 0° and inclination angle of 30° had the minimum reaction moment. The finite element analysis results showed that with the deflection angle of 0°, the maximum von Mises stress of the hook was the smallest and did not change with the inclination angle of the hook changing. Conclusions The established mathematical model can accurately explain the relationship between the moment at the end face of the hook and the deflection angle and inclination angle of the hook. This study provides the theoretical basis for designing hook geometry of the soft tissue suture passer, and improves the safety of the soft tissue suture passer in operation process.

Peripheral odontogenic keratocysts in buccal soft tissues: two cases report / 华西口腔医学杂志

Peripheral odontogenic keratocysts are rarely observed, and cases of odontogenic keratocysts of buccal soft tissues are even rarer. This study was performed to present two rare cases of odontogenic keratocysts in buccal soft tissues and review related literature.

Gangrena de Fournier. Reporte de caso / Fournier's Gangrene. A Case Report

Resumen La gangrena de Fournier es una fascitis necrotizante tipo II que produce trombosis de los pequeños vasos subcutáneos, lo que genera que se propague a través de la piel del periné, área perianal y región genital. La mayoría de los casos tienen un foco perianal o colorectal en la mayoría de los casos y en una menor proporción se origina del tracto urogenital. La tasa de mortalidad varía entre el 7.8 y 50%1-3, únicamente el diagnóstico oportuno disminuye la morbilidad y mortalidad de este padecimiento. El tratamiento incluye desbridamiento quirúrgico de todo el tejido necrótico y el uso de antibióticos de amplio espectro.

Abstract Fournier's Gangrene is a type II necrotizing fascitis that leads to thrombosis of small subcutaneous vessels and spreads through the perianal and genital regions and the skin of the perineal. Most cases have a perianal or colorectal focus and in a smaller proportion it originates from the urogenital tract. The mortality rate varies between 7.8 and 50%1-3, only timely diagnosis decreases the morbidity and mortality of this condition. Treatment includes surgical debridement of all necrotic tissue and the use of broad-spectrum antibiotics.

Calcificaciones de tejidos blandos: consideraciones diagnósticas / Soft tissue calcifications: diagnostic considerations

RESUMEN Introducción: Las calcificaciones en tejidos blandos se refieren al depósito de sales de calcio en tejidos que no incluye el hueso; son un conjunto de imágenes radiopacas que se pueden identificar fácilmente en una imagen radiográfica, generalmente la panorámica, siendo esta una de las técnicas más utilizadas en la práctica odontológica; la presencia de estas calcificaciones, de acuerdo con la localización, forma, tamaño y número, presumirá el tipo de tejido blando calcificado. Objetivo: Identificar los tipos de calcificaciones en tejidos blandos, su descripción en una imagen de diagnóstico dental y su probable asociación con una enfermedad sistémica subyacente. Métodos: Estudio de tipo descripción narrativa de la literatura en el que se buscaron publicaciones en las bases de datos PubMed y Google Scholar de artículos relacionados con calcificaciones en tejidos blandos desde enero de 2014 hasta mayo de 2019. Se utilizaron términos como calcificación, radiografía panorámica, tejidos blandos, entre otros. Análisis e integración de la información: La revisión resume de forma detallada varios tipos de calcificaciones, su implicación clínica y aspectos imagenológicos. Conclusiones: Las calcificaciones en tejidos blandos son entidades que se identifican como hallazgos en técnicas de imágenes dentales y que en muchas ocasiones pasan desapercibidas, esta revisión recalca que, es responsabilidad del radiólogo bucal y maxilofacial la identificación e información de estas calcificaciones, sin embargo, los odontólogos generales deben también familiarizarse con este tipo de entidad y de la misma forma informar a los pacientes(AU)

ABSTRACT Introduction: Soft tissue calcifications are the accumulation of calcium salts in tissues other than bones. They are a set of radio-opacities easily identifiable on a radiographic image, generally the panoramic sort, this being one of the most commonly used techniques in dental practice. The presence of these calcifications in terms of their location, shape, size and number, will suggest the type of soft tissue calcified. Objective: Identify the types of soft tissue calcifications, their description on a dental diagnosis image and their probable association with an underlying systemic disease. Methods: A narrative literature review was conducted of papers about soft tissue calcifications published in the databases PubMed and Google Scholar from January 2014 to May 2019. The search terms used included "calcification", "panoramic radiograph" and "soft tissues", among others. Data analysis and integration: The review is a detailed summary of several types of calcifications, their clinical implication and imaging features. Conclusions: Soft tissue calcifications are conditions identified as findings of dental image techniques which often go unnoticed. The revision stresses that it is the responsibility of oral and maxillofacial radiologists to identify and report these calcifications. However, general dental practitioners should also familiarize themselves with this sort of condition and likewise inform the patients(AU)

La vertical verdadera al punto A´(blando), al Pg´(blando), al Labrale superior y al Labrale inferior en posición ideal asistida de la cabeza (PIAC) / The true vertical from point A´(soft), to Pg´ (soft), to superior Labrale and inferior Labrale in Ideal Assisted Head Position (PIAC)

El 81,3% de una encuesta realizada a 96 ortodoncistas y ortopedistas calificados y técnicos radiólogos consultados informan que ubican la cabeza del paciente en una posición ideal, subjetiva del profesional instruido que lo asiste, ya que muchas de sus fotografías y telerradiografías no son posiciones naturales de la cabeza genuinas. Se ha utilizado la vertical verdadera como parámetro para mediciones, todas angulares, para definir la disposición ánteroposterior del punto A´ (de construcción) para el cuerpo del labio superior, el punto Pg´para el mentón, el Labrale superior y el Labrale inferior para el bermellón de cada labio, con la finalidad de planificar correcciones ortopédicas, ortodóncicas u ortodóncicas-quirúrgicas de acuerdo a la anomalía detectada (AU)

Dermatofibrosarcoma Protuberans. Presentación de un caso / Dermatofibrosarcoma protuberant. Presentation of a case

RESUMEN El dermatofibrosarcoma protuberante es un raro tumor fibrohistiocitario de la piel y grado intermedio de malignidad. Localmente tiene un comportamiento agresivo, se extiende al tejido celular subcutáneo y músculo subyacente. Su crecimiento es lento e indoloro con una alta frecuencia de recurrencia posterior a la intervención quirúrgica. Se presentó una paciente operada en el Servicio de Cirugía General del "Hospital Universitario Dr. Mario Muñoz Monroy" de Colón, Matanzas. Diagnosticada con dermatofibrosarcoma protuberans se presentó con un tumor de partes blandas, localizado en parrilla costal izquierdo, recidivante sobre una lesión resecada anteriormente hacia 8 meses. El tumor de superficie multinodular e irregular, de aproximadamente 3 a 4 cm de diámetro, presentaba zonas de color azuladas y otras más oscuras con un área enrojecida circundante, consistencia dura, y no adherida a planos profundos. Con el resultado anatomopatológico se ratificó el diagnóstico. Nuevamente se aplicó tratamiento quirúrgico con amplios márgenes libres de tumor. Las metástasis son raras y pocos frecuentes, pero localmente pueden infiltrar, grasa, fascia, músculos y hasta estructuras óseas. Cuando se presentan ocurren generalmente en pulmón y ganglios linfáticos regionales, en estos casos la supervivencia es muy poca.

ABSTRACT Dermatofibrosarcoma protuberant (DFSP) is a rare fibrohistiocytic skin tumor of intermediate level of malignance. Locally it has an aggressive behavior extending to the subcutaneous cellular tissue and underlying muscle. Its grow is slow and painless with a high recurrence frequency after surgery. The authors present the case of a female patient operated in the Service of General Surgery of the University Hospital ¨Dr. Mario Muñoz Monroy¨ of Colon, Matanzas. Diagnosed with dermatofibrosarcoma protuberant, she arrived to the consultation with a tumor of soft tissues located in left rib cage, recidivist on a lesion resected 8 months before. It had a multinodular and irregular surface, of around 3-4 cm diameter, with bluish and dark blue areas and a reddened surrounding area of hard consistence, not adhered to deep planes. The diagnosis was ratified by the neuropathologic result. The surgical treatment was applied again with wide free-tumors margins. Metastases are rare and few frequent, but locally they can infiltrate fat, fascia, muscles and even bone structures. When they present they occur mainly in lung and regional lymphatic ganglia; in these cases survival is scarce.

Diagnosis and treatment of retained wooden foreign bodies in the extremities using ultrasound / Diagnóstico e tratamento com ultra-som de corpos estranhos de madeira retidos nas extremidades

ABSTRACT Objective This study investigates ultrasonography as an effective tool for localizing and measuring the depth and size of wooden foreign bodies to perform less invasive and easier surgery without the need for any additional radiological techniques. Methods Fifteen patients were operated to remove foreign bodies in the extremities in 2016. The side of the affected extremity, the material, size, and location of the foreign body and time of admission after injury were noted, along with CRP, WBC, and erythrocyte sedimentation rate; length of incision, surgery duration, and complications were evaluated. Results The mean patient age was 39.66 (range: 6 to 68). Of the total, 8 of the foreign bodies were in the plantar surfaces of the feet, 3 were in the cruris, 2 were in the palm of the hand, and 2 were in the fingers. All patients underwent ultrasound evaluation before surgery. The surgeries lasted less than 10 min in 13 (87%) of the cases and from 10 to 20 min in 2 cases. No complications were observed in any of the patients. Conclusion Delayed extraction of foreign bodies can lead to local infections. Ultrasonography can be a reliable option for diagnosing and localizing radiolucent foreign bodies such as wooden objects. Level of Evidence IV; Case series.

RESUMO Objetivo Neste estudo, procuramos mostrar que a ultra-sonografia é uma ferramenta eficaz para localizar e medir a profundidade e o tamanho dos corpos estranhos em madeira, a fim de realizar uma cirurgia menos invasiva e mais fácil, sem a necessidade de técnicas radiológicas adicionais. Métodos 15 pacientes foram submetidos à cirurgia para penetração de corpo estranho nas extremidades em 2016. O lado da extremidade afetada, o material, tamanho e localização do corpo estranho e o tempo de admissão após lesão foram observados. CRP, WBC e taxa de sedimentação de eritrócitos também foram observados. O comprimento da incisão, duração da operação e complicações foram avaliados. Resultados A idade média do paciente foi de 39,66 (intervalo: 6 a 68). No total, oito de todos os corpos estranhos estavam no lado plantar dos pés, três estavam no crúis, dois estavam na palma da mão e dois estavam nos dedos. Todos os pacientes foram submetidos a avaliação ultra-sonográfica antes da cirurgia. A duração da operação foi inferior a 10 minutos em 13 (87%) dos casos e entre 10 a 20 minutos em dois casos. As complicações não foram observadas em todos os pacientes. Conclusão A extração retardada de corpos estranhos pode levar a infeções locais. A ultra-sonografia pode ser uma opção confiável para diagnosticar e localizar corpos estranhos radiolúcidos, como objetos de madeira. Nível de evidência IV; Série de casos.

Lesiones Orales en Tejidos Blandos de una Población Escolar en la Ciudad de México / Orales Lesions in Soft Tissues of a School Population in Mexico City

RESUMEN: Identificar la distribución y frecuencia de las lesiones orales en los tejidos blandos de la población escolar de seis a doce años de diez escuelas primarias de la delegación Iztapalapa en la Ciudad de México, es el propósito de este estudio de tipo descriptivo, transversal y observacional realizado en una muestra por conveniencia de 2394 escolares de seis a doce años, que entregaron su permiso firmado previa información a los padres de familia. La información se capturó en el Programa de Cómputo SPSS versión 17.0. El 85,6 % de los escolares participantes se encontraron libres de lesiones orales en sus tejidos blandos. Las lesiones traumáticas, fueron las de mayor frecuencia ya que 183 de ellos (7,75), las presentaron, ya sea en carrillo, labio o en la lengua. El contar con estudios que nos permitan identificar las lesiones en los tejidos blandos en la población escolar es de suma importancia debido a que se podrá actuar con programas específicos para su control y prevención. Con respecto a la prueba t=0,001, se encontró significancia estadística entre el sexo y la distribución y localización de las lesiones orales en los tejidos blandos de los escolares.

ABSTRACT: The aim of the study was to identify the distribution and frequency of oral injuries in soft tissues in a school population of six to twelve year-old children, in ten elementary schools of the Iztapalapa delegation in Mexico city. The study type was descriptive, transversal and observational and was carried out in a sample of 2394 schoolchildren from six to twelve years of age, with prior consent signature from the parents or guardians. The information was captured in the software SPSS vesion 17.0. Of the schoolchildren participating in the study, 85.6 % were found to be free of soft tissue injuries. Traumatic injuries were the most frequent as 183 of them (7.75), presented in the cheek, lip or tongue. Studies that identify lesions in soft tissues in school children are important because they are beneficial in establishing specific control and prevention programs in these populations. Statistical significant differences were found between sexes, distribution and site of oral injuries in soft tissues of the population studied.

Clinincal research for superficial palmar branch of radial artery flaps with anastomosed accompanying vein to treat soft tissues defec / 中华显微外科杂志

Objective To investigate the clinincal curative effects of superficial palmar branch of radial artery (SPBRA) flaps with anastomosed accompanying vein repairing soft tissues defects in fingers.Methods From January,2016 to June,2017,10 cases with soft tissues defects received the operation of superficial palmar branch of radial artery flaps transplantation.In the process of operation,the superficial palmar branch of radial artery (SPBRA) was carefully separated,accompanying vein and superficial vein.The SPBRA was anastomosed with the proper digital artery,while the accompanying vein of superficial palmar branch and superficial vein were anastomosed with the palm vein.The nerve supplied this flap was anastomosed with the proper digital nerve.Mesured the range of motion and two-points discrimination of fingers with following-up.Regular followed-up was performed after operation.Results All patients were followed-up ranged from 6 to 24 months,averaged of 13.8 months.All flaps survived.The shape of flaps was plump and the two-points discriminations ranged from 8 to 12mm.Conclusion Using SPBRA flaps with anastomosed accompanying vein to repair soft tissues defects in fingers,there were minor damage to donor and recipient sites,and the shape and sense of recipient site was perfect.It is a promising treatment choice for patients with soft tissues defects in fingers.

Aesthetic soft tissue management in facial trauma

Facial soft tissue injury due to trauma is common. Severe damage of soft tissue causes functional and cosmetic problems. In the initial evaluation of patients with facial trauma, airway maintenance and respiratory maintenance are the most important. The principles of treatment include adequate irrigation and debridement, primary closure, or secondary wound healing. Postoperative care such as taping, silicone gel sheeting, and sun screening is important to prevent scarring. The scalp and forehead are abundant in blood and can cause severe bleeding. The eyelid is very thin and has a multi-layered structure, requiring accurate suturing and reconstruction of the layers. It is advisable to determine the presence of hematoma in the ear and treat it. When the cheek area is damaged, it is necessary to identify and treat the damage of the parotid gland and the facial nerve branch. The lips should be sewn with the white roll of lip and vermillion.

A study on the application of the bran-new method of sampling and forensic for the identification of electrocution: 23 cases analysis / 中国法医学杂志

Objective To confirm the optimal tissue sampling location of current injury combined with the histopathological observation in specific parts of electrocution based on previous animal experiments. Methods Twenty-three human cases from the autopsy through the hand-to-foot circuit pathway were analyzed. Additional ten autopsy patients who died from traffic accidents and sudden cardiac attacks were used as the control group. All cases were extracted the soft tissues from the upper anterior wrist and medial malleolus to further observe and analysis the L/S axis ratio of the nuclei of the skeletal muscle cells (SkMCs) and artery smooth muscle cells (ASMCs). Results The age of the 23 eligible electrical deaths ranged from 19 to 59 years, including 19 cases were male and 4 cases were female. 3 cases were high-voltage 20 cases were low voltage. The occurrence rate of electric marks averaged 31.18% in all cases. The incidence of the classical arborizing pattern of fine branching was 36.4%, appearing on the pleura in 5 cases (22.7%). The nuclei of the SkMCs and ASMCs nuclei in the anterior wrist and medial malleolus within the electrical current pathway were obviously stretched, narrowed, and coalesced, presenting a nuclear polarization and arranging as line-like and moniliform patterns. The L/S axis ratio of those nuclei in the anterior wrist and medial malleolus were markedly increased as compared with the control group (p < 0.001). Through the ROC curve analysis, the critical diagnostic values of the L/S axis ratio of those nuclei were respectively 4.84 and 3.81. Conclusion These findings suggest that the soft tissues of the anterior wrist and/or the medial malleolus, as the narrowest parts of the limbs, could be used as the sites for tissue sampling and considered as necessary locations for histopathological examinations to determine the electrocution in medicolegal identification.

In vitro susceptibility of methicillin-resistant Staphylococcus aureus isolates from skin and soft tissue infections to vancomycin, daptomycin, linezolid and tedizolid

Abstract Introduction Treatment of multidrug-resistant Gram-positive infections caused by Staphylococcus aureus remains as a clinical challenge due to emergence of new resistance mechanisms. Tedizolid is a next-generation oxazolidinone, recently approved for skin and soft tissues infections. We conducted a study to determine in vitro susceptibility to vancomycin, daptomycin, linezolid and tedizolid in MRSA clinical isolates from adult patients with skin and soft tissue infections. Material and methods Methicillin-resistant S. aureus isolates were collected in three tertiary-care hospitals of Medellin, Colombia, from February 2008 to June 2010 as part of a previous study. Clinical characteristics were assessed by medical records and MIC values were determined by Epsilometer test. Genotypic analysis included spa typing, MLST, and SCCmec typing. Results A total of 150 MRSA isolates were evaluated and tedizolid MIC values obtained showed higher in vitro activity than other antimicrobials, with MIC values ranging from 0.13 µg/mL to 0.75 µg/mL and lower values of MIC50 and MIC90 (0.38 µg/mL and 0.5 µg/mL). In contrast, vancomycin and linezolid had higher MIC values, which ranged from 0.5 µg/mL to 2.0 µg/mL and from 0.38 µg/mL to 4.0 µg/mL, respectively. Tedizolid MICs were 2- to 5-fold lower than those of linezolid. Clinical characteristics showed high previous antimicrobial use and hospitalization history. The majority of the strains belong to the CC8 harboring the SCCmec IVc and were associated with the spa t1610 (29.33%, n = 44). Conclusion In vitro effectiveness of tedizolid was superior for isolates from skin and soft tissue infections in comparison with the other antibiotics evaluated. The above added to its less toxicity, good bioavailability, daily dose and unnecessity of dosage adjustment, make tedizolid in a promising alternative for the treatment of infections caused by MRSA.