Autoimmune/inflammatory syndrome induced by adjuvants: a review

The autoimmune/inflammatory syndrome induced by adjuvants (ASIA) includes several autoimmune conditions and phenomena that occur after exposure to substances with adjuvant activity. The spectrum of the disease is heterogeneous with respect to the clinical presentation as well as the severity of the clinical manifestations. Different substances and medical devices with adjuvant activity are currently known, such as vaccines, oils, silicones, mineral salts, lipopolysaccharides, peptidoglycans, among others. These adjuvants are immunological molecules that function through potentiation of antigen-specific immune responses. Thus, the etiopathogenesis of ASIA syndrome involves a multifactorial interaction between environmental factors and genetic predisposition, and secondary activation of the adaptive and innate arms of the immune system through various mechanisms. Although in some reported cases the ASIA syndrome improves considerably when removing the implants, there are no conclusive results for the clinical benefit of removing the implants, so it is necessary to carry out further basic, clinical and surgical investigations in order to determine the best therapeutic decision.

Breast reconstruction: a review

Surgeons in the late 19th - 20th century performed radical mastectomies as the only possible treatment for breast cancers. Since then, the medical-surgical/scientific community has been constantly encouraged to develop and study different less invasive alternatives in breast reconstruction. Over time, locoregional perforator flap options have served as practical alternatives to implant-based reconstruction and abdominal flaps, especially in the setting of patients who have received radiation therapy or have a history of failed reconstruction, as they effectively fill the missing volume and respect the musculature of the donor site. Breast reconstruction using strategies with one of the different locoregional flaps can preserve the musculature and innervation of the post-mastectomy site, which manages to reduce possible adverse events. In addition to evaluating the anatomical characteristics of the defect and affected quadrant, it is essential to assess the patient's body constitution and the skills of the surgical team as well as microsurgery training when designing a reconstructive plan. Different research protocols should be developed in the study and development of new medical-surgical therapeutic alternatives; we suggest joint development with tissue engineering.