Alternativas de reconstrucción mamaria inmediata

La mastectomía total por cáncer de mama produce una deformidad importante en las pacientes, con alteraciones severas de su autoestima, imagen corporal, sexualidad, y calidad de vida en general. El gold estándar en los países desarrollados es la reconstrucción mamaria inmediata y, actualmente existen pocas contraindicaciones absolutas para realizar alguna técnica de reconstrucción. Este artículo se describen las opciones reconstructivas (colgajos e implantes), tiempos de reconstrucción, ventajas y desventajas de ambas técnicas, potenciales complicaciones, y se propone un algoritmo de tratamiento. La elección de la técnica de reconstrucción debería ser decidida entre la paciente y su cirujano/a, considerando características físicas, factores relacionados con la enfermedad y tratamiento oncológico, y preferencias de las pacientes.

Total mastectomy for breast cancer treatment can be a cause of deformity and distress for patients, with severe impairment of self-esteem, body image, sexuality, and quality of life. In developing countries, immediate breast reconstruction is the gold standard, and there are only a few absolut contraindications for some technique of breast reconstruction. This article describes reconstructive options (flaps and allo-plastic material), reconstructive timing, pros and cons of both techniques, potential complications, and an algorithm of treatment is proposed. Choice of the reconstructive technique should be decided by the patient and her surgeon, considering physical characteristics, factors related with the disease and oncologic treatments, and patients' preferences.

Hemangioma intramuscular con flebolitos de lengua. Reporte de un caso clínico-patológico

Se presenta un caso de hemangioma intramuscular con flebolitos de lengua en una mujer de 60 años. Clínicamente correspondía a una tumefacción de dos años de evolución, sin signos que sugirieran su origen vascular. Luego de su evaluación inicial se realizó biopsia excéresis de la lesión para su estudio histopatológico. En el estudio histológico se pudo observar una formación tisular redondeada y circunscripta constituida por tejido conjuntivo fibroso con abundantes capilares congestivos que desplazaban el tejido muscular, destacándose la presencia de trombos con calcificaciones dispuestas en capas concéntricas (flebolitos). En base a estos hallazgos morfológicos, el diagnóstico definitivo fue de hemangioma capilar intramuscular con flebolitos de lengua. Para confirmar la naturaleza neoplásica vascular de la lesión se realizó inmunomarcación con el anticuerpo GLUT1. Es de destacar, de acuerdo a la revisión bibliográfica realizada en PubMed, que esta entidad patológica es rara, particularmente en la lengua.

Apresentamos um caso de hemangioma intramuscular com flebólitos de língua em uma mulher de 60 anos. Clinicamente, correspondia a um inchaço com duração de dois anos, sem sinais que sugerissem sua origem vascular. Após sua avaliação inicial, foi realizada biópsia excisional da lesão para estudo histopatológico. No estudo histológico pôde-se observar uma formação tecidual arredondada e circunscrita constituída por tecido conjuntivo fibroso com abundantes capilares congestivos que deslocavam o tecido muscular, destacando a presença de trombos com calcificações dispostos em camadas concêntricas (flebólitos). Com base nesses achados morfológicos, o diagnóstico definitivo foi de hemangioma capilar intramuscular com flebólitos de língua. Para confirmar a natureza neoplásica vascular da lesão, foi realizada imunocoloração com o anticorpo GLUT1. Ressalta-se, de acordo com a revisão bibliográfica realizada no PubMed, que esta entidade patológica é rara, principalmente na língua.

Summary We present a case of intramuscular hemangioma with tongue phleboliths in a 60-year-old woman. Clinically it corresponded to a swelling of two years of evolution, without signs that suggested its vascular origin. After her initial evaluation, an excisional biopsy of the lesion was performed for histopathological study. In the histological study it was possible to observe a rounded and circumscribed tissue formation made up of fibrous connective tissue with abundant congestive capillaries that displaced the muscle tissue, highlighting the presence of thrombi with calcifications arranged in concentric layers (phleboliths). Based on these morphological findings, the definitive diagnosis was intramuscular capillary hemangioma with tongue phleboliths. To confirm the vascular neoplastic nature of the lesion, histochemical immunostaining was performed with the GLUT1 antibody. It is noteworthy, according to the bibliographic review carried out in PubMed, that this pathological entity is rare, particularly in the tongue.

Effects of Solar Drying on the Structural and Thermodynamic Characteristics of Bee Pollen / Efectos del secado solar sobre las características estructurales y termodinámicas del polen apícola

Background: Bee pollen is a natural product collected and transformed by bees, intended for human consumption, given its nutritional and bioactive richness. The fundamental operation of adequacy is drying, which allows its preservation, avoiding chemical or microbiological degradation, typically using tray dryers with hot air that use electricity or fuel for heat generation. Solar drying is an alternative that uses radiation as an energy source. However, it should be ensured that this type of process guarantees the quality of the product while not degrading its properties and, therefore, maintaining its morphological integrity. Objective: to establish the effect of solar drying on bee pollen structure compared to the conventional cabin dehydration process. Methods: Bee pollen was dehydrated using two types of dryers: a solar dryer and a forced convection oven. The solar dryer operating conditions were an average temperature of 19-35 °C with a maximum of 38 °C and average relative humidity (RH) of 55 %. Cabin dryer operating conditions were a set point temperature of 55 ± 2 °C and 10 % RH average humidity. The morphologic and thermodynamic properties of dried bee pollen, such as phase transition enthalpy through Differential Scanning Calorimetry (DSC), porosity and surface area through surface area analysis, and microscopic surface appearance by Scanning Electron Microscopy (SEM), were measured. Results: The results showed dry bee pollen, both in the cabin dryer and solar dryer, did not suffer morphological changes seen through SEM compared to fresh bee pollen. Moreover, surface area analysis indicated the absence of porosity in the microscopic or macroscopic structure, demonstrating that solar or cabin drying processes did not affect the specific surface area concerning fresh bee pollen. Additionally, Differential Scanning Calorimetry (DSC) and Thermo Gravimetric Analysis (TGA) showed that endothermic phase transitions for dried bee pollen by cabin or solar dryer were at 145 °C and 160 °C, respectively. This can be mostly associated with free water loss due to the morphological structure preservation of the material compared to fresh bee pollen. Conclusion: These results demonstrate that solar drying is a reliable alternative to bee pollen dehydration as there were no effects that compromised its structural integrity

Antecedentes: El polen apícola es un producto natural recolectado y transformado por las abejas. La operación fundamental de adecuación del polen es el secado, lo que permite su conservación, evitando su degradación química o microbiológica, típicamente se utilizan secadores de bandejas con aire caliente que emplean electricidad o combustibles para la generación de calor. El secado solar es una alternativa que utiliza la radiación solar como fuente de energía. Sin embargo, se debe garantizar que este tipo de proceso asegure la calidad del producto a la vez que no degrade sus propiedades, manteniendo su integridad morfológica. Objetivo: Establecer el efecto del secado solar sobre la estructura del polen apícola en comparación al proceso convencional de deshidratación en cabina. Métodos: El polen de abeja se deshidrató utilizando dos tipos de secadores: secador solar y horno de convención forzada. Las condiciones de operación del secador solar fueron una temperatura promedio de 19-45 °C con un máximo de 38 °C y una humedad relativa (HR) promedio de 55 %. Las condiciones de operación del secador de cabina fueron una temperatura de referencia de 55 ± 2 °C y una humedad promedio de 10 % HR. Se midieron las propiedades morfológicas y termodinámicas del polen de abeja desecado, como la entalpía de transición de fase mediante calorimetría diferencial de barrido (DSC), la porosidad y el área superficial mediante análisis de área superficial y el aspecto microscópico de la superficie mediante microscopía electrónica de barrido (SEM). Resultados: Los resultados mostraron que el polen seco tanto en el secador de cabina como en el secador solar muestra que no sufrió cambios morfológicos vistos a través de Microscopía Electrónica de Barrido y en comparación con el polen fresco de abeja, además un análisis de sortometría indicó la ausencia de porosidad en la estructura microscópica y macroscópica, lo que indica que los procesos de secado solar o en cabina no tuvieron efectos sobre el área superficial específica con respecto al polen fresco de las abejas. En adición, los resultados de calorimetría diferencial de barrido (DSC) y análisis termogravimétrico (TGA) muestran que las transiciones de fase endotérmicas para el polen seco tanto en secado de cabina como solar fueron a 145 °C y 160 °C, que puede asociarse mayormente a la pérdida de agua libre, debido a la conservación de la estructura morfológica del material y en comparación al polen fresco. Conclusión: Estos resultados demuestran que el secado solar es una alternativa viable para la deshidratación del polen al no existir efectos que comprometan su integridad estructural

Defecto oncológico maxilar reconstruido mediante colgajo de músculo temporal / Maxillary oncologic defect reconstructed with temporal muscle flap / Defeito oncológico maxilar reconstruído por aba muscular temporal

El macizo facial es una región anatómica compleja que alberga órganos sensoriales. El desarrollo de una enfermedad oncológica, así como su tratamiento, causan defectos funcionales y estéticos con un alto costo físico y psíquico para el paciente y su entorno. Es por ello que la reconstrucción representa un reto. Las diferentes posibilidades incluyen prótesis obturatríces, colgajos libres, pediculados o microvascularizados. En este artículo se describirá el colgajo de músculo temporal y se desarrolla un caso clínico de cirugía oncológica maxilar reconstruido mediante éste en un paciente que presenta una lesión exofítica en cuadrante superior derecho, que se extiende sobre el flanco vestibular, reborde alveolar y zona palatina, desde zona de premolares hasta la zona del segundo molar inclusive, impidiéndole usar la prótesis dental. Esta cirugía es una técnica económica, que requiere menor tiempo quirúrgico que otras técnicas, asociándose a poco porcentaje de fracaso y pocas complicaciones post operatorias.

The facial mass is a complex anatomical region that houses sensory organs. The development of an oncologic disease, as well as its treatment, causes functional and esthetic defects with a high physical and psychological cost for the patient and his environment. This is why reconstruction represents a challenge. The different possibilities include obturator-root prostheses, free, pedicled or microvascularized flaps. In this article the temporal muscle flap will be described and a clinical case of maxillary oncologic surgery reconstructed by means of it is developed in a patient who presents an exophytic lesion in the right upper quadrant, which extends over the vestibular flank, alveolar ridge and palatal area, from the premolar area up to and including the second molar area, preventing him from using the dental prosthesis. This surgery is an economical technique that requires less surgical time than other techniques, and is ass

A massa facial é uma região anatômica complexa que abriga órgãos sensoriais. O desenvolvimento de uma doença oncológica, assim como seu tratamento, causa defeitos funcionais e estéticos com alto custo físico e psicológico para o paciente e seu ambiente. A reconstrução é, portanto, um desafio. As diferentes possibilidades incluem as próteses de raiz obturadora, abas livres, pediculadas ou microvascularizadas. Este artigo descreve o retalho muscular temporal e descreve um caso clínico de cirurgia oncológica maxilar reconstruída utilizando-o em um paciente com lesão exofítica no quadrante superior direito, estendendo-se pelo flanco vestibular, rebordo alveolar e área palatina, desde a área do pré-molar até a área do segundo molar inclusive, impedindo-o de utilizar a prótese dentária. Esta cirurgia é uma técnica econômica, que requer menos tempo cirúrgico que outras.

Use of advanced flap and microsurgery techniques in the resolution of mediastinitis as a complication of cardiac surgery

In the majority of cases, mediastinitis is a potential complication in any cardiac surgical procedure. The objective of this case report is to accurately describe how the combination of microsurgery and soft tissue flaps can be an effective therapeutic alternative in the treatment of mediastinitis as a complication of cardiac valve replacement. Female 63-year-old patient with a background of obesity, hypertension and extense cardiac interventions, she was programmed for necrosectomy with left pectoralis flap technique. Mediastinitis, although a rare complication of the sternotomy performed in cardiac surgery, occurring in 1-2%, carries a high mortality rate.  Early diagnosis of mediastinitis after cardiac surgery requires high clinical suspicion, initially making the diagnosis may be difficult, risk factors should be considered. An early surgical approach can reduce the morbidity and mortality of this condition. The pectoralis flap should be considered as a safe therapeutic option.

Reverse-flow anterolateral thigh flap for knee soft-tissue reconstruction: case report

The reconstruction of the injured tissue around the knee is a complex procedure for the plastic and orthopaedic surgeon. The objective is to provide an acceptable function and aesthetic result. Successful wound management includes meticulous debridement, planning and proper execution of the surgical procedure. An 11-year-old male patient with a right patellar fracture using an anterolateral thigh flap with reverse flow to cover the skin defect. For such purposes, the reverse flow anterolateral flap is an effective, trustworthy and well-documented option. The correct obtaining and implantation of the flap reduces the morbidity of the donor site, offers options in size and design, an adequate length of the pedicle and the possible combination with the fascia lata in case it is required. The versatility of the reverse flow anterolateral flap makes it a possible therapeutic alternative in reconstructive surgery since it is aesthetic and functional for the reconstruction of tissue near the knee joint.

Angiosome study of the first digital feet space, for reconstruction of the digital tip

Background: The concept of angiosome explains the anatomical variations that exist between the vessels of different regions of the body and helps to understand the contributions of arterial blood supply to the skin and adjacent structures, dividing the human body into three-dimensional vascular blocks.Methods: This was an observational and descriptive study. In both lower extremities of 5 corpses with adequate tissue preservation in the operating room attached to the teaching area of the National Institute of Forensic Sciences in Mexico City. Angiosome study of the medial neurocutaneous flap of the second toe of both feet was performed.Results: The average, in centimeters, of the surface of the flaps was 1.57 cm x 2.47 cm, the average diameter of the inter-metatarsal digital artery was 1.1 millimeters and the average diameter of the veins draining the angiosome was 1.4 millimeters. The most constant anatomy was that of the nerve, which was present in all cases, with the digital nerve forming the neurosome of the flap.Conclusions: To obtain optimal results in microsurgery transfers, it is necessary to have a technique that is quick for harvesting the flap and with adequate systematization so as not to injure the neurovascular bundle, this is achieved through complete anatomical knowledge, without forgetting the main variants.

Manejo quirúrgico de pacientes adultos con anomalías vasculares: serie de casos / Surgical management of adult patients with vascular anomalies: series of cases

Introducción: Las anomalías vasculares son un grupo heterogéneo de patologías, que considera tanto tumores como malformaciones vasculares. Son, habitualmente, de diagnostico y manejo durante la infancia, algunas lesiones persisten hasta la edad adulta. El tratamiento habitual considera terapias poco invasivas, siendo la alternativa resecctiva un opcion infrecuente. Objetivos: El objetivo de este estudio es presentar el manejo quirúrgico de pacientes portadores de anomalías vasculares realizado por el equipo de Cirugía Plástica y Reconstructiva del Hospital Clínico de la Universidad de Chile. Material y Métodos: Serie de casos retrospectiva de pacientes con diagnóstico de anomalias vasculares, sometidos a manejo quirúrgico por el equipo de Cirugía Plástica y Reconstructiva del Hospital Clínico de la Universidad de Chile. Se incluyó todos los pacientes con diagnóstico de anomalías vasculares intervenidos entre los años 2010 ­ 2016. Se realizó una revisión del historial clínico de cada paciente elaborando un análisis descriptivo. Resultados: Serie de 9 pacientes, 6 (66,6%) de sexo femenino, con edad promedio de 34,88 ±15,70 años. De los cuales 6 (66,67%) presentaron malformaciones vasculares y 2 (22,22%) tumores vasculares. Se observo compromiso de cabeza en 6 (66,67%) casos y 2 (22,22,%) genital. Se utilizo colgajos locales de avance en 6 (66,67%) y colgajos de transposición en 2 (22,22%) casos. Conclusiones: El manejo quirúrgico es una alternativa terapéutica segura que ofrece resultados buenos a las lesiones complejas. Y por tanto, creemos que es necesario un trabajo multidisciplinario entre pediatras, dermatólogos, radiólogos fisiatras, psicólogos y cirujanos plásticos para poder ofrecer mejores resultados a nuestros pacientes.

Introduction: Vascular anomalies are a heterogeneous group of pathologies, which considers tumors and vascular malformations. Usually diagnosed and treated during childhood, some lesions persist into adulthood. The usual treatment considers non-invasive therapies, being the respective alternative an uncommon option. Objectives: Present the surgical management of adults patients with vascular anomalies performed by the Plastic and Reconstructive Surgery team of the Clinical Hospital of the University of Chile. Material and methods: Retrospective case series of patients with diagnosis of vascular anomalies submitted to surgical management by the Plastic and Reconstructive Surgery team of the Clinical Hospital of the University of Chile. All patients with diagnosis of vascular anomalies operated between the years 2010 - 2016 were included. A review of the clinical history of each patient was carried out and a descriptive analysis was done. Results: Series of 9 patients, 6 (66.6%) female, with a mean age of 34.88 ± 15.70 years. Of these, 6 (66.67%) had vascular malformations and 2 (22.22%) had vascular tumors. Head involvement was observed in 6 (66.67%) cases and 2 (22.22%) genital. Local flaps were used in 6 (66.67%) and transposition flaps in 2 (22.22%) cases. Conclusions: Surgical management is a safe therapeutic alternative that offers beneficial results to complex lesions. Therefore, we believe a multidisciplinary work between pediatricians, dermatologists, radiologists.

Lesión postraumática de la arteria axilar asociada a fractura de la escápula / Post-traumatic axillary artery injury associated with scapula fracture

La isquemia aguda del miembro superior a causa de la lesión postraumática de la arteria axilar asociada a la fractura de la escápula es muy poco frecuente. Se refiere el caso clínico de un paciente con antecedente de accidente en motocicleta con lesión de la arteria axilar y fractura cerrada de la escápula.

Acute ischemia of the upper limb due to traumatic lesion of the axillary artery associated with scapula fracture is very rare. We refer the case of a patient with a history of motorcycle accident with axillary artery injury and closed fracture of the scapula.

Manejo quirúrgico de pacientes con hidrosadenitis supurativa: experiencia del Hospital Clínico de la Universidad de Chile / Surgical management of patients with hidradenitis suppurativa: experience of the Clinical Hospital of the University of Chile

Introducción: La hidrosadenitis supurativa es una enfermedad crónica de la piel en zonas que contienen glándulas apocrinas. Clásicamente se describe un manejo multimodal. La cirugía es una estrategia reconstructiva eficaz, frecuentemente postergada. No existen reportes sobre la experiencia a nivel nacional en el manejo de este grupo de pacientes. Objetivos: Exponer los resultados de manejo quirúrgico reconstructivo de pacientes con diagnóstico de hidrosadenitis supurativa por parte de un equipo de cirugía plástica de un hospital clínico. Material y Métodos: Serie de casos retrospectiva de pacientes con diagnóstico de hidrosadenitis supurativa con manejo quirúrgico. Se realizó una revisión del historial clínico de cada paciente y se elaborando un análisis descriptivo. Resultados: Trece pacientes, 7 (53,8%) de sexo femenino, edad promedio de 30,5±5,9 años. Se realizó manejo quirúrgico de 17 lesiones, siendo las más frecuentes 9 (52,9%)Axilar y 5 (29,4%) Inguino-perianal. Se realizó drenaje­curaciones en 2 (11,8%) y resección-cobertura en 15 (88,2%), 14 (82,3%) con colgajos y 2 (11,8%) injertos. Discusión: El manejo quirúrgico es una alternativa terapéutica eficaz para el control de la hidrosadenitis supurativa, presentando buenos resultados estéticos y funcionales con bajas complicaciones.

Introduction: Hidradenitis suppurativa is a chronic skin diseases of areas that contain apocrine glands. Classically a multimodal management is described. Surgery is an effective treatment, often postponed. Objectives: Present results of reconstructive surgical management of patients with hidradenitis suppurativa by a plastic surgery team of a clinical hospital. Material and methods: Retrospective case series of patients with hidradenitis suppurativa with surgical management. A review of the clinical history of each patient was carried out and a descriptive analysis was carried out. Results: 13 patients, 7 (53.8%) female, mean age of 30.5 ± 5.9 years. Surgical management of 17 lesions was performed, the most frequent lesions were 9 (52.9%) Axillary and 5 (29.4%) Inguino-perianal. Drainage were performed in 2 (11.8%) and resection-coverage in 15 (88.2%), 14 (82.3%) with flaps and 2 (11.8%) grafts. Discussion: Surgical management is an effective therapeutic alternative for the management of hidradenitis suppurativa, presenting good esthetic and functional results with low complications.

Factores que afectan la calidad de vida en pacientes con cirugía de aumento mamario: estudio de cohorte / Factors that affect the quality of life of patients with breast augmentation surgery: a cohort study

Introducción: El instrumento Breast-Q® se ha ocupado para medir la calidad de vida de las pacientes sometidas a cirugía de aumento mamario. Se desconocen los factores que determinan la mejoría en la calidad de vida de estas pacientes. El objetivo de este trabajo es identificar los factores determinantes de la mejoría de la calidad de vida en pacientes sometidas a aumento mamario. Materiales y métodos: Se estudió una cohorte prospectiva de 52 pacientes sometidas a aumento mamario. Se estudiaron características sociodemográficas, mediciones antropométricas, variables relativas a la cirugía y se aplicó el instrumento Breast-Q®. Para el análisis estadístico se utilizó estadística descriptiva, el test de Wilcoxon para muestras pareadas y modelos de regresión lineal y logística. Resultados: Se encontró mejoría en la calidad de vida de forma global (p < 0,00001) y en todos los dominios salvo en el de «síntomas físicos¼. Dentro de los factores determinantes, existió una relación positiva entre el volumen de la prótesis y la mejoría en la calidad de vida de forma global (p = 0,032) y en los dominios «autoimagen y autoestima¼ (p = 0,01) y «vida sexual¼ (p = 0,001). Conclusión: La cirugía de aumento mamario incrementa significativamente la calidad de vida medido mediante el instrumento Breast-Q®. Los determinantes de la mejoría en la calidad de vida estarían directamente relacionados con el volumen de la prótesis.

Introduction: Breast-Q® instrument has been used for measuring the quality of life of patients undergoing breast augmentation surgery. The factors that determine the improvement in the quality of life of these patients are unknown. The aim of this work is to identify the determinant factors of improvement in the quality of life in patients undergoing breast augmentation. Materials and methods: A prospective cohort of 52 patients undergoing breast augmentation was studied. Sociodemographic features, anthropometric measurements, variables related to surgery were studied and the Breast-Q® instrument was applied. For statistical analysis it was used descriptive statistics and linear and logistic regression models. Results: We found improvement in the quality of life, globally (P < .00001) and in all domains except "physical symptoms’ domain. Among the determining factors, there was a positive correlation between the prosthesis volume and improvement in quality of life globally (P = .032) and in the domains "self-image and self-esteem" (P = .01) and "sexual life" (P = .001). Conclusion: Breast augmentation surgery significantly increases the quality of life measured by the Breast-Q® instrument. The determinant factors of improvement in quality of life, would be directly related to the implants volume.

¿Qué factores influyen en la satisfacción de los pacientes sometidos a reducción mamaria?: análisis de un estudio de cohorte utilizando el instrumento Breast-Q® / The factors that influence the satisfaction of patients subjected to breast reduction: analysis of a cohort study using Breast-Q® scores

Introducción: El instrumento Breast-Q® se ha ocupado de medir la calidad de vida de las pacientes sometidas a cirugía de reducción mamaria o mastopexia. Se desconocen los factores que determinan la mejoría en la calidad de vida de estas pacientes. El objetivo de este trabajo es identificar los factores determinantes de la mejoría de la calidad de vida en pacientes sometidas a reducción mamaria. Materiales y métodos: Se estudió una cohorte prospectiva de 41 pacientes sometidas a reducción mamaria o mastopexia sin implantes. Se estudiaron características sociodemográficas, mediciones antropométricas, variables relativas a la cirugía y se aplicó el instrumento Breast-Q®. Para el análisis estadístico se utilizó estadística descriptiva, modelos de ecuaciones de estimación generalizada y modelos de regresión lineal y logística. Resultados: Se encontró mejoría en la calidad de vida de forma global (p < 0,0001) y por dominios. Dentro de los factores determinantes, existió una relación positiva entre la magnitud de la resección y la mejoría en la calidad de vida de forma global (p = 0,032) y en el dominio de síntomas físicos (p = 0,012). Destaca además una mejoría del 50% con resecciones de tejido mamario sobre los 300 g. Conclusión: La cirugía de reducción mamaría y mastopexia incrementan significativamente la calidad de vida medida mediante el instrumento Breast-Q® en pacientes con hipertrofia o ptosis mamaria. Los determinantes de esta mejora estarían directamente relacionados con la cantidad de tejido resecado, con una mejoría del 50% con resecciones sobre los 300 g.

Introduction: Breast-Q® instrument has been used for measuring the quality of life of patients undergoing breast reduction or breast lift surgery. The factors that determine the improvement in the quality of life of these patients are unknown. The aim of this work is to identify the determinant factors of improvement in the quality of life in patients undergoing breast reduction. Materials and methods: A prospective cohort of 41 patients undergoing breast reduction or breast lift without implants was studied. Sociodemographic features, anthropometric measurements, variables related to surgery were studied and the Breast-Q® instrument was applied. For statistical analysis it was used descriptive statistics, generalized estimating equations models and linear and logistic regression models. Results: We found improvement in the quality of life, globally (P < .0001) and per domains. Among the determining factors, there was a positive correlation between the extent of resection and improved quality of life globally (P = .032) and in the domain of physical symptoms (P = .012). Also highlights an improvement of 50% with resection of breast tissue above 300 g. Conclusion: Breast reduction and breast lift surgery significantly increases the quality of life measured by the Breast-Q® instrument in patients with breast hypertrophy or ptosis. The determinant factors of this improvement would be directly related to the amount of tissue resected, with a 50% improvement with resections above 300 g.

Cambios en la calidad de vida en mujeres sometidas a aumento mamario: resultados preliminares de un estudio de cohortes / Changes in quality of life in women subjected to augmentation mammoplasty: preliminary results of a cohort study

Objetivo Determinar los cambios en calidad de vida en mujeres sometidas a mamoplastia de aumento o mastopexia con prótesis, usando el instrumento validado Breast-Q®. Materiales y métodos Estudio de cohortes prospectivo. Se incluyeron todas las pacientes operadas de mamoplastia de aumento o mastopexia de aumento en el Hospital Clínico de la Universidad de Chile entre octubre de 2013 y mayo de 2014. La calidad de vida (CdV) se midió con el instrumento validado Breast-Q®. Se realizó estadística descriptiva y analítica para evaluar el cambio global en CdV y por dominios considerando estadísticamente significativo un valor p < 0,05. Resultados En el periodo estudiado se operaron 58 pacientes, 33 (56,9%) completaron el instrumento Breast-Q® en el preoperatorio y 25 (75,7%) de ellas en el postoperatorio. La CdV subió de un 49,7% a un 82,5% (p < 0,001); analizando por dominio hubo mejoría en autoestima (52% a 88%, p < 0,001), autoimagen (22% a 80%, p < 0,001) y vida sexual (31% a 86%, p < 0,001). Los síntomas físicos empeoraron desde un 94% a 75% (p < 0,001). Conclusiones El aumento mamario mejora la CdV, específicamente la autoestima, la autoimagen y la vida sexual, pero las molestias físicas aumentan. La satisfacción global fue alta.

Objective To determine the changes in the quality of life of women subjected to augmentation mammoplasty or a prosthesis mastopexy, using the validated tool Breast-Q®. Materials and methods A prospective cohorts study was conducted that included operated on for augmentation mammoplasty or augmentation mastopexy in the Hospital Clínico de la Universidad de Chile (HCUCH) between October 2013 and May 2014. The quality of life (QoL) was measured using the Breast-Q® validated tool. Descriptive and analytic statistics were performed to evaluate the overall change in QoL and by domains, considering a p<.05 as statistically significant. Results A total of 58 patients were operated on, of whom 33 (56.9%) completed the Breast-Q® questionnaire before surgery, and 25 (75.7%) of them in the post-operative period. The quality of life increased from 49.7% to 82.5% (p<.001). When analysed by domain, there was an improvement in Self-esteem (52% to 88%, p<.001), Self-image (22% to 80%, p<.001) and Sex Life (31% to 86%, p<.001). The physical symptoms increased from 75% to 94% (p<.001). Conclusions Breast augmentation improves the quality of life, in particular, self-esteem, self-image, and sex life, but physical discomforts increased. The overall satisfaction was high.

Enfermedad de Fabry, a propósito de un caso interesante / Fabry’s disease, a propos of an interesting case

La enfermedad de Fabry es una enfermedad por almacenamiento lisosómico hereditaria ligada al cromosoma X, y se deriva de mutaciones en el gen que codifica la enzima alfa-galactosidasa. Se presentó el caso de un paciente masculino de 33 años de edad, con antecedentes de hipertensión arterial, que presenta dolor en el pecho retroesternal, opresivo, quemante, se irradiaba a epigastrio, hombro izquierdo, mano izquierda, cuello y mandíbula, con una duración mayor de 30 minutos. Se sospechó de un infarto agudo de miocardio, pero al ser esta una patología poco frecuente en pacientes menores de 35 años, se decidió realizar una evaluación clínica, dermatológica, neurológica, oftalmológica, nefrológica y cardiológico, donde se constató síntomas típicos de la enfermedad de Fabry.

Fabry’s disease is a disease caused by hereditary lysosomic storage linked to the X chromosome, and derives from mutations on the gene codifying the alpha-galactosidase enzyme. It is presented the case of a male patient aged 33 years, with antecedents of arterial hypertension, referring oppressive, burning pain in the retrosternal chest, irradiating to epigastrium, left shoulder, left hand, neck and mandible, with more than 30 minutes last. An acute myocardial infarct was suspected, but being this pathology few frequent in patients aged less than 35 years, we decided a cardiologic, nephrological, ophthalmologic, neurologic, dermatologic and clinical evaluation, finding typical symptoms of the Fabry’s disease.

Carcinoma escamoso sarcomatoide de la unión gastroesofágica: caso clínico / Esophageal sarcomatoid squamous carcinoma: Report of one case

Sarcomatoid squamous carcinoma (ESC) is a rare esophageal neoplasm, with a clinical, etiological and pathological behavior that differs from squamous cancer. From the histological point of view it has a dual configuration. The squamous epithelial component is usually limited to small areas, while the major part is constituted by mesenchymatous (sarcomatoid) polypoid tissue. Treatment is esophagectomy or total esophagogastrectomy depending on the tumor location. Early detection is critical in terms of survival. For large lesions, preoperative chemo-radiotherapy can be considered. We report a 78-year-old male presenting with dysphagia. An upper gastrointestinal endoscopy showed a tumor located below the cardia. The patient was subjected to a total esophageal and gastric resection. In a second operation, the digestive transit was reconstituted in 2 steps. The pathology report informed a sarcomatoid squamous carcinoma. After 18 months of follow up, the patient is ambulatory.

Factors associated with unmet needs in individuals with schizophrenia in Chile / Fatores associados com as necessidades não satisfeitas em indivíduos com esquizofrenia no Chile

OBJECTIVE: To evaluate the possible associations between different sociodemographic, clinical, and healthcare factors and the number of unmet needs among people being treated for schizophrenia. METHODS: The sample was made up of 141 subjects who were being treated at eight mental health service networks throughout Chile. Unmet need was assessed with the Camberwell Assessment of Need, which was specifically created for people with severe mental disorders. A multiple linear regression analysis was also applied. RESULTS: It was found a direct association with clinical variables: score in the Positive and Negative Syndrome Scale, global functioning at diagnosis, and change in global functioning at diagnosis from diagnosis to interview. However, sociodemographic (ethnicity, education level, and number of people who live with subject) and other clinical variables (age at diagnosis, and annual rate of relapse) were indirectly associated with unmet needs. CONCLUSIONS: Our results can be applied in order to coordinate and improve the effectiveness of mental health services in Chile.

OBJETIVO: Avaliar as possíveis associações entre diversos fatores sociodemográficos, clínicos e de cuidado à saúde e o número de necessidades não atendidas entre pessoas que estão sendo tratadas devido à esquizofrenia. MÉTODOS: A amostra foi composta por 141 indivíduos que estavam sendo tratados em oito redes de serviço de saúde mental por todo o Chile. A necessidade não atendida foi avaliada pela Camberwell Assessment of Need, que foi especificamente criada para pessoas com distúrbios mentais graves. Também foi aplicada uma análise de regressão linear múltipla. RESULTADOS: Encontrou-se associação direta com variáveis clínicas: escore na Positive and Negative Syndrome Scale, funcionamento global ao diagnóstico e mudança no funcionamento global ao diagnóstico desde o diagnóstico à entrevista. Entretanto, variáveis sociodemográficas (etnia, nível educacional e número de pessoas que moram com o indivíduo) e clínicas (idade no momento do diagnóstico e taxa anual de recidiva) foram indiretamente associadas com as necessidades não atendidas. CONCLUSÕES: Os presentes resultados podem ser aplicados para coordenar e aprimorar a eficácia dos serviços de saúde mental no Chile.

Relación entre balance energético, concentración de metabolitos sanguíneos y expresión hipotalámica del receptor Tipo 1 de orexina y neuropéptido y en vacas mestizas durante el postparto / Relationship among energy balance, blood metabolites and hypothalamic expression of orexin receptor type 1 and neuropeptide y in crossbred dairy cows during postpartum

En vacas mestizas bajo condiciones tropicales, donde la oferta y calidad de la dieta pueden ser limitadas, la relación entre el estatus energético (EE), metabólico y productivo de los animales son aún poco claras. En tal sentido, 27 vacas (3/4 a 5/8 Bos taurus x 1/4 a 3/8 Bos indicus) doble propósito (DP), fueron distribuidas al azar en los siguientes tratamientos, tomando en cuenta la condición corporal (CC) al parto (P) y el nivel de alimentación (A) postparto (PP): 1) CAAA: CC alta al P (CA: ≥2,5) y alto A PP (AA); 2) CBAA: CC baja al P (CB: < 2,5) y AA; 3) CAAB: CA y bajo A PP (AB) y, 4) CBAB: CB y AB. Se evaluó el balance energético (BE) PP; la concentración de glucosa (GLU), colesterol (COL) y nitrógeno ureico (NU) y, la expresión hipotalámica del neuropéptido Y (NPY) y el receptor tipo 1 de orexina (OX-1R) por Western Blot. Se aplicó ANAVAR para medidas repetidas en el tiempo, incluyendo el efecto de CC, nivel de A y su interacción. No hubo efecto de CC x A en las variables evaluadas. Las vacas AA consumieron (kg.anim.d-1) más alimento (10,9 a 12,9) que las AB (8,8 a 10,6) (P<0,01); sin embargo, el BE fue negativo (-7,9±19,4 para AA y -27,2±13,1 para AB; P<0,01). Se obtuvo una concentración promedio de GLU (mg.dL-1) de 61,5 y 56,7 (P<0,05) y COL (mg.dL-1) de 142,6 y 157,6 (P=0,10) para CA y CB, respectivamente, sin efecto de A. El NU (mg.dL-1) fue afectado por A (15,9 para AB y 19,2 para AA; P<0,05). Se observó una reducción de la expresión del neuropétido Y (NPY) y receptor-1 de orexina (OX-1R) en CBAB a los 45 d PP, asociado a una disminución de la respuesta del sistema nervioso central por la magnitud de la restricción energética. La CC al P es el componente del EE más importante a considerar en sistemas de DP, sobre todo, cuando la dieta no permite elevados consumos y aportes de energía neta.

In crossbred dairy cows under tropical conditions, where supply and diet quality may be limited, the relationship among energy status (ES), metabolic and productive status of the animals are still not clear. In this regard, 27 dual purpose (DP) cows (3/4 to 5/8 Bos taurus x 1/4 to 3/8 Bos indicus), were randomly assigned to the following treatments, a combination of body condition (BC) at calving (AC) and feeding level (FL) postpartum (PP): 1) HBCHFL: High BC to PP (BC: ≥ 2.5) and high FL PP (HFL), 2) LBCHFL: Low BC to PP (BC: < 2.5) and HFL, 3) HBCLFL: HBC and low FL PP (LFL) and 4) LBCLFL: LBC and LFL. Energy balance (EB) PP, the concentration of glucose (GLU), cholesterol (COL) and urea nitrogen (UN) and hypothalamic expression of neuropeptide Y (NPY) and orexin receptor type 1 (OX-1R ) by Western Blot, were evaluated. The data was analyzed by ANOVA for repeated time measures, including the effect of BC level of FL and their interaction. No effect of BC x FL on any variable was found. Cows under HFL consumed (kg.anim.d-1) more feed (10.9 to 12.9 than LFL (8.8 to 10.6) (P<0.01), however, the EB was negative (-7.9 ± 19.4 for HFL and -27.2 ± 13.1 for LFL, (P<0.01). The GLU (mg.dL-1) concentration was of 61.5 and 56.7 (P<0.05) and COL (mg.dL-1) of 142.6 and 157.6 (P=0.10) for HBC and LBC, respectively, without effect of FL. The UN (mg.dL-1) was affected by FL (15.9 to 19.2 for LFL and HFL, (P<0.05). A reduction of NPY expression and OX-1R in the 45 d LBCLFL PP was observed and was associated to a diminished central nervous system response caused by marked energetic restriction. The BC to PP is the most important component of ES to consider in DP systems, especially when the diet does not allow high consumption and input of total energy.

Relación entre los niveles de glucosa e insulina sanguínea y el reinicio de la actividad ovárica en vacas de doble propósito con diferentes condiciones corporales al parto y diferente nivel de alimentación postparto / Relationship between blood glucose and insulin levels with ovarian activity onset in dual purpose cows with different body condition score at calving and different postpartum food level / Relação entre os níveis de glicose e insulina sanguinea e o reinício da atividade ovariana em vacas de duplo propósito com diferentes condições corporais ao parto e diferente nível de alimentação pós-parto

Para evaluar el efecto de la condición corporal (CC) al parto y el nivel de alimentación (A) postparto (PP) en las concentraciones de glucosa e insulina PP y reinicio de la actividad ovárica en vacas doble propósito, 28 vacas adultas fueron distribuidas al azar en cuatro tratamientos, a saber, ACAA: alta CC al parto (AC ³2,5) y alto nivel de A PP (AA); BCAA: baja CC al parto (BC <2,5) y AA; ACBA: AC y bajo nivel de A PP (BA); BCBA: BC y BA. El nivel de A PP no afectó las variables estudiadas. La concentración de glucosa acumulada a los 45 días PP fue 239,4 y 262,6mg·dl-1 (P= 0,083) y la de insulina fue 34,21 y 19,39µUI·mg-1 (P<0,01), para las vacas de AC y BC, respectivamente. La población de folículos de las clases 1 y 2 (C1 y C2) no fue afectada por la CC al parto o el nivel de A PP. Para los folículos de la clase 3 (C3) y número de cuerpos lúteos (CL), se observó efecto de la CC al parto (P<0,01). Así, las vacas de AC presentaron una población folicular de C3 y CL superiores a las de BC. Este trabajo confirma que la CC al parto es un factor determinante en el reinicio de la actividad ovárica en vacas mestizas de doble propósito.

The effect of body condition (CC) at parturition and feeding level (A) during the postpartum period (PP) on glucose concentration and PP insulin, as well as the resumption of ovarian activity in dual purpose cows, was evaluated. Twenty-eight adult cows were randomly allocated to four different treatments, ACAA: high CC (AC ³2.5) at parturition and high A PP (AA); BCAA: low CC (BC<2.5) at parturition and AA; ACBA: AC and low A PP (BA); BCBA: BC and BA. A during PP did not affect the variables studied. The accumulated glucose levels at 45 days PP were 239.4 and 262.6mg·dl-1 (P= 0.083) and those of insuline were 34.21 and 19.39µIU·mg-1 (P<0.01) for cows with AC and BC, respectively. Either the CC at parturition or the A PP did not exert any effect on class 1 (C1) and 2 (C2) follicle population. In contrast, the CC at parturition affected (P<0.01) class 3 follicles (C3) and number of corpora lutea (CL). Thus, cows with AC showed both higher C3 follicle populations and CL, when compared to cows with BC. This work confirms that CC at parturition is a determinant factor in the resumption of AO in dual purpose crossbred cows.

Para avaliar o efeito da condição corporal (CC) ao parto e o nível de alimentação (A) pós-parto (PP) nas concentrações de glicose e insulina PP e reinício da atividade ovariana em vacas duplo propósito, 28 vacas adultas foram distribuídas de maneira aleatória entre quatro tratamentos a seguir, ACAA: alta CC ao parto (AC ³2,5) e alto nível de A PP (AA); BCAA: baixa CC ao parto (BC <2,5) e AA; ACBA: AC e baixo nível de A PP (BA); BCBA: BC e BA. O nível de A PP não afetou as variáveis estudadas. A concentração de glicose acumulada aos 45 dias PP foi 239,4 e 262,6mg·dl-1 (P= 0,083) e a de insulina foi 34,21 e 19,39µUI·mg-1 (P<0,01), para as vacas de AC e BC, respectivamente. A população de folículos das clases 1 e 2 (C1 e C2) não foi afetada pela CC ao parto ou pelo nível de A PP. Para os folículos da clase 3 (C3) e número de corpos lúteos (CL), foi observado efeito da CC ao parto (P<0,01). Assim, as vacas de AC apresentaram uma população folicular de C3 e CL superiores às de BC. Este trabalho confirma que a CC ao parto é um fator determinante no reinício da atividade ovariana em vacas mestiças de duplo propósito.

Preferencia de árboles forrajeros por cabras en la zona baja de Los Andes venezolanos / Goats preference of fodder tree in the venezuelan Andes low zone

Con el objetivo de conocer la preferencia de cabras por doce especies forrajeras (Chlorophora tinctoria, Morus alba, Pithecellobium pedicellare, Gliricidia sepium, Guazuma ulmifolia, Cordia alba, Trichantera gigantea, Tithonia diversifolia, Leucaena leucocephala, Moringa oleifera, Azadirachta indica y Samanea saman) se efectuó una prueba de cafetería a través de mediciones del consumo de follaje mediante un diseño experimental cuadrado latino con periodo de evaluación de doce días en el estado Trujillo, Venezuela. Cada especie se analizó en términos de su composición química (PC, FDN, FDA, lignina, celulosa, hemicelulosa, Calcio, Fósforo, ceniza, presencia de metabolitos secundarios y niveles de fenoles totales, taninos condensados e inhibidores de tripsina). La especie más preferida fue C. tinctoria (0,334 kg MS). Le siguieron M. alba (0,271 kg MS) y P. pedicellare (0,255 kg MS) las cuales fueron estadísticamente diferentes (P<0,05) a las medianamente consumidas: G. sepium (0,183 kg MS), G. ulmifolia (0,164 kg MS), C. alba (0,157 kg MS), T. gigantea (0,156 kg MS) y T. diversifolia (0,141 kg MS), estas difirieron de: L. leucocephala (0,079 kg MS) y M. oleifera (0,067 kg MS). El consumo más bajo se observó con A. indica (0,025 kg MS) y S. saman (0,022 kg MS). Durante el periodo experimental se observaron diferentes tendencias en el consumo de cada especie, las cuales podrían estar asociadas a la composición química de los forrajes, específicamente la presencia de metabolitos secundarios con posibles propiedades disuasivas. Los resultados destacan la importancia de realizar estudios de preferencia animal en la caracterización inicial de árboles y arbustos con potencial forrajero.

In order to know the preference of twelve fodder species (Chlorophora tinctoria, Morus alba, Pithecellobium pedicellare, Gliricidia sepium, Guazuma ulmifolia, Cordia alba, Trichantera gigantea, Tithonia diversifolia, Leucaena leucocephala, Moringa oleifera, Azadirachta indica and Samanea saman) a cafeteria trial was carried out in goats at Trujillo State, Venezuela. An experimental square latin design with evaluation period of twelve days was used. Measurements included forage intake for species which were chemically analyzed in terms of chemical composition (CP, NDF, ADF, lignin, cellulose, Calcium, Phosphorus, ash, secondary metabolites presences and total phenols, condensed tannins and tripsin inhibitors level). C. tinctoria (0.334 kg DM) showed the greatest preference, with significant differences (P<0.05) in relation to the others. M. alba (0.271 kg DM) and P. pedicellare (0.255 kg DM) followed by G. sepium (0.183 kg DM), G. ulmifolia (0.164 kg DM), C. alba (0.157 kg DM), T. gigantea (0.156 kg DM) and T. diversifolia (0.141 kg DM). L. leucocephala (0.079 kg DM) and M. oleifera (0.067 kg DM) showed low preference. The lowest intake was observed with A. indica (0.025 kg DM) and S. saman (0.022 kg DM). During the experimental period different intake tendencies were observed in the which could be associated to the chemical composition of forages, specifically the presence of secondary metabolites with possible dissuasive properties. The results emphasize the importance of studies of animal preference in the initial characterization of trees and shrubs with fodder potential.