Epidemiología de pacientes con Cáncer de Piel sometidos a Cirugía Micrográfica de Mohs en Solca-Guayaquil entre 2015 y 2017 / Epidemiology of Patients with Skin Cancer undergoing Mohs Micrographic Surgery at Solca-Guayaquil between 2015 and 2017

Introducción: El cáncer de piel es la segunda neoplasia más común en la población guayaquileña, se presenta predominantemente en áreas expuestas a luz solar. Los tipos más frecuentes son el carcinoma basocelular y el escamocelular. La técnica de cirugía micrográfica de Mohs pese a ser descrita hace varias décadas continua vigente en el tratamiento de este tipo de neoplasias. El objetivo del estudio es presentar una serie de casos sometidos a esta cirugía. Métodos: El presente estudio observacional, fue realizado en el Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" Solca-Guayaquil. Se revisaron historias clínicas de los períodos comprendidos de enero del 2015 a diciembre del 2017. Se seleccionaron casos de pacientes con neoplasias malignas de la piel, sometidos a cirugía micrográfica de Mohs. El tipo de muestreo fue no probabilístico de conveniencia. Las variables estudiadas fuero sexo, edad, diagnóstico anatomopatológico, localización de las lesiones y recidivas. Se utiliza estadística descriptiva. Resultados: Se analizaron 153 pacientes con edad media de 71.9 ±12 años, el tipo histológico más frecuente fue el carcinoma basocelular nodular con 115 casos (75.16 %). Las lesiones se localizaron predominantemente en el dorso nasal 40 casos (26.14%) y en el ala nasal 17 casos (11.11%). Al momento de la intervención quirúrgica más de la mitad de las lesiones se encontraban en estadio 1 (58.1%). La técnica de cobertura empleada con mayor frecuencia fue el colgajo de rotación (49 %). No se registraron casos de recidiva posterior a la cirugía micrográfica de Mohs en los pacientes estudiados. Conclusión: Las características epidemiológicas de cáncer de piel en la población de Guayaquil son similares a las reportadas en literatura internacional. Los pacientes sometidos a cirugía micrográfica de Mohs no presentaron recidiva en este reporte.

Introduction: Skin cancer is the second most common neoplasm in the Guayaquil population. It occurs predominantly in areas exposed to sunlight. The most frequent types are basal cell carcinoma and squamous cell carcinoma. The technique of micrographic surgery of Mohs despite being described several decades ago continues in force in the treatment of this type of neoplasms. The aim of the study is to present a series of cases submitted to this surgery. Methods: The present observational study was carried out in the National Oncological Institute "Dr. Juan Tanca Marengo "Solca-Guayaquil. Clinical histories of the periods between January 2015 and December 2017 were reviewed. Cases of patients with malignant neoplasms of the skin were selected, who underwent Mohs micrographic surgery. The type of sampling was non-probabilistic of convenience. The variables studied were sex, age, anatomopathological diagnosis, location of the lesions and recurrences. Descriptive statistics is used. Results: 153 patients with a mean age of 71.9 ± 12 years were analyzed, the most frequent histological type was nodular basal cell carcinoma with 115 cases (75.16%). The lesions were located predominantly on the nasal dorsum, 40 cases (26.14%) and in the nasal ala, 17 cases (11.11%). At the time of surgery, more than half of the lesions were in stage 1 (58.1%). The coverage technique most frequently used was the rotation flap (49%). There were no cases of recurrence after Mohs micrographic surgery in the patients studied. Conclusion: The epidemiological characteristics of skin cancer in the population of Guayaquil are similar to those reported in international literature. Patients undergoing Mohs micrographic surgery did not present recurrence in this report.

Reliability of Nasofacial Analysis Using Rhinobase® Software.

OBJECTIVE: Rhinoplasty is a constant challenge for the surgeon, where the correct evaluation of facial aesthetic parameters allows harmonic changes appropriate for each patient. The aim of this study was to compare the preoperative and postoperative results of nasofacial analysis, performed by Rhinobase® software (indirect anthropometry) compared with direct anthropometry (caliper), in patients undergoing aesthetic rhinoplasty. METHODS: The authors assessed the reliability of using Rhinobase® software for measuring nasofacial characteristics in 20 individuals (18 F, 2 M). In each patient, the nasofacial analysis was performed before and after surgery. Two raters performed indirect anthropometry on each image on two separate occasions. RESULTS: Intrarater and interrater reliability for most indirect anthropometric measurements had intraclass correlation coefficients greater than 0.8. Regarding intermethod reliability, Pearson correlation coefficients ranged from 0.6 to 0.9 for most measurements. The highest correlation was found in interalar width, chin vertical, and lower facial height. The Cronbach's α coefficient calculated for all measurements was 0.8. CONCLUSIONS: The Rhinobase® software is an easy and safe method for facial analysis. This study provides evidence of high reliability for several nasofacial measurements. The nasofacial analysis allows an accurate preoperative evaluation, surgical planning, and analysis of outcomes in rhinoplasty and may be a useful tool for both novice and experienced surgeons. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Syphilitic tonsillitis presenting as an ulcerated tonsillar tumor with ipsilateral lymphadenopathy.

We describe a 49-year-old man who presented with a cervical mass of a week's evolution, which clinically mimicked a tumoral expansion. Physical examination showed a left cervical mass of 6 x 4 x 2 cm, associated to a left ulcerated tonsillar tumor. The presumptive diagnosis was a tonsillar cancer with lymph node involvement. An amygdalectomy and a frozen section biopsy of the cervical tumor were performed. The biopsy displayed a reactive lymphadenopathy with follicular and interfollicular hyperplasia rich in plasma cells, epithelioid areas, and an outstanding parcel fibrosis of subcapsular, interfollicular, and perifollicular distribution associated to an isolated focus of polymorphonuclear leukocytes and obliterative parietal angiovascular proliferation. The tonsil presented a similar but ulcerated process. These results suggested an infectious reactive process, probably luetic. A Warthin-Starry stain revealed spirochetes in the tonsillar ulcer. Laboratory examinations revealed a positive VDRL test and negative serology for HIV. In conclusion, a primary syphilis of the oropharyngeal tonsil with a syphilic lymphadenopathy was diagnosed. The literature about tonsillar syphilis is reviewed.

[Sun exposure behaviors and knowledge among Chileans]. / Conocimientos y hábitos de exposición solar de la población Chilena.

BACKGROUND: Ultraviolet light exposure has a pathogenic effect on the development of skin cancer, whose prevalence increases worldwide. In Chile and the rest of the world, preventive educational campaigns are carried out to change high risk sun exposure behaviors. AIM: To study the behavior of the Chilean population towards skin cancer prevention and to identify erroneous preventive practices and concepts. MATERIAL AND METHODS: A survey containing 17 questions about sun exposure behaviors, photoprotective measures and knowledge about ultraviolet radiation and skin cancer was used. It was applied during January and February 2004, to 1,143 subjects (mean age 30 years, 409 males), taking vacations in beach resorts in Chile. RESULTS: The hours of higher sun exposure ranged from 12 AM to 4 PM. Thirty seven percent of subjects were exposed more than 2 hours during this high risk lapse. Women and subjects aged less than 25 years were those with the riskiest behaviors. Fifty four percent used some type of photoprotection and 50% used ocular protection. Seventy percent used creams with sun screen and 74% used a sun protection factor higher than 15. Seventy percent applied the sun screen as recommended. Thirty eight percent had at least one sun burn in the last two years. More than 90% of subjects were aware of the relationship between sun exposure and skin cancer but 60% did not know the hours of higher ultraviolet radiation. The information about sun exposure was obtained from television in 57% of surveyed individuals. CONCLUSIONS: More educational campaigns about the risk of sun exposure are needed to reduce risky behaviors in the Chilean population.

Relevancia Clínica de la Apoptosis / Clinical Pertinence of apoptosis

La apoptosis o muerte celular programada, es el resultado de la expresión de un programa endógeno genético que resulta en la muerte celular sin inducir una respuesta inflamatoria. Hace parte del proceso normal del desarrollo embrionario en los organismos multicelulares y de los tejidos de organismos maduros para asegurar su buen funcionamiento. Su importancia clínica se debe a que la alteración de este mecanismo de suicido celular, ya sea por defecto o por exceso, podría contribuir al desarrollo de entidades tales como el cáncer, el Alzheimer, la artritis reumatoidea o incluso la disfunción orgánica múltiple. La apoptosis tiene una serie de características morfológicas y fisiológicas distintivas que la diferencian claramente de la forma más conocida de la muerte celular para los cirujanos, la necrosis. Se puede identificar una célula apoptósica morfológicamnete por la presencia de condensación de cromatina nuclear, cuerpos apoptósicos y el reconocimiento por parte del macrófago, de la célula apoptósica para ser fagocitada. El entendimiento de los mecanismos de regulación y de la biología molecular de las enfermedades puede crear nuevas alternativas terapéuticas en la resolución de los procesos inflamatorios sistémicos...