Cobb angle measurement with a conventional convex echography probe and a smartphone.

BACKGROUND CONTEXT: Serial X-rays are needed during the follow-up of adolescent idiopathic scoliosis. They are done every 6 or 3 months in cases of high risk of progression. Thanks to the advances in ultrasound techniques, deformity measurement systems free from ionizing radiations have been validated, although spinal surgeons did not use them routinely due to the need of special software. OBJECTIVE: The aim of our work is to assess the reproducibility and correlation of an ultrasound measuring system based on the positioning of the transverse processes. STUDY DESIGN: Prospective, single center, randomized, triple blinded. METHODS: Two independent researchers trained in ultrasound examined the spinal deformities of 31 children. The measurements were compared against those performed with an X-ray by three scoliosis expert surgeons. Statistics were performed by an independent researcher. Parametric methods were used. RESULTS: We found a 95% [(0.91-0.97) p < 2.2e-16] correlation between the degree of scoliosis measured with the proposed ultrasound system and the 30 cm × 90 cm X-rays in standing position. There was an intra-observer reliability of 97% [r-squared = 0.97; CI 95% (0.95-0.98) p < 2.2e-16] and an inter-observer reliability of 95% [r-squared = 0.95; CI 95% (0.90-0.97) p < 2.2e-16]. CONCLUSIONS: An approximation of the Cobb angle measure is possible with ultrasound by using the transverse processes as reference. This is a very rapid and simple system for assessing the principal spinal deformity measure in young people, although it does not allow estimating the associated axial or sagittal rotation. These slides can be retrieved under Electronic Supplementary Material.

Colgajo fronto-nasal paramedial en la reconstrucción de defectos nasales extensos / Paramedian Forehead Flap for the Reconstruction of Extensive Nasal Defects

Introducción: El Servicio de Dermatología del Hospital Universitario de Guadalajara es un centro de referencia en cirugía de Mohs, por lo que con cierta frecuencia nos vemos enfrentados al problema de la reconstrucción de defectos quirúrgicos nasales de gran tamaño. El colgajo frontonasal paramedial está considerado en la actualidad como una de las técnicas de elección en la reconstrucción de defectos nasales extensos. Material y métodos: Revisamos nuestra experiencia en la reconstrucción nasal mediante el colgajo fronto-nasal paramediano entre los años 2004 y 2008. Describimos la técnica quirúrgica, las complicaciones y los resultados finales. Resultados: Diez pacientes con una media de edad de 75,1 años fueron reconstruidos mediante este colgajo. Un 20% requirió además injertos cartilaginosos y reconstrucción de la cobertura nasal interna. Las complicaciones más frecuentes fueron el sangrado (60%) y la necrosis parcial (10%). Los resultados finales, tanto estéticos como funcionales, fueron considerados buenos o excelentes en el 90% de los pacientes. Conclusiones: El colgajo fronto-nasal sigue siendo una de las mejores alternativas para el cierre de defectos quirúrgicos mayores de 2 cm localizados en la pirámide nasal. El conocimiento de su técnica y su realización cuidadosa permite obtener excelentes resultados con pocas complicaciones (AU)

Background: The Department of Dermatology at Hospital Universitario de Guadalajara in Spain is a referral center for Mohs micrographic surgery. Consequently, we are regularly faced with the problem of repairing large surgical defects on the nose. The paramedian forehead flap is currently one of the techniques of choice for the repair of such defects. Materials and methods: We review our experience in the repair of nasal defects using the paramedian forehead flap over the period from 2004 to 2008. We describe the surgical technique, complications, and final results. Results: Ten patients (mean age, 75.1 years) were treated using this flap. Two patients also required cartilage grafts and reconstruction of the internal nasal lining. The most common complications were bleeding (60%) and partial necrosis (10%). The final cosmetic and functional results were considered good or excellent in 90% of cases. Conclusions: The forehead flap continues to be one of the best options for the closure of surgical defects of the nasal pyramid larger than 2 cm. Adequate knowledge and careful application of the technique allows excellent results to be obtained with few complications (AU)

[Paramedian forehead flap for the reconstruction of extensive nasal defects]. / Colgajo fronto-nasal paramedial en la reconstrucción de defectos nasales extensos.

BACKGROUND: The Department of Dermatology at Hospital Universitario de Guadalajara in Spain is a referral center for Mohs micrographic surgery. Consequently, we are regularly faced with the problem of repairing large surgical defects on the nose. The paramedian forehead flap is currently one of the techniques of choice for the repair of such defects. MATERIALS AND METHODS: We review our experience in the repair of nasal defects using the paramedian forehead flap over the period from 2004 to 2008. We describe the surgical technique, complications, and final results. RESULTS: Ten patients (mean age, 75.1 years) were treated using this flap. Two patients also required cartilage grafts and reconstruction of the internal nasal lining. The most common complications were bleeding (60%) and partial necrosis (10%). The final cosmetic and functional results were considered good or excellent in 90% of cases. CONCLUSIONS: The forehead flap continues to be one of the best options for the closure of surgical defects of the nasal pyramid larger than 2 cm. Adequate knowledge and careful application of the technique allows excellent results to be obtained with few complications.

[Clinical findings in 67 patients with tuberous sclerosis]. / Esclerosis tuberosa. Hallazgos clínicos en 67 pacientes.

BACKGROUND: Tuberous sclerosis is an uncommon neurocutaneous syndrome characterized by the appearance of hamartomas in multiple organs. Diagnosis is based on clinical criteria. OBJECTIVE. To report the clinical findings in a series of 67 patients with tuberous sclerosis. MATERIAL AND METHODS: This was a descriptive and observational retrospective study of patients with tuberous sclerosis referred to our dermatology clinics between January 1994 and March 2007. RESULTS: All patients presented neurological or dermatological disorders. Other disorders, in descending frequency, were psychiatric (55.5%), renal (32.8%), cardiac (22.4%), skeletal and pulmonary (13.4%), and ophthalmological (11.9%). CONCLUSIONS: We report the clinical findings in a series of patients with tuberous sclerosis. According to our literature search, this is the first such study in the Spanish population. Overall, our findings support those already published.

Esclerosis tuberosa. Hallazgos clínicos en 67 pacientes / Clinical Findings in 67 Patients with Tuberous Sclerosis

Introducción. La esclerosis tuberosa (ET) es un síndrome neurocutáneo infrecuente caracterizado por la aparición de hamartomas en múltiples órganos. Su diagnóstico se basa en criterios clínicos. Objetivo. Describir los hallazgos clínicos en una serie de 67 pacientes afectos de ET. Material y métodos. Llevamos a cabo un estudio retrospectivo, descriptivo y observacional de los pacientes con ET remitidos a nuestras consultas de Dermatología entre enero de 1994 y marzo de 2007. Resultados. El 100 % de los pacientes presentaron alteraciones neurológicas o dermatológicas. El resto fueron, por orden: psiquiátricas (55,5 %), renales (32,8 %), cardíacas (22,4 %), esqueléticas y pulmonares (13,4 %) y oftalmológicas (11,9 %). Conclusiones. Describimos los hallazgos clínicos en una serie de pacientes afectos de ET. Se trata, según la literatura revisada, del primer estudio de este tipo en la población española. Globalmente, nuestros datos apoyan lo hasta ahora publicado (AU)

Background. Tuberous sclerosis is an uncommon neurocutaneous syndrome characterized by the appearance of hamartomas in multiple organs. Diagnosis is based on clinical criteria. Objective. To report the clinical findings in a series of 67 patients with tuberous sclerosis. Material and methods. This was a descriptive and observational retrospective study of patients with tuberous sclerosis referred to our dermatology clinics between January 1994 and March 2007. Results. All patients presented neurological or dermatological disorders. Other disorders, in descending frequency, were psychiatric (55.5 %), renal (32.8 %), cardiac (22.4 %), skeletal and pulmonary (13.4 %), and ophthalmological (11.9 %). Conclusions. We report the clinical findings in a series of patients with tuberous sclerosis. According to our literature search, this is the first such study in the Spanish population. Overall, our findings support those already published (AU)

Hiperqueratosis palmar simétrica y carcinoma esofágico / Symmetric palmar hyperkeratosis and esophageal carcinoma

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[Pulsed dye laser treatment of acne. Study of clinical efficacy and mechanism of action]. / Láser de colorante pulsado en el tratamiento del acné. Estudio de la eficacia clínica y mecanismo de acción.

INTRODUCTION: Acne vulgaris is a multifactorial disease of the pilosebaceous unit characterized by the development of inflammatory (papules, pustules, cysts) and/or non inflammatory lesions (open and closed comedones) that may progress to scars. The increase of bacterial resistances, adverse effects and teratogenicity of retinoids and lack of response to usual therapies have led to investigate new therapeutic alternatives for acne. MATERIAL AND METHOD: We studied 36 patients with mild to moderate acne vulgaris. We performed treatment every 4 weeks using pulsed dye laser therapy with a wavelength of 585 nm and pulse duration of 350 microseconds. RESULTS: At twelve weeks of treatment a decrease of 27 % of non inflammatory lesions and of 57 % of active lesions was observed. Treatment was well tolerated and considered positive, in terms of healing, in 25 patients. CONCLUSIONS: Pulse dye laser therapy mainly improves inflammatory lesions of acne with few adverse effects.

Láser de colorante pulsado en el tratamiento del acné. Estudio de la eficacia clínica y mecanismo de acción / Pulsed dye laser treatment of acne. Study of clinical efficacy and mechanism of action

Introducción. El acné vulgar es una enfermedad multifactorial de la unidad pilosebácea caracterizada por la aparición de lesiones inflamatorias (pápulas, pústulas, quistes) y/o no inflamatorias (comedones cerrados y abiertos) que pueden evolucionar al desarrollo de cicatrices. El aumento de las resistencias bacterianas, los efectos adversos y teratogenicidad de los retinoides y la falta de respuesta a tratamientos habituales llevan a la necesidad de investigar nuevas opciones terapéuticas para el acné. Material y métodos. Estudiamos a 36 pacientes con acné vulgar de grado leve a moderado. Realizamos tratamiento cada 4 semanas utilizando un láser de colorante pulsado de 585 nm de longitud de onda y 350 microseg de duración de pulso. Resultados. A las doce semanas de tratamiento se observa descenso del 27 % de lesiones no inflamatorias y de un 57 % de lesiones activas. El tratamiento fue bien tolerado y considerado como positivo, en cuanto a curación, en 25 pacientes. Conclusiones. El láser de colorante pulsado mejora principalmente las lesiones inflamatorias del acné con pocos efectos adversos

Introduction. Acne vulgaris is a multifactorial disease of the pilosebaceous unit characterized by the development of inflammatory (papules, pustules, cysts) and/or non inflammatory lesions (open and closed comedones) that may progress to scars. The increase of bacterial resistances, adverse effects and teratogenicity of retinoids and lack of response to usual therapies have led to investigate new therapeutic alternatives for acne. Material and method. We studied 36 patients with mild to moderate acne vulgaris. We performed treatment every 4 weeks using pulsed dye laser therapy with a wavelength of 585 nm and pulse duration of 350 microseconds. Results. At twelve weeks of treatment a decrease of 27 % of non inflammatory lesions and of 57 % of active lesions was observed. Treatment was well tolerated and considered positive, in terms of healing, in 25 patients. Conclusions. Pulse dye laser therapy mainly improves inflammatory lesions of acne with few adverse effects

13-cis-retinoic acid affects oxidation and DNA damage in oxidative-positive SLE lymphocytes but may not be useful for therapy.

13-cis-Retinoic acid (13-CRA), a water-soluble vitamin A analog and 5'-lipoxygenase inhibitor, was tested in vitro for effects on excess oxidative metabolism and DNA damage in mitogen-stimulated lymphocytes from patients with systemic lupus erythematosus (SLE), because other 5'-lipoxygenase enzyme inhibitors were shown to lower the excess oxidative metabolism in SLE cells. Excess chemiluminescence (CL) was abolished within minutes after the addition of 1 x 10(-6) M 13-CRA in five of five CL-positive mitogen-stimulated SLE lymphocytes, and was lowered in five of eight samples after 48 to 72 h culture. Similarly, low concentrations of 13-CRA for 48-72 h largely prevented the S1 nuclease-sensitive DNA changes/DNA damage observed in CL-positive lupus lymphocytes in vitro. However, 13-CRA did not affect DNA damage in four of four CL-negative lymphocyte samples. 13-CRA, like other retinoic acid compounds, was known to stimulate B-cell activities in vivo and in vitro but effects on dividing lupus T cells had not been studied. 13-CRA further inhibited the diminished PHA-stimulated lupus T-cell growth in tissue culture at a concentration of 9 x 10(-6) M in three of five lupus lymphocyte samples. 13-CRA has positive and negative effects on multiple aspects of the immune system and it is not clear whether 13-CRA will have positive or adverse clinical effects on SLE patients. Close attention to vitamin A and vitamin "supplements" in patients with SLE may answer this question.

Phytohemagglutinin-stimulated lymphocytes from patients with systemic lupus erythematosus demonstrate DNA damage.

DNA samples from control and lupus lymphocytes were studied for DNA integrity and single-strand breaks by agarose gel electrophoresis following digestion with the enzyme S1 nuclease. S1 nuclease digests single-strand gaps in double-stranded DNA. Gel patterns of phytohemagglutinin (PHA)-stimulated control and lupus lymphocyte DNAs were identical in the absence of S1 nuclease incubation. DNA isolated from PHA-stimulated control lymphocytes was relatively resistant to S1 nuclease digestion in 14 of 16 samples. However, 15 of 16 DNA samples from PHA-stimulated lupus lymphocytes demonstrated dramatically greater S1 nuclease digestion than paired control DNAs from lymphocytes analyzed at the same time under the same conditions. Increased S1 sensitivity suggests that more single-strand DNA breaks were found in PHA-stimulated lupus lymphocytes and/or the lupus DNA was more damaged than control DNA. We suggest that structural changes found in DNA from stimulated T lymphocytes of lupus patients are consistent with an endogenous antigen-mediated disorder.

Chemiluminescence is increased in a subgroup of PHA-stimulated lymphocytes from patients with systemic lupus erythematosus and inhibited by 5-lipoxygenase inhibitors.

Chemiluminescence (CL) was examined in phytohemagglutinin (PHA)-stimulated control and lupus lymphocytes because oxidative radicals have the chemical potential to generate DNA changes recently observed in lupus lymphocytes. Increased CL was found in 30 of 65 PHA-stimulated lupus lymphocyte samples by a luminol assay. CL did not correspond statistically to oxidative potential measured by a nitroblue tetrazolium assay. CL did not appear to be related to disease activity, organ involvement, or drug therapy. However, six of six males tested had positive CL activity. Cocultivation of CL-positive PHA-stimulated lupus lymphocytes with metabolic inhibitors of various oxidative enzymes revealed that 50 microM arachidonic acid dramatically inhibited the excess oxidation. A specific inhibitor of 5-lipoxygenase activity, 3 microM nordihydroguaiaretic acid, abolished excess CL activity. These studies suggest that chemiluminescence assays can be used to better understand the oxidative metabolism in lupus lymphocytes. The enzyme 5-lipoxygenase may be dysfunctional in a subgroup of lupus patients.