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1.
AJNR Am J Neuroradiol ; 43(4): 534-539, 2022 04.
Article in English | MEDLINE | ID: mdl-35332015

ABSTRACT

BACKGROUND AND PURPOSE: Acute inflammatory activity of MS lesions is traditionally assessed through contrast-enhanced T1-weighted MR images. The aim of our study was to determine whether a qualitative evaluation of non-contrast-enhanced SWI of new T2-hyperintense lesions might help distinguish acute and chronic lesions and whether it could be considered a possible alternative to gadolinium-based contrast agents for this purpose. MATERIALS AND METHODS: Serial MR imaging studies from 55 patients with MS were reviewed to identify 169 new T2-hyperintense lesions. Two blinded neuroradiologists determined their signal pattern on SWI, considering 5 categories (hypointense rings, marked hypointensity, mild hypointensity, iso-/hyperintensity, indeterminate). Two different blinded neuroradiologists evaluated the presence or absence of enhancement in postcontrast T1-weighted images of the lesions. The Fisher exact test was used to determine whether each category of signal intensity on SWI was associated with gadolinium enhancement. RESULTS: The presence of hypointense rings or marked hypointensity showed a strong association with the absence of gadolinium enhancement (P < .001), with a sensitivity of 93.0% and a specificity of 82.9%. The presence of mild hypointensity or isohyperintensity showed a strong association with the presence of gadolinium enhancement (P < .001), with a sensitivity of 68.3% and a specificity of 99.2%. CONCLUSIONS: A qualitative analysis of the signal pattern on SWI of new T2-hyperintense MS lesions allows determining the likelihood that the lesions will enhance after administration of a gadolinium contrast agent, with high specificity albeit with a moderate sensitivity. While it cannot substitute for the use of contrast agent, it can be useful in some clinical settings in which the contrast agent cannot be administered.


Subject(s)
Contrast Media , Gadolinium , Gadolinium DTPA , Humans , Magnetic Resonance Imaging/methods
2.
Rev. Esp. Cir. Ortop. Traumatol. (Ed. Impr.) ; 60(3): 167-174, mayo-jun. 2016. tab, ilus
Article in Spanish | IBECS | ID: ibc-152345

ABSTRACT

Objetivo. Reportar los resultados clínico-radiológicos del tratamiento de las fracturas del húmero distal (FHD) con prótesis total de codo. Material y métodos. Este trabajo retrospectivo fue realizado en 2 centros quirúrgicos. Se incluyeron: pacientes con FHD, operados con prótesis total de Coonrad-Morrey y con seguimiento > 1 año. Se incluyeron 23 pacientes. Veintiuno de los pacientes eran mujeres con una edad promedio de 79 años. Según la clasificación AO, las fracturas eran: 15 del tipo C3, 7 del tipo C2 y una A2. Todos los pacientes fueron operados sin desinserción del aparato extensor. El seguimiento promedio fue de 40 meses. Resultados. La flexoextensión fue de 123-17°, con un arco de movilidad de 106° (un 80% con respecto al lado sano). El dolor según EVA fue de un punto. El SCM promedio fue de 83 puntos: 8 pacientes tuvieron resultados excelentes, 13 buenos, uno regular y otro malo. El DASH promedio fue de 24 puntos. No se evidenciaron aflojamientos en 15 pacientes. Se observaron 10 complicaciones: 2 desgastes del polietileno, un desensamble protésico, 3 parestesias postoperatorias del nervio cubital, una necrosis de piel que necesitó un colgajo braquial, 2 aflojamientos protésicos, y una falsa vía intraoperatoria. Conclusiones. El tratamiento de FHD con prótesis total de codo puede ofrecer una opción razonable de tratamiento, pero las indicaciones deben estar limitadas a fracturas complejas donde la fijación interna puede ser precaria, en pacientes con osteoporosis y con baja demanda funcional. En pacientes jóvenes la utilización está limitada a casos graves donde no exista otra opción de tratamiento. Nivel de evidencia. Nivel de evidencia IV (AU)


Objective. To report the clinical-functional outcomes of the treatment of humeral distal fractures with a total elbow prosthesis. Material and methods. This retrospective study was performed in two surgical centres. A total of 23 patients were included, with a mean age of 79 years, and of which 21 were women. The inclusion criteria were: patients with humeral distal fractures, operated on using a Coonrad-Morrey prosthesis, and with a follow-up of more than one year. According to AO classification, 15 fractures were type C3, 7 C2 and 1 A2. All patients were operated on without de-insertion of the extensor mechanism. The mean follow-up was 40 months. Results. Flexor-extension was 123-17°, with a total mobility arc of 106° (80% of the contralateral side). Pain, according to a visual analogue scale was 1. The Mayo Elbow Performance Index (MEPI) was 83 points. Excellent results were obtained in 8 patients, good in 13, medium in 1, and poor in 1. The mean DASH (disability) score was 24 points. Conclusion. Treatment of humeral distal fractures with total elbow arthroplasty could be a good treatment option, but indications must be limited to patients with complex fractures, poor bone quality, with osteoporosis and low functional demands. In younger patients, the use is limited to serious cases where there is no other treatment option. Level of Evidence. Level of Evidence IV (AU)


Subject(s)
Humans , Male , Female , Aged , Arthroplasty, Replacement, Elbow/methods , Arthroplasty, Replacement, Elbow/trends , Arthroplasty, Replacement, Elbow , Elbow Prosthesis/trends , Elbow Prosthesis , Humeral Fractures/diagnosis , Humeral Fractures/surgery , Arthroplasty, Replacement, Elbow/statistics & numerical data , Arthroplasty, Replacement, Elbow/standards , Elbow Prosthesis/statistics & numerical data , Elbow Prosthesis/standards , Prosthesis Failure/adverse effects , Prosthesis Failure/trends , Retrospective Studies , Anesthesia, Conduction/methods , Polyethylene/therapeutic use
3.
Rev Esp Cir Ortop Traumatol ; 60(3): 167-74, 2016.
Article in English, Spanish | MEDLINE | ID: mdl-26948532

ABSTRACT

OBJECTIVE: To report the clinical-functional outcomes of the treatment of humeral distal fractures with a total elbow prosthesis. MATERIAL AND METHODS: This retrospective study was performed in two surgical centres. A total of 23patients were included, with a mean age of 79years, and of which 21 were women. The inclusion criteria were: patients with humeral distal fractures, operated on using a Coonrad-Morrey prosthesis, and with a follow-up of more than one year. According to AO classification, 15fractures were type C3, 7 C2 and 1 A2. All patients were operated on without de-insertion of the extensor mechanism. The mean follow-up was 40 months. RESULTS: Flexor-extension was 123-17°, with a total mobility arc of 106° (80% of the contralateral side). Pain, according to a visual analogue scale was 1. The Mayo Elbow Performance Index (MEPI) was 83 points. Excellent results were obtained in 8 patients, good in 13, medium in 1, and poor in 1. The mean DASH (disability) score was 24 points. CONCLUSION: Treatment of humeral distal fractures with total elbow arthroplasty could be a good treatment option, but indications must be limited to patients with complex fractures, poor bone quality, with osteoporosis and low functional demands. In younger patients, the use is limited to serious cases where there is no other treatment option. LEVEL OF EVIDENCE: Level of Evidence IV.


Subject(s)
Arthroplasty, Replacement, Elbow , Humeral Fractures/surgery , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Humeral Fractures/diagnosis , Male , Middle Aged , Retrospective Studies , Treatment Outcome
4.
Cir. plást. ibero-latinoam ; 40(4): 421-428, oct.-dic. 2014. ilus
Article in Spanish | IBECS | ID: ibc-133685

ABSTRACT

La pérdida de cobertura cutánea compleja secundaria a traumatismos, úlceras por presión, desforramientos cutáneos, etc, plantea un desafío a la hora de elegir la técnica quirúrgica que solucione el problema. Cualquiera que sea la elegida, conlleva un riesgo asociado de mayor pérdida cutánea, hematoma o seroma. En base a un estudio experimental sobre medición de presiones bajo y sobre colgajos sometidos a aplicación de presión negativa, decidimos aplicar el método a diferentes planos anatómicos de profundidad en pacientes con defectos complejos de cobertura tisular. Presentamos nuestra experiencia con el uso de presión negativa externa e interna (multinivel) como técnica de apoyo y prevención de complicaciones en la resolución de 19 casos de cobertura tisular compleja: desforramientos de piel, hematomas disecantes del tejido celular subcutáneo, úlceras por presión, colgajos complejos, cicatrices extensas y loxocelismo cutáneo, obteniendo resultados satisfactorios (AU)


Complex tissue loss secondary to traumatisms, pressure sores, degloving, etc, are a challenge when we try to choose the surgical technique to solve the problem. Every technique brings a risk of major skin coverage defect, hematoma or seroma. Based on an experimental study to measure pressure over and below a flap submitted to negative pressure, we decided to apply a vacuum system in different anatomic planes in patients with complex tissue loss. We report our experience with the use of negative pressure as external and internal (multilevel) technical support and prevention of complication in resolving 19 clinical cases of complex tissue loss: degloving, subcutaneous hematoma, pressure sores, complex flaps, extensive scarring skin loss, loxoscelism, with successful results (AU)


Subject(s)
Humans , Negative-Pressure Wound Therapy/methods , Wound Closure Techniques , Skin Ulcer/therapy , Tissue Expansion Devices , Wound Healing , Seroma/epidemiology , Hematoma/epidemiology , Free Tissue Flaps , Case-Control Studies
5.
Cir. plást. ibero-latinoam ; 40(3): 307-312, jul.-sept. 2014. ilus, tab
Article in Spanish | IBECS | ID: ibc-130017

ABSTRACT

Presentamos nuestra experiencia con el uso de un colgajo previamente descrito, el colgajo denominado en cono por la forma final que obtiene, como la de un barquillo de helado con su bocado. Consta de 2 colgajos acoplados: uno de rotación local y otro un avance en V-Y, ambos fasciocutáneos. Realizamos un análisis retrospectivo de 108 pacientes intervenidos entre 2000 y 2013 por lesiones en diferentes partes del organismo, con edades comprendidas entre los 20 y los 52 años, de los cuales 99 fueron varones, y en los que empleamos este tipo de colgajo. Los defectos cubiertos afectaban a las piernas en el 27% de los casos, tobillos en el 10%, planta del pie en el 9%, al talón en el 8% y a otras localizaciones en el resto de los pacientes. Del total, 80 colgajos tuvieron buena evolución (74%), 11 sufrieron dehiscencia mayor (10,2 %), 13 dehiscencia menor (12%) y 4 necrosis (3,7 %). Los resultados confirman que el colgajo en cono es versátil, reproducible, sencillo y seguro de realizar, y permite al cirujano plástico resolver problemas quirúrgicos complejos de forma muy segura y a bajo costo (AU)


We present our experience with a previously described flap, the shaped cone flap, to cover skin defects. This flap due its name to the shape, similar to an ice cream cone, that is formed by locally rotated and V-Y advance flaps joined together, being both fasciocutaneous flaps. We perform a retrospective analysis of 108 patients operated on between 2000 and 2013, aged 20 to 52 years, 99 males, treated with a cone shaped flap. The defects covered were located in the leg in 27%, in the ankle in 10%, in the sole of the foot in 9%, in the heel in 8% and in other locations in the rest of patients. Eighty flaps (74%) had a good evolution, 11 (10,2%) had a major dehiscence, 13 (12%) had a minor dehiscence and 4 flaps (3,7 %) had necrosis. We confirm the cone shaped flap as an easy and safe alternative for reconstruction that avoid complications in most of the cases and with a low surgical cost (AU)


Subject(s)
Humans , Surgical Flaps , Myocutaneous Flap , Skin Transplantation/methods , Plastic Surgery Procedures/methods , Retrospective Studies
6.
Cir. plást. ibero-latinoam ; 39(1): 61-65, ene.-mar. 2013. ilus, tab
Article in Spanish | IBECS | ID: ibc-113577

ABSTRACT

El cuero cabelludo es la barrera más externa y más importante del cráneo y del cerebro. Si bien las quemaduras de esta zona son raras, cuando se producen suelen estar causadas por alta tensión eléctrica, fuego, líquidos hirvientes u otras fuentes de calor. El objetivo de este trabajo es presentar una serie de casos de quemaduras de cuero cabelludo tratadas en los últimos10 años en el Hospital del Trabajador de Santiago (Chile).Se trata de un estudio descriptivo retrospectivo en el que se analizó la información demográfica y terapéutica de los pacientes que requirieron hospitalización al tiempo que se revisó la literatura al respecto. En total se registraron 2.266 consultas por quemaduras en la cabeza, de las cuales 34 fueron del cuero cabelludo y11 requirieron hospitalización; la mayoría fueron quemaduras eléctricas, 4 casos y por fuego, otros 4 casos. En el tratamiento, destacó el uso en 1 caso de colgajo libre asociado a colgajos locales de avance. En el tratamiento de las secuelas se utilizaron expansores y posteriormente colgajos locales de avance. Sólo una pequeña parte de los pacientes que consultan por quemaduras en la cabeza corresponden a quemaduras del cuero cabelludo. La mayoría son tratadas de forma ambulatoria y no requieren acciones mayores. Los pacientes con quemaduras eléctricas suelen requerir tratamientos más agresivos. Para el tratamiento de las secuelas son preferibles los expansores y los colgajos de avance (AU)


The scalp is the most external and important barrier of the skull and brain. Burns in this area are rare, but often caused by high voltage injuries, fire, liquid or other heat sources. The aim of this paper is to present a series of cases of scalp burns of the last 10 years in the Hospital del Trabajador de Santiago (Chile). This is a retrospective and descriptive study. We analyzed the demography and treatment of patients requiring hospitalization and we reviewed the literature. There were 2.266 visits for head burns, of which 34 patients consulted with scalp burns, 11 of them were hospitalized. Most were due to electrical burns, 4 patients, and fire,4 patients. In the treatment, highlighted the use in a case of free flap and local advancement flaps. In the management of sequelae, expanders and then local advancement flaps were performed. Only a small proportion of patients attending with head burns had scalp burns. Most were treated on as outpatient and did not require further action. The group of patients with electrical burns required more aggressive treatments while the management of the sequelaes is done with expanders and local advancement flaps (AU)


Subject(s)
Humans , Burns/surgery , Scalp/surgery , Surgical Flaps , Plastic Surgery Procedures/methods , Retrospective Studies , Hair/transplantation
8.
Cir. plást. ibero-latinoam ; 38(4): 359-362, oct.-dic. 2012. ilus, tab
Article in Spanish | IBECS | ID: ibc-110125

ABSTRACT

La traqueostomía es un procedimiento frecuentemente para asegurar una vía aérea permeable en casos de intubación prolongada, trauma facial severo y neoplasias de cabeza y cuello. Tras la extubación, el defecto se deja cerrar por segunda intención con el resultado de una cicatriz defectuosa, de pobre resultado estético y con frecuentes alteraciones funcionales asociadas, como por ejemplo disfagia. Se han descrito muchas técnicas para la corrección de estas cicatrices, sin embargo, algunas no corrigen los defectos funcionales y otras requieren una gran disección y movilización de los tejidos. Proponemos una técnica basada en dos colgajos adipofasciales de base opuesta y dependientes de circulación random realizada en 7 pacientes con cicatriz defectuosa postraqueostomía con buenos resultados estéticos y funcionales (AU)


Tracheostomy is a frequently used procedure to secure a viable airway in cases such as prolonged intubation, facial trauma and head and neck cancer. After decannulation, the defect is left to heal by secondary intention resulting in a poor aesthetic and functional outcome. Many techniques have been described to correct this defects, however they don't correct functional defect and some of them require large and complex dissections and manipulation of subdermal tissues. In order to correct these defects we present a technique using a doble opposite adipofascial flap based on random irrigation. This technique has been used in 7 patients with good aesthetical and functional results (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Plastic Surgery Procedures/methods , Cicatrix, Hypertrophic/surgery , Tracheotomy , Surgical Flaps , Adipose Tissue/transplantation
9.
Cir. plást. ibero-latinoam ; 36(4): 355-358, dic. 2010. ilus
Article in Spanish | IBECS | ID: ibc-96771

ABSTRACT

Las úlceras trocantéreas por presión representan un problema importante a nivel extra e intrahospitalario. Existen múltiples opciones terapéuticas, ya sean colgajos randomizados, musculocutáneos, fasciocutáneos o libres. Presentamos la técnica quirúrgica del colgajo en hacha detensor de fascia lata para el tratamiento de esta patología. Consiste en el diseño de un colgajo en V con irrigación por su base superior, que contacta con la úlcera por uno de sus extremos, simulando la forma de un hacha. Resecamos la úlcera hasta obtener un lecho vital, resecando además el hueso prominente dicho hasta un plano en que se visualice tejido sano. Levantamos y rotamos el colgajo cubriendo el defecto. Finalmente se realiza el cierre primario en VY sintensión. La zona donante permite un cierre primario sin tensión. Mantenemos drenajes durante 10 días Este colgajo permite obtener una buena cobertura para úlceras trocantéreas por decúbito con un adecuado resultado cosmético. Recogemos una casuística de 17 úlceras tratadas mediante el colgajo descrito; como complicaciones se presentaron 3 seromas, resueltos con sistema de cierre con presión negativa externa e interna; 2 casos de dehiscencia de sutura y 2 hematomas resueltos en pabellón de cirugía. Creemos pertinente conocer este colgajo que debe estar siempre presente dentro de las posibilidades terapéuticas para pacientes con úlceras trocantereas por decúbito (AU)


The trochanteric pressure sore it’s an important intra and extrahospitalary problem. There are different therapeutic options for this pathology, for example random, musculocutaneous, fasciocutaneous or free flaps. We present the hatchet-shaped fascia lata tensor flap to treat this kind of lesions. We design a V flap with irrigation in the superior base, having one of the extreme in contact with the sore. The shape of the flap is a hatchet. It´s important to get a vitalbed resecting affected tissues and prominent bone; then, the flap stands up and rotates to covering the defect. We carried out primary closure in V-Y without tension. Drains are removed not before 10 days. This flap allows a good coverage for trochanteric decubitussores with an adequate cosmetic result. There have been 3 seromas, solved with internal and external negative pressure system; 2 cases of suture dehiscence and 2 hematomas solved with surgical procedures. The donor site allows primary closure without tension. As a conclusion, we believe that is relevant to know this flap and taking it on count to be offered to patients with trochanteric decubitus sore (AU)


Subject(s)
Humans , Pressure Ulcer/surgery , Surgical Flaps , Fascia Lata/surgery , Plastic Surgery Procedures/methods , Wound Closure Techniques
10.
Cir. plást. ibero-latinoam ; 36(2): 163-166, abr.-jun. 2010. tab, ilus
Article in Spanish | IBECS | ID: ibc-95221

ABSTRACT

Los colgajos de avance en V-Y han sido una alternativa popular para el cierre de heridas profundas, pero su movilidades limitada. Los colgajos basados en perforantes son especialmente útiles cuando se necesita un mayor avance y cobertura. Diseñamos un colgajo de gastrocnemio que utiliza ambas técnicas para cubrir los defectos del tercio medio y superior de la pierna en sus caras lateral y posterolateral. Evaluamos en forma retrospectiva 5 pacientes con heridas en el tercio medio y superior de la pierna, tratados entre enero de 2005 y septiembre de 2007 en un solo centro y por un mismo cirujano. Todos fueron varones, con un promedio de edad de 48 años y la etiología fue traumática en todos los casos. El vaso perforante se evaluó preoperatoriamente por medio de doppler color en todos los casos. Valoramos telefónicamente la satisfacción del paciente en el postoperatorio tardío. En todos los casos, encontramos los vasos perforantes identificados en el preoperatorio; el tiempo operatorio promedio fue de 1.8 horas. No hubo complicaciones; la cobertura fue exitosa en todos los casos y los pacientes se mostraron satisfechos en la encuesta realizada. El tiempo medio de seguimiento postoperatorio fue de 19 meses. En conclusión, creemos que el colgajo de avance en V-Y degastrocnemio basado en perforante se presenta como una alternativa segura para el cierre de defectos del tercio medial y superior de la pierna, en un sólo tiempo quirúrgico y con buenos resultados estéticos y funcionales a largo plazo (AU)


Advancement V-Y flaps have been a popular choice for closure of deep wounds but their mobility is limited. Perforant based flaps are specially useful when greater advancement and bigger coverage are needed. We designed a gastrocnemius based flap that uses both techniques for covering the defects of the medial third of the leg. We follow a retrospective evaluation of 5 patients that had their wounds in the medial and superior third of the leg covered by an advancement V-Y gastrocnemius perforant based flap between January 2005 and September 2007. All were men, mean age 48 years and the ethiology was traumatic in all cases. The perforant vessel was evaluated by colour duplex preoperatively. All procedures were made by the same surgeon. Patient satisfaction was evaluated telephonically in late evolution. All vessels were found preoperatively, mean surgical time was 1.8 hours. No complications were observed; coverage was successful in all cases and there was complete satisfaction in the group. Mean follow up was 19 months. As a conclusion, we propose that advancement V-Y gastrocnemius perforant based flap appears to be a safe alternative in the closure of medial third leg defects in a onetime surgery with good a esthetic and functional results (AU)


Subject(s)
Humans , Male , Female , Adult , Aged , Leg Injuries/surgery , Surgical Flaps , Muscle, Skeletal/transplantation , Postoperative Complications , Surgical Flaps/blood supply , Recovery of Function
11.
Cir. plást. ibero-latinoam ; 36(1): 19-24, ene.-mar. 2010. tab, ilus
Article in Spanish | IBECS | ID: ibc-85579

ABSTRACT

La ginecomastia es la anomalía mamaria más frecuente en el sexo masculino. La pseudoginecomastia es un cuadro que a menudo se confunde con la ginecomastia y consiste en el aumento de tejido graso en la región pectoral. El equipo de Cirugía Plástica del Hospital Militar de Santiago (Chile), por atender una población de jóvenes que realizan el servicio militar obligatorio, ha tenido una gran experiencia en el manejo de esta enfermedad; es por esto que nos planteamos como objetivo de estudio evaluar el manejo de los pacientes operados por esta patología en el Hospital Militar y la Clínica Santa María de Santiago, e intentar ofrecer pautas para el manejo de esta patología de la Cirugía General a nivel nacional. Realizamos un estudio retrospectivo y descriptivo sobre 106pacientes operados con diagnóstico de ginecomastia o pseudoginecomastia entre Enero de 1987 y Julio de 2005 en las instituciones antes mencionadas. El promedio de edad de los pacientes incluidos en el estudio fue de 24 años (rango: 15 a 50 años): 32% por ginecomastia pura,29,4% por pseudoginecomastia y 38,8% por ambas. Todos fueron grado I y II a de la clasificación de Simon. En el 50% de los casos se realizó adenectomía más lipoaspiración; adenectomía sola en 26,4%y lipoaspiración exclusiva en 23,6%. Casos complicados, 3,8% con hematomas y equimosis. La ginecomastia es una enfermedad frecuente en la adolescenciaque además de provocar alteraciones estéticas, provoca alteraciones psicológicas en el paciente. La liposucción se consagra como una técnica quirúrgica importante para el tratamiento quirúrgico de esta anormalidad (AU)


Gynecomastia is common among men. Pseudogynecomastia, caused by an increased subcutaneous fat in the mammary area, can be confused with gynecomastia. We report our experience with the surgical treatment of both making a review of medical records of106 patients, aged 15 to 50 years, operated at the Plastic Surgery Unit of the Military Hospital and Clínica Santa María in Santiago(Chile).Thirty two percent of patients had a pure gynecomastia, 29, 4%had pseudogynecomastia, and 38,8% had both conditions. All were mild or moderate. A mastectomy plus liposuction was performed in 50% of patients, solely mastectomy in 26,4% and solely liposuction in 26,4%. There were surgical complications in 3,8%such as hematomas or echymoses. As a conclusion: Ginecomastia is a frequent pathology in young men that can produce aesthetic and psychological pathologies. Surgical treatment requires liposuction in most patients to achieve a good result (AU)


Subject(s)
Humans , Male , Gynecomastia/surgery , Mammaplasty/methods , Lipectomy/methods , Intraoperative Complications/epidemiology , Retrospective Studies , Adipose Tissue/surgery
12.
Cir. plást. ibero-latinoam ; 35(2): 115-122, abr.-mayo 2009. ilus, tab
Article in Spanish | IBECS | ID: ibc-85475

ABSTRACT

Los defectos del tercio superior auricular son un desafío reconstructivo. Están descritas diferentes técnicas quirúrgicas para este fin con resultados a veces desfavorables Realizamos un estudio anatómico en cadáveres frescos que mostró la presencia constante de un pedículo neurovascular que penetra la raíz del hélix. Mostramos la localización y los diámetros de los vasos. Basándonos en este estudio anatómico, presentamos una serie de 10 casos consecutivos tratados por el autor principal. Analizamos la etiología, técnica quirúrgica, complicaciones y resultado a largo plazo. La técnica del autor introduce refinamientos a la técnica de Davis, el cual usa un colgajo condrocutáneo de concha auricular basado en la rama superior de la arteria temporal superficial y un colgajo cutáneo axial de base superior basado en la arteria retroauricular, para crear el nuevo hélix auricular superior. El aspecto posterior de este colgajo condrocutáneo se cubre con un injerto de piel total. En un segundo tiempo empleamos una zetaplastia de la base del hélix que nos dará una mejor forma. El estudio anatómico demostró la presencia de un pedículo neurovascular que penetra la raíz del hélix. La serie clínica está compuesta por 8 defectos postraumáticos, una quemadura eléctrica y un tumor de piel. Todos los colgajos condrocutáneos de concha auricular sobrevivieron comprobándose la seguridad del pedículo del hélix. Dos colgajos retroauriculares presentaron sufrimiento vascular transitorio distal, uno de ellos con recuperación completa y otro con necrosis distal mínima. Dos casos sufrieron pérdida parcial del injerto de piel total. Durante el desarrollo de la serie descubrimos algunos detalles de la técnica quirúrgica, que ahora discutimos en el artículo. Todos los pacientes recuperaron el contorno auricular, obteniendo los mejores resultados en aquellos en los que se aplicaron los refinamientos descritos (AU)


Acquired defects of the upper third of the ear constitute a surgical challenge. Several techniques have been described, and results are sometimes unfavourable. An anatomical study in 10 fresh cadavers shows the constant presence of a neurovascular pedicle penetrating the root of helix. Location and vessel diameters are shown. Based on that anatomical knowledge, a series of 10 consecutive cases treated by the senior author is presented. Etiology, surgical technique, complications and long-term results are analyzed. The author’s technique introduces a refinement of the Davis’ technique, which uses a (..) (AU)


Subject(s)
Humans , Ear Auricle/surgery , Plastic Surgery Procedures/methods , Ear Cartilage/surgery , Ear Auricle/abnormalities , Surgical Flaps
13.
Spinal Cord ; 46(2): 135-9, 2008 Feb.
Article in English | MEDLINE | ID: mdl-17607312

ABSTRACT

STUDY DESIGN: Descriptive case series study. OBJECTIVE: To describe the course of five spinal cord injury (SCI) patients who underwent proximal amputation of the inferior extremity, secondary to recurrent, complicated pressure ulcers (PU) and the clinical impact this intervention had in these patients. PLACE: Trabajador Hospital in Santiago, Chile. METHOD: Revision of five clinical cases of patients who underwent partial hemipelvectomy or hip disarticulation with amputation of the extremity as treatment for pelvic recurrent PU with chronic secondary osteomyelitis. The clinical impact was quantified as days of hospital stay, number of surgeries and previous and post surgery PU. RESULTS: After the proximal amputation of the extremity, patients significantly decreased number of days of hospital stay (P=0.035), number of surgeries (P=0.015) and PU (P=0.0065). CONCLUSION: Partial hemipelvectomy and hip disarticulation with proximal amputation of the inferior extremity are rescue procedures that can be last resource treatment for chronic recurrent pelvic PU secondary to chronic osteomyelitis.


Subject(s)
Amputation, Surgical , Leg/surgery , Osteomyelitis/surgery , Pressure Ulcer/complications , Spinal Cord Injuries/complications , Chronic Disease , Hemipelvectomy , Hospitalization , Humans , Male , Osteomyelitis/etiology , Treatment Outcome
14.
Cir. plást. ibero-latinoam ; 29(3): 237-242, jul.-sept. 2003. ilus, tab
Article in Spanish | IBECS | ID: ibc-135637

ABSTRACT

Producto de nuestro moderno estilo de vida, los traumatismos encéfalocraneanos (TEC) son una importante causa de morbimortalidad; afectando especialmente a población joven. Algunos pacientes pueden quedar con graves secuelas neurológicas, en estado vegetativo y permanentemente postrados. Por otra parte, la mejor atención, tanto en fase aguda como crónica, ha mejorado su expectativa de vida, apareciendo complicaciones que plantean nuevos desafíos terapéuticos, entre las que se incluyen las úlceras por presión (UP). Tradicionalmente, en nuestro medio, las UP en estos pacientes han sido tratadas de forma conservadora. Sin embargo, esta conducta. muchas veces implica. curaciones por largos períodos de tiempo, significando un deterioro en la calidad de vida del enfermo, una carga adicional para los familiares y un encarecimiento para las instituciones de salud. Por estos motivos presentamos la experiencia del Hospital del Trabajador de Santiago, en el tratamiento quirúrgico de 7 pacientes con graves secuelas neurológicas post TEC, portadores de UP, 5 sacras y 2 trocantéreas; planteándose la cirugía como una alternativa válida ele tratamiento. Se discuten algunos aspectos relevantes a su evaluación preoperatoria, tipo de cirugía, evolución, complicaciones, resultados y costos (AU)


The craneal trauma is, actually, an important etiology of morbity and mortality, mainly in young people. Some of these patients lay in bed for ever, with importants neurological sequelaes secondary to their brain injury. In the other hand the berter attention in acute as well as cronic phase have improve their expectative of Iife, appearing complications with new challenges such as the pressure sores. Traditionally, in our environment these pressure sores, in the these pauents, have been treated in conservative way. Nevertheless, these treatments mean wounds cares for long times, with a detrimental quality of Iife for the patient, an emotional comminent for their relatives ancl a big investment for the Hospital del Trabajador Santiago. Chile in the surgical treatment of 7 patients with important neurological sequeales post brain injury and with pressure sores: 5 sacral, and 2 trocanterics. Pre operatory evaluation, type of surgery, evolution, complications, results and costare discussed (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pressure Ulcer/surgery , Quality of Life , Malnutrition/complications , Surgical Flaps/surgery , Surgical Flaps , Surgical Wound Dehiscence/complications , Surgical Wound Dehiscence/surgery , Nursing Care/trends , Nursing Care , Pressure Ulcer/economics
15.
Rev. Inst. Nac. Cancerol. (Méx.) ; 43(3): 142-6, jul.-sept. 1997. tab, ilus
Article in Spanish | LILACS | ID: lil-225047

ABSTRACT

En el Servicio de Radioterapia de la Unidad de Oncología del Hospital General de México, entre agosto de 1993 a diciembre de 1995, se realizó una investigación sobre altas dosis de radiación con hipofraccionamiento administradas en pacientes con recurrencias locorregionales de melanoma maligno, previamente manejado por los servicios quirúrgicos de nuestra unidad. Un total de 28 lesiones en 22 pacientes con diagnóstico de melanoma maligno metastásico o recurrente fueron tratados con altas dosis de radiación por fracción. El seguimiento osciló entre nueve y 30 meses (promedio 11.2 meses). Fueron analizados dos esquemas de tratamiento: Esquema A: 40 Gy en ocho fracciones administradas en cuatro semanas y esquema B: 24 Gy en tres fracciones, una por semana. Se analizó la respuesta local a estas dosis y el control del dolor. Veintiún campos de tratamiento fueron tratados con el esquema A y siete con el esquema B. Se obtuvieron respuestas completas en siete campos de tratamiento, parciales (entre 50 y 90 por ciento) en 12 campos y menores de 50 por ciento o estatismo en nueve campos. Se obtuvo paliación total del dolor en 18 pacientes. Existe evidencia de progresión de la enfermedad en seis pacientes, a pulmón en cuatro casos y óseas en dos. Seis pacientes se encuentran con vida y sin actividad tumoral, ocho están vivos con actividad tumoral y los ocho restantes se perdieron con actividad tumoral. El análisis de estos datos muestra que el melanoma maligno es más radiosensible de lo que tradicionalmente se había señalado y puede tener un manejo en el papel de estas lesiones, ya sea en la paliación local, en la satelitosis y en el control del dolor


Subject(s)
Humans , Dose-Response Relationship, Radiation , Melanoma/radiotherapy , Melanoma/surgery , Neoplasm Metastasis , Neoplasm Recurrence, Local/radiotherapy , Radiation Tolerance , Radiotherapy
16.
Mycoses ; 40(5-6): 203-7, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9476489

ABSTRACT

The authors report the clinical and microbiological findings of a 6-month follow-up of nine AIDS patients affected with cryptococcosis. Among these, seven patients suffered from meningoencephalitis and two from disseminated infection. The antifungal therapy during acute illness included the administration of amphotericin B at doses of 0.6 mg kg-1 day-1 i.v. plus flucytosine at doses of 100 mg kg-1 day-1 i.v. during the first 15 days followed by itraconazole at doses of 400 mg day-1 p.o. in the following 15 days. The maintenance treatment included itraconazole at doses of 200 mg day-1 p.o. indefinitely. During the 6-month follow-up, one patient died of hepatic failure related to C virus (HCV) hepatitis reactivation and another patient died of polymicrobial pneumonia. In two patients, the presence of multiple nodular lesions in the cerebral computerized tomography (CT) scan, related to cryptococcal granulomas, was associated with the persistance of fungi in the cerebrospinal fluid. In three patients with meningoencephalitis the three-drugs regimen was effective in eradicating the neurological infection, and relapses were not observed during the maintenance therapy with itraconazole during the 6-month follow-up. The two patients with haematogenous cryptococcosis did not relapse after the 6-month follow-up.


Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Amphotericin B/therapeutic use , Cryptococcosis/drug therapy , Flucytosine/therapeutic use , Itraconazole/therapeutic use , Acute Disease , Antifungal Agents/therapeutic use , Antigens, Fungal/blood , Antigens, Fungal/cerebrospinal fluid , Chronic Disease , Drug Therapy, Combination , Follow-Up Studies , Humans , Meningitis, Cryptococcal/drug therapy
17.
Gastroenterology ; 111(5): 1169-77, 1996 Nov.
Article in English | MEDLINE | ID: mdl-8898629

ABSTRACT

BACKGROUNDS & AIMS: Contrasting opinions exist about the pharmacological treatment of esophageal candidiasis in patients with acquired immunodeficiency syndrome (AIDS). The aim of this study was to assess the long-term efficacy of fluconazole and itraconazole treatment. METHODS: This study evaluated 2213 human immunodeficiency virus-positive patients at first episode of esophageal candidiasis diagnosed by endoscopy; 1105 received fluconazole and 1108 received itraconazole. The endoscopic and clinical response to treatment was assessed periodically until the end of the follow-up period (1 year). RESULTS: At week 2, endoscopic cure occurred in 81.2% of patients treated with fluconazole and in 65.6% of patients treated with itraconazole (P < 0.001). Clinical cure was observed in 81.5% of patients treated with fluconazole and in 75.2% of patients treated with itraconazole (P < 0.001). At the end of the follow-up period, endoscopic and clinical cure were observed in 96% of patients treated with fluconazole and in 95.6% of patients treated with itraconazole (P = 0.788), with similar differences by intention-to-treat analysis (93.6% vs. 93.3%; P = 0.853). Treatment failure was observed in 22.3% of fluconazole-treated patients and in 26.6% of itraconazole-treated patients (P = 0.022). CONCLUSIONS: Fluconazole and itraconazole are provided with good long-term therapeutic efficacy in the treatment of Candida esophagitis in patients with AIDS. Fluconazole is associated with a higher rate of cure than itraconazole in short-term treatment.


Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Esophagitis/drug therapy , Fluconazole/therapeutic use , Itraconazole/therapeutic use , Adult , Female , Fluconazole/adverse effects , Follow-Up Studies , Humans , Itraconazole/adverse effects , Male , Patient Compliance , Treatment Failure
18.
Infez Med ; 4(4): 204-7, 1996.
Article in Italian | MEDLINE | ID: mdl-12858025

ABSTRACT

The Authors report the clinical and microbiological findings about a 6-months follow up of 9 AIDS-patients with Cryptococcosis. Among these, 7 patients suffered from meningo-encephalitis and 2 from haematogenous infection. The fungicidal treatment during acute illness, included the administration of Amphotericin B (0.6 mg/Kg/die i.v.) plus Flucytosine (100 mg/kg/die i.v.) during the first 15 days followed from itraconazole at doses of 400 mg/die in a single administration, during the following 15 days. The chronic suppressive therapy included itraconazole at doses of 200 mg/die p.o. indefinitely. During the 6-months follow up, one patient died of polymicrobial pneumonia and another of hepatic failure related to a reactivation of a previous HCV hepatitis. In 2 patients the presence of multiple nodular lesions in the cerebral CT scan, related to cryptococcal granulomas, was associated to a persistence of positive liquoral cultures and to a poor prognosis. In 3 patients with meningo-encephalitis, the three drugs regimen was quite effective in eradicating the neurological infection and no relapses were observed during the 6-months follow up. The 2 patients with hematogenous infection alone, didn't relapse during the 6-months follow up.

19.
Acta Neurol (Napoli) ; 12(2): 132-7, 1990 Apr.
Article in English | MEDLINE | ID: mdl-2360477

ABSTRACT

Evolution of syphilis has been studied in HIV-seropositive patients with regard to progression mode and clinical pictures. Reciprocal interactions between syphilis and HIV have been suggested based on the observation of unusually aggressive forms of treponemic infection, particularly at the CNS level. We describe a case of a 52-year-old homosexual male AIDS presenting with clinically manifest tabe dorsalis. The evolution to neurosyphilis seems, at least in this stage, to be accelerated by superimposed HIV infection.


Subject(s)
Acquired Immunodeficiency Syndrome/complications , Syphilis/complications , Humans , Male , Middle Aged , Syphilis/immunology , Syphilis/physiopathology
20.
Boll Ist Sieroter Milan ; 68(1): 51-6, 1989.
Article in English | MEDLINE | ID: mdl-2491286

ABSTRACT

In this work we reported the results obtained using two ELISA-tests (the seropositivity was confirmed by Western-Blot) for detection of HIV-Ab in normal and at risk population (according by the classification from C.D.C. 1982) exposed to screening for various, sanitary measures. Our results concerning the percentage of seropositivity to HIV-Ab in drug-addicts (49%) are in agreement with the results obtained in the most qualified Italian Centres. The incidence of congenital infection is high, pointed 50%; the 100% of seropositive children were infected by drug-addicts seropositive parents. Casuistry among haemophilic patients we have demonstrated a greater seropositivity in B haemophilic subjects than A haemophilic ones. The seropositivity (24%) verified among prisoners is totally related to drug-addiction. Prevalence of seropositivity among heterosexual partners of HIV positive subjects was 22% among female partners of infected men, and 9% among male partners of infected women. Checking performed upon nursing staff who casually were contaminated by seropositive patient's blood confirmed 100% of seronegativity after eight months. No seropositive subjects were performed in every not a risk group.


Subject(s)
HIV Infections/epidemiology , Adult , Female , HIV Antibodies/blood , HIV Infections/complications , HIV Infections/congenital , HIV Infections/transmission , Hemophilia A/complications , Homosexuality , Humans , Infant, Newborn , Italy/epidemiology , Male , Personnel, Hospital , Pregnancy , Pregnancy Complications, Infectious , Prevalence , Prisoners , Risk Factors , Sex Work , Sexual Behavior , Substance Abuse, Intravenous/complications
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