Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution.

OBJECTIVE: To assess the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids on fertility. MATERIAL AND METHODS: A retrospective observational study was conducted of 560 reproductive-age women with symptomatic uterine fibroids who underwent USgHIFU therapy at Mútua Terrassa University Hospital, Spain, between February 2008 and February 2018. We analyzed pregnancy outcomes including time to conception, pregnancy approach, gestational age, delivery mode, neonatal outcomes and complications during pregnancy and delivery. RESULTS: After USgHIFU treatment, 71 pregnancies were obtained in 55 patients. Of these, 58 (82%) cases were natural pregnancies and 13 (18%) were in vitro fertilization (IVF) pregnancies. The median time to conception was 12 (range 1-72) months. There were 43 (61%) successful deliveries, including a twin gestation, 22 (31%) spontaneous abortions and 6 (8%) therapeutic abortions. The rate of full-term deliveries was 91% (39/43) and the remaining 9% (4/43) were preterm deliveries. Of the 44 live births, 25 (57%) were born vaginally and 19 (43%) by cesarean section. The complications reported included 3 women with retained placenta (7%), 2 with placenta previa (5%) and 1 with severe preeclampsia (2%). The mean birth weight was 3.1 (range: 1.4-4.3) kg, and except for a baby born with a tetralogy of Fallot, all newborns developed well without complications during postpartum and breastfeeding. CONCLUSION: Patients undergoing USgHIFU treatment of uterine fibroids can achieve full-term pregnancies with few intrapartum or postpartum complications. More studies are required to compare fertility and perinatal outcomes between patients who underwent or not USgHIFU.

Minimal Incision Approach for Condyle Fracture Treatment.

INTRODUCTION: Surgical treatment of condylar neck fractures requires an extraoral approach when, due to the degree of difficulty of the fracture, an intraoral approach or an endoscopically supported treatment is not possible. In contrast to the cosmetically more favorable oral approach, extraoral approaches offer a better overview of the operating field and thus an easier fracture repositioning and osteosynthetic treatment. In 2007, Marti et al. described a minimal pre- and retroauricular incision with no extension to the hair-bearing skin and which aimed to improve the parotidectomy approach. MATERIALS AND METHODS: We present two cases in which minimal incision was used as a surgical approach for treatment of the condylar neck. DISCUSSION: Using the minimal incision, we were able to access the condylar neck. This type of approach as well as having the advantages of an open approach makes it possible to conceal the scar in the periauricular region and reduce the likelihood of salivary fistula.

Human papillomavirus in carcinomas of the tongue: clinical and prognostic implications.

It is not clear whether the presence of human papillomavirus (HPV) in squamous cell carcinomas of the tongue (SCCT) is of etiopathogenic and clinical significance. This study was designed to establish the incidence of HPV in SCCT and to determine the influence of HPV detection on clinical parameters and the prognosis. Clinical and histopathological data of 64 patients with SCCT were collected. Thirty benign lesions of the tongue were analyzed in parallel, in order to compare the HPV incidence and genotypes in these lesions with those of SCCT. Paraffin blocks of all cases were collected and PCR was carried out using SPF10 primers and the INNO-LiPA genotyping methodology. HPV was detected in 26.2% of the patients. Hybridization results showed that all patients except one had high-risk (HR)-HPV. HPV56 was the most common (42.1%), followed by HPV18 (26.3%), HPV16 (10.5%), HPV66 (10.5%), HPV39 (5.3%), and HPV51 (5.3%). The odds ratio of HR-HPV infection in cases vs. controls was statistically significant (9.45, 95% confidence interval 1.18-75.46). Among the results of the univariate analysis correlating the presence of HR-HPV with different clinical parameters, only mortality showed a statistically significant correlation, being higher in HR-HPV patients (odds ratio 3.97, 95% confidence interval 1.07-14.7).

Aetiology of community-acquired pneumonia among adults in an H1N1 pandemic year: the role of respiratory viruses.

This study aimed to determine the aetiology of community-acquired pneumonia (CAP) by adding polymerase chain reaction (PCR) to conventional methods and to describe the clinical and laboratory features between patients with bacterial pneumonia (BP) and viral pneumonia (VP). Adults with CAP admitted from November 2009 to October 2010 were included. Demographics, comorbidities, severity and clinical features were recorded. Conventional microbiological methods included blood and sputum cultures, acute and convalescent serologic samples, and antigen urinary detection. New methods included multiplex PCR for Mycoplasma pneumoniae, Legionella pneumophila, Chlamydophila pneumoniae, Bordetella pertussis and 15 respiratory viruses. A total of 169 patients were included. Using conventional methods, we identified a pathogen in 51 % of cases. With PCR, up to 70 % of cases had an aetiological diagnosis. Forty-five patients had BP (34 %), 22 had VP (17 %) and 25 (19 %) had co-infection (BP and VP). Pneumococci and respiratory syncytial virus (RSV) were the most frequently identified pathogens. Procalcitonin (PCT) and C-reactive protein (CRP) median values were significantly higher in BP than in VP patients. Shaking chills, higher CURB score and shock were significantly more frequent in BP. A viral infection was identified in more than one-third of patients with CAP. Clinical and laboratory features could help to differentiate between VP and BP and to guide empirical therapy.

Colgajo lateral de brazo en reconstrucción de la cavidad oral / Lateral arm flap in oral cavity reconstruction

Introducción. La posibilidad de emplear una piel fácilmenteplegable ha permitido reconstruir defectos de la cavidad oral consiguiendouna gran funcionalidad. Aunque el colgajo radial es el colgajo que se utilizacon más frecuencia para reconstruir defectos de superficie de la cavidad oral,el colgajo lateral de brazo puede ser de elección en algunas situaciones.Objetivos. El objetivo del presente trabajo es mostrar las ventajas e inconvenientesy nuestras indicaciones y resultados del colgajo lateral de brazo enreconstrucción de defectos de la cavidad oral.Material y método. Se trata de un estudio prospectivo sobre la utilización delcolgajo lateral de brazo en la reconstrucción de defectos de la cavidad oraltras cirugía ablativa. Se ha valorado: la viabilidad del colgajo, la morbilidaddel lecho donante, la longitud del pedículo, la selección de vasos receptores,las complicaciones y los resultados funcionales de la zona reconstruida.Resultados. Hemos utilizado el colgajo lateral de brazo en 10 pacientes enreconstrucciones primarias tras cirugía ablativa por carcinoma epidermoidede la cavidad oral. Hubo un caso de necrosis por trombosis venosa. El defectodonante se cerró en 8 casos de modo directo y en 2 con un injerto librede espesor parcial. La longitud media del pedículo ha sido de 8,75 cm. En 9casos el resultado funcional de los pacientes ha sido satisfactorio.Conclusiones. El colgajo fasciocutáneo lateral de brazo permite la reconstrucciónde la cavidad oral consiguiendo buenos resultados funcionales. Ademásla morbilidad de la zona donante es mínima y puede realizarse cierredirecto del defecto cutáneo del brazo en la mayoría de los casos(AU)

Introduction. The availability of easily pliable skin hasallowed the functional reconstruction of oral cavity defects. Althoughthe radial forearm free flap is the most frequently used flap for thereconstruction of surface defects of the oral cavity, the lateral armfree flap may be preferable in some situations.Objectives. The aim of the present paper is to show the advantagesand disadvantages and our indications and results for the lateralarm flap in intraoral reconstruction.Material and methods. This is a prospective work on the use of thelateral arm free flap for the reconstruction of oral cavity defects afterablative surgery. The parameters that have been evaluated are: flapviability, morbidity in the donor site, length of the pedicle, selectionof recipient vessels, complications and functional results in thereconstructed area.Results. The lateral arm flap has been used in primary reconstructionafter ablative surgery for squamous cell carcinoma of the oral cavityin ten patients. One flap was lost because of venous thrombosis.The donor site was repaired by direct closure in 8 cases and a splitthickness skin graft had to be used in 2 cases. Mean pedicle lengthwas 8.75 cm. In 9 cases a favorable functional result was achieved.Conclusions. Fasciocutaneous lateral arm flap allows thereconstruction of oral cavity defects achieving good functional results.Morbidity in the donor site is minimal and, in most cases, directclosure permits the repair of the donor site(AU)

Tumor fibroso solitario intraoral: análisis clinicopatológico e inmunohistoquímico / Intraoral solitary fibrous tumor: clinical, pathologic, and immunohistochemical analysis

El tumor fibroso solitario (TFS) es una neoplasia de partes blandascompuesta por células fusiformes, que principalmente se origina en lassuperficies mesoteliales. Generalmente tiene una localización intratorácica yla afectación de la cavidad oral es excepcional. Clínicamente el TFS intraoralsuele presentarse como una masa móvil, submucosa, no dolorosa, bien circunscrita,de lento crecimiento. El diagnóstico se obtiene mediante al análisishistopatológico e inmunohistoquímico. Histológicamente se caracterizapor una disposición variable de células fusiformes ovoides, generalmentepositivas para el marcador CD34. El tratamiento de elección es la extirpaciónquirúrgica de la lesión, recomendándose un seguimiento postoperatorio alargo plazo por la posibilidad de aparición de recurrencias y metástasis tardías.Presentamos un caso de TFS intraoral, localizado en el fondo del vestíbulomandibular. Un año después de la resección quirúrgica de la lesión, no haysignos de recidiva local o regional. Asimismo, realizamos una revisión de laliteratura(AU)

Solitary fibrous tumors (SFT) are spindle cell neoplasmsthat most often originate from mesothelial lined surfaces.Intrathoracic tumors are more common and oral mucosalinvolvement is uncommon. Clinically, intraoral SFT is usually apainless, well delimited, slow-growing, mobile submucosal mass.Diagnosis is based on immunohistochemical and histopathologicanalysis. Histologically, SFT is characterized by a variable provisionof spindle cells, which generally are CD34-positive. Resection is thetreatment of choice and long-term follow-up is recommended becauserecurrences and late metastases.We present a case of intraoral SFT of the mandibular vestibularsulcus. One year after surgical resection, there were no signs of localor regional recurrence. The literature was reviewed(AU)

Osteonecrosis de los maxilares asociada al empleo de bifosfonatos / Bisphosphonate-associated osteonecrosis of the jaw

Los bifosfonatos constituyen un grupo de fármacos inhibidoresde la resorción ósea, utilizados en el tratamiento de numerosas patologíascomo la osteoporosis, la enfermedad de Paget, el mieloma múltiple,la hipercalcemia maligna y las metástasis óseas asociadas al cáncer de mamao de próstata. El principal efecto farmacológico de los bifosfonatos es lainhibición de la resorción ósea, mediante una disminución de la actividadde los osteoclastos, sin intervenir en la formación y mineralización del hueso.Son fármacos utilizados a nivel mundial con unos claros beneficios contrastadosclínicamente. Numerosas publicaciones durante los últimos tresaños, y debido a su utilización masiva, consideran que la osteonecrosisde los maxilares está asociada al tratamiento con bifosfonatos.Es importante que los pacientes sean informados del riesgo de presentarseesta complicación, para tener la oportunidad de someterse a procedimientosdentales previos al inicio del tratamiento. Las medidas preventivasdeben realizarse antes, durante y después del tratamiento con bifosfonatos.El tratamiento quirúrgico debe reservarse para aquellos pacientesque presenten síntomas. Son necesarias nuevas investigaciones que clarifiquenesta complicación(AU)

Bisphosphonates constitute a group of inhibitors of boneresorption that are used for treating many disor-ders such asosteoporosis, Paget’s disease, multiple myeloma, malignanthypercalcemia and bone metas-tases associated with breast andprostate cancer. The main pharmacological effect of bisphosphonatesis the inhibition of bone resorption, mediated by a decreased functionof osteoclasts without interfering in bone formation andmineralization.These drugs are used worldwide, with clear and clinically provenbenefits. Several publications within the last three years considerosteonecrosis of the jaw to be associated with bisphosphonatetherapy as a result of their extensive use.It is important for patients to be informed of the risk of thiscomplication, so that they have the oppor-tunity to assess the needfor dental treatment before starting therapy. Preventive measuresmust be taken before, during, and after treatment withbisphosphonates. Surgical treatment should be reserved for thosepatients who are symptomatic. Further investigation is needed tocompletely elucidate this complication(AU)

Limitaciones de la PAAF en el diagnóstico del pilomatrixoma / FNA limitations in the diagnosis of pilomatrixoma

El pilomatrixoma es un tumor benigno de la piel que procede de la matriz celular del folículo piloso. Se localiza preferentemente en la cara y cuello. Clínicamente se presenta como un nódulo subcutáneo solitario y firme, no doloroso y de lento crecimiento. El tratamiento de elección es la resección quirúrgica.La PAAF (Punción Aspiración con Aguja Fina), como prueba diagnóstica prequirúrgica, puede hacer confundir el pilomatrixoma con un tumor maligno por la alta concentración de células, junto a la presencia de célulasaisladas con una tasa aumentada de la relación núcleo/citoplasma. Presentamos un caso clínico de pilomatrixoma cuyo diagnóstico inicial, trasla PAAF, fue tumor epitelial maligno de bajo grado. Asimismo, realizamos una revisión de la literatura

Pilomatrixoma is a benign skin neoplasm that arises fromhair follicle matrix cells. The most common anatomical location is the head and neck region. Clinically, it manifests as a firm, solitary, slow-growing, painless nodule of the dermis. Complete surgical excisionis the treatment of choice.With FNAB (Fine Needle Aspiration Biopsy) as a presurgical diagnostic test, the highly cellular smear with isolated cells showing a high nuclear/cytoplasmic ratio can be mistaken for a malignant tumor. We report a case of pilomatrixoma with an initial diagnosis,after the FNAB, of low-grade malignant epithelial tumor. Also, a review of the literature is made (AU)

Sarcoma sinovial, monofásico fusocelular, cervical / Monophasic spindle cell synovial sarcoma of the neck

No disponible

Neurilemomas de cavidad oral y cuello / Neurilemmomas of the oral cavity and the neck

Los neurilemomas son tumores neurogénicos benignos, con origen en la vaina neural. De los neurilemomas extracraneales, aproximadamente un 25 a un 45 por ciento ocurren en cabeza y cuello. La edad de afectación predominante es entre la tercera y la cuarta décadas de vida. El neurilemoma es un tumor claramente circunscrito y, generalmente, de pequeño tamaño. Clínicamente aparece como una masa de crecimiento lento y gradual. El examen microscópico es necesario para el diagnóstico. El tratamiento de elección es la escisión quirúrgica completa tumoral y después de ésta es muy rara su recurrencia.El propósito de este artículo es presentar un estudio retrospectivo, de nueve casos, de neurilemomas de cavidad oral y cuello, tratados en nuestro servicio de Cirugía Oral y Maxilofacial, entre 1997 y 2001. Hemos valorado una serie de parámetros epidemiológicos (edad, sexo, localización, tamaño, clínica, estudios previos a la cirugía, tiempo trascurrido entre aparición de síntomas y primera consulta, nervio de origen, patrón histológico predominante (Antoni A, Antoni B), y evolución postquirúrgica. Se ha realizado una revisión de la literatura (AU)

Enfermedad de Madelung. Presentación de un nuevo caso y revisión de la literatura / Madelung's syndrome: a report of a new case and review of the literature

La enfermedad de Madelung se caracteriza por la presencia de un acúmulo de grasa, no encapsulada, de distribución simétrica, generalmente de localización cervical. Se trata de una enfermedad de etiología desconocida. Su incidencia es mayor en el sexo masculino y en el area mediterránea, con edades de aparición comprendidas entre los 30 y los 60 años. Existe una fuerte correlación con el consumo abusivo de alcohol. El diagnóstico de la enfermedad es eminentemente clínico. El tratamiento de elección es la resección quirúrgica.El propósito de este artículo es presentar un nuevo caso de enfermedad de Madelung, así como la revisión de la literatura existente. (AU)

Parosteal osteoma of the iliac bone.

A 33-year-old patient with a 2-year history of intermittent pain in the right gluteal region and thigh presented with a large sclerotic lesion of the iliac bone. From the findings on radiography, scintigraphy, CT and MRI, a giant parosteal osteoma was suspected. The histological examination confirmed the diagnosis. Since the lesion was extensive it was observed with periodic follow-up examinations. At present, 5 years after the diagnosis, the patient is asymptomatic and imaging studies show that the lesion persists with reduction of sclerosis and size. The tumor was on the surface as well as intramedullary--only one other case with such a distribution is known to us--and it was also in the iliac bone.

Imaging of the azygos lobe: normal anatomy and variations.

We describe the normal appearance of the azygos lobe on plain radiography and CT. Several findings are presented that, to our knowledge, have not been previously reported, such as the inferior prolongation of the fissure, the apparent intrapulmonary path of the right brachiocephalic vein and superior vena cava seen on the anteroposterior chest radiograph, and the visible fissure on the lateral chest radiograph.