Incidencia, tendencia y distribución municipal de los tumores asociados al tabaco en el Área de Salud de León: 1997-2014 / Incidence, trend and municipal distribution of tobacco-associated tumours in the Health Area of León: 1997-2014

OBJETIVO: El consumo de tabaco es uno de los principales factores de riesgo evitables para el desarrollo de cáncer. El objetivo de este estudio es describir la frecuencia, la tendencia y la distribución geográfica de la incidencia de los tumores asociados al tabaco en el Área de Salud de León. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, que recoge los tumores asociados al consumo de tabaco del Registro Hospitalario de Tumores del Complejo Asistencial Universitario de León, entre 1997 y 2014 en residentes del Área de Salud de León. Se calcularon tasas brutas y ajustadas por trienios. Para el análisis de la distribución espacial se estimaron los riesgos relativos municipales suavizados mediante el ajuste del modelo de Besag, York y Mollié y sus probabilidades posteriores de que los riesgos relativos fuesen mayores de 1, utilizando métodos bayesianos. RESULTADOS: Se incluyeron 7.103 casos. Las tasas de incidencia brutas ascendieron de 116,4 (1997-1999) a 228,0 (2012-2014) por 100.000 hombres y de 19,8 (1997-1999) a 44,5 (2012-2014) por 100.000 mujeres. Las tasas ajustadas a población europea también ascendieron de 116,2 (1997-1999) a 136,9 (2012-2014) por 100.000 hombres y de 11 (1997-1999) a 24,5 (2012-2014) por 100.000 mujeres. En la zona sur y centro de la provincia son más frecuentes los municipios con riesgos relativos altos, varios de ellos superiores a 2 con unas probabilidades posteriores de 1. CONCLUSIONES: Los casos de tumores asociados al tabaco aumentaron en los trienios estudiados, especialmente en las mujeres. La diferente distribución geográfica puede ser utilizada como herramienta de prevención del consumo de tabaco en las áreas implicadas

OBJECTIVE: For cancer incidence, tobacco use is one of the main avoidable risk factors. The aim of this study is to describe the frequency, trend and geographical distribution of the incidence of tobacco-associated tumours in the León Health Area, Spain. MATERIAL AND METHODS: An observational, descriptive study was carried out on tumours of Hospital Registry of Tumours of the University Hospital Complex of León between 1997 and 2014. León Health Area residents, associated with smoking were included. Gross and adjusted rates were calculated and adjusted for triennials. For the analysis of spatial distribution, municipal relative hazards were smoothed by adjusting the Besag, York, and Mollié model and for their posterior probabilities for relative hazards to be higher than 1, using Bayesian methods. RESULTS: A total of 7,103 cases were included. Crude incidence rates rose from 116.4 (1997-1999) to 228.0 (2012-2014) per 100,000 men, and from 19.8 (1997-1999) to 44.5 (2012-2014) per 100,000 women. The adjusted rates for the European population also increased from 116.2 (1997-1999) to 136.9 (2012-2014) per 100,000 men, and from 11 (1997-1999) to 24.5 (2012-2014) per 100,000 women. In the south and centre of the province, there were municipalities with high relative hazards, several of them higher than 2 with posterior probabilities of 1. CONCLUSIONS: Tumours associated with tobacco increased in the triennial studied, especially in women. The different geographical distribution can be used as a tool to prevent tobacco consumption in the areas involved

[Incidence, trend and municipal distribution of tobacco-associated tumours in the Health Area of León: 1997-2014]. / Incidencia, tendencia y distribución municipal de los tumores asociados al tabaco en el Área de Salud de León: 1997-2014.

OBJECTIVE: For cancer incidence, tobacco use is one of the main avoidable risk factors.The aim of this study is to describe the frequency, trend and geographical distribution of the incidence of tobacco-associated tumours in the León Health Area, Spain. MATERIAL AND METHODS: An observational, descriptive study was carried out on tumours of Hospital Registry of Tumours of the University Hospital Complex of León between 1997 and 2014. León Health Area residents, associated with smoking were included. Gross and adjusted rates were calculated and adjusted for triennials. For the analysis of spatial distribution, municipal relative hazards were smoothed by adjusting the Besag, York, and Mollié model and for their posterior probabilities for relative hazards to be higher than 1, using Bayesian methods. RESULTS: A total of 7,103 cases were included. Crude incidence rates rose from 116.4 (1997-1999) to 228.0 (2012-2014) per 100,000 men, and from 19.8 (1997-1999) to 44.5 (2012-2014) per 100,000 women. The adjusted rates for the European population also increased from 116.2 (1997-1999) to 136.9 (2012-2014) per 100,000 men, and from 11 (1997-1999) to 24.5 (2012-2014) per 100,000 women. In the south and centre of the province, there were municipalities with high relative hazards, several of them higher than 2 with posterior probabilities of 1. CONCLUSIONS: Tumours associated with tobacco increased in the triennial studied, especially in women. The different geographical distribution can be used as a tool to prevent tobacco consumption in the areas involved.

Diseño, validación y aplicación clínica de un cuestionario de conocimiento (ConocEAP) de los pacientes con enfermedad arterial periférica / Design, validation and clinical application of a knowledge questionnaire (ConocEAP) in patients with peripheral arterial disease

INTRODUCCIÓN: Existe mucha desinformación en la población general y en los pacientes vasculares en particular sobre la enfermedad arterial periférica (EAP). Su adecuado conocimiento puede mejorar el autocuidado y la adherencia al tratamiento en los pacientes que la padecen. OBJETIVO: Desarrollar, validar e implementar un cuestionario que evalúe el conocimiento de los pacientes con EAP sobre su enfermedad y determinar las características clínicas y sociodemográficas que influyen en dicho conocimiento. MATERIAL Y MÉTODO: Se diseñó un cuestionario autoadministrado denominado ConocEAP, con 24 ítems de respuesta dicotómica estructurado en 5 áreas: conocimientos generales (4 ítems), factores de riesgo (6), régimen terapéutico (10), farmacoterapia (2) y signos de alarma (2). Se analizó su validez racional, de contenido mediante valoración de expertos y se implementó un pretest cognitivo. Se administró a 120 pacientes hospitalizados por EAP. La fiabilidad se analizó mediante alfa de Cronbach. RESULTADOS: Edad de los encuestados 72 °æ 13 a˜nos, 79% varones. El conocimiento global de la enfermedad fue del 60,5%. El régimen terapéutico y los signos de alarma fueron las áreas de mayor desconocimiento, y los factores de riesgo y farmacoterapia las que tuvieron mayor número de aciertos. El sexo femenino y un nivel de estudios superior se asocian a mayor conocimiento. Respecto al conocimiento de los factores de riesgo, no hubo diferencias significativas entre los pacientes que los presentaban y los que no. CONCLUSIONES: El diagnóstico de EAP no va ligado a un incremento del conocimiento sobre la enfermedad. El cuestionario ConocEAP es una herramienta válida y fiable que permite identificar el nivel de conocimiento de cada paciente y ofrece la oportunidad de individualizar las intervenciones educativas

INTRODUCTION: Peripheral artery disease (PAD) is largely unrecognised, but adequate knowledge can improve self-care and compliance in PAD patients. OBJECTIVE: To develop, validate and implement a questionnaire to assess the knowledge PAD patients have about their disease and to determine the clinical and sociodemographic characteristics determining that knowledge. MATERIAL AND METHOD: A self-administered questionnaire called ConocEAP was designed. It had 24 dichotomous response items structured into 5 areas: general knowledge (4 items), risk factors (6), therapeutics (10), pharmacotherapy (2), and warning signs (2). Rational validity was analysed by expert assessment and a cognitive pre-test was also implemented. It was administered to 120 patients admitted to hospital due to PAD. Reliability was analysed using Cronbach's alpha. RESULTS: The mean age was 72 °æ 13 years, with 79% males. Overall knowledge of the disease was 60.5%. Therapeutic regimen and warning signs were the areas of less knowledge, and risk factors and pharmacotherapy those with the highest number of correct answers. Female sex and higher education levels are associated with greater knowledge. There was no significant difference between patients as regards knowledge of risk factors, whether they had them or not. CONCLUSIONS: Diagnosis of PAD is not related to a greater knowledge about the disease. ConocEAP questionnaire is a valid and reliable tool, able to identify the level of knowledge of each patient and provides the opportunity to individualise educational interventions

[Gastric tube esophagoplasty using the retroesternal route in children]. / Sustitución esofágica con estómago tubulizado retroesternal en la infancia.

INTRODUCTION: Esophageal replacement is a surgical alternative once native esophagus can't be preserved. Different organs and routes for the replacement have been described, being the retroesternal route the least used. The aim is to present our results using gastric tube esophagoplasty with a retroesternal approach. PATIENTS AND METHODS: We performed a retrospective and descriptive study of 11 patients operated from 2000 to 2015. Median age at surgery was 2.2 years (5 months-9 years) and median weight was 11.2 kg (7.8-21). A gastric tube esophagoplasty using the retroesternal route, forced pyloric dilatation and end-to-side esophago-gastric cervical anastomosis were performed. RESULTS: Ten esophagus replacements had long-gap esophageal atresia and one, severe esophagus caustication secondary to button battery ingestion. No intraoperatory complications were observed. Three patients developed anastomosis leak. Two cases developed anastomotic stenosis managed with endoscopic dilatation in 2 and 4 occasions, respectively. Four patients showed occasional dumping syndrome and are asymptomatic after medical treatment. With a median follow up of 6.3 years (0.2-14.8), all our patients are alive and complete oral diet has been established in all of them. CONCLUSIONS: Gastric tube esophagoplasty using the retroesternal route is a suitable technique in order to reestablish gastrointestinal continuity once native esophagus can't be preserved. In our experience is a safe option, related to few complications.

INTRODUCCION: La sustitución esofágica es una de las opciones quirúrgicas en pacientes en los que no es posible la preservación del esófago. Existen diferentes técnicas según el órgano ascendido y la vía de ascenso, siendo la vía retroesternal la menos empleada. Se describen los resultados con el uso de estómago tubulizado retroesternal. PACIENTES Y METODOS: Estudio descriptivo retrospectivo de una serie de 11 pacientes intervenidos entre los años 2000 y 2015, con una edad media en el momento de la intervención de 2,2 años (5 meses-9 años) y un peso de 11,2 kg (7,8-21 kg). Se realizó gastroplastia tubulizada con dilatación forzada de píloro, ascenso gástrico por vía retroesternal y anastomosis esófago-gástrica cervical término-lateral. RESULTADOS: Diez sustituciones se realizaron en pacientes con atresia de esófago long-gap y una, tras una causticación esofágica por pila de botón. No hubo ninguna complicación intraoperatoria. En tres pacientes hubo fuga anastomótica. En dos pacientes se produjo estenosis que precisó dilataciones en 2 y en 4 ocasiones, respectivamente. Cuatro pacientes presentaron síndrome dumping ocasional que se resolvió con tratamiento médico. Con un seguimiento medio de 6,3 años (0,2-14,8), ningún paciente ha fallecido y en todos se ha logrado la nutrición oral completa. CONCLUSIONES: La gastroplastia tubulizada retroesternal es una técnica eficaz para restablecer la continuidad gastrointestinal en aquellos pacientes en los que no es posible preservar el esófago. Puede ser una opción segura y con escasas complicaciones.

Sustitución esofágica con estómago tubulizado retroesternal en la infancia / Gastric tube esophagoplasty using the retroesternal route in children

Introducción. La sustitución esofágica es una de las opciones quirúrgicas en pacientes en los que no es posible la preservación del esófago. Existen diferentes técnicas según el órgano ascendido y la vía de ascenso, siendo la vía retroesternal la menos empleada. Se describen los resultados con el uso de estómago tubulizado retroesternal. Pacientes y métodos. Estudio descriptivo retrospectivo de una serie de 11 pacientes intervenidos entre los años 2000 y 2015, con una edad media en el momento de la intervención de 2,2 años (5 meses-9 años) y un peso de 11,2 kg (7,8-21 kg). Se realizó gastroplastia tubulizada con dilatación forzada de píloro, ascenso gástrico por vía retroesternal y anastomosis esófago-gástrica cervical término-lateral. Resultados. Diez sustituciones se realizaron en pacientes con atresia de esófago long-gap y una, tras una causticación esofágica por pila de botón. No hubo ninguna complicación intraoperatoria. En tres pacientes hubo fuga anastomótica. En dos pacientes se produjo estenosis que precisó dilataciones en 2 y en 4 ocasiones, respectivamente. Cuatro pacientes presentaron síndrome dumping ocasional que se resolvió con tratamiento médico. Con un seguimiento medio de 6,3 años (0,2-14,8), ningún paciente ha fallecido y en todos se ha logrado la nutrición oral completa. Conclusiones. La gastroplastia tubulizada retroesternal es una técnica eficaz para restablecer la continuidad gastrointestinal en aquellos pacientes en los que no es posible preservar el esófago. Puede ser una opción segura y con escasas complicaciones

Introduction. Esophageal replacement is a surgical alternative once native esophagus can’t be preserved. Different organs and routes for the replacement have been described, being the retroesternal route the least used. The aim is to present our results using gastric tube esophagoplasty with a retroesternal approach. Patients and methods. We performed a retrospective and descriptive study of 11 patients operated from 2000 to 2015. Median age at surgery was 2.2 years (5 months-9 years) and median weight was 11.2 kg (7.8-21). A gastric tube esophagoplasty using the retroesternal route, forced pyloric dilatation and end-to-side esophago-gastric cervical anastomosis were performed. Results. Ten esophagus replacements had long-gap esophageal atresia and one, severe esophagus caustication secondary to button battery ingestion. No intraoperatory complications were observed. Three patients developed anastomosis leak. Two cases developed anastomotic stenosis managed with endoscopic dilatation in 2 and 4 occasions, respectively. Four patients showed occasional dumping syndrome and are asymptomatic after medical treatment. With a median follow up of 6.3 years (0.2-14.8), all our patients are alive and complete oral diet has been established in all of them. Conclusions. Gastric tube esophagoplasty using the retroesternal route is a suitable technique in order to reestablish gastrointestinal continuity once native esophagus can’t be preserved. In our experience is a safe option, related to few complications

Tendencia y distribución municipal de la incidencia de cáncer de vejiga en el área de salud de León (1996-2010) / Municipal distribution and trends in bladder cancer incidence in health area of León, Spain (1996-201

Objetivo: España presenta unas de las tasas más elevadas de incidencia y mortalidad por cáncer de vejiga del mundo. El presente estudio tiene por objeto conocer la incidencia, tendencia y distribución geográfica del cáncer de vejiga en el área de salud de León. Material y métodos: Fueron incluidos los casos nuevos de cáncer de vejiga (CIE-188) del registro hospitalario de tumores del Centro Asistencial Universitario de León, entre 1996-2010 con residencia en el ASL. Se calcularon las incidencias brutas trienales y ajustadas a población mundial y europea. Como denominador se utilizaron los datos del INE de población desagregada por sexo y grupos quinquenales de edad de residentes en municipios del ASL. Para el análisis de la distribución espacial se estimaron los riesgos relativos (RR) municipales suavizados mediante el ajuste del modelo de Besag, York y Mollié y sus probabilidades posteriores de que los RR fuesen > 1 (PP), utilizando métodos bayesianos. Resultados: Se incluyeron 1.573 casos. Las tasas estandarizadas a población europea ascendieron de 20,8 (1996-98) a 33,1 (2006-2008) casos nuevos por 100.000 hombres y de 1,9 a 5,9 en las mujeres. No se observaron diferencias de interés en la distribución municipal de las incidencias. Conclusiones: Las tasas de incidencia observadas son elevadas en el contexto europeo. Se observan tendencias ascendentes en hombres y especialmente relevantes en mujeres

Objective: Spain is a country where bladder cancer incidence and mortality rates are some of the highest in the world. The aim of this study is to know the incidence, trends and geographical distribution of bladder cancer in the health area of León. Material and methods: the new cases of bladder cancer (CIE-188) in patients residing in the health area of León and registered in the Hospital Tumor Registry of the Centro Asistencial Universitario in León (Spain) between 1996-2010 were included in this study. Triennial crude incidence and adjusted incidence rates to the worldwide and European population were calculated. Population data of the municipalities of Leon (Spain) were obtained from National Institute of Statistic of Spain (INE, Instituto Nacional de Estadística). Data were disaggregated by sex-groups and five-year age groups. Spatial distribution of smoothed municipal relative risks (RR) of bladder cancer was carried out using a Besag, York and Mollié model. Bayesian model were used to calculate the posterior probability (PP) of RR greater than one. Results: 1.573 cases were included. Incidence rates standardized to European population increased among men from 20,8/100.000 (1996-98) to 33,1/100.000 (2006-2008) and among women these rates increased from 1,9/100.000 to 5,9/100.000 for the same period of time. No relevant differences were found in the municipal distribution of the incidences. Conclusions: bladder cancer incidence rates are high in the European context. Rising trends in incidence in both sexs, particularly in women are observed

Municipal distribution and trends in bladder cancer incidence in health area of León, Spain (1996-2010).

OBJECTIVE: Spain is a country where bladder cancer incidence and mortality rates are some of the highest in the world. The aim of this study is to know the incidence, trends and geographical distribution of bladder cancer in the health area of León. MATERIAL AND METHODS: the new cases of bladder cancer (CIE-188) in patients residing in the health area of León and registered in the Hospital Tumor Registry of the Centro Asistencial Universitario in León (Spain) between 1996-2010 were included in this study. Triennial crude incidence and adjusted incidence rates to the worldwide and European population were calculated. Population data of the municipalities of Leon (Spain) were obtained from National Institute of Statistic of Spain (INE, Instituto Nacional de Estadística). Data were disaggregated by sex-groups and five-year age groups. Spatial distribution of smoothed municipal relative risks (RR) of bladder cancer was carried out using a Besag, York and Mollié model. Bayesian model were used to calculate the posterior probability (PP) of RR greater than one. RESULTS: 1.573 cases were included. Incidence rates standardized to European population increased among men from 20,8/100.000 (1996-98) to 33,1/100.000 (2006-2008) and among women these rates increased from 1,9/100.000 to 5,9/100.000 for the same period of time. No relevant differences were found in the municipal distribution of the incidences. CONCLUSIONS: bladder cancer incidence rates are high in the European context. Rising trends in incidence in both sexs, particularly in women are observed.

Temporal spreading generated by diffraction in the focusing of ultrashort light pulses with perfectly conducting spherical mirrors.

We study femtosecond pulses at the focal plane of a perfectly conducting spherical mirror which is a dispersionless system, that is, it introduces no group velocity dispersion and no propagation time difference to the pulses after reflection. By using the scalar diffraction theory we will show that the neglected terms in the diffraction integral, when using the approximation of the bandwidth being smaller than the frequency of the carrier, have a significant influence on imaging if a laser pulse of a few femtoseconds is used in time-resolved imaging. The neglected terms introduce temporal spreading to extremely short pulses of a few optical cycles incident on the mirror, which avoids a fully compensated pulse, i.e., a one optical cycle pulse, at the focus of the mirror. The study in this paper also applies to refracting optical systems such as microscope objectives or lenses.

Gauss-Legendre quadrature method used to evaluate the spatio-temporal intensity of ultrashort pulses in the focal region of lenses.

We analyze the spatio-temporal intensity of sub-20 femtosecond pulses with a carrier wavelength of 810 nm along the optical axis of low numerical aperture achromatic and apochromatic doublets designed in the IR region by using the scalar diffraction theory. The diffraction integral is solved by expanding the wave number around the carrier frequency of the pulse in a Taylor series up to third order, and then the integral over the frequencies is solved by using the Gauss-Legendre quadrature method. The numerical errors in this method are negligible by taking 96 nodes and the computational time is reduced by 95% compared to the integration method by rectangles. We will show that the third-order group velocity dispersion (GVD) is not negligible for 10 fs pulses at 810 nm propagating through the low numerical aperture doublets, and its effect is more important than the propagation time difference (PTD). This last effect, however, is also significant. For sub-20 femtosecond pulses, these two effects make the use of a pulse shaper necessary to correct for second and higher-order GVD terms and also the use of apochromatic optics to correct the PTD effect. The design of an apochromatic doublet is presented in this paper and the spatio-temporal intensity of the pulse at the focal region of this doublet is compared to that given by the achromatic doublet.

Reconstrucción genital integral en la Hiperplasia Suprarrenal Congénita: sensibilidad, estética y función (embarazo) / Integral genital reconstruction: sensitivity, aesthetic and function (pregnancy), in the Congenital Adrenal Hyperplasia

La Hiperplasia Suprarrenal Congénita o Síndrome Adrenogenitales un cuadro clínico poco frecuente. Las anomalías que presenta van asociadas a síndromes que a veces son muy complejos, destacando, entre otros, el seudohermafroditismo femenino y el hermafroditismo verdadero. Las mujeres que la padecen presentan como alteración más evidente un clítoris aumentado de tamaño (megaloclítoris) y otras alteraciones en los genitales externos. Ante estas pacientes es necesario realizar un diagnóstico correcto mediante exploración física y otras pruebas complementarias: estudios genéticos, analíticos, hematológicos y urinarios. La corrección quirúrgica del megaloclítoris es necesaria no sólo para mejorar el aspecto de los genitales externos, sino también para que tanto la paciente como su familia se encuentren menos afectados psicológicamente. Existen varias técnicas quirúrgicas que intentan corregir esta malformación, como la amputación o clitorectomía total, la retroposición o enterramiento y la clitorectomía parcial selectiva. Todas ellas, junto con otras correcciones de los genitales externos afectados, han sido utilizadas hasta el día de hoy. Presentamos el caso de una paciente con Hiperplasia Suprarrenal Congénita por déficit del enzima 21-hidroxilasa. Describimos su clínica, la técnica quirúrgica aplicada en su caso y, sobretodo, dado la rareza de esta patología, comunicamos que, tras dos embarazos, los dos hijos nacidos, no presentaron la alteración congénita materna (AU)

Congenital Adrenal Hyperplasia is a rare patology, whith clinical expressions like female pseudo hermaphroditism or true hermaphroditism. Females affected mainly suffer clitoral hypertrophy and externalgenitalia abnormalityes. The complete diagnosis includes: careful examination of the genitals, complementary imaging proofs, hormonal and genetic testing. The surgical correction of the external genitals and megaloclitoris improves the physical and psychological condition of patients and relatives. Many surgical procedures has been used to correct these malformations, such as total clitorectomy, clitoris reposition, and partial clitorectomy. We report a female patient with Congenital Adrenal Hyperplasia caused by enzyme 21-hydroxilasa deficit, who suffered severe masculinizing of the external genitals. We describe surgical correction. Patient gave birth successfully two times and her descendents have not genetic disorders (AU)

Condiloma gigante del pene (Tumorde Buschke-Lowenstein): Presentación de un caso / Peneal Buschke-Lowenstein tumor: Case report

El condiloma gigante del pene o tumor de Buschke-Lowenstein, es un tumor epitelial benigno de origen viral y sexualmente transmisible, que en raros casos puede malignizar. Presentamos un paciente en el que el condiloma de localización peneana, creció rápidamente y destruyó estructuras. Su histología se caracteriza por papilomatosis y acantosis endo y exofítica. Existen diferentes tratamientos del tumor, pero el más efectivo es la extirpación quirúrgica radical para evitar recidivas y malignización (AU)

Buschke-Lowenstein tumour is an epithelial benign tumour sexually transmitted with a viral origin. We present a case of peneal localization with exofitic growth, compression and displacement of the deeper tissues, ulceration and urethral fistulae. Histologyis characterized by papillomatosis and endo orexophytic acantosis. Local malignancy is still discussed. There are many possible treatments, but radical excision is the best to avoid malignant transformation and recurrences (AU)

Enfermedad de la Peyronie. De la extirpación a la incisión de la placa de fibrosis / Peyronie’s disease. Incision or extirpation of the plaque

La Enfermedad de La Peyronie es una entidad médica bien descrita y conocida, sin embargo su tratamiento quirúrgico no siempre consigue el resultado esperado. Las técnicas habituales (Nesbitt, Horton-Devine), basadas en la extirpación de la placa fibrosa que desvía el pene eréctil, suelen conllevar acortamiento peneano y/o recidiva de la enfermedad. Presentamos una serie de 20 pacientes con Enfermedad de La Peyronie tratados con una nueva técnica basada en la incisión de la placa fibrosa e interposición de injerto dérmico autólogo. Describimos indicación, procedimiento quirúrgico y resultados obtenidos en un período de seguimiento de entre 16 y 1 años(último paciente incluido).La técnica supone un cambio sustancial del enfoque terapéutico; la incisión de la placa frente a su extirpación respeta el tejido peneano, protege el paquete vasculo nervioso aminorando la incidencia de impotencia, no acorta la longitud peneana, disminuye la incidencia de recidivas y su ejecución quirúrgica es asequible y simple (AU)

Peyronie’s disease is a well-known medical entity but its surgical treatment does not get the expected outcome all the time. Usual techniques are based on the extirpation of fibrous plaque which distorts the erectile penis. These traditional techniques can produce shortening of the penis and/or disease recidivation. We report a 20 patient series afflicted of Peyronie’s disease who were treated by a new surgical procedure; it consists of the incision over the fibrotic plaque and the insertion of a dermal autologous graft. We describe indication, surgical procedure, and results achieved by us with a following time within16 to 1 year (last patient included).This technique changes the essential therapeutic approach. Using plaque incision instead of plaque extirpation we contribute to preserve vessels, nerves and we penis length. The incidence of impotence and disease recidivation also decreases with this simple and available technique (AU)

Infección de neovagina en Síndrome de Rokitansky por virus del papiloma humano / Neovaginal infection for human papiloma virus in Rokitansky Syndrome

Presentamos el caso de una paciente con Síndrome de Rokitansky que, seis años después de la reconstrucción de una neovagina mediante un injerto de piel parcial, presentó una infección vaginal por el virus del papiloma humano. Tras el tratamiento adecuado, la paciente curó, desapareciendo las lesiones locales hasta el momento actual (AU)

We are presenting the case of a patient with Rokitansky Syndrome who had a vaginal infection six years after the reconstruction of a neovagina with splint-thickness skin graft. The infection was caused by the human papilloma virus. After the appropriate treatment, the patient healed and the lesions disappeared completely (AU)

Cobertura plantar distal mediante colgajo cutáneo de perforantes. Caso clínico / Coverage of distal plantar area with a medial plantar perforator cutaneous flap. Case report

En las últimas dos décadas, el desarrollo de las técnicas microquirúrgicas ha hecho que cada vez existan más posibilidades de cobertura en zonas anatómicas difíciles, como la región plantar distal. La aplicación de esta técnicas ha dado lugar al empleo de colgajos libres, tanto musculares como fasciocutáneos, para defectos en esta zona. La llegada de los colgajos basados en perforantes ha hecho que el abanico de posibilidades sea aún mayor, tanto en forma de colgajos libres como pediculados. Sin embargo, hoy en día se sigue admitiendo que la mejor cobertura plantar es la de la propia zona anatómica. Presentamos el caso de un paciente que sufrió una lesión compleja traumática plantar, con fractura luxación de la primera articulación metatarsofalángica y avulsión de partes blandas del primer radio, con exposición de la articulación, la falange proximal y el sistema músculotendinoso. Tras el desbridamiento seriado se llevó a cabo la reparación de todas las estructuras y la cobertura de la pérdida cutánea con un colgajo plantar cutáneo basado en una perforante de la arteria plantar medial, localizada mediante Eco-Doppler. La baja morbilidad de la técnica utilizada, el menor tiempo operatorio, así como el resultado funcional y estético, hacen que este tipo de colgajos se deban considerar entre las técnicas de reconstrucción para cobertura plantar (AU)

In the last two decades development of microsurgical techniques has provided a wider range of possibilities within the coverage of difficult anatomical regions such as the distal plantar area. Development of perforator flaps furthermore permits the application of new techniques in this area, however, the authors always advise that the best coverage of the plantar area is the actual itself. We report the case of a distal plantar injury with a fracture- luxation of the first metatarsophalangeal joint and avulsion of soft tissue of the first radix with exposure of the joint, proximal phalangeal and muscle-tendinosus system. A cutaneous plantar flap based on a perforator of the medial plantar artery located with directional Doppler probe was used to cover soft tissue loss. The low morbidity of this technique, its low operative time and the excellent functional and aesthetic results have allowed these type of flaps to become a prefered choice in the coverage of partial defects of the distal plantar area (AU)

Prevención de las úlceras por presión en Cuidados Paliativos: recomendaciones basadas en la evidencia médica / Prevention of pressure sores in Palliative Care: recomendations in evidence based medicine

Las úlceras por presión son una patología frecuente en pacientes que sufren alguna limitación de la movilidad, afectando habitualmente apacientes crónicos, ancianos y personas en situación de enfermedad avanzada. En este trabajo, revisamos la literatura médica sobre las UPP para obtener información basada en la evidencia médica. La medicina basada en la evidencia propone utilizar la mejor evidencia científica y clínica disponible sobre las úlceras por presión, afirmando que la prevención es un objetivo fundamental en estos pacientes. Nuestros resultados destacan que estos pacientes requieren una valoración integral, con un enfoque preventivo que permita: identificar el riesgo, minimizar el efecto de la presión, evaluar el estado nutricional, evitar encamamientos prolongados y preservar la integridad de la piel. Podemos concluir que son medidas efectivas en la prevención de las úlceras por presión: reconocer el estadio de la úlcera, reducir las fuerzas de presión y cizallamiento, mejorar el cuidado de la piel, eliminar el exceso de humedad debido a incontinencia y corregir los déficits nutricionales (AU)

Pressure sores affect patients who are unable to change position regularly, usually cronic, elderly and advanced disease patients. We review pressure sores literature, searching into evidence based medicine. Evidence based medicine proposes the best clinical and scientifical evidence available relative to pressure sores, so it affirms, prevention is a very important goal in this problem. Outcomes emphasize: patients require general approach with preventive strategies include recognizing risk, decreasing the effects of pressure, assessing nutritional status, avoiding excessive bed rest and preserving the integrity of the skin. Our study concludes that effective actions in pressure sores prevention are: assessing the severity of the ulcer, reducing pressure and shear forces, optimising skin care, avoiding excess moisture due to incontinence and correcting nutritional deficits (AU)

Cyclin T1 domains involved in complex formation with Tat and TAR RNA are critical for tat-activation.

Tat activates transcription from the human immunodeficiency virus type 1 (HIV-1) long terminal repeat (LTR) by increasing the processivity of RNA polymerase II. Recently, it has been demonstrated that the cellular kinase CDK9 and its binding partner cyclin T1 are involved in regulating transcriptional elongation and tat-activation. Cyclin T1, CDK9 and Tat bind as a complex to elements in TAR RNA that are required for tat-activation. Here, we used cyclin T1 mutants to define domains in this protein that bind to both CDK9 and Tat and are involved in stimulating tat-activation. The region of cyclin T1 extending from amino acid residues 1 to 263 is necessary for complex formation with Tat bound to TAR RNA and for stimulation of tat-activation in murine cells that are normally poorly responsive to the actions of Tat. In contrast, a smaller region of cyclin T1 was required to bind to CDK9 and stimulate its kinase activity. Recombinant cyclin T1 and CDK9 stimulated both basal and tat-induced in vitro transcriptional elongation from the HIV-1 LTR. The effects of Tat on transcriptional elongation may be mediated by its ability to increase CDK9 phosphorylation of the RNA polymerase II C-terminal domain. These results demonstrate that cyclin T1 interactions with Tat and TAR RNA are critical for activation of HIV-1 gene expression.

DNA-dependent protein kinase phosphorylation of IkappaB alpha and IkappaB beta regulates NF-kappaB DNA binding properties.

Regulation of the IkappaB alpha and IkappaB beta proteins is critical for modulating NF-kappaB-directed gene expression. Both IkappaB alpha and IkappaB beta are substrates for cellular kinases that phosphorylate the amino and carboxy termini of these proteins and regulate their function. In this study, we utilized a biochemical fractionation scheme to purify a kinase activity which phosphorylates residues in the amino and carboxy termini of both IkappaB alpha and IkappaB beta. Peptide microsequence analysis by capillary high-performance liquid chromatography ion trap mass spectroscopy revealed that this kinase was the DNA-dependent protein kinase catalytic subunit (DNA-PKcs). DNA-PK phosphorylates serine residue 36 but not serine residue 32 in the amino terminus of IkappaB alpha and also phosphorylates threonine residue 273 in the carboxy terminus of this protein. To determine the biological relevance of DNA-PK phosphorylation of IkappaB alpha, murine severe combined immunodeficiency (SCID) cell lines which lack the DNA-PKcs gene were analyzed. Gel retardation analysis using extract prepared from these cells demonstrated constitutive nuclear NF-kappaB DNA binding activity, which was not detected in extracts prepared from SCID cells complemented with the human DNA-PKcs gene. Furthermore, IkappaB alpha that was phosphorylated by DNA-PK was a more potent inhibitor of NF-kappaB binding than nonphosphorylated IkappaB alpha. These results suggest that DNA-PK phosphorylation of IkappaB alpha increases its interaction with NF-kappaB to reduce NF-kappaB DNA binding properties.