Eccema de contacto por extracto de pimienta negra como tratamiento de vitíligo / Contact Dermatitis Due to Black Pepper Extract Used to Treat Vitiligo

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Aplicación del colgajo de keystone en dermatología. Experiencia clínica en 18 pacientes / The Keystone Flap in Dermatology: Clinical Experience with 18 Patients

INTRODUCCIÓN Y OBJETIVOS: El colgajo de keystone es un colgajo fasciocutáneo cuya vascularización proviene de las arteriolas perforantes musculares. Su aplicación en dermatología es para cubrir defectos en zonas de piel poco distensible (miembros inferiores, superiores y de la espalda). Presentamos nuestra experiencia clínica y los resultados quirúrgicos del centro. MATERIAL Y MÉTODOS: Estudio descriptivo retrospectivo de pacientes con tumores cutáneos malignos en miembros inferiores en los que se realizó el colgajo de keystone. RESULTADOS: Se operaron 18 pacientes con una edad media de 77,83 años. Se realizaron 17 mediante la técnica propuesta por Behan y uno con la técnica modificada de Moncrieff. El 38,8% de los tumores extirpados fueron carcinomas basocelulares, el 33,3% carcinomas epidermoides y el 27,7% tumores malignos pigmentados. El 72,22% presentaba algún factor de riesgo cardiovascular. Se observó un 38,8% de complicaciones menores y ningún caso de necrosis parcial o total del colgajo. CONCLUSIONES: Consideramos que el colgajo de keystone es una buena alternativa terapéutica a otros colgajos e injertos para la reconstrucción de defectos en miembros inferiores. Los resultados estéticos y funcionales son buenos, con una tasa de éxito elevada

INTRODUCTION AND OBJECTIVES: The keystone flap is a fasciocutaneous flap supplied by perforating arteries. It is used in dermatology to repair surgical defects in areas with low skin extensibility (the upper and lower limbs and the back). We review the clinical experience gained with keystone flap reconstruction at our hospital and report on the surgical outcomes. MATERIAL AND METHODS: Descriptive retrospective study of patients with malignant skin tumors on the lower limbs who underwent keystone flap reconstruction. RESULTS: Eighteen patients (mean age, 77.83 years) underwent keystone flap reconstruction using the Behan technique in 17 cases and the modified Moncrieff technique in one. Basal cell carcinomas accounted for 38.8% of the tumors excised, squamous cell carcinomas 33.3%, and malignant pigmented tumors 27.7%. Cardiovascular risk factors were observed in 72.2% of patients. Minor complications occurred in 38.8% of patients, and there were no cases of partial or total flap necrosis. CONCLUSIONS: We consider the keystone flap to be a good alternative to other flaps and grafts for the surgical reconstruction of lower limb defects. The success rate was high, and the cosmetic and functional outcomes were good

Dermatitis de contacto alérgica aerotransportada por aceite de neem / Airborne Allergic Contact Dermatitis Caused by Neem Oil

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The Keystone Flap in Dermatology: Clinical Experience with 18 Patients. / Aplicación del colgajo de keystone en dermatología. Experiencia clínica en 18 pacientes.

INTRODUCTION AND OBJECTIVES: The keystone flap is a fasciocutaneous flap supplied by perforating arteries. It is used in dermatology to repair surgical defects in areas with low skin extensibility (the upper and lower limbs and the back). We review the clinical experience gained with keystone flap reconstruction at our hospital and report on the surgical outcomes. MATERIAL AND METHODS: Descriptive retrospective study of patients with malignant skin tumors on the lower limbs who underwent keystone flap reconstruction. RESULTS: Eighteen patients (mean age, 77.83 years) underwent keystone flap reconstruction using the Behan technique in 17 cases and the modified Moncrieff technique in one. Basal cell carcinomas accounted for 38.8% of the tumors excised, squamous cell carcinomas 33.3%, and malignant pigmented tumors 27.7%. Cardiovascular risk factors were observed in 72.2% of patients. Minor complications occurred in 38.8% of patients, and there were no cases of partial or total flap necrosis. CONCLUSIONS: We consider the keystone flap to be a good alternative to other flaps and grafts for the surgical reconstruction of lower limb defects. The success rate was high, and the cosmetic and functional outcomes were good.

InP photonic integrated externally injected gain switched optical frequency comb.

We report on an InP photonic integrated circuit for the generation of an externally injected gain switched optical frequency comb. The device is fully characterized and generates a comb with frequency spacing ranging from 6 to 10 GHz, good noise properties that include relative intensity noise of <-130 dB/Hz and linewidth of 1.5 MHz, and a high phase correlation between comb lines. These characteristics, in conjunction with the compactness and cost efficiency of the integrated device, demonstrate the quality of the resultant comb source for numerous applications.

Flexible wavelength de-multiplexer for elastic optical networking.

We report an injection locked flexible wavelength de-multiplexer (de-mux) that shows 24-h frequency stability of 1 kHz for optical comb-based elastic optical networking applications. We demonstrate 50 GHz, 87.5 GHz equal spacing and 6.25G-25G-50 GHz, 75G-50G-100 GHz unequal spacing for the de-multiplexer outputs. We also implement an unequally spaced (75G-50G-100 GHz), mixed symbol rate (12.5 GBaud and 40 GBaud) and modulation format (polarization division multiplexed quadrature phase shift keying and on-off keying) wavelength division multiplexed transmission system using the de-multiplexer outputs. The results show 0.6 dB receiver sensitivity penalty, at 7% hard decision forward error correction coding limit, of the 100 km transmitted de-mux outputs when compared to comb source seeding laser back-to-back.

Hemangioma facial como clave diagnóstica de PHACES / Facial haemangioma as a diagnostic key of PHACES

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Biopsia del ganglio centinela en una mujer embarazada con melanoma. ¿Es un procedimiento seguro? / Sentinel lymph node biopsy in a pregnant woman with melanoma. Is a safe procedure?

El diagnóstico y estadiaje del melanoma en la mujer embarazada es un reto difícil para los dermatólogos. La biopsia del ganglio centinela (BGC) es la técnica diagnóstica de elección en pacientes con melanomas gruesos. Sin embargo, existen pocos datos sobre su seguridad en pacientes gestantes. Presentamos una mujer embarazada de 29 años con un melanoma nodular diagnosticado en su segundo trimestre de gestación. Se realizó la BGC en la semana 28 de gestación sin observarse efectos adversos materno-fetales. La BGC no es una contraindicación absoluta durante el embarazo, pero como en cualquier procedimiento médico, se ha de valorar los beneficios y riesgos que conlleva (AU)

The diagnosis of melanoma in pregnant women presents some unique and difficult challenges for both, patients and medical specialists. Sentinel lymphnode biopsy (SLNB) is a diagnostic technique of choice in patients with thick melanomas. However, there is not enough data on its safety in pregnant patients. We present a 29 years-old pregnant woman with a nodular melanoma (Breslow = 12 mm) diagnosed in the second trimester of gestation. We performed the SLNB in the 28 weeks of pregnancy and no adverse maternal-fetal effects were observed. The SLNB is currently not a contraindication during pregnancy, but as in any medical procedure, the decision must take into consideration the overall risk-benefit balance (AU)

Lichen sclerosus and squamous cell carcinoma.

Lichen sclerosus is a chronic inflammatory disease that can progress to malignancy. The literature indicates an association with anogenital squamous cell carcinoma and verrucous carcinoma. Two pathogenic pathways, differentiated vulvar and penile intraepithelial neoplasias, which have recently been described in relation to squamous cell carcinoma, are both highly associated with genital lichen sclerosus independently of human papilloma virus (HPV) infection. Furthermore, tumor-promoting molecular changes unrelated to HPV infection have been demonstrated and may explain the malignant potential of lichen sclerosus. The possible relationship between HPV and genital lichen sclerosus currently remains open to discussion, and the prognostic importance of the overlapping of these 2 diseases is still unclear. This review considers the relationship between lichen sclerosus and squamous cell and verrucous carcinomas, the possible oncogenic mechanisms involved, and their possible association with HPV infection.

Liquen escleroso y carcinoma escamoso / Lichen Sclerosus and Squamous Cell Carcinoma

El liquen escleroso (LE) es una enfermedad inflamatoria crónica con un potencial maligno conocido. En la literatura se recogen datos de su asociación tanto con el carcinoma epidermoide (CE) como con el carcinoma verrucoso de localización anogenital. Recientemente se han descrito dos modalidades de neoplasias intraepiteliales de vulva y pene, el Vulva Intraepithelial Neoplasia (Neoplasia Intraepitelial Vulvar, [VIN]) y el Penile Intraepithelial Neoplasia (Neoplasia Intraepitelial de Pene, [PIN]) diferenciados, relacionadas con el CE genital. Ambas son entidades altamente ligadas al LE genital e independientes de la infección por el virus del papiloma humano (VPH). Además, se han demostrado alteraciones moleculares oncogénicas independientes de la infección por VPH que podrían explicar el potencial maligno del LE por sí mismo. La posible relación entre el VPH y el LE genital sigue siendo un tema controvertido en el momento actual, y se desconoce la implicación pronóstica cuando coexisten ambas entidades. En el presente artículo revisaremos la relación del LE con el carcinoma epidermoide y el carcinoma verrucoso, los mecanismos oncogénicos implicados, así como su posible asociación con el VPH (AU)

Lichen sclerosus is a chronic inflammatory disease that can progress to malignancy. The literature indicates an association with anogenital squamous cell carcinoma and verrucous carcinoma. Two pathogenic pathways, differentiated vulvar and penile intraepithelial neoplasias, which have recently been described in relation to squamous cell carcinoma, are both highly associated with genital lichen sclerosus independently of human papilloma virus (HPV) infection. Furthermore, tumor-promoting molecular changes unrelated to HPV infection have been demonstrated and may explain the malignant potential of lichen sclerosus. The possible relationship between HPV and genital lichen sclerosus currently remains open to discussion, and the prognostic importance of the overlapping of these 2 diseases is still unclear. This review considers the relationship between lichen sclerosus and squamous cell and verrucous carcinomas, the possible oncogenic mechanisms involved, and their possible association with HPV infection (AU)

Squamous cell carcinoma of the lip. A retrospective study of 146 patients.

BACKGROUND: Squamous cell carcinoma of the lip (SCCL) accounts for 90% of all tumours of the oral cavity. We present a series of 146 patients with SCCL studied in our hospital. OBJECTIVE: To evaluate and identify the primary tumour parameters related to local and lymph node recurrence. METHODS: We retrospectively analysed the clinical characteristics, surgical procedures and tumour recurrences of the 146 patients diagnosed with SCCL in Hospital Universitario Fundación Alcorcón (Spain). RESULTS: A total of 122 of the 146 patients (91.7%) showed tumour stage ≤ T1N0M0 at diagnosis, and 11 (8.3%) showed stage >T1N0M0. Local recurrences were observed in 11 of the 146 patients (7.5%), and five patients (3.4%) developed lymph node metastases during follow-up. Kaplan-Meier survival analysis showed an increased tumour size to imply a greater risk of local recurrence (P = 0.025). The probability of local recurrence over the 24 months of follow-up was 1% for tumour stages ≤ T1N0M0 and 20% for stages ≥ T1N0M0. There appears to be a greater tendency towards local relapse in male patients, in smokers, patients living in rural areas, in lower lip tumours and in those patients showing infiltration at physical exploration. Eleven patients (8%) died during follow-up, although in only two of them (18%), SCCL was the cause of death. CONCLUSION: The low tumour stage of our patients may explain the few local and lymph node disease recurrences seen in our study. We have shown tumour size to be directly related to the probability of local recurrence.

[Lichen sclerosus and squamous cell carcinoma]. / Liquen escleroso y carcinoma escamoso.

Lichen sclerosus is a chronic inflammatory disease that can progress to malignancy. The literature indicates an association with anogenital squamous cell carcinoma and verrucous carcinoma. Two pathogenic pathways, differentiated vulvar and penile intraepithelial neoplasias, which have recently been described in relation to squamous cell carcinoma, are both highly associated with genital lichen sclerosus independently of human papilloma virus (HPV) infection. Furthermore, tumor-promoting molecular changes unrelated to HPV infection have been demonstrated and may explain the malignant potential of lichen sclerosus. The possible relationship between HPV and genital lichen sclerosus currently remains open to discussion, and the prognostic importance of the overlapping of these 2 diseases is still unclear. This review considers the relationship between lichen sclerosus and squamous cell and verrucous carcinomas, the possible oncogenic mechanisms involved, and their possible association with HPV infection.

Tratamiento de malformaciones vasculares de mucosas con láser Nd: YAG de pulso variable / Treatment of Mucosal Vascular Malformations With Variable-Pulse Neodymium: Yttrium-Aluminum-Garnet Laser

Introducción y objetivos: El tratamiento de las lesiones vasculares en las mucosas supone un reto para el dermatólogo; diversos tratamientos han probado su eficacia: cirugía, escleroterapia, inyección intralesional de corticoides, transfixión y láser. El objetivo de este trabajo es describir los resultados del tratamiento de 11 malformaciones y ectasias venosas de mucosas con láser Nd:YAG. Pacientes y métodos: Presentamos 11 pacientes, 8 mujeres y tres varones con diferentes dilataciones y malformaciones venosas en la mucosa oral y genital tratados con láser Nd:YAG de pulso variable durante un año en nuestro centro. Resultados: Los parámetros utilizados fueron una longitud de onda de 1.064nm, una fluencia entre 100 y 200J/cm2, un tamaño de campo entre 3 y 5mm y un tiempo de pulso entre 30 y 65ms. El tamaño de las lesiones era de 5mm la menor de ellas y de 30mm la mayor. En todos ellos se produjo un aclaramiento del 75-100% de las lesiones con una sola sesión, con excelente cicatrización y sin efectos adversos significativos. Conclusiones: Para el tratamiento de lesiones vasculares en las mucosas el láser Nd:YAG se posiciona como un tratamiento de elección por su eficacia y facilidad de uso, aunque son necesarios futuros estudios comparativos que demuestren su superioridad frente a otras técnicas (AU)

Background and objectives: Treatment of mucosal vascular lesions is a challenge for dermatologists, although various approaches have proven efficacy, including surgery, sclerotherapy, intralesional injection of corticosteroids, transfixion, and laser therapy. The aim of this study was to describe the results of treatment with neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in 11 patients with venous malformations and varicosities. Patients and methods: We describe the use of variable-pulse Nd:YAG to treat venous malformations or varicosities in the oral or genital mucosa of 8 women and 3 men seen in our hospital over a 1-year period. Results: The following laser parameters were used: wavelength, 1064nm; fluence, 100 to 200J/cm2; spot diameter, 3 to 5mm; and pulse duration, 30 to 65ms. The size of the lesions ranged from 5 to 30mm. In all cases, a clearance of 75% to 100% was achieved in a single session with excellent healing and no significant side effects. Conclusions: Given its efficacy and ease of use, Nd:YAG may become a treatment of choice for mucosal vascular lesions. Comparative studies are now required to assess its potential superiority over other treatment options (AU)

[Treatment of mucosal vascular malformations with variable-pulse neodymium:yttrium-aluminum-garnet laser]. / Tratamiento de malformaciones vasculares de mucosas con láser Nd:YAG de pulso variable.

BACKGROUND AND OBJECTIVES: Treatment of mucosal vascular lesions is a challenge for dermatologists, although various approaches have proven efficacy, including surgery, sclerotherapy, intralesional injection of corticosteroids, transfixion, and laser therapy. The aim of this study was to describe the results of treatment with neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in 11 patients with venous malformations and varicosities. PATIENTS AND METHODS: We describe the use of variable-pulse Nd:YAG to treat venous malformations or varicosities in the oral or genital mucosa of 8 women and 3 men seen in our hospital over a 1-year period. RESULTS: The following laser parameters were used: wavelength, 1064 nm; fluence, 100 to 200J/cm(2); spot diameter, 3 to 5mm; and pulse duration, 30 to 65 ms. The size of the lesions ranged from 5 to 30 mm. In all cases, a clearance of 75% to 100% was achieved in a single session with excellent healing and no significant side effects. CONCLUSIONS: Given its efficacy and ease of use, Nd:YAG may become a treatment of choice for mucosal vascular lesions. Comparative studies are now required to assess its potential superiority over other treatment options.