Modified Lip Revision Surgery for the Severe Whistle Lip Deformity in Bilateral Cleft Lip.

PURPOSE: Whistle deformity is a sequela of primary surgical repair of the bilateral cleft lip that leads to a vertical tissue deficiency and a nonfunctional orbicularis oris muscle in the medial portion of the upper lip. This sequel is significantly limiting functionally and esthetically. We propose a complete labial revision with a secondary cheiloplasty of Mulliken and a submucosal inferiorly based flap in the central tubercle to increase the volume at this usually deficient area. METHODS: We present our series of 9 patients with whistle deformity who underwent our modified technique. Width and length lip measurements were analyzed pre- and postoperatively. RESULTS: There was a significant decrease in the width of the philtrum (mean 18.7% and 37% measured at the columella base and Cupid's apexes, respectively), an increase in the labial length (mean 11.2%), and improvement of the shape and volume of the vermilion in its middle third. All patients reported a very good to excellent improvement in the function and shape of their lips. CONCLUSIONS: The addition to a complete revision cheiloplasty of our inferiorly based submucosal flap technique solved in a single operation the function of the orbicularis oris and the normal labial anatomy with good functional outcomes in all cases and improved esthetic results.

Hipotermia inducida en el tratamiento del ictus isquémico. Revisión sistemática y metanálisis / Therapeutic hypothermia for ischemic stroke: a systematic review and meta-analysis

Se presenta una revisión sistemática para evaluar la eficacia y seguridad de la hipotermia inducida en el ictus isquémico. Se consultaron Medline, Embase y Web of Science, además de otras fuentes de información, obteniendo 534 publicaciones potencialmente relevantes. Se seleccionaron 6 trabajos, 5 ensayos clínicos y uno cuasi-experimental que presentaron resultados de mortalidad, función neurológica o seguridad. El análisis crítico, realizado según las escalas CASPe y Jadad, mostró bajo riesgo de sesgo en los resultados, pero limitaciones en la validez externa. El metanálisis de los 6 estudios evidenció una tendencia hacia una mayor mortalidad entre los pacientes con hipotermia inducida(RR = 1,67; IC95%: 0,95-2,91), sin diferencias entre grupos en la evolución de la función neurológica. El porcentaje de eventos adversos fue mayor en el grupo experimental. En conclusión, no se encontraron resultados favorables en la eficacia y seguridad de la inducción de hipotermia para esta indicación (AU)

This systematic review to assess the efficacy and safety of therapeutic hypothermia to treat ischemic stroke was based on searches of the MEDLINE, Embase, and Web of Science databases and other sources. A total of 534 potentially relevant publications were found. Six studies (5 clinical trials and 1 quasi-experimental study) that reported results for mortality, neurologic function, or safety were reviewed. The Critical Appraisal Skills Programme tools (Spanish versions) and the Jadad scoring system were used to guide critical analysis. The selected articles proved to have low risk of bias butlimitations on external validity. Meta-analysis revealed a tendency to higher mortality for patients undergoing induced hypothermia (relative risk, 1.67; 95% confidence interval, 0.95-2.91) and no significant differences for neurologic function between treatment groups. The experimental group had a higher percentage of adverse events. Our conclusion is that the evidence does not support the efficacy and safety of therapeutic induction of hypothermia to treat ischemic stroke (AU)

Frontal sinus obliteration after trauma: analysis of bone regeneration for two selected methods.

We present a prospective randomized experimental study comparing bone regeneration obtained in 60 post-traumatic frontal sinuses obliterated with either calvarial bone dust (n=30, group I) or calvarial bone and demineralized bone matrix (DBM; n=30, group II). Radiological follow-up included high-resolution computed tomography with quantitative micro-density analysis in Hounsfield units (HU), together with a volumetric evaluation of the ossification at 6 and 24 months after surgical treatment. Epidemiological information and potential drawbacks were analysed. Bone volume and density data (HU) for the regenerated areas were subjected to statistical analysis at 6 and 24 months for both groups. Results were compared with reference values obtained from frontal and temporal bone in every patient. Complications developed for 10% of operated sinuses. The resulting bone formation (HU) in group I patients was significantly better than that obtained in group II. Ossification progressed in a statistically significant manner in both groups when compared at 6 and 24 months postoperatively. The use of DBM as a biomaterial associated with calvarial bone dust for sinus obliteration shows long-term safe results, similar to autogenous bone, but with a lower final bone density.

[Dermatoses in pregnancy. Presentation of a case]. / Dermatosis del embarazo. A propósito de un caso.

Family physicians usually follow up pregnancies in which no special incidences are expected to occur. Cutaneous pruritus is a common symptom in pregnant women, on most occasions without further consequences. However, noteworthy is a group of very rare pathologies known as pregnancy dermatoses, some of which may have potentially severe complications, mainly for the fetus and the pregnancy outcome, and also, to a lesser degree, for the mothers and other future pregnancies. It is essential to know how to manage the pruritus, and how to take an adequate clinical history in order to diagnose these severe conditions. The case of a pregnant woman who consulted for pruriginous dermatoses (pemphigoid gestationis) is presented to illustrate this topic. A description of the diagnostic process, differential diagnosis, treatment and outcome, is included.

Postraumatic frontal sinus obliteration with calvarial bone dust and demineralized bone matrix: a long term prospective study and literature review.

Defining the ideal material for frontal sinus obliteration remains controversial. Autogenous cancellous bone is effective because of its biological properties: it undergoes fast revascularization acting as an active scaffold for bone healing, but is linked to additional donor site morbidity. Bone dust harvesting from the skull surface produces no sequelae but availability is limited. Many efforts have been made to overcome these drawbacks, and an ideal bone substitute sought. Demineralized Bone Matrix (DBX; Musculoskeletal Transplant Foundation, Edison, NJ, USA) is a commercially available product composed of demineralized bone particles reduced after proper processing of human bone in combination with sodium hyaluronate. It generates an osteoconductive surface and it is also a source of osteoinductive factors. Radiological follow-up using computed tomography is a very reliable method of following-up ossification and detecting the early signs of possible complications. The authors present their clinical series of postraumatic frontal sinus obliteration using a mixture of calvarial bone dust and DBX shell, with long-term radiological monitoring. The technique was demonstrated to be effective, reliable, stable in the long term and associated with minimal morbidity.

[Subcranial approach. Technical aspects and application in craneofacial traumatic pathology]. / Abordaje subcraneal. Consideraciones técnicas y aplicaciones en patología traumática craneofacial.

UNLABELLED: INTRODUCTION. Suitable approach to anterior cranial base is mandatory to get global satisfactory surgical outcomes. In the beginning it depends on the exactly anatomical position into the cranial fossa and tridimensional spread. Surgical approach implies the evaluation of the patient status, reconstructive options and surgical team experience. Subcranial approach is a safe surgical option in the treatment of frontal traumatic pathology. It allows adequate management of frontal sinus and its obliteration with easy radiologic follow-up. OBJECTIVES. To analyse subcranial approach as a treatment option in traumatic pathology of the anterior cranial base and to present our review of subcranial approach. Valuation of surgical technical aspects. and related complications. MATERIAL AND METHODS. Retrospective analysis of 50 patients operated (subcranial approach) from January 2004 to December 2009 by Maxillofacial and Neurosurgery Department, University Hospital 12 de Octubre, Madrid. 34 patients presented craniofacial trauma or postraumatic sequela and 16 patients presented craniofacial tumours. Oncological cases offers experience to discuss surgical aspects. Results are related to traumatic pathology and sequela. Main items review were surgical technique including materials used for frontal sinus obliteration, associated traumatic pathology, hospital stay and complication rates. RESULTS. No perioperatory mortality was found. Patients´ age ranged 15-76 years. 22 were male and 12 female. Description of frontal fractures involved. Frontal sinus obliteration was made with calvarian bone dust. Morbidity rates was 29% in posttraumatic patients. Mean hospital stay was 13 days. CONCLUSIONS: Subcranial approach to anterior cranial base is a safe and reliable treatment option to the pathology of this area. It allows outstanding exposure of the nasal cavity, orbits, ethmoidal cells-sphenoid sinus and great access to anterior fossa without frontal lobe retraction.

Abordaje subcraneal. Consideraciones técnicas y aplicaciones en patología traumática craneofacial / Subcranial approach. Technical aspects and application in craneofacial traumatic pathology

Introducción. La elección del abordaje más adecuado a la base craneal en cada caso es esencial para la obtención de resultados quirúrgicos globales satisfactorios. Inicialmente dependerá de la localización anatómica exacta de la lesión dentro de la base craneal y de su extensión tridimensional, así como de la naturaleza de la misma. Las opciones posibles deben ser depuradas finalmente en función del status global del paciente, planificación reconstructiva y experiencia del equipo quirúrgico. El abordaje subcraneal es una opción terapéutica segura en el tratamiento de la patología traumática frontal. Permite el manejo adecuado del seno frontal y su obliteración si es precisa, favoreciendo el seguimiento radiológico del mismo. Objetivos. Validar el abordaje subcraneal como vía adecuada de acceso en patología traumática de la base craneal anterior. Revisión de nuestra serie clínica. Valoración de aspectos técnicos quirúrgicos. Análisis de complicaciones. Material y métodos. Estudio retrospectivo de 50 pacientes intervenidos desde Enero de 2004 hasta Diciembre 2009 por el Servicio de Cirugía Maxilofacialy Servicio de Neurocirugía del Hospital Universitario 12 de Octubre (Madrid) mediante abordaje subcraneal. 34 pacientes presentaban traumatismos cráneo faciales o secuelas postraumáticas y 16 pacientes presentaban patología oncológica. Se enumeran los casos oncológicos como base de experiencia para la descripción de los aspectos técnicos. La casuística descrita se refiere a la patología traumática y sus secuelas. Los principales parámetros analizados fueron la técnica quirúrgica incluyendo el material de relleno para la obliteración del seno frontal, patología traumática asociada, estancia hospitalaria y tasa de complicaciones. Resultados. No existió mortalidad intra-postoperatoria inmediata. La edad varía entre los 15-76 años siendo 22 varones y 12 mujeres. Se describe el tipo de fracturas frontales (..) (AU)

Introduction. Suitable approach to anterior cranial base is mandatory to get global satisfactory surgical outcomes. In the beginning it depends on the exactly anatomical position into the cranial fossa and tridimensional spread. Surgical approach implies the evaluation of the patient status, reconstructive options and surgicalteam experience. Subcranial approach is a safe surgicaloption in the treatment of frontal traumatic pathology. It allows adequate management of frontal sinus and its obliteration with easy radiologic follow-up. Objectives. To analyse subcranial approach as atreatment option in traumatic pathology of the anteriorcranial base and to present our review of subcranial approach. Valuation of surgical technical aspects. andrelated complications. Material and methods. Retrospective analysis of 50 patients operated (subcranial approach) from January 2004 to December 2009 by Maxillofacial and (..) (AU)

Olive oil and health: summary of the II international conference on olive oil and health consensus report, Jaén and Córdoba (Spain) 2008.

Olive oil (OO) is the most representative food of the traditional Mediterranean Diet (MedDiet). Increasing evidence suggests that monounsaturated fatty acids (MUFA) as a nutrient, OO as a food, and the MedDiet as a food pattern are associated with a decreased risk of cardiovascular disease, obesity, metabolic syndrome, type 2 diabetes and hypertension. A MedDiet rich in OO and OO per se has been shown to improve cardiovascular risk factors, such as lipid profiles, blood pressure, postprandial hyperlipidemia, endothelial dysfunction, oxidative stress, and antithrombotic profiles. Some of these beneficial effects can be attributed to the OO minor components. Therefore, the definition of the MedDiet should include OO. Phenolic compounds in OO have shown antioxidant and anti-inflammatory properties, prevent lipoperoxidation, induce favorable changes of lipid profile, improve endothelial function, and disclose antithrombotic properties. Observational studies from Mediterranean cohorts have suggested that dietary MUFA may be protective against age-related cognitive decline and Alzheimer's disease. Recent studies consistently support the concept that the OO-rich MedDiet is compatible with healthier aging and increased longevity. In countries where the population adheres to the MedDiet, such as Spain, Greece and Italy, and OO is the principal source of fat, rates of cancer incidence are lower than in northern European countries. Experimental and human cellular studies have provided new evidence on the potential protective effect of OO on cancer. Furthermore, results of case-control and cohort studies suggest that MUFA intake including OO is associated with a reduction in cancer risk (mainly breast, colorectal and prostate cancers).

Reconstrucción de defectos torácicos de espesor total. Presentación de 8 casos de especial complejidad / Reconstruction of full thickness defects on the chest wall. Presentation of 8 complex cases

Las lesiones de gran tamaño en el tórax, requieren casi siempre para su reparación plastias complejas, que en algunos casos han de combinar el uso de tejidos autólogos y/o materiales sintéticos. Por tanto, la reconstrucción de la pared torácica supone un desafío desde el punto de vista reconstructivo en el que es fundamental el papel de los cirujanos plásticos. Los grandes defectos torácicos suelen ser secundarios a exéresis tumoral (tumores parietales de origen primario o secundario), infecciones, radionecrosis, traumatismos y malformaciones congénitas. Si bien los principios de la reconstrucción del tórax exigen una escisión amplia de la lesión, desbridamiento de los tejidos desvitalizados o irradiados y control de la infección local, dichas actuaciones no podrían abordarse con seguridad si no dispusiéramos de un amplio arsenal de técnicas reconstructivas, capaces de aportar tejidos sanos y bien vascularizados o voluminosos y amplios en superficie, junto con soportes rígidos mediante materiales aloplásticos. Gracias a estos avances, en la mayoría de los casos conseguimos el objetivo con sólo una intervención, cuando hace unos años necesitábamos varios procedimientos quirúrgicos. Presentamos una muestra variada de la experiencia de nuestro Servicio en el tratamiento de grandes defectos del tórax, en el que resumimos las distintas posibilidades que podemos encontrar en la práctica clínica diaria, y las soluciones que mejor se adaptan a las mismas (AU)

Reconstruction of full thickness defects on the chest wall is controversial and require the use of complex techniques that combine autologous tissue and/or alloplastic materials. Thus it is a challenge for plastic surgeons since it needs a suitable and functional reconstruction. The aethiology for these defects include tumoral surgery (primary wall tumors, or recurrences or metastasis), infections, radiation injury, trauma and congenital defects. Otherwise, first surgical treatment require wide resection of the tumor or ischaemic or radiated tissue and control of the infection, but these principles could not be safely faced without the multiple reconstructive techniques that can afford the use of well vascularized, large or bulky tissues to reconstruct this anatomical area in combination with alloplastic materials, in order to give a solid stabilization. Thanks to these advances, we can actually perform our objectives in only one procedure. We present a selection of complex chest wall defects tha thave been operated in the last years by our surgical team. We will describe the solutions and the results obtained by means of a variety of possible flaps and synthetic materials (AU)

Sarna neonatal / Neonatal scabies

No disponible

High-power ultrasound in olive paste pretreatment. Effect on process yield and virgin olive oil characteristics.

The effect of high-power ultrasound on olive paste, on laboratory thermo-mixing operations for virgin olive oil extraction, has been studied. Direct sonication by an ultrasound probe horn (105 W cm(-2) and 24 kHz) and indirect sonication with an ultrasound-cleaning bath (150 W and 25 kHz) were applied and their effects compared with the conventional thermal treatment. A quick-heating of olive paste, from ambient (12-20 degrees C) to optimal temperature conditions (28-30 degrees C), and an oil extractability improvement were observed when applying sonication. Better extractability was obtained by direct sonication for high moisture olives (>50%) whereas indirect sonication gave greater extractability for low moisture olive fruits (<50%). Optimal application of ultrasound was achieved with direct sonication for 4 min at the beginning of paste malaxation and with indirect sonication during the malaxation time. Effect of high-power ultrasound on oil quality parameters and nutritional and sensory characteristics were studied. Changes in quality parameters (free acidity value, peroxide value, K270 and K232) were not found, however significant effects on the levels of bitterness, polyphenols, tocopherols (vitamin E), chlorophyll and carotenoids were observed. Oils from sonicated pastes showed lower bitterness and higher content of tocopherols, chlorophylls and carotenoids. Related to sensory characteristics, off-flavour volatiles were not detected in oils from sonication treatments. Total peak areas of volatiles and the ratio hexanal/E-2-hexenal, as determined by SPME analysis, were lower than non-sonicated reference oils; sensory evaluation by panel test showed higher intensity of positive attributes and lesser of negative characteristics than those untreated.

Low-cholesterol and high-fat diets reduce atherosclerotic lesion development in ApoE-knockout mice.

We have investigated the effect of most common oils used in human nutrition on the development of atherosclerosis in apoE-knockout mice. Seven groups of animals, separated according to sex, were fed for 10 weeks either chow diet or the chow diet 10% (wt/wt) enriched with different oils (palm, coconut, 2 types of olive oil, and 2 types of sunflower oil) without addition of cholesterol. At the end of this period, plasma lipid parameters were measured and vascular lesions scored. None of the diets induced changes in plasma cholesterol concentrations, whereas plasma triglycerides were uniformly reduced in all diet groups. Some diets caused significant reductions in the size of atherosclerotic lesions in males and others in females; males responded most to sunflower oils and females to palm oil and one olive oil (II). The lesion reduction in males consuming sunflower oils was associated with the decrease of triglycerides in triglyceride-rich lipoproteins, whereas the decrease in females consuming olive oil II or palm oil was accompanied by an increase in plasma apoA-I. The increase in plasma apoA-I in the latter condition, is mainly due to overexpression of hepatic message elicited by a mechanism independent of apoE ligand. The data suggest that the different diets modulate lesion development in a gender specific manner and by different mechanisms and that the development of atherosclerosis, due to genetic deficiencies, may be modulated by nutritional maneuvers that may be implemented in human nutrition.

[Primary testicular lymphoma. Report of two cases]. / Linfoma testicular primario. Presentación de dos casos.

Primary testicular lymphoma (PTL) is the most frequently diagnosed testicular tumor in men over 60 years, in spite of this circumstance it is a rare process. Two cases of PTL are reported, the first one in a child and the second in an adult. Both cases were intermediate grade lymphoma and had low stage (IEA), presenting initially as an enlargement of the testicle as the only symptom, the second case presented involvement by contiguity of the abdominal muscles. Immunohistological markers showed T nature in the first case, and B in the second. The treatment applied in both cases was orchiectomy and systemic chemotherapy using COP-BLAM/IMVP-16, in the child prophylaxis of the central nervous system using methotrexate was made. Response to treatment was good, the first patient achieved complete remission and his survival at present is 24 months, the second patient died 5 month after diagnosis due to stroke without having completed chemotherapy but with an important reduction of the tumoral mass. A review of the literature on clinical, diagnostic and therapeutic issues is made.