Oral cavity colon adenocarcinoma metastases: case report with surgical approach and review of more than 30 years literature.

INTRODUCTION: Metastatic oral tumours are rare, contributing to 1% of all malignant oral cavity tumours. CASE REPORT: We report the case of a 59-year-old man with colon cancer at an advanced disease stage, with progression to the peritoneum and maxillary gingiva. Palliative surgery was indicated to improve the patient's quality of life. DISCUSSION: In a review of the literature, we compiled a list of 27 cases (including the present case) reflecting some 30 years of literature on oral cavity metastatic disease originating in colon cancer. CONCLUSION: Oral cavity metastasis should be taken into account in the differential diagnosis of a synchronous or metachronous oral cavity lesion. The therapeutic goal should include palliative alternatives when necessary. Intraoral reconstruction using local flaps may be a simple and reliable palliative resection option aimed at improving the patient's quality of life.

How does drought impact burned area in Mediterranean vegetation communities?

Drought and water stress are widely known to influence fuel moisture content and flammability, although differences do exist according to the response mechanisms and adaptive traits displayed by plant communities. In the Mediterranean basin, as a result of climate change, extreme drought events are expected to become more frequent and severe, envisaging episodes of increased fire risk. In this paper, we expand the scale of analysis on how does drought influence wildfire incidence exploring the joint influence on burned area of drought duration, magnitude and temporal distribution, and the affected vegetation communities (VCs). We leveraged the weekly adaptation of the Standardized Precipitation Evapotranspiration Index (SPEI) and historical fire perimeters to model complex interactions between drought and burned area mediated by VC composition and structure. We applied multivariate factor analysis (multi-group Principal Component Analysis) and non-parametric mixed regression models (GAMM) to a set of 1-to-48 weeks SPEI and 10 dominant VCs. We detected a significant influence of drought events (negative SPEI) on burned area, although differences in terms of seasonal distribution and VC were observed. Drought played a major role in explaining burned area in late spring and autumn by altering the usual positive rainfall-evapotranspiration balance, suggesting a potential lengthening of the fire season given the projected drought trends in the next decades.

Improving fire season definition by optimized temporal modelling of daily human-caused ignitions.

Wildfire suppression management is usually based on fast control of all ignitions, especially in highly populated countries with pervasive values-at-risk. To minimize values-at-risk loss by improving response time of suppression resources it is necessary to anticipate ignitions, which are mainly caused by people. Previous studies have found that human-ignition patterns change spatially and temporally depending on socio-economic activities, hence, the deployment of suppression resources along the year should consider these patterns. However, full suppression capacity is operational only within legally established fire seasons, driven by past events and budgets, which limits response capacity and increases damages out of them. The aim of this study was to assess the temporal definition of fire seasons from the perspective of human-ignition patterns for the case study of Spain, where people cause over 95% of fires. Humans engage in activities that use fire as a tool in certain periods within a year, and in locations linked to specific spatial factors. Geographic variables (population, infrastructures, physiography and land uses) were used as explanatory variables for human-ignition patterns. The changing influence of these geographic variables on occurrence along the year was analysed with day-by-day logistic regression models. Daily models were built for all the municipal units in the two climatic regions in Spain (Atlantic and Mediterranean Spain) from 2002 to 2014, and similar models were grouped within continuous periods, designated as ignition-based seasons. We found three ignition-based seasons in the Mediterranean region and five in the Atlantic zones, not coincidental with calendar seasons, but with a high degree of agreement with current legally designated operational fire seasons. Our results suggest that an additional late-winter-early-spring fire season in the Mediterranean area and the extension of this same season in the Atlantic zone should be re-considered for operational purposes in the future.

Caso clínico: utilización clínica de aloinjerto de piel humana con pomada de tacrolimus / Case report: clinical use of skin human allograft with topical tacrolimus ointment

Exponemos el caso de una mujer de 52 años que presenta dos úlceras en su pierna derecha secundarias a traumatismo. La paciente había sufrido un transplante renal y recibía tratamiento inmunosupresor por vía sistémica: ciclosporina y corticoides. Debido a su extrema gravedad se rechazó el tratamiento quirúrgico de las úlceras, por lo que tras revisar la literatura decidimos realizar la cobertura de las mismas con aloinjertos de piel criopreservada más pomada de Tacrolimus al 0.3%. El injerto de la úlcera de mayor tamaño se rechazó de forma parcial a las dos semanas, siendo necesarios cultivos de queratinocitos hasta lograr una epitelización total. Sin embargo, en la úlcera de menor tamaño el aloinjerto no fue rechazado, obteniéndose un 100% de supervivencia. En la actualidad la paciente lleva 18 meses de evolución sin ningún signo de rechazo (AU)

We report a case of a 52 year-old-woman with two traumatic skin ulcers on his right leg. The patient was kidney grafted with immunosuppressor sistemic treatment: ciclosporine and corticoids. This patient was critical, so surgical treatment was refused. After reviewing literature we decided to cover the ulcers with cryopreserved allograft skin with Tacrolimus ointment in 0.3 % strength. The big ulcer skin graft was rejected 2 weeks later, being necessary keratinocytes cultures to heal. But in the small ulcer, the allograft suffered no rejection at all, with a 100% survival. At this moment the patient is 18 months postoperative with no signs of allograft rejection (AU)

Reconstrucción de la zona Donante del Colgajo de Antebrazo Libre radial mednate Colgajo de avance – rotación cubita / Reconstruction of the Radial Forearm Free Flap with Ulnar Rotation

En la clínica diaria, ha sido criticado en muchas ocasiones por las potenciales complicaciones de su zona donante. Estas son: fallo del injerto de piel, retardo de cicatrización, exposiciones y adherencias tendinosas. Describimos un método rápido y seguro para el cierre del defecto con un colgajo cubital de avance ­ rotación. Lo hemos usado en 9 pacientes, sobre 66 colgajos radiales realizados, para reconstrucción faringoesofágica, postmaxilectomía y paladar. En todos los casos los tendones flexores en la muñeca han sido satisfactoriamente cubiertos. Gracias a la movilización precoz que permite esta técnica, no ha habido rigideces ni adherencias tendinosas, con balance articular normal en todos los pacientes. Como complicaciones puede haber linfedema temporal y alteraciones sensitivas en la superficie volar de antebrazo. El cierre de la zona donante del colgajo "chino" libre mediante colgajo cubital resuelve satisfactoriamente las potenciales complicaciones de rigideces, exposición tendinosa y disfunción manual que se pueden dar con otras técnicas de cobertura (AU)

Been criticized for the poor quelity of its donor site. Potencial problems include skin graft failure, deleyed wound healing, and Rendon exposure and adhesion. A quick and safe method of closure of the large donor site defect creared by the harvest of a RFFF for head and neck reconstruction is described, This flap has been used in 9 of 66 patients who underwent RFFF reconstruction of the pharyngoesophagus, posnnaxillectomy and palate. In all cases the flexor tendons at the wrist were successfully covered. All patients obtained a full range of motion in the wrist and hand without tendon adhesión. The procedure required significant skin mobilization with the potencial disadvantages of denervation of the volar forearm and temporary Iymphedema, Closure of the RFFF donar site with an ulnar rotation­advancement flap can avoid problerns of delayed healing, tendon adhesion, and wrist stiffness (AU)

Tumores Oseos Benignos en Cirugía de Mano / Bone tumors in hand surgery

Los tumores de origen óseo a nivel de la mano son bastante frecuentes. El propósito de este trabajo es exponer nuestra experiencia en el diagnóstico y tratamiento de los mismos. Se presenta una serie de 73 pacientes con el diagnóstico de tumores de origen óseo de naturaleza benigna localizados en la mano y los dedos, en el periodo de tiempo comprendido entre los años 1985 y 2000, ambos inclusive (AU)

Bone tumors are relatively common at hand. The purpose of this arride is to report our experience in the diagnosis and treatment of those tumors.We present 73 cases ofbenign bone rumors localizated at hand and fingers over the period from 1985 to 2000 ( both years included) (AU)