Septocutaneous gluteal artery perforator flap in breast reconstruction: An insight into the related anatomy and preoperative imaging.

BACKGROUND: Although without a widespread popularity, the septocutaneous gluteal artery perforator flap (sc-GAP) can be an excellent choice in breast reconstruction. The purpose of the article is to further study the preoperative imaging anatomy and surgical technique for a safe operation. PATIENTS AND METHODS: A clinical experience in four unilateral breast reconstructions is reported, and an analysis is made of the computed tomography angiography (CTA) variables (36 studies/72 sides) that might define the microsurgical consistency and reliability of the technique. RESULTS: After a careful preoperative imaging evaluation, the surgical operation confirmed a predictable, although not straightforward, anatomy. All the flaps were raised in the supine position. With a remarkably quick postoperative recovery, the resulting scar was well hidden and did not significantly distort the gluteal aesthetics although contralateral contouring liposuction might be desirable in unilateral cases. Good aesthetic results were obtained in all the patients. In the evaluation of the CTA studies, a right/left septocutaneous perforator arising from the superficial branch of the superior gluteal artery could be found in 80.6% of the patients, with a few patients having 2-3 perforators on one side. Although with an overall suitable pedicle length (mean 7.4 cm), the arterial diameter at the suture site was found to be small (mean 1.6 mm). CONCLUSION: Given the adequate body habitus and reconstructive requirements, the sc-GAP can be a good choice even in large breasts. However, the technique requires the appropriate surgical expertise and mandates a thorough preoperative imaging evaluation that defines whether the technique should be done in a particular patient.

Angiotomografía computerizada, colgajos de perforante, cirujano y OsiriX / Computed tomography angiography, perforator flaps, surgeon and OsiriX

Desde la introducción de la transferencia cutánea basada en perforantes, la angiotomografía computerizada ha emergido como una técnica de gran valor en la planificación preoperatoria de los colgajos de perforante. Sin embargo, parece probable que el aprovechamiento de la técnica sea menor del deseable. Evaluamos, a través de la experiencia en 144 pacientes, la utilidad del visor gratuito de imágenes DICOM OsiriX para Mac en la planificación preoperatoria de los colgajos de perforante con tres objetivos: 1) ampliarlos conocimientos actuales relacionados con la aplicación de la angiotomografía computerizada en la planificación preoperatoria de los colgajos de perforante, 2) evaluar la aplicación OsiriX en el post-procesamiento de imágenes en la planificación preoperatoria de colgajos de perforante y3) evaluar el rendimiento obtenible de la angiotomografía considerando que el postprocesamiento es realizado por un cirujano (no especialista en Radiodiagnóstico).La experiencia permite afirmar que el postprocesamiento de las imágenes DICOM por el cirujano con la aplicación Osirix permite habitualmente evaluar de manera adecuada diversas estructuras y parámetros de gran interés en la cirugía de colgajos de perforante: 1) arteria principal, origen de la perforante, 2) diámetro de arteria y vena/s en el hipotético sitio de anastomosis microquirúrgica, 3) recorrido y patrón de ramificación del pedículo del colgajo, 4) disposición de la perforante en la grasa subcutánea(teórico eje de diseño del colgajo), 5) medición del grosor cutáneo en el punto de perforación de la fascia profunda por la rama perforante (teórico grosor de colgajo), 6) medición de la distancia entre el punto de perforación de la fascia profunda por la rama perforante (..) (AU)

With the advent of perforator-based skin transfer, computed tomography angiography has emerged as an invaluable tool in the preoperative planning of perforator flaps. But most likely, the exploitation of the technique is less than desirable. Through our experience with 144 patients, we evaluate the use of the free DICOM viewer OsiriX for Mac in the preoperative planning of perforator flaps with three objectives: 1) increase the present knowledge related with the preoperative planning of perforator flaps with computed tomography angiography, 2) evaluate the OsiriX application in the image post-processing of perforator flaps and 3) evaluate the performance of the procedure when performed by a surgeon (not specialized in Radiology).The experience has shown that the image post-processing performed by the surgeon with the OsiriX application usually allows an adequate evaluation of different structures and parameters of great preoperative interest in perforator flap surgery: 1) source artery, 2) diameter of artery and vein/s at the hypothetical site of microsurgical anastomoses, 3) course and branching pattern of the flap pedicle, 4) perforator course in the subcutaneous fat (theoretical flap axis), 5) measurement of the skin and fat where the perforator pierces the deep fascia (theoretical flap thickness ), 6) measurement of the (..)(AU)

[Acute tryptophan depletion in eating disorders]. / Depleción aguda de triptófano en trastornos de la conducta alimentaria.

INTRODUCTION: This work describes the rational bases justifying the use of acute tryptophan depletion technique in eating disorders (ED) and the methods and design used in our studies. Tryptophan depletion technique has been described and used in previous studies safely and makes it possible to evaluate the brain serotonin activity. Therefore it is used in the investigation of hypotheses on serotonergic deficiency in eating disorders. Furthermore, and given the relationship of the dysfunctions of serotonin activity with impulsive symptoms, the technique may be useful in biological differentiation of different subtypes, that is restrictive and bulimic, of ED. METHODS: 57 female patients with DSM-IV eating disorders and 20 female controls were investigated with the tryptophan depletion test. A tryptophan-free amino acid solution was administered orally after a two-day low tryptophan diet to patients and controls. Free plasma tryptophan was measured at two and five hours following administration of the drink. Eating and emotional responses were measured with specific scales for five hours following the depletion. A study of the basic characteristics of the personality and impulsivity traits was also done. Relationship of the response to the test with the different clinical subtypes and with the temperamental and impulsive characteristics of the patients was studied. RESULTS: The test was effective in considerably reducing plasma tryptophan in five hours from baseline levels (76%) in the global sample. The test was well tolerated and no severe adverse effects were reported. Two patients withdrew from the test due to gastric intolerance. CONCLUSIONS: The tryptophan depletion test could be of value to study involvement of serotonin deficits in the symptomatology and pathophysiology of eating disorders.

Colgajo anterolateral de muslo. Nuestra experiencia con 32 casos / Anterolateral thigh flap. Our experience with 32 cases

Los colgajos basados en perforante han irrumpido con fuerza en los países occidentales en los últimos años. Entre ellos, el colgajo anterolateral de muslo ha demostrado su polivalencia, versatilidad y excelencia. Describimos nuestra experiencia con 32 colgajos (microquirúrgicos y pediculados) en reconstrucción de cabeza y cuello, miembro superior e inferior y área genitourinaria, a la vez que describimos diversos aspectos técnicos, causas potenciales de fracaso y cómo evitarlas (AU)

Perforator-based flaps have recently gained great popularity in western countries. The anterolateral thigh flap has proved unbeatable in terms of versatility and excellence. We describe our experience with 32 transfers (free and pedicled) performed in head and neck, upper and lower limbs and genital area, and describe different technical tips and pitfalls to prevent flap failure (AU)

Contenidos en As, Cd, Pb, Cu y Zn en músculo e hígado de liebres (Lepus europaea) capturadas en el Corredor Verde del Guadiamar / Contents in As, Cd, Pb, Cu and Zn in the muscle and liver of the mare (Lepus europaea) captured in the Guadiamar Green Corridor

Tras muestrear individuos de liebre en diversas zonas el Corredor Verde del Guadiamar, se procede a procesar muestras de tejidos de hígado y músculo para analizar sus contenidos en As, Cd, Pb, Cu y Zn, elementos químicos de especial significado ambiental, sobre todo en una zona de tradición minera, que además fue afectada por una catástrofe ambiental de gran magnitud por la rotura de una balsa de estériles (donde se acumulaban los restos del procesado del mineral) con altas concentraciones de metales pesados en forma de lodos y aguas contaminadas, en abril del año 1998. Los resultados muestran una situación de mejora ambiental y de normalidad si se comparan con los valores encontrados en bibliografía especializada y los animales empleados como control

After having collected samples of brown hares in several areas from the Guadiamar Green Corridor, the following step consisted of processing samples of both liver tissues and muscle so as to analyse their As, Cd, Pb, Cu and Zn constituents. These are chemical elements with a special environmental significance, especially in an area with mining tradition which was, in addition, affected by an important environmental disaster that took place in April 1998 as a result of the collapse of the retention wall of the talings dam, containing a high proportion of heavy metals in the form of sludge and contaminated water.The results indicate a situation of normality and even environmental improvement when compared with the results appearing in specialized reference literature and in the individuals used as control

Modality-specific effects of immediate word repetition: electrophysiological evidence.

Event-related potentials (ERPs) elicited by visually presented words were employed to investigate whether the neural correlates of repetition within- and across-modality differ when repetition is immediate, and the influence of explicit memory maximal. Relative to the ERPs elicited by first presentations, ERPs elicited by immediate, within-modality repetitions began to differ from approximately 200 ms post-stimulus onset. ERP repetition effects elicited by across-modality repetition did not onset until approximately 150 ms later. Within- and across-modality repetition effects were also dissociable neuroanatomically, exhibiting different scalp distributions. The findings support the proposal that the modality-sensitive component of visual word repetition effects operates at an early, pre-semantic processing stage.

[Nasal injuries. Retrospective study of 123 cases]. / Traumatismos nasales. Estudio retrospectivo sobre 123 casos.

A retrospective study was made of 123 cases of nose injury seen in our hospital. Clinical and diagnosis aspects useful for the management of these injuries are discussed. Local inflammation, nosebleed, and deformity were the most common clinical signs. Most injuries were closed and about 80% were fractures. Immediate reduction under local anesthesia was the preferred treatment. The literature was reviewed and the technique is described.

[The Alagille syndrome. Apropos 3 cases]. / Síndrome de Alagille. A propósito de tres casos.

The clinical, biochemical, and histopathological characteristics of three patients who had jaundice and other findings suggestive of the syndrome are reported. Studies showed the presence of hypoplasia of the intrahepatic biliary ducts associated with facial, vertebral, cardiovascular, and eye abnormalities and a delay in the weight-height development. This group of abnormalities establish the Alagille syndrome, an entity which has not, until now, been extensively studied in our country.

[Prominent ears. Correction using a modified Chongchet technique]. / Orejas prominentes. Correccion mediante la tecnica de Chongchet modificada.

The authors describe their experience with the correction of prominent ears using a modified Chongchet technique. This method is based on the investigations of GIBSON and DAVIS (1958), who showed the tendency of cartilage to warp when one surface is cut. The prominent ear is folded back to produce the desired antihelix fold, which is outlined with methylene blue. An elliptical piece of retroauricular skin is excised. An incision is made through the whole thickness of the cartilage, following the posterior marked linea of the new antihelical fold, from the superior crus to the tail of antihelix. The anterior surface of the cartilage is dissected from the skin. A series of parallel incisions are made through the taut outer layer of the future fold. The tension on that side is released, and therefore it will bend towards the opposite side. The antihelical fold is corrected. This method was used in 192 patients with prominent ears. The results were satisfactory, with a normal-looking fold of antihelix. No recurrence of the deformity was seen.

Effect of three dietary treatments upon the histopathology of jejunal biopsies of children with chronic diarrhea.

Thirty two children with chronic diarrhea of unknown etiology were prospectively investigated in a special hospitalization unit. They were all under 5 percentile for weight/height (NCHS). They had no edema and their age range was between three and eighteen months. The patients were given cow's milk and following the first jejunal biopsy they were fed one of three different diets as their only intake for a period of 15 days. The diets consisted of cow's milk and of two semi-elemental diets with different carbohydrate compositions. A second biopsy was taken at the conclusion of the specific diet. The jejunal biopsies were taken with a Crosby capsule just after the duodenal-jejunal junction and were analyzed by light microscopy. The morphological changes before and after 15 days of dietary treatment were evaluated. The children on semi-elemental diets showed a marked reduction of the number of interepithelial lymphocytes, and of lymphocytes in lamina propria. The infants on cow's milk showed no improvement. Our results suggest that cow's milk could be the cause of the persistent mucosal alterations observed in these infants.

Lipid-laden macrophages in tracheal aspirates of newborn infants receiving intravenous lipid infusions: a cytologic study.

Seventy-four neonates with respiratory distress syndrome had cytologic study of tracheal aspirates. Thirteen, all of whom were receiving intravenous lipid and nothing orally had abundant macrophages with foamy cytoplasm, positive for intracytoplasmic lipid by Sudan black stain, in the tracheal aspiration specimens. Cytologic surveillance of tracheal aspiration specimens may be a useful method of monitoring infants receiving intravenous lipid infusions.

Moderate and severe protein energy malnutrition in childhood: effects on jejunal mucosal morphology and disaccharidase activities.

The enzymatic activities of maltase, sucrase, and lactase were determined in jejunal biopsies obtained from 24 children with gastrointestinal symptoms and different degrees of protein energy malnutrition (PEM) to see if these differences were related to the extent of malnutrition or concomitant small intestinal mucosal injury. Even in patients with moderate PEM, lactase activities were significantly lower than control values. The decrease in lactase activity seemed to depend on the severity of malnutrition. In contrast, maltase and sucrase activities were decreased only in second and third degrees of PEM, while no significant changes were observed in first degree and marasmic kwashiorkor. Histologically, all children with PEM had grade I to II mucosal injury which did not correlate with the degree of malnutrition. These results indicate that PEM affects each of the disaccharidases of the jejunal mucosa differently, with lactase being most sensitive to PEM and reflecting most closely the degree of PEM. In contrast, morphological changes showed no correlation with the degree of PEM.

Evaluacion de ninos con giardiasis y su tratamiento con tinidazol. / Evaluation of children with giardiasis and their treatment with tinidazole

Se estudiaron 22 ninos con giardiasis que presentaban diarrea o dolor abdominal y se trataron con tinidazol en dosis unica a 60 mgr por Kg/p. La curacion parasitologica fue del 95,4% y la desaparicion o mejoria de los sintomas ocurrio en el 89,47% de los casos. Despues del tratamiento se obtuvo un incremento significativo de la absorcion de d-xilosa, disminucion de los linfocitos intraepiteliales y una disminucion del numero de las celulas que infiltraban la lamina propia