Reconstruction Techniques of Choice for the Facial Cosmetic Units. / Técnicas reconstructivas de elección por unidades estéticas faciales.

BACKGROUND AND OBJECTIVES: A broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units. MATERIAL AND METHODS: This was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit. A score of 10 was given to the first flap and a score of 5 to the second. RESULTS: The total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip. CONCLUSIONS: The results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units.

[RN4CAST Study in Murcia: Hospital organizational characteristics and nursing staff profiles]. / Estudio RN4CAST en Murcia: características organizacionales de los hospitales y perfiles enfermeros.

OBJECTIVE: To determine the profile of nurses in public hospitals in Murcia and to assess how they perceive their work environment, the quality of care and their level of burnout (the RN4CAST project repetition). MATERIAL AND METHODS: A cross-sectional descriptive study was carried out in 8 hospitals in Murcia. Data were collected between 2009 and 2010 from 687 nurses (stratified by the type of unit) using a self-completed questionnaire with 149 items covering variables related to sociodemographics; work; perception of the work place (PES-NWI); burnout (Maslach Burnout Inventory); and the quality of patient care, and patient safety. ANALYSIS: Non parametric tests, for two samples or k samples according to the comparison. RESULTS: A total of 495 questionnaires were collected (72%). Most respondents were female (80.4%) having a mean age of 34.1 (SD=7.1) years, and they had been working for 9.4 (SD=7.4) years. Just over one-quarter (25.7%) had carried out more than 300 hours of training in the previous 24 months. The patient/nurse ratio was 11.7 (SD=3.6), varying between hospitals. The nurses reported 25% of hospitals as having an unfavorable work environment, whereas 37.5% had favorable ones; large hospitals were less highly valued. Few respondents intended to give up their jobs (16.8%). Burnout levels revealed emotional exhaustion in 18.4% of respondents; depersonalization in 7.5%, and personal fulfillment in 28.8%. Perception of quality varied between centers and the perception of adverse effects was more favorable in small hospitals. CONCLUSIONS: Our professionals were generally satisfied, but given the unfavorable work environment, measures should be adopted for improving well-being and reducing weaknesses.

The naevus count on the arms as a predictor of the number of melanocytic naevi on the whole body.

A study of melanocytic naevi was carried out in southern Spain to examine the relationship between numbers of naevi at different body sites as predictors of whole-body naevus count and to determine whether the naevus count on the arms is valid for identifying the risk factors for total naevi. Subjects were the control group from a case-control study on risk factors for cutaneous melanoma. They were selected from visitors to the University of Granada Hospital (southern Spain) between 1989 and 1993. Of 200 people invited to participate, 146 accepted (73%). Data were collected by personal interview, and melanocytic naevi were counted over the entire body surface by clinical skin examination performed by one dermatologist. Partial correlation coefficients (R) estimated by multiple linear regression were calculated. Comparisons between whole-body naevi and naevi on the arms, and their relationship with risk factors, were assessed by analysis of variance and covariance. Arms in men (adjusted R = 0.88) and thighs in women (adjusted R = 0.82) were the best predictors of total naevi after adjusting for age and sun exposure. Age, occupational and leisure sun exposure, and sunburns showed significant correlations with the total number of naevi. Similar results were found for the naevus count on the arms. In conclusion, the prediction of whole-body numbers of naevi by a naevus count on specific sites differs between men and women: arms in men and thighs in women are the best predictors. Nevertheless, naevus counts on the arms allowed us to study the risk factors for total naevi as well as whole-body naevus count: age and occupational sun exposure were the strongest determinants.

Autoimmune progesterone dermatitis: treatment with oophorectomy.

Autoimmune progesterone dermatitis is a rare manifestation of hypersensitivity to endogenous hormones with polymorphic clinical manifestations. We report a 28-year-old woman with a 5-year history of mucocutaneous erythema multiforme occurring cyclically in the premenstrual period. Progesterone sensitivity was demonstrated by challenge test with medroxyprogesterone acetate. Treatments with oestrogens, tamoxifen and triptorelin had to be withdrawn because of intolerable adverse effects. Oophorectomy finally cured the disease.

Melanocytic nevi and risk of cutaneous malignant melanoma in southern Spain.

The main objective of this study was to assess whether cutaneous malignant melanoma (CMM) shows a stronger relation with the melanocytic nevi count at the site where CMM was diagnosed than with the melanocytic nevi count at other sites, stratifying by histologic CMM type, in a southern Mediterranean population. Cases and controls were selected from a population in southern Spain in 1988-1993. The study population included 116 incident cases with non-familial CMM (International Classification of Diseases 9th Revision (ICD-9) code 172), and 116 controls matched 1:1 for sex and age (+/- 4 years). Data were collected by personal interview, and melanocytic nevi were counted over the entire body surface by clinical skin examination performed by a dermatologist. Crude and multiple risk factor-adjusted odds ratios and 95% confidence intervals were computed by conditional logistic regression analysis. After adjustment by skin type, unexposed skin color, and sun exposure, CMM was found to occur significantly more frequently in individuals with a high number of melanocytic nevi at the same site where CMM originated (odds ratio (OR) for >8 nevi = 12.0, 95% confidence interval (CI) 1.3-108.2). The ability to predict the number of melanocytic nevi on different anatomic sites on CMM, but excluding the CMM cases on each corresponding site, was also examined. A significant trend with the number of nevi on the anterior surface of thighs was found (OR for >4 nevi = 4.5, 95% CI 1.4-14.9). Melanocytic nevi count on the melanoma site was the variable most closely related to superficial spreading melanoma subtype (SSM) (OR for >8 nevi = 82.19, 95% CI 2.72-2,454). On the other hand, the number of melanocytic nevi on the melanoma site was unrelated to risk of CMM subtypes other than SSM. These results support the hypothesis that nevi are an important risk factor for melanoma, especially SSM, in populations with a darker ethnic background.

Linear IgA disease in a patient with bladder carcinoma.

We report a patient with a transitional bladder carcinoma who developed a widespread blistering eruption. The lesions showed immunopathological findings characteristic of linear IgA disease with a good response to sulphapyridine. The relationship between linear IgA disease and neoplasia has been the subject of several reports suggesting that this association is not due to chance.

Sun exposure, pigmentary traits, and risk of cutaneous malignant melanoma: a case-control study in a Mediterranean population.

The main objective of this study was to assess the influence of sun exposure and pigmentary traits on the risk of cutaneous malignant melanoma (CMM) in a Mediterranean population (Andalusia, southern Spain). Cases and controls were selected from 1988 to 1993. The study population included 105 incident cases with non-familial CMM (ICD-9 code 172) and 138 controls aged 20 to 79 years. Data were collected by personal interview, and melanocytic nevi were counted over the entire body surface. Crude, and multiple-risk factor adjusted, odds ratios (OR) and their 95 percent confidence intervals (CI) were computed. After adjustment, the major constitutional risk factor was skin type I-II (OR = 29.8, CI = 8.9-100) compared with skin type V. Statistically significant and positive trends were observed between the risk of CMM and occupational sun exposure of the skin (P = 0.003), recreational exposure (P < 0.001), and cumulative lifetime sun exposure (P < 0.001). Several characteristics related to sun exposure during summer increased the CMM risk, e.g., episodes of blistering sunburns and the number of sunbaths in childhood. Use of sunscreens and spending summer holidays in places other than beach were associated with a lower risk of CMM. Regarding pigmentary traits, CMM significantly occurred with more frequency in individuals with a high degree of freckling and quoted numbers of melanocytic nevi. In conclusion, the results support sun exposure and pigmentary traits (skin type, melanocytic nevi, and freckles) as main risk factors for CMM in this population.

Multivariate analysis of cutaneous markers of aging in chronic hemodialyzed patients.

BACKGROUND: Although hemodialysis has been associated with lesions of cutaneous aging, no controlled studies have been done in patients with chronic renal failure under periodic hemodialysis. Our purpose was to determine the prevalence of several clinical parameters of cutaneous aging and their relationship with hemodialysis. METHODS: One hundred fourteen patients on chronic hemodialysis were investigated for the presence of several cutaneous aging markers in a cross-sectional study, using multivariate analysis to minimize the confounding effect of age. RESULTS: Skin cancer was diagnosed in 3 patients (2.6%), actinic keratoses in 12 (10.5%), senile lentigo in 22 (20%), senile purpura in 15 (13%), and Favre-Racouchot disease in 6 (5%). There was no association with skin types or facial wrinkles with any other of the skin-aging features studied. Multivariate analysis, controlling for age as a confounding variable, indicated that the degree of facial wrinkles and the decrease in stratum corneum hydration (capacitance) correlated significantly with the length of time on hemodialysis (P = 0.012 and P = 0.012, respectively). Favre-Racouchot disease (Odds Ratio [OR] = 1.23, P = 0.055, 95% confidence interval [CI] 0.99-1.52) and actinic keratoses (OR = 1.15, P = 0.076, CI 0.98-1.34) became increasingly frequent with the duration of chronic hemodialysis. CONCLUSIONS: These data show a high prevalence of cutaneous aging lesions in patients on chronic hemodialysis. Acceleration of cutaneous aging is associated with time on hemodialysis.

[Skin aging and smoking]. / Envejecimiento cutáneo y tabaquismo.

Facial wrinkling is a marker of skin ageing. The association between smoking and facial wrinkling has been previously studied. Nevertheless, there are no reports assessing the role of sun exposure and smoking in an area with a great proportion of sunny days. Smoking habits were investigated in 282 healthy individuals. Facial wrinkles were measured according to the Daniell scale at the external canthus. A logistic regression model was developed controlling for age, sex, sun exposure, smoking habit and searching for the interaction between sun exposure and smoking. A statistically significant risk was found for smoking habit (OR = 3.1; 95% CL 1.28-7.76; p = 0.008), sun exposure (OR = 1.50; 95% Cl 1.25-1.80; p = 0.05), and age (OR = 1.18; 95% Cl 1.13-1.23; p = 0.024) for facial wrinkling. These results show the evidence of an accelerated skin ageing in smokers. A clear explanation given to smokers could be a useful strategy to persuade them to leave smoking.

Muir-Torre syndrome associated with a family history of hyperlipidemia.

The Muir-Torre syndrome is a rare disorder characterized by sebaceous neoplasms of the skin and multiple visceral malignancies. The syndrome appears to be a familial, autosomal dominant condition. We diagnosed this syndrome in a previously unreported patient and found a personal and family history of malignancies and hyperlipidemia. The association of Muir-Torre syndrome with a family history of hyperlipidemia, another autosomal dominant condition, has not been previously reported. The possible genetic relationship between the two disorders is discussed.