Correlación entre histopatología y tricoscopia en alopecias no cicatriciales / Histopathologic and Trichoscopic Correlations in Nonscarring Alopecias

La tricoscopia es una herramienta esencial en el examen de las alopecias. La semiología elaborada durante las últimas décadas ha contribuido a la comprensión patogénica y al diagnóstico diferencial entre las distintas formas de alopecia. Todos los signos tricoscópicos tienen su base en la patogenia de la alopecia examinada. En el presente artículo, examinamos la correlación entre los principales hallazgos tricoscópicos de las alopecias no cicatriciales y la base histopatológica que sustenta esos signos tricoscópicos (AU)

Trichoscopy is an essential tool in the evaluation of alopecia. The current compilation of trichoscopic signs in this setting helps distinguish between different forms of hair loss and has improved our understanding of the pathogenic mechanisms involved. The trichoscopic signs are always linked to the pathogenic mechanisms of the alopecia being examined. We examine correlations between the main trichoscopic and histopathologic findings in nonscarring alopecias (AU)

[Translated article] Histopathologic and Trichoscopic Correlations in Nonscarring Alopecias / Correlación entre histopatología y tricoscopia en alopecias no cicatriciales

Trichoscopy is an essential tool in the evaluation of alopecia. The current compilation of trichoscopic signs in this setting helps distinguish between different forms of hair loss and has improved our understanding of the pathogenic mechanisms involved. The trichoscopic signs are always linked to the pathogenic mechanisms of the alopecia being examined. We examine correlations between the main trichoscopic and histopathologic findings in nonscarring alopecias (AU)

La tricoscopia es una herramienta esencial en el examen de las alopecias. La semiología elaborada durante las últimas décadas ha contribuido a la comprensión patogénica y al diagnóstico diferencial entre las distintas formas de alopecia. Todos los signos tricoscópicos tienen su base en la patogenia de la alopecia examinada. En el presente artículo, examinamos la correlación entre los principales hallazgos tricoscópicos de las alopecias no cicatriciales y la base histopatológica que sustenta esos signos tricoscópicos (AU)

[Translated article] Histopathologic and Trichoscopic Correlations in Nonscarring Alopecias.

Trichoscopy is an essential tool in the evaluation of alopecia. The current compilation of trichoscopic signs in this setting helps distinguish between different forms of hair loss and has improved our understanding of the pathogenic mechanisms involved. The trichoscopic signs are always linked to the pathogenic mechanisms of the alopecia being examined. We examine correlations between the main trichoscopic and histopathologic findings in nonscarring alopecias.

Fijación artroscópica sin metal del bloque óseo en la inestabilidad anterior del hombro. Resultados funcionales y radiológicos a corto plazo / Arthroscopic bone block metal-free fixation for anterior shoulder instability. Short-term functional and radiological outcomes

Introducción: Existen múltiples técnicas para la reconstrucción del defecto óseo glenoideo con bloque óseo en la inestabilidad glenohumeral anterior que reducen el riesgo de recidiva tras cirugía de partes blandas, la mayoría utilizando fijación metálica. El objetivo de este estudio es evaluar la seguridad quirúrgica y los resultados funcionales y radiológicos a corto plazo de los pacientes sometidos a una técnica artroscópica con bloque óseo y fijación sin metal. Material y métodos: Estudio retrospectivo de pacientes con inestabilidad y defecto óseo glenoideo>15% con 12 meses de seguimiento mínimo. Se sometieron a estudio radiográfico y tomografía axial computarizada. Se cumplimentaron escalas funcionales de manera pre y postoperatoria: el Western Ontario Shoulder Instability Index y la escala de Rowe. Resultados: Se incluyeron un total de 21 pacientes con una edad media de 30,6 (DE 7,1). Todos mostraron consolidación radiográfica a los 3 meses. El 90,4% de los injertos presentó osteólisis en las áreas más periféricas y el 95,2% presentó consolidación en las áreas de contacto con la glenoides. La media del área de superficie de la glenoides pasó del 79,3% preoperatoria al 98,4% a los 12 meses. Los resultados funcionales medios resultaron estadísticamente significativos (p<0,001) tanto para el Western Ontario Shoulder Instability Index (de 35,6 a 86,9) como para la escala de Rowe (de 25,2 a 96,4). No se presentaron complicaciones graves. Conclusión: La técnica de bloque óseo y fijación sin metal es un método de fijación seguro, sin componentes metálicos. Consigue una consolidación completa del injerto con buenos resultados funcionales y radiográficos a los 12 meses.(AU)

Introduction: Anterior glenohumeral bone loss reconstruction reduces failure rates after soft tissue surgery in patients with large glenoid bone defects. Multiple bone block techniques have been described, most with metal hardware fixation. The objective of this study is to evaluate the safety, as well as the short-term functional and radiological results of an arthroscopic bone block metal-free fixation or bone block cerclage. Material and methods: Retrospective study of patients with glenohumeral instability and>15% glenoid bone loss operated during 2019 with follow-up of at least 12 months. Radiography and computerized tomography studies were performed. Functional outcomes were evaluated before and after surgery with the Western Ontario Shoulder Instability Index and Rowe score. Results: A total of 21 patients with a median age of 30.6 (SD 7.1) were included. All showed radiographic consolidation at 3 months follow-up. A percentage of 90.4 of bone grafts presented osteolysis at peripherical areas and 95.2% revealed consolidation in the areas with contact to the glenoid. The median glenoid estimated surface went from 79.3% before surgery to 98.4% at 12 months. Functional scores were statically significant (P<.001) for Western Ontario Shoulder Instability Index (35.6-86.9) and Rowe score (25.2 to 96.4). No serious complications were reported. Conclusion: The bone block cerclage is a safe, metal-free technique that achieves total consolidation of the bone graft and favorable functional and radiological outcomes at 12 months follow-up.(AU)

Arthroscopic bone block metal-free fixation for anterior shoulder instability. Short-term functional and radiological outcomes / Fijación artroscópica sin metal del bloque óseo en la inestabilidad anterior del hombro. Resultados funcionales y radiológicos a corto plazo

Introduction: Anterior glenohumeral bone loss reconstruction reduces failure rates after soft tissue surgery in patients with large glenoid bone defects. Multiple bone block techniques have been described, most with metal hardware fixation. The objective of this study is to evaluate the safety, as well as the short-term functional and radiological results of an arthroscopic bone block metal-free fixation or bone block cerclage. Material and methods: Retrospective study of patients with glenohumeral instability and>15% glenoid bone loss operated during 2019 with follow-up of at least 12 months. Radiography and computerized tomography studies were performed. Functional outcomes were evaluated before and after surgery with the Western Ontario Shoulder Instability Index and Rowe score. Results: A total of 21 patients with a median age of 30.6 (SD 7.1) were included. All showed radiographic consolidation at 3 months follow-up. A percentage of 90.4 of bone grafts presented osteolysis at peripherical areas and 95.2% revealed consolidation in the areas with contact to the glenoid. The median glenoid estimated surface went from 79.3% before surgery to 98.4% at 12 months. Functional scores were statically significant (P<.001) for Western Ontario Shoulder Instability Index (35.6-86.9) and Rowe score (25.2 to 96.4). No serious complications were reported. Conclusion: The bone block cerclage is a safe, metal-free technique that achieves total consolidation of the bone graft and favorable functional and radiological outcomes at 12 months follow-up.(AU)

Introducción: Existen múltiples técnicas para la reconstrucción del defecto óseo glenoideo con bloque óseo en la inestabilidad glenohumeral anterior que reducen el riesgo de recidiva tras cirugía de partes blandas, la mayoría utilizando fijación metálica. El objetivo de este estudio es evaluar la seguridad quirúrgica y los resultados funcionales y radiológicos a corto plazo de los pacientes sometidos a una técnica artroscópica con bloque óseo y fijación sin metal. Material y métodos: Estudio retrospectivo de pacientes con inestabilidad y defecto óseo glenoideo>15% con 12 meses de seguimiento mínimo. Se sometieron a estudio radiográfico y tomografía axial computarizada. Se cumplimentaron escalas funcionales de manera pre y postoperatoria: el Western Ontario Shoulder Instability Index y la escala de Rowe. Resultados: Se incluyeron un total de 21 pacientes con una edad media de 30,6 (DE 7,1). Todos mostraron consolidación radiográfica a los 3 meses. El 90,4% de los injertos presentó osteólisis en las áreas más periféricas y el 95,2% presentó consolidación en las áreas de contacto con la glenoides. La media del área de superficie de la glenoides pasó del 79,3% preoperatoria al 98,4% a los 12 meses. Los resultados funcionales medios resultaron estadísticamente significativos (p<0,001) tanto para el Western Ontario Shoulder Instability Index (de 35,6 a 86,9) como para la escala de Rowe (de 25,2 a 96,4). No se presentaron complicaciones graves. Conclusión: La técnica de bloque óseo y fijación sin metal es un método de fijación seguro, sin componentes metálicos. Consigue una consolidación completa del injerto con buenos resultados funcionales y radiográficos a los 12 meses.(AU)

Arthroscopic bone block metal-free fixation for anterior shoulder instability. Short-term functional and radiological outcomes. / Fijación artroscópica sin metal del bloque óseo en la inestabilidad anterior del hombro. Resultados funcionales y radiológicos a corto plazo.

INTRODUCTION: Anterior glenohumeral bone loss reconstruction reduces failure rates after soft tissue surgery in patients with large glenoid bone defects. Multiple bone block techniques have been described, most with metal hardware fixation. The objective of this study is to evaluate the safety, as well as the short-term functional and radiological results of an arthroscopic bone block metal-free fixation or bone block cerclage. MATERIAL AND METHODS: Retrospective study of patients with glenohumeral instability and>15% glenoid bone loss operated during 2019 with follow-up of at least 12 months. Radiography and computerized tomography studies were performed. Functional outcomes were evaluated before and after surgery with the Western Ontario Shoulder Instability Index and Rowe score. RESULTS: A total of 21 patients with a median age of 30.6 (SD 7.1) were included. All showed radiographic consolidation at 3 months follow-up. A percentage of 90.4 of bone grafts presented osteolysis at peripherical areas and 95.2% revealed consolidation in the areas with contact to the glenoid. The median glenoid estimated surface went from 79.3% before surgery to 98.4% at 12 months. Functional scores were statically significant (P<.001) for Western Ontario Shoulder Instability Index (35.6-86.9) and Rowe score (25.2 to 96.4). No serious complications were reported. CONCLUSION: The bone block cerclage is a safe, metal-free technique that achieves total consolidation of the bone graft and favorable functional and radiological outcomes at 12 months follow-up.

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

Introducción y objetivos: Existe una enorme variedad de colgajos cutáneos empleados para la reparación de defectos quirúrgicos faciales tras la extirpación de tumores. El objetivo del estudio fue consensuar una guía práctica de los colgajos más útiles para cada una de las distintas unidades estéticas faciales. Material y métodos: Estudio multicéntrico donde 10 dermatólogos de larga experiencia quirúrgica reconstructiva eligieron sus técnicas preferidas para cada unidad estética. La elección de estos colgajos se fundamentó en la experiencia personal de cada dermatólogo basándose en factores como la idoneidad de la técnica reconstructiva para ese defecto, el resultado estético final, la facilidad de ejecución y la baja probabilidad de complicaciones, entre otros. Eligieron 2 colgajos por orden de preferencia para cada subunidad estética y se le asignaron 10 puntos al primer colgajo y 5 al segundo. Resultados: Con la suma obtenida de todas las opciones aportadas por los dermatólogos encuestados se obtuvo una relación de los 3 mejores colgajos para cada localización. Destacar la unanimidad de criterio por parte de la mayoría de los dermatólogos para técnicas reconstructivas como el colgajo glabelar para defectos de canto interno del ojo, el colgajo de avance bilateral en bandera o H para frente, el colgajo en puerta giratoria para concha auricular, el colgajo pangeniano para mejilla infraorbitaria, el colgajo de rotación O-Z para cuero cabelludo, el colgajo de Tenzel para párpado inferior y el colgajo en isla para labio superior. Conclusiones: Los resultados de este estudio son de utilidad para ofrecer una guía práctica para la elección de las mejores técnicas reconstructivas en cada una de las distintas subunidades estéticas faciales (AU)

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 (AU)

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.

Ultrasonography: a useful tool for plastic surgeons.

UNLABELLED: Ultrasonography is a diagnostic technique used in many clinical specialties that should also be used by plastic surgeons. The authors have used ultrasonography since 2011 as part of the routine follow-up evaluation for all their patients who have undergone breast augmentation (the main indication), body implants, gynecomastia, fat transfer, or abdominoplasty. The main goal of this study was to correlate normal and pathologic conditions clinically with their respective imaging findings. The secondary aim was to establish the utility of this tool in a plastic surgery setting. With increasing experience, the use of ultrasound evaluation was expanded to include evaluation of seromas and hematomas, determination of the diastasis recti width, and confirmation of the presence of hernias, especially in patients with high adiposity, who are difficult to scan. This report describes several clinical cases of complications associated with breast augmentation and discusses the most significant common problems encountered during the first 2 years of ultrasonography scanner use in a plastic surgeon's office. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Luxación de la articulación metatarso falángica del 2° dedo como causa de metatarsalgia / Luxation of the metatarsophalangeal joint of the 2nd finger as a cause of forefoot pain

Presentamos dos casos de luxación dorsal de la segunda articulación metatarsofalángica, como causa de metatarsalgia. Aunque clínicamente puede confundirse con otras patologías, como el neuroma interdigital, el conocimiento del proceso y una simple radiología convencional, la diagnosticaría sin necesidad de otras pruebas complementarias. Se realizó intervención quirúrgica de la deformidad dolorosa y se completó con resección de la base de la falange proximal de los dedos del pie (AU)

We report 2 cases of dorsal dislocation of the second metatarsophalangeal joint, a source of forefoot pain. Although clinically they could be mistaken for other pathologies, such as interdigital neuroma, the knowledge of the entity, and simple roentgenographic examination, should diagnose them without the need for other complementary tests. Surgical correction of the painful deformity was completed by resecting the bases of the proximal phalanges of second toes (AU)

Clinical diagnosis of toenail onychomycosis is possible in some patients: cross-sectional diagnostic study and development of a diagnostic rule.

BACKGROUND: Suspected toenail onychomycosis is a frequent problem. Clinical diagnosis has been considered inadequate. OBJECTIVES: To assess the diagnostic accuracy of clinical findings for detecting fungi in toenails, and to develop and validate a clinical diagnostic rule aimed at improving dermatologists' diagnosis of onychomycosis. METHODS: A cross-sectional diagnostic study was performed including a total of 277 patients seen by 12 dermatologists. The gold standard was the presence of dermatophytes on culture or a positive nail plate biopsy. For each sign we described prevalence, sensitivity, specificity, positive and negative predictive values, and likelihood ratios for positive and negative results. We developed a diagnostic clinical rule and validated it in a subsample. RESULTS: Helpful findings to predict the presence of fungi are: previous diagnosis of fungal disease; abnormal plantar desquamation (affecting > 25% of the sole); onychomycosis considered the most probable diagnosis by a dermatologist; and presence of interdigital tinea. When dermatologists considered onychomycosis the most probable diagnosis and plantar desquamation was present (13% of patients), the positive predictive value for presence of fungi was 81%. When both signs were absent (34% of patients), the positive predictive value for absence of fungi was 71%. In other situations, clinical diagnosis might not give enough information to decide on therapy. CONCLUSIONS: In 13% of the patients (a large number in absolute terms), when dermatologists consider onychomycosis the most probable diagnosis and plantar desquamation is present, therapy should be started without any further test, as clinical diagnosis is at least as accurate as laboratory tests. In other situations, an optimal management strategy should be defined.

Observer agreement in toenail disorders: implications for diagnosis and clinical research.

BACKGROUND: Toenail disorders are frequent, especially onychomycosis. The interobserver variability of nail signs needs to be known before these signs can be confidently applied for diagnosis. OBJECTIVES: To describe observer agreement in toenail findings as described by dermatologists in standard clinical practice, focusing on signs that could be useful for diagnosis of onychomycosis. METHODS: Prospective cross-sectional study in five dermatology departments. Eighty-six patients with abnormal toenails that could have onychomycosis as a differential diagnosis were independently examined by a pair of dermatologists using a predefined questionnaire, to describe the presence of 10 findings on previous history and 14 physical signs. RESULTS: Agreement was fine for previous history findings: it was very good (kappa > 0.81) for previous diagnosis of diabetes, smoking and use of public dressing rooms or swimming pools. Agreement was good (kappa 0.61-0.80) for immune suppression (drugs or cancer), previous diagnosis of fungal disease and worsening in the last year. It was moderate (kappa 0.41-0.60) for previous diagnosis of arterial disease, trauma induced by work or sports, and distal vs. proximal or lateral vs. central start of the lesion. Agreement was worse for physical signs: we found good agreement for the presence of the same disease in fingernails, abnormal plantar desquamation, deformity causing nail trauma, and subungual hyperkeratosis. It was moderate for the presence of nail destruction, tinea interdigitalis, onycholysis, and the type of material obtained by subungual curettage (dust vs. hard). Agreement was fair (kappa 0.21-0.40) for the presence of longitudinal or transverse striae, trachyonychia, pachyonychia, and change in colour of the nail plate. Pitting was too infrequent to allow for kappa calculation. Chance expected agreement was between 51% and 84% for all signs except pitting. CONCLUSIONS: Agreement is adequate for most signs. It is low for the presence of longitudinal or transverse striae, trachyonychia, and change in colour of the nail plate. Pitting is rare in toenails.

Estructura social de la Dermatología: entre la Edad Media y la Contemporánea / The social structure of dermatology: between the Medieval and the Early Modern

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Drug-induced hepatitis in a patient with malignant melanoma treated with interferon alfa 2b adjuvantly who had been administered gemfibrozil in therapy.

A well-known side effect of chemotherapy, covering a wide range of drugs, is drug-induced hepatitis. We are reporting on a 61-yr-old female patient whose malignant melanoma had been surgically removed, and on whom adjuvant therapy with interferon alfa 2b was initiated. The patient had mild hyperlipidemia, of which she had been aware for several years, but which had gone untreated with medicinal intervention. After the patient was started on interferon alfa therapy, continuously increasing values of triglyceride were measured. Therefore, 3 mo after the introduction of adjuvant therapy, gemfibrozil was prescribed at a dose of 600 mg per day. Within a few days after the patient had been taking this combined therapy, the clinical and laboratory values of drug-induced hepatitis developed. Soon after discontinuance of treatment by both drugs, the signs and symptoms of hepatitis disappeared. Adjuvant interferon therapy was not continued afterward owing to the patient's wish. We do not know if the hepatitis was the side effect to gemfibrozil alone, or the side effect was a result of an interaction between the two drugs. As far as we could find, this is the first case report of possible negative interaction between interferon alfa 2b and gemfibrozil. Our intention in this article is to point out that prescription of any drugs, especially new ones, should be balanced and carefully monitored because of possible side effects.

A fully Bayesian model to cluster gene-expression profiles.

MOTIVATION: With cDNA or oligonucleotide chips, gene-expression levels of essentially all genes in a genome can be simultaneously monitored over a time-course or under different experimental conditions. After proper normalization of the data, genes are often classified into co-expressed classes (clusters) to identify subgroups of genes that share common regulatory elements, a common function or a common cellular origin. With most methods, e.g. k-means, the number of clusters needs to be specified in advance; results depend strongly on this choice. Even with likelihood-based methods, estimation of this number is difficult. Furthermore, missing values often cause problems and lead to the loss of data. RESULTS: We propose a fully probabilistic Bayesian model to cluster gene-expression profiles. The number of classes does not need to be specified in advance; instead it is adjusted dynamically using a Reversible Jump Markov Chain Monte Carlo sampler. Imputation of missing values is integrated into the model. With simulations, we determined the speed of convergence of the sampler as well as the accuracy of the inferred variables. Results were compared with the widely used k-means algorithm. With our method, biologically related co-expressed genes could be identified in a yeast transcriptome dataset, even when some values were missing. AVAILABILITY: The code is available at http://genome.tugraz.at/BayesianClustering/

ArrayNorm: comprehensive normalization and analysis of microarray data.

SUMMARY: ArrayNorm is a user-friendly, versatile and platform-independent Java application for the visualization, normalization and analysis of two-color microarray data. A variety of normalization options were implemented to remove the systematic and random errors in the data, taking into account the experimental design and the particularities of every slide. In addition, ArrayNorm provides a module for statistical identification of genes with significant changes in expression. AVAILABILITY: The package is freely available for academic and non-profit institutions from http://genome.tugraz.at

Proyecto TPM (Transplant Procurement Management): Formación avanzada internacional de coordinadores de trasplante / The TPM Project (Transplant Procurement Management): international advanced training of transplant coordination

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