Simultaneous maxillomandibular distraction in unilateral mandibular hypoplasia.

In craniomaxillofacial surgery we often deal with hypoplastic mandibles and mandibular asymmetries, the correction of which is critical to obtaining acceptable aesthetic results. In all of them we find common skeletal problems once growth has finished, such as an inclined occlusal plane and facial asymmetry with a stable dental occlusion. Simultaneous maxillomandibular distraction, which involves a Le Fort I osteotomy and a mandibular osteotomy with intermaxillary fixation during the period of active distraction, is an excellent technique to solve these problems. Virtual surgical planning, stereolithographic models, and surgical guides are supportive tools for obtaining excellent results. In this paper we present our experience with five cases of hypoplastic mandibles and mandibular asymmetries of different aetiologies. In all patients we achieved a considerable improvement in their physical appearance in the distance between the lateral canthus and oral commissure, the height of the mandibular ramus, the inclination of the occlusal plane, and the medial position of the chin. The benefits of virtual surgical planning in terms of choosing the optimal vector and the amount of distraction make it a promising technological tool to achieve excellent outcomes.

Bilateral auricular reconstruction with osseointegrated implant-retained prostheses. Optimization of aesthetic outcomes using virtual planning.

Auricular reconstruction in microtia patients is challenging, particularly in bilateral cases. The use of osseointegrated implants is a safe and effective way to retain the auricular prostheses. With the help of virtual planning we can produce more predictable results with better aesthetic outcomes. We present a case of an 8-year-old bilateral microtia patient who underwent auricular reconstruction with implant-retained prostheses, using virtual planning. Using stereolithographic models and surgical guides was also very helpful to achieve excellent results.

Is submental flap safe for the oncological reconstruction of the oral cavity?

AIM: The reconstruction of oral defects after oncological surgery is not an easy task for head and neck surgeons. The main aim of this work is to evaluate the functionality, viability and safety of submental flap for oral reconstruction. MATERIALS AND METHOD: We analyzed the records of patients diagnosed with oral and oropharyngeal SCC and reconstructed with the use of submental flap in Virgen de las Nieves University Hospital of Granada (Spain) from 2014 and 2015. Nine patients were found. Specific features such as age, sites of occurrence, sex distribution, T stage at diagnosis, nodal involvement, functionality of reconstruction and local and regional failure were determined. RESULTS: The male/female ratio was 8:1. The average age of the patients was 59.6 years (range: 42-75). Tumor locations were base of the tongue (n2), lateral edge of the tongue (n4), floor of the mouth (n2) and buccal mucosa (n1). Six tumors were classified as a T2 tumor and 3 as T3. No major complications were evidenced during the immediate postoperative period. Moreover, all patients showed excellent tissue coverage with acceptable aesthetic and functional outcomes. However, 1 patient showed partial epithelial loss of the skin paleta. Finally, the recurrence rate of disease was 44,4%. Four of 9 patients experienced a local (1/9) or cervical relapse (3/9). DISCUSSION: Submental flap might offer great aesthetic and functional results in oral reconstruction. However, the recurrence rate of disease was too high in our sample. From our point of view, submental flap should be carefully indicated in oncological reconstruction, especially in case of suspicion of lymph node involvement at level Ib.

Fuchs' dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty? / Distrofia de Fuchs asociada a queratotomía radial: ¿queratoplastia penetrante o lamelar?

CASE REPORT: A 70 year-old male patient with a history of radial keratotomy suffering from Fuchs' dystrophy and a cataract. The patient received a two-step surgery: lens phacoemulsification and intraocular lens implant, followed by descemet stripping automated endothelial keratoplasty in both eyes, four months later. There were no complications apart from a recurrent cystoid macular oedema in both eyes. The best corrected visual acuity was 20/40 both eyes, and the patient was satisfied. DISCUSSION: Descemet stripping automated endothelial keratoplasty may be considered as an alternative to penetrating keratoplasty in the case of endothelial dysfunction and radial keratotomy in patients with no corneal ectasia or significant stromal opacity.

Multiresidue method for trace pesticide analysis in honeybee wax comb by GC-QqQ-MS.

The aim of this analytical study is to develop an improved multi-residue methodology of high sensitivity and expanded scope for pesticide residue analysis in honeybee wax combs. The method was validated for 160 pesticide residues (including acaricides, insecticides, fungicides and herbicides) gas chromatography amenable and covering a wide variety of polarity and chemical structure. This method of analysis applied gas chromatography coupled to a triple quadrupole mass spectrometer for the quantitative analysis of pesticide residues. The extraction procedure applied was based QuEChERs method allowing acceptable recoveries for most of the pesticides (98%), within the range 60-120% with an associated precision (RSD) <20%, at concentration levels of MQL of 10µgkg-1 for all pesticides with the exception of 3,5-dichloroaniline and chlordane (20µgkg-1). The expanded uncertainty of the results was ±35% on average (coverage factor k=2 for a confidence level of 95%). The chromatographic multi-residue method was applied to determine levels of pesticide residues in 50 honeybee wax comb samples randomly collected from different apiaries in Spain. A total of 32 pesticide residues (14 insecticides/acaricides, 10 insecticides, 6 fungicides and 2 herbicides) were detected in the samples. The highest pesticide concentrations were found for those with insecticide-acaricide activity like acrinathrin, chlorfenvinphos, coumaphos and fluvalinate-tau, some of them are mainly applied in apiculture for controlling the honeybee parasite Varroa destructor. The total load of pesticide residues ranged from 69 to 1000µgkg-1 for 40% of the analysed samples, 22% contained pesticide residues in the ranges of 1000-2000µgkg-1, 24% between 2000 and 5000µgkg-1 and 14% of the samples contained residues between 5000 and 9557µgkg-1.

Effects of nanocrystalline hydroxyapatites on macrophage polarization.

Silicon substituted and nanocrystalline hydroxyapatites have attracted the attention of many researchers due to their up-regulation in osteoblast cell metabolism and enhanced bioreactivity, respectively. On the other hand, the biomaterial success or failure depends ultimately on the immune response triggered after its implantation. Macrophages are the main components of the innate immune system with an important role in healing and tissue remodelling due to their remarkable functional plasticity, existing in a whole spectrum of functional populations with varying phenotypic features. The effects of nanocrystalline hydroxyapatite (nano-HA) and nanocrystalline silicon substituted hydroxyapatite (nano-SiHA) on the macrophage populations defined as pro-inflammatory (M1) and reparative (M2) phenotypes have been evaluated in the present study using RAW 264.7 cells and mouse peritoneal macrophages as in vitro models. M1 and M2 macrophage phenotypes were characterized by flow cytometry and confocal microscopy by the expression of CD80 and CD163, known as M1 and M2 markers, respectively. The polarization of primary macrophages towards the M1 or M2 phenotype was induced with the pro-inflammatory stimulus LPS or the anti-inflammatory stimulus IL-10, respectively, evaluating the biomaterial effects under these conditions. Our results show that both nano-HA and nano-SiHA favour the macrophage polarization towards an M2 reparative phenotype, decreasing M1 population and ensuring an appropriate response in the implantation site of these biomaterials designed for bone repair and bone tissue engineering.

Lentibacillus persicus sp. nov., a moderately halophilic species isolated from a saline lake.

A Gram-staining-positive, moderately halophilic bacterium, designated strain Amb31(T), was isolated from water of the hypersaline lake Aran-Bidgol in Iran and characterized taxonomically using a polyphasic approach. Cells were rods, motile and able to produce ellipsoidal endospores at a central position in swollen sporangia. Strain Amb31(T) was facultatively anaerobic and catalase- and oxidase-positive. The strain grew in a complex medium supplemented with 3-25 % (w/v) NaCl (optimum 7.5-10 %). Optimal growth was at 30-35 degrees C and pH 7.5. Phylogenetic analysis based on 16S rRNA gene sequence comparisons showed that strain Amb31(T) belonged to the genus Lentibacillus; it exhibited 16S rRNA gene sequence similarity values of 96.8 and 96.4 % to Lentibacillus salicampi SF-20(T) and Lentibacillus salinarum AHS-1(T), respectively, and values of 95.9-94.7 % to the type strains of other recognized species of Lentibacillus. The cell-wall peptidoglycan of strain Amb31(T) was based on meso-diaminopimelic acid and MK-7 was the respiratory isoprenoid quinone. The major fatty acids were anteiso-C(15 : 0) (44.7 %), iso-C(16 : 0) (21.4 %) and anteiso-C(17 : 0) (15.9 %) and the polar lipid pattern consisted of phosphatidylglycerol, diphosphatidylglycerol, five phospholipids and a glycolipid. The DNA G+C content was 44.1 mol%. All these features confirmed the placement of strain Amb31(T) within the genus Lentibacillus and the strain could be clearly differentiated from strains of the other species of Lentibacillus on the basis of several phenotypic, genotypic and chemotaxonomic features. DNA-DNA relatedness with the type strain of the most closely related strain, L. salicampi DSM 16425(T), was 28 %. Therefore, strain Amb31(T) represents a novel species of the genus Lentibacillus, for which the name Lentibacillus persicus sp. nov. is proposed. The type strain is Amb31(T) (=CCM 7683(T) =CECT 7524(T) =DSM 22530(T) =LMG 25304(T)).

Colgajo libre osteocutáneo escapular en el tratamiento diferido de herida por arma de fuego / Scapular osteocutaneous free flap in the deferred treatment of firearm wounds

Las heridas por arma de fuego de velocidad alta o intermedia, provocanimportantes pérdidas de tejido óseo y blando. El tratamiento diferido de estoscasos (tratamiento reconstructivo) requiere el aporte de tejido sano de regionesdistantes mediante técnicas microquirúrgicas en la mayoría de las ocasiones. Exponemosla utilidad del colgajo osteocutáneo escapular(COE) para la reconstrucciónde defectos óseos mandibulares laterales con amplio defecto cutáneomucoso. Citamosdetalles técnicos de la realización del colgajo ilustrados con la presentación deun caso clínico de un varón de 19 años con herida por arma de fuego en tercio inferiorde la región lateral izquierda. Pérdida ósea del cuerpo mandibular y cutánea dela mejilla y región yugal ipsilateral.El tratamiento inicial consistió en traqueotomía, desbridamiento de tejidos desvitalizados,ferulización dentaria, bloqueo intermaxilar, colocación de placa de reconstrucciónmandibular y colgajo de avance cervico-facial para cierre del defecto cutáneo.La necrosis del colgajo de avance cervicofacial produjo comunicación orofacial.La retracción cicatricial limitó la apertura oral a 0,8 cm. De forma diferida se procedióa colgajo osteomiocutáneo escapular-paraescapular del brazo izquierdo parareconstrución mandibular y de partes blandas intra y extraorales. Resultados satisfactoriosestética y funcionalmente. Complicaciones producidas: fístula salival, desinsercióndel brazo largo del tríceps, y dehiscencia de herida de zona donante escapularque necesitó intervención para cierre mediante colgajo local(AU)

Firearm wounds caused by high-velocity projectiles causeenormous losses of bone and soft tissue. The deferred treatment ofthese cases (delayed reconstruction) in most cases requires thetransfer of free tissue from other areas of the body. The use ofscapular and parascapular free flaps with scapular bone for thereconstruction of large lateral mandibular defects with extensivesoft-tissue avulsion is reported. The technical details of a free flapare offered with illustrations in the case report of a 19-year-old malewho was shot at close range in the lower third of the left lateralface. Avulsion of the left mandibular body and soft tissue occurredin the region from the cheek to the oral commissure. The initialtreatment was tracheostomy, cleaning of necrotic and devitalizedtissues, wiring of a mandible-to-maxilla arch bar and intermaxillaryfixation, rigid fixation with a reconstructive mandibular plate, anda regional cervical flap to close the skin wound. The cervical flapwas lost and a postoperative oral-cervical fistula appeared. Scarcontraction limited the mouth opening to 0.8 cm. In deferredtreatment, a scapular and parascapular free flap with scapular bonefrom the left shoulder was used to reconstruct the mandibular andintraoral-facial soft-tissue defects. The aesthetic and functionalresults were optimal. Some complications occurred: postoperativesalivary fistula, deinsertion of the long head of the brachial triceps,and scapular wound dehiscence, which will be closed surgically witha local flap(AU)

Sobre el síndrome de quemarse por el trabajo en anestesiología / On burnout syndrome in anesthesiology

No disponible

No disponible

Implicaciones anestésicas en los pacientes portadores de la variante termolábil de la enzima metilén tetrahidrofólico reductasa (MTHFR) / Anesthetic implications for patients with the thermolabile variant of the methylenetetrahydrofolate reductase gene

No disponible

Asistolia asociada a la utilización de remifentanilo / Asystole as a consequence of remifentanil use

No disponible

Profilaxis antimicrobiana de la infección de localización quirúrgica: monodosis versus multidosis. Revisión sistemática de Ensayos Clínicos aleatorizados / No disponible

Objetivo: Valorar la evidencia científica acerca de la duración óptima de la profilaxis antimicrobiana quirúrgica. Material y Métodos: Revisión sistemática que incluye ensayos clínicos aleatorizados (ECAs) que comparan profilaxis antimicrobiana con monodosis prequirúrgica frente a profilaxis multidosis, publicados hasta Septiembre de 2004. Resultados: Se localizó una revisión sistemática publicada en 1998 que obtiene un OR de 1'04 con un Intervalo de Confianza (IC) al 95% [0'86-1'27] al comparar frecuencia de infección de localización quirúrgica en pacientes que reciben monodosis y multidosis. Tras esta revisión, se publicaron cuatro ECAs con los siguientes RR e IC al 95%: 2 [1'02-3'92], 0'51[0'10-2'65], 0'46[0'21-1'02] y 1'18[0'33-4'24]. Conclusiones: La administración de dosis adicionales de antimicrobiano posquirúrgicas no reduce la incidencia de infección de localización quirúrgica. No obstante, es preciso realizar nuevos ensayos clínicos para asentar esta evidencia en aquellas especialidades quirúrgicas con poca representación en los estudios realizados hasta ahora

Objective: To assess the scientific evidence about the optimum length for the antimicrobial prophylaxis in surgery. Methods: Systematic review including randomized clinical trials comparing single-dose preoperative prophylaxis with multiple-dose surgical prophylaxis, published until September 2004. Results: A systematic review published in 1998 was identified. The combined OR of surgical site infection for single versus multiple-dose prophylaxis was 1'04, 95% CI [0'86,1'27]. After this review another four trials were published with the following RR and CI 95%: 2 [1'02-3'92], 0'51 [0'10-2'65], 0'46 [0'21-l'02] and l'18[0'33-4'24]. Conclusions: Administration of postsurgery doses don't reduce the surgical site infection incidence. However, new trials are necessary to support this evidence in surgical disciplines with little participation in previous trials

[Health risks associated with the migration of Atlantic salmon (Salmo salar L.): an epidemiological surveillance programme in Northern Spain]. / Riesgos sanitarios asociados al ciclo migratorio del salmón atlántico (Salmo salar L.): programa de vigilancia epidemiológica en el Norte de España.

The authors present the results of an epidemiological surveillance programme involving Atlantic salmon (Salmo salar) populations in north-eastern Spain. The study investigates the risk factors critical in disease transmission, which include the presence of potentially pathogenic micro-organisms, the innate cell-mediated immune response of the salmon, and the potential interactions between the two. Also taken into account are the biological and migratory cycles of these salmon populations. The results showed that Aeromonas salmonicida and Saprolegnia parasitica were the micro-organisms that played the most important role in the transmission of the disease by virtue of their pathological characteristics, their occurrence in large numbers, and their capacity to transmit disease. With regard to the cell-mediated immune response, the authors observed a wide variability between individuals in some cell groups, as well as certain seasonal and age differences. These may be factors that predispose the animals to infection or to becoming asymptomatic carriers, with the attendant risk of transmitting infection in the course of migration. This could be especially relevant in the case of salmon infected with A. salmonicida and S. parasitica, since it has been observed that such salmon have a decreased number of leucocytes compared to non-infected salmon.

Incomplete duplication of the esophagus: one case.

A single case of incomplete duplication of the esophagus is presented, which was fortuitously diagnosed in an asymptomatic older male. The endoscopic findings are described, and the various features of these esophageal anomalies discussed.