Suspensión dinámica de la mama: recurso técnico para reactivar componentes de fijación y soporte mamario / Dynamic suspension of the breast: technical resort to reactivate the components of mammary support and fixation

Presentamos un nuevo concepto en el manejo de las estructuras anatómicas con efecto dinámico sobre la ptosisy pseudoptosis mamarias, consistente en la inclusión de artificios técnicos para generar la retensión de los elementos de suspensión relajados de la mama. Describimos la anatomía de la región enfocando el análisis hacia la importancia de las fascias, aponeurosis, ligamentos, etc., que se encuentran en el plano submamario-prepectoral, los cuales son lesionados en muchos procedimientos de mastopexia. Proponemos la sección, a nivel del 5º espacio intercostal, de la aponeurosis y del músculo pectoral mayor en la mitad de su espesor, lo que provoca una retracción cefálica del músculo que arrastra los elementos que lo vinculan con la fascia posterior mamaria. Los resultados observados, justifican considerar esta práctica, que puede ser realizada como complemento de algunas de las técnicas clásicas (AU)

The authors present a new concept in the management of the anatomic structures that concern mammaryptosis and pseudoptosis, using techniques that stimulate the retensing of the suspensory elements when they are found relaxed.The anatomy of the region is described, focusing on the importance of fascias. ligaments, and other suspension components in the submammary-prepectoral space, which are damaged on many mastopexy procedures. The technique consists on the incision of the aponeurosis and one half of the thickness of the pectoralis majorat the 5th intercostal space, causing the cephalic retraction of the muscle which drags the elements in contact with the posterior mammary fascia. The results obtained justify the use of this method tha tcan be added to other conventional techniques (AU)

Mamoplastia de aumento en doble plano: una alternativa subfascial en la optimización de las indicaciones / Breast augmentation in dual plane: a subfascial alternative towards optimizing indications

Proponemos el Doble Plano en la cirugía de aumento mamario como una alternativa a las indicaciones de uso del plano subfascial. Presentamos 30 casos en los que se utilizan variantes de la técnica en doble plano y discutimos sus indicaciones y ventajas a la vez que describimos detalles de la técnica. Este método consiste en crear un bolsillo donde el implante queda cubierto por el músculo pectoral solamente en su tercio superior y por la fascia en el resto. Las proporciones de estos componentes se ajustan según las características anatómicas de cada caso. Las indicaciones de la técnica son las mamoplastias primarias, y más específicamente, las secundarias con ptosis, encapsulamiento o ripling (AU)

We propose Dual Plane tecnique in augmentative mammoplasty as an alternative for individual adjustment when using the subfascial plane. Thirty cases are presented in which a variation of the dual plane technique is used. Its indications, advantages and surgical highpoints are discussed. This method consists on a pocket where the implant is covered by the pectoral muscle only on it supper pole, and by the fascia on the rest of it. The percentages of this components are adjusted to the anatomical characteristics of each case. Indications of this technique are primary mammoplasties, and more precisely secondary ones with ptosis, contractile capsule or ripling (AU)

Ritidoplastia con cicatrices cortas: ligamentos de retención y vectores de corrección / Rhytidoplasty with short scars: retention ligaments and correction vectors

Las intervenciones actuales de ritidectomía tienden a emplear abordajes menos extensos, con postoperatorios más sencillos. Los autores exponen las bases anatómicas de las técnicas de suspensión con suturas tractoras que remolcan los tejidos anulando los ligamentos de retención ósteo-músculo- cutáneos. Se analizan y emplean múltiples vectores de corrección (AU)

Actually, lifting procedures tend to be less extensive and with a simpler postoperative course. The authors explain the anatomical basis of suspension techniques that use traction sutures to tow the tissues, by-passing the effect of the osteo-musclecutaneous ligaments. The different correction vectors used are analyzed (AU)

Un zócalo como soporte del implante mamario / Plinth to support mammary implants

En los trabajos sobre implantes mamarios, la principal preocupación de muchos autores en el postoperatorio alejado es la eventual formación de una cápsula. Otros cambios importantes, son las modificaciones en la posición del implante en relación con la glándula y su cobertura y las alteraciones de la glándula generadas por fenómenos habituales que ocurren a través de la vida de la mujer. Hemos generado conductas en el planteamiento quirúrgico que tienen por objeto atenuar o retrasar estos fenómenos. Creemos haberlo logrado mediante la aplicación de un zócalo de apoyo del implante, produciendo al mismo tiempo una firme interfase entre el plano dermocelular y la prótesis. Este plano subfascial para el polo inferior actúa como estante que da firmeza y estabilidad al neosurco (AU)

On many presentations about long term results in mammary implants, the main concern of the authors is capsule formation. We have also observed important changes in the position of the implant in relation to the glandular and other overlying tissues, as well as changes characteristic to the gland in the different ages of women. We have applied conducts on our surgical planning aiming to diminish or delay this facts. We believe this has been achieved with the creation of a plinth to sustain the implant, generating in this way a firm interphase between the dermocellular plane and the implant. This subfascial plane acts as a shelf giving firmness and stability to the new inframmamary fold (AU)

Síndrome de Marfan. Reporte de un caso / The Marfan's Syndrome. A case report

El síndrome de Marfan es un proceso autosómico dominante con penetrancia completa, pero de expresividad variable. Se diagnostica basándose en los datos clínicos, algunos de los cuales depende del crecimiento. En este trabajo se presenta un caso de un niño de 8 años de edad, que se ingresó en el Hospital General Docente de Morón con la variedad clínica clásica del síndrome, que mostraba afectación esquelética, ocular y cardiovascular. Se describen las características clínicas del paciente y se compara con la literatura médica revisada. Se destaca la importancia del consejo genético. (AU)

Ultrastructural evaluation of recurrent and in-vitro maturation resistant metaphase I arrested oocytes.

An infertile couple whose female partner showed recurrent retrieval of immature metaphase I (MI) oocytes that were resistant to in-vitro maturation, was studied. Four spermiograms revealed teratozoospermia. Consistent non-fertilization and negative pregnancy outcomes were obtained after intrauterine insemination, gamete intra-Fallopian transfer and IVF. Two intracytoplasmic sperm injection (ICSI) cycles were finally performed. All oocytes (n = 17) in both cycles were arrested at MI and failed to mature after 48 h culture. ICSI also resulted in total non-fertilization. In the last cycle, two oocytes were analysed by transmission electron microscopy and showed almost identical results. All organelles showed normal characteristics of an MI oocyte. The main abnormality found was related to the MI spindle, with absence of microtubules and dispersion of the female chromosomes. Minor abnormalities were observed (immature fibrous appearance of the zona pellucida; the presence of small vesicle aggregates which formed a foam-like body). The injected sperm nucleus was arrested in the middle of the chromatin decondensation process, with no visible nuclear envelope reformation. Normal disruption of sperm acrosomal and flagellar components were observed. Only a partial cortical reaction was observed. This represents the first documented case of developmental arrest due to complete absence of spindle formation in association with an otherwise mature ooplasm.

Reconstruction of the eye socket.

Ten cases of irradiated and exenterated orbits in retinoblastoma patients were treated for reconstruction of the eye socket. The follow-up was from 1 to 5 years, with no retraction of the treated area and without sequels of the donor site. The author finds that this pathology is a new and precise indication for the grafted temporofascial island flap described by Dr. O. Erol.

Fitting of electronic elbow on an elbow disarticulated patient by means of a new surgical technique.

Rehabilitation of trans-humeral amputees represents a challenge. One of the difficulties to overcome is prosthetic suspension. In the case of elbow disarticulation the presence of humeral condyles permits better suspension, but there is no room for elbow joints, particularly electronic ones, and the only available mechanisms are provided by external hinges. The purpose of this report is to present a case of a primarily elbow disarticulated patient, with indication for surgical revision due to bad skin coverage, neuroma and the wish to improve prosthetic fitting. The surgical plan outlined was to produce a shortening of the humerus, by means of an osteotomy just above the humeral condyles, preserving them for prosthetic suspension. This bone reduction was carried out with complementary shaping of bone segments with an indentation to enhance fixation. The operation was completed with neuroma resection, myodesis and removal of the skin grafted area. Preservation of the humeral condyles actually produced effective suspension. For final fitting a Utah Arm II was used, with wrist rotator, and interchangeable hand and Greifer for terminal devices. Good initial results and at nine months follow-up suggest this procedure should be considered in other elective situations.

Effect of the media composition on the growth parameters and biological properties ofBacillus thuringiensis var.israelensis delta-endotoxin.

The effects of media composition on growth parameters, total protein production (including delta-endotoxin) and its relation to the biological properties ofBacillus thuringiensis var.israelensis was investigated. The replacement of glucose by glycerol as the carbon source yielded higher concentrations of delta-endotoxin. This increase in toxicity was associated with increased amounts of the 130 kDa polypeptide fraction. The biocide activity was not related to haemolytic activity. specific growth rate nor spore count.