Análisis fotogramétrico de las alteraciones cartilaginosas y de tejidos blandos nasales en pacientes intervenidos por labio-paladar hendido unilateral / Photogrammetric analysis of the alterations in nasal cartilaginous and soft tissue structures in patients operated for unilateral cleft lip and palate

Los pacientes con fisura labio-palatina unilateral presentan alteraciones anatómicas de la nariz y de las estructuras odontológicas que afectan a la simetría facial, estética y al crecimiento. Estas alteraciones pueden corregirse durante la cirugía labial con corrección nasal primaria si se realiza una técnica quirúrgica correcta. En el caso de que la reparación primaria sea inadecuada, la región nasal mostrará deformidades como estigma del problema inicial. El objetivo de este estudio es describir las alteraciones nasales y la relación que guardan las estructuras nasales con las unidades estéticas de la mejilla y del labio superior en 50 pacientes con labio y paladar hendido unilateral no sindrómico, operados mediante queiloplastia. Además, describimos los parámetros o mediciones nasales obtenidos en los pacientes con un resultado quirúrgico adecuado. Las alteraciones anatómicas que con mayor frecuencia hemos encontrado en nuestra serie son: desplazamiento caudal de la cúpula alar en 48 pacientes (96%); desviación del eje longitudinal nasal de 5 a 10o en 24 pacientes (48%); narina más grande del lado hendido en 28 pacientes (56%); presencia de muesca en la narina en 18 pacientes (36%); inserción de la base alar con el labio superior más caudal en el lado hendido en 35 pacientes (70%) y desplazamiento medial de la unión del borde lateral del ala con la mejilla en el lado hendido en 34 pacientes (68%). Estos datos permiten suponer que es posible llevar a cabo una adecuada corrección en la primera intervención (AU)

Patients with unilateral cleft lip and palate show anatomic disturbances related to nasal and odontologic tissues which directly affect facial symmetry, aesthetics and growth. These malformations can be repaired during the initial lip closure procedure with primary nasal correction, if a correct surgical technique is followed. If an incorrect surgical repair is performed, the nasal structures will show deformities which represent stigmata of the initial problem. The aim of this study is to describe the nasal deformities and the relationship between the nasal structures and the cheek and superior lip aesthetic units in 50 patients with nonsyndromic unilateral cleft lip and palate that previously underwent a cheiloplasty. Furthermore, nasal measurements in patients with an adequate surgical result are also described. The most frequent nasal anatomic abnormalities in our series were: caudal displacement of the alar dome in 48 patients (96%); deviation of the nasal longitudinal axis in 5 to 10o in 24 patients (48%); larger nostril on the cleft side in 28 patients (56%); nostril notch in 18 patients (36%); alar base junction with the upper lip caudally oriented on the cleft side in 35 patients (70%), and medial displacement of the tissue corresponding to the intersection of the alar lateral border with the cheek on the cleft side in 34 patients (68%). The data obtained show that an adequate surgical correction can be attained during the first intervention (AU)

Thrombin formation and fibrinolytic activity in patients with acute myocardial infarction or unstable angina: in-hospital course and relationship with recurrent angina at rest.

OBJECTIVES: The goal of this study was to investigate possible differences in thrombin generation or fibrinolytic capacity in patients with unstable angina (UA) or acute myocardial infarction (AMI) with or without recurrent angina at rest. BACKGROUND: Angina at rest in patients with AMI or UA is generally produced by a reduction in coronary flow, but it is unclear whether patients with or without this event differ in their thrombin generation or in their fibrinolytic capacities, which might influence the course of the culprit lesion. METHODS: Thrombin-antithrombin complex (TAT), D-dimer, fibrinogen and plasminogen activator inhibitor (PAI-1) antigen plasma levels were determined in 40 patients with AMI and in 23 with UA on admission, at 10 days and at three months. RESULTS: First day values for TAT, fibrinogen and D-dimer were comparable in patients with AMI and in those with UA. At 10 days they increased significantly in each group, and at 3 months they decreased to a similar extent. First day PAI-1 levels, however, were highest in both groups and declined in AMI patients at 10 days and at three months, whereas they also decreased at 10 days in UA patients but not any further at three months. Ten patients with AMI (25%) and 12 with UA (52%) developed in-hospital angina at rest. First day values for TAT, fibrinogen and D-dimer were similar in patients with or without angina, but PAI-1 levels were higher in the former subset (p < 0.008). At 10 days, however, TAT (p < 0.013) and D-dimer (p < 0.013) were higher in patients who developed angina than in those who did not. CONCLUSIONS: The higher inhibition of fibrinolytic activity in the first day in patients with AMI or UA who will develop recurrent angina suggests that maintenance of a prothrombotic status may contribute to its mechanisms, perhaps by preventing passivation of the culprit thrombus/plaque. This is consistent with greater thrombin generation and greater levels of fibrynolitic products at 10 days observed in these patients compared with those who attain early stability.

[Primary antiphospholipid syndrome: study of 27 patients]. / Síndrome antifosfolípido primario: estudio de 27 pacientes.

The clinical and biological features of a series of 27 patients with the recently described primary antiphospholipid syndrome are reported. Most of them belonged to a cohort of 90 patients who were carriers of lupus anticoagulant, which had been detected in the systematic evaluation of prolonged activated partial thromboplastin times in our hospital. Since the diagnosis they underwent a prospective protocol of follow up, with a peak follow up period of 9 years. The mean age of the 27 patients was 40.8 years and there were virtually no differences between sexes. Venous thrombosis was the most common clinical finding (16 episodes in 14 of the 27 patients). The most prevalent laboratory findings were lupus anticoagulant and IgG anticardiolipin antibodies.