Colgajos Locales en Reconstrucción Facial. Alternativas de Tratamiento

RESUMEN: Los defectos faciales de piel son frecuentemente secuelas producto de carcinomas basoceulares, carcinomas espinocelulares, melanomas, grandes tumores benignos o traumatismos de tejidos blandos. Las unidades y subunidades estéticas de la cara, la textura y color de la piel, junto a otros parámetros deben ser considerados durante la planificación de la reconstrucción mediante colgajos locales. El objetivo de este artículo de revisión bibliográfica fue describir y definir las técnicas más relevantes en los de colgajos locales aplicados en la reconstrucción facial y sus algoritmos actuales, en relación con la unidad o subunidad facial involucrada; sus consideraciones estéticas y cirugía complementaria. Las unidades y subunidades estéticas de la cara se dividen en regiones de la frente, párpados, mejillas, nariz, labios y mentón. Los colgajos de rotación, en isla, de avance y transposición son la base para la mayoría de los colgajos faciales; los más conocidos según la zona donante son: el colgajo frontal, colgajo de rotación y avance de mejilla; colgajo cérvico-facial, y colgajos nasolabiales, entre otros. La elección del colgajo depende de la zona y la unidad estética facial involucrada, siendo importante elegir y usar las líneas, los surcos y márgenes de estas unidades cuando sea posible con el fin de mejorar los resultados estéticos y reducir la posibilidad de secuelas. La cirugía complementaria y los procedimientos estéticos pueden lograr un buen camuflaje de algunas complicaciones estéticas o secuelas.

ABSTRACT: Skin face defects are frequently sequels of basal cell carcinomas, squamous cell carcinomas, melanomas, and large benign tumors or soft tissue trauma. Aesthetics units and subunits of the face, texture, color, and other parameters must be considered in the local flaps reconstructive planning. This review article aims to describe and define the most relevant techniques of facial local flaps in facial reconstruction and their current algorithms, regarding the unit or subunit, involve, their aesthetics considerations and complementary surgery. The aesthetics units and subunits of the face are divided into forehead, eyelids, cheek, nasal, lips, and chin. There are several well-known concepts and flaps used in these proceedings as rotation, island, advancement, and transposition flaps, and they are the basis for facial local flaps; The most relevant are: forehead flap, cheek advancement, and rotate flap; rhomboid, cervicofacial and bilobed flap, nasolabial flaps. The flap election depends on the zone and unit involve; it is important to choose the lines, sulcus, and borders of these units when is possible to enhance these aesthetics outcomes. These concerning improve the aesthetics outcomes and reduce the aesthetics sequels. Complementary surgery and aesthetics proceedings may accomplish a good camouflage of some aesthetics complications or sequels.

Recent trends in global emissions of hydrochlorofluorocarbons and hydrofluorocarbons: reflecting on the 2007 adjustments to the Montreal Protocol.

Global-scale atmospheric measurements are used to investigate the effectiveness of recent adjustments to production and consumption controls on hydrochlorofluorocarbons (HCFCs) under the Montreal Protocol on Substances that Deplete the Ozone Layer (Montreal Protocol) and to assess recent projections of large increases in hydrofluorocarbon (HFC) production and emission. The results show that aggregate global HCFC emissions did not increase appreciably during 2007-2012 and suggest that the 2007 Adjustments to the Montreal Protocol played a role in limiting HCFC emissions well in advance of the 2013 cap on global production. HCFC emissions varied between 27 and 29 kt CFC-11-equivalent (eq)/y or 0.76 and 0.79 GtCO2-eq/y during this period. Despite slower than projected increases in aggregate HCFC emissions since 2007, total emissions of HFCs used as substitutes for HCFCs and chlorofluorocarbons (CFCs) have not increased more rapidly than rates projected [Velders, G. J. M.; Fahey, D. W.; Daniel, J. S.; McFarland, M.; Andersen, S. O. The Large Contribution of Projected HFC Emissions to Future Climate Forcing. Proc. Natl. Acad. Sci. U.S.A. 2009, 106, 10949-10954] for 2007-2012. HFC global emission magnitudes related to this substitution totaled 0.51 (-0.03, +0.04) GtCO2-eq/y in 2012, a magnitude about two times larger than emissions reported to the United Nations Framework Convention on Climate Change (UNFCCC) for these HFCs. Assuming accurate reporting to the UNFCCC, the results imply that developing countries (non-Annex I Parties) not reporting to the UNFCCC now account for nearly 50% of global HFC emissions used as substitutes for ozone-depleting substances (ODSs). Global HFC emissions (as CO2-eq) from ODS substitution can be attributed approximately equally to mobile air conditioning, commercial refrigeration, and the sum of all other applications.

Listeriosis in pregnancy: a secular trend in a tertiary referral hospital in Barcelona.

The purpose of this study was to describe the variation in listeriosis infection incidence during pregnancy over a 25-year period based on salient clinical and laboratory features compiled in a tertiary referral hospital and to depict the clinical characteristics of these cases. A cohort was created of all cases of listeriosis in pregnant women or their neonates (early-onset form) diagnosed between 1985 and 2010. Forty-three cases of perinatal listeriosis were diagnosed among the 82,320 hospitalised pregnant women (incidence 0.5‰). Whereas the incidence remained almost constant at 0.24‰ until 2000, an increasing incidence was observed from then on, reaching 0.86‰ during the last years of the study period. A four-fold increase in listeriosis rate during pregnancy has occurred in recent years, with poorer outcome for those cases occurring before 28 weeks and for those in which early antibiotic treatment was not provided. These results should raise the awareness of the agencies and professionals involved in prenatal care.

Amyloidosis (AA type) associated with nodular nonsuppurative panniculitis.

A 42-year-old man had a 9-year history of idiopathic, nodular nonsuppurative panniculitis that was complicated by generalized AA-type amyloidosis. We believe that this is the first report of this association.

[Angiotensin-converting enzyme in sarcoidosis: diagnostic and prognostic value (author's transl)]. / Enzima de conversíon de la angiotensina (ECA) y sarcoidosis: valor diagnóstico y pronóstico.

Between April 1976 and February 1980, serum levels of angiotensin-converting enzyme were determined in 61 cases of sarcoidosis at different stages of evolution. Cases were divided in three groups on the basis of social determinations done every 3-6 months. In the group with 46 active cases the increase in mean value of the enzyme is statistically significant compared to the control group; 30 of these (65.2%) had values higher than + 2DS. In the second group with 24 cases of non-progressive or inactive sarcoidosis the mean value was slightly higher than the normal mean value, without being statistically significant; 21 patients (87.5%) showed normal values: in the third group with 19 patients who had been treated with corticosteroids, mean value was equal to normal values; after 12 months treatment values were normal in 17 cases (89.5%). In the control group of 80 patients with a variety of pulmonary diseases other than sarcoidosis (pulmonary tuberculosis, pneumonia, pulmonary thromboembolism and primary lung cancer) only 9 cases presented values higher than the normal + 2SD (11.2% false positive). Serial determination of angiotensin-converting enzyme is a useful diagnostic parameter in sarcoidosis; especially in evaluating progression of the disease as well as the efficacy of corticosteroid treatment.

[Eosinophilic pleural effusion during the course of a giardiasis. Report of a case (author's transl)]. / Derrame pleural eosinófilo en el curso de una giardiasis. A propósito de una observación.

A case of eosinophilic pleural effusion with coincidental intestinal infestation by Giardia lamblia is reported. After reviewing the possible causes of this type of pleuritis no clinical or laboratory data were obtained which could explain this condition, excepting the giardiasis, in the course of which there is no bibliographic reference in this sense. After the parasitosis had been treated with metronidazole the parasitologic negativization coincided with the disappearance of the pleural effusion. A review of the etiologies described in relation to eosinophilic pleural effusion and of the factors involved in the movilization of eosinophils, especially those which have a relationship with parasitosis, was carried out. Parasitosis may be capable of determining immune reactions with release of eosinophilotactic substances. The fact that the lung of experimental animals has been shown to be a suitable tissue for the release of factors with eosinophilotactic activity, could indicate that this organ has a special reactive capacity and probably, together with it, a closely related structure such as the pleura could have it too.