Craniofacial Fibrous Dysplasia: Surgical Management and Long-Term Outcomes at a Referral Center in Mexico City.

Background Craniofacial fibrous dysplasia (CFD) is an uncommon benign condition in which a bone is replaced by fibrous tissue. An adequate clinical characterization considering the number of affected bones and functional impairment is important to determine the most effective surgical intervention for its management. This study aims to present our institution's experience in the evaluation and management of CFD. Methods This was a retrospective study that included patients with CFD managed at our institution. Data included demographic characteristics, afflicted bones, surgical procedures performed, and recurrence. Results are presented as mean and percentages. Recurrence-free years and association between the type of surgery and recurrence was evaluated. Results Eighteen patients were included (11 females, 61%). The zygomatic, maxillary, and frontal bones were the most commonly affected with eight (18%) cases each. The most common procedure was bone burring, with 36 procedures. Recurrence was more prevalent after burring (58.3%) and occurred earlier than in the bone resection group (13 vs. 15 years, p > 0.05). Conclusion Surgery continues to be the cornerstone of CFD treatment. Bone burring is effective for debulking and contouring but increases the risk for recurrence. An individualized approach should be tailored according to the anatomical location of the disease, type of CFD, behavior of the lesion, and accompanying clinical complaints.

Effect of Liposuction on Body Weight and Serum Concentrations of Leptin, Lipids, Glucose, and Insulin: A Meta-Analysis.

BACKGROUND: Abdominal obesity has been associated with an increased risk of insulin resistance, metabolic syndrome, and diabetes. Central fat removal procedures such as liposuction, lipectomy, and abdominoplasty are among the most common surgical procedures. The impact of the latter on the former is controversial and understudied. The authors aimed to explore the effect of subcutaneous fat elimination procedures on insulin resistance measures and adipokine levels. METHODS: Relevant studies regarding the effects of surgical subcutaneous fat removal on glucose, insulin, adipokines, and lipid metabolism, as well as blood pressure, were identified by searching PubMed and Ovid-Cochrane without limits in date, type of publication, or language. After the selection process, 24 studies were obtained. The results of the articles were summarized using descriptive statistics. For the final analysis, a randomized effects model was used to evaluate heterogeneity; averages and meta-analytic differences were expressed with a confidence interval of 95%. RESULTS: All studies reported a reduction in weight (-2.64 kg; 95% CI, -4.32 to -0.96; P = 0.002; I 2 = 36%; P of I 2 < 0.001) and body mass index after liposuction. A significant improvement in triglycerides (-10.06 mg/dL; 95% CI, -14.03 to -6.09; P < 0.001; I 2 = 48%; P of I 2 = 0.05), serum glucose concentration (-4.25 mg/dL; 95% CI, -5.93 to -2.56; P < 0.001; I 2 = 68%; P of I 2 < 0.001), serum insulin concentration (-2.86 µIU/mL; 95% CI, -3.75 to -1.97; P < 0.001; I 2 = 59%; P of I 2 = 0.003), and serum leptin concentration (-7.70 ng/mL; 95% CI, -11.49 to -3.92; P = 0.0001; I 2 = 96%; P of I 2 < 0.001) was consistently observed. CONCLUSION: In addition to weight loss, there is a significant decrease in leptin, triglyceride, glucose, and insulin serum concentrations after liposuction, a fact that should be considered in future discussions.

Aplicaciones de la impresión 3D en cirugía plástica reconstructiva / Use of 3D printing in reconstructive plastic surgery

Resumen La impresión 3D es una tecnología interesante en constante evolución. También conocida como manufactura aditiva, consiste en la conversión de diseños digitales a modelos físicos mediante la adición de capas sucesivas de material. En años recientes, y tras el vencimiento de múltiples patentes, diversos campos de las ciencias de la salud se han interesado en sus posibles usos, siendo la cirugía plástica una de las especialidades médicas que más ha aprovechado sus ventajas y aplicaciones, en especial la capacidad de crear dispositivos altamente personalizados a costos accesibles. Teniendo en cuenta lo anterior, el objetivo del presente artículo es describir los usos de la impresión 3D en cirugía plástica reconstructiva a partir de una revisión de la literatura. Las principales aplicaciones de la impresión 3D descritas en la literatura incluyen su capacidad para crear modelos anatómicos basados en estudios de imagen de pacientes, que a su vez permiten planificar procedimientos quirúrgicos, fabricar implantes y prótesis personalizadas, crear instrumental quirúrgico para usos específicos y usar biotintas en ingeniería tisular. La impresión 3D es una tecnología prometedora con el potencial de implementar cambios positivos en la práctica de la cirugía plástica reconstructiva en el corto y mediano plazo.

Abstract 3D printing is an interesting technology in constant evolution. Also known as additive manufacturing, it consists of the conversion of digital designs into physical models by successively adding material layer by layer. In recent years, and after the expiration of multiple patents, several fields of health sciences have approached this type of technology, plastic surgery being one of the medical specialties that has taken advantage of its benefits and applications, especially the ability to create highly customized devices at low costs. With this in mind, the objective of this work is to describe the uses of 3D printing in reconstructive plastic surgery based on a literature review. The main applications of 3D printing described in the literature include its ability to create anatomical models based on patient imaging studies, which in turn allow planning surgical procedures, manufacturing custom implants and prostheses, creating surgical or instrumental simulators, and using bioinks in tissue engineering. 3D printing is a promising technology with the potential to cause positive changes in the field of reconstructive plastic surgery in the short and medium term.

Trombosis masiva posterior a la colocación de filtro en vena cava inferior. Reporte de un caso / Massive thrombosis after placement of the inferior vena cava filter. Case report

Resumen Tras la colocación de un filtro de vena cava inferior, hasta un 30% de los pacientes puede desarrollar trombosis, una complicación severa con alta morbimortalidad. Presentamos el caso de una paciente de 84 años con trombosis masiva en la vena cava inferior y sistema venoso de miembros inferiores tras la colocación de un filtro de vena cava inferior.

Abstract After lower vena cava filter placement, up to 30% of patients can develop thrombosis, a severe complication with high morbidity and mortality. We present the case of an 84-year-old patient with massive thrombosis in the inferior vena cava and venous system of the lower limbs after a lower vena cava filter placement.

Predictive value of antinuclear antibodies in autoimmune diseases classified by clinical criteria: Analytical study in a specialized health institute, one year follow-up.

INTRODUCTION: Determination of antinuclear antibodies (ANA) by indirect immunofluorescence (IIF) is usually the initial test for the diagnosis of systemic rheumatic diseases (SRD). Assigning predictive values to positive and negative results of the test is vital because lack of knowledge about ANAs and their usefulness in classification criteria of SRD leads to inappropriate use. METHODS: Retrospective study, ANA tests requested by different specialties, correlation to patients' final diagnosis. RESULTS: The prevalence of autoimmune disease was relatively low in our population yielding a low PPV and a high NPV for the ANA test. 40% of the patients had no clinical criteria applied prior to test. Coexistence of two or more autoimmune disorders affects prevalence and predictive values. CONCLUSION: Application of the test after careful evaluation for clinical criteria remarkably improves the positive likelihood ratio for the diagnosis.

[Drainage of amoebic liver abscess by single incision laparoscopic surgery. Report of a case]. / Drenaje de absceso hepático amebiano por laparoscopia de puerto único. Reporte de un caso.

BACKGROUND: Single incision laparoscopic surgery has increased recently due to successful results, achieved in several procedures. The aim of the present work is to present the first case in which single incision laparoscopy is used for the drainage of an amoebic liver abscess. CLINICAL CASE: A 44-year-old man presented with intense right upper quadrant pain, generalised jaundice, tachycardia, fever, hepatomegaly and a positive Murphy's sign. Laboratory results revealed an increased plasma bilirubin, elevated alkaline phosphatase and transaminases, leucocytosis, negative viral panel for hepatitis, and positive antibodies against Entamoeba histolytica. On an abdominal computed tomography a 15 × 12.1 cm hypodense lesion was observed in the patient's liver, identified as an amoebic liver abscess. Analgesics and antibiotics were started and subsequently the patient was submitted to laparoscopic drainage of the abscess using a single port approach. Drainage and irrigation of the abscess was performed. Four days later the patient was discharged without complications. CONCLUSION: Management of amoebic liver abscess is focused on the elimination of the infectious agent and obliteration of the abscess cavity in order to prevent its complications, especially rupture. Laparoscopic surgery has proved to be a safe and effective way to manage this entity.

Tetralogía de Fallot: reporte de un caso y revisión de la literatura / Tetralogy of Fallot: Case report and literature review

La tetralogía de Fallot es una cardiopatía congénita que se caracteriza por presentar estenosis infundibular de la arteria pulmonar, cabalgamiento aórtico, comunicación interventricular e hipertrofia del ventrículo derecho. Es la cardiopatía congénita cianógena más prevalente, representando entre el 3.5 a 8% de los defectos cardiacos congénitos. Presentamos el caso de un paciente de 6 años que acudió al hospital con cianosis peribucal y acrocianosis y episodios recurrentes de crisis hipóxicas. Se le hizo un ecocardiograma con el cual se diagnóstico tetralogía de Fallot y posteriormente se le realizó una fístula de Blalock-Taussig.

Tetralogy of Fallot is a congenital cardiopathy characterized by infundiblutar stenosis of the pulmonary artery, overriding aorta, ventricular septal defect and right ventricular hypertrophy. It is the most prevalent cyanotic congenital heart defect, with a prevalence between 3.5 to 8%. We present the case of a 6-year-old male who was taken to our hospital due to perioral and distal cyanosis and paroxistic episodes of hypoxia (tet spell), who was diagnosed with tetralogy of Fallot after echocardiography and was treated with Blalock-Taussig shunt.

[Necrotizing fasciitis caused by cutaneous mucormycosis. A case report]. / Fascitis necrosante causada por mucormicosis cutánea. Reporte de un caso.

BACKGROUND: Mucormycosis are opportunistic infections with high morbidity and mortality caused by fungi of the class Zygomycetes, they mainly affect diabetic and immunocompromised patients. In up to 20% of all cases the main infection is localized in the skin, with a great number of them presenting in healthy patients that have suffered from severe trauma or burns. Zygomycetes tend to invade arteries, which leads to thrombosis and generates wide necrotic areas; this favors the progress of the infection and invasion of deep tissues. Up to 24% of primary cutaneous mucormycosis can be complicated with necrotizing fasciitis. CLINICAL CASE: We present the case of a 52 year-old male that received the clinical diagnosis of necrotizing fasciitis. The patient received wide spectrum antibiotics and was submitted to extensive debridement of the wound bed; transoperative biopsy revealed the presence of zygomycetes in the tissues and the diagnosis of primary cutaneous zygomycosis was made. Antifungal treatment with amphotericin B was initiated and two weeks later autologous skin grafts were applied over the wounds. CONCLUSION: A high index of suspicion is needed to diagnose cutaneous zygomycosis, therefore it should always be considered amongst the differentials of necrotic wounds that do not respond to standard treatment. The rapid evolution of the disease remarks the importance of biopsying the wound bed early and treating aggressively.