Manejo quirúrgico de nariz mestiza con injerto de extensión septal / Surgical management of the mongrel nose with graft of septal extension

Resumen Objetivo: La nariz mestiza presenta características muy diferentes de la caucásica resultando en un desafío quirúrgico para el cirujano estético facial. El objetivo del estudio fue describir el manejo quirúrgico de la nariz mestiza con injerto de extensión septal y evaluar los resultados estéticos. Materiales y Método: Estudio de una serie de casos de corte longitudinal, muestra de 25 pacientes. Se realizó un plan quirúrgico mediante abordaje abierto y el uso de injerto de extensión septal, se compararon las fotos pre y postoperatorias midiendo el ángulo y la proyección de la punta nasal, junto con el nivel de satisfacción postoperatoria de los pacientes. Se utilizó estadística descriptiva que incluyó frecuencias absolutas y relativas. Resultados: 56% de los pacientes corresponden al sexo femenino, al 52% se colocó injertos espaciadores, 8% necesitó alotomía, el 100% mejoró el ángulo nasolabial y solo un paciente presentó hematoma septal a los 10 días postquirúrgico, se resolvió con drenaje, la encuesta de satisfacción realizada a los pacientes postquirúrgicos mostró un resultado satisfactorio. Conclusiones: La técnica quirúrgica con injerto de extensión septal es de gran utilidad, se logró una correcta definición, proyección/rotación de la punta nasal y mayor estabilidad estructural del trípode central, con resultados armónicos satisfactorios en su apariencia de frente y de perfil, evitando colocar injertos en la punta nasal.

Aim: The mongrel nose has very different characteristics from the caucasian one resulting in a surgical challenge for the facial cosmetic surgeon. The objective of the study was to describe the surgical management of the mongrel nose with graft of septal extension and to evaluate the aesthetic results. Materials and Method: Study of a series of cases of longitudinal section, sample of 25 patients. A surgical plan was performed using an open approach and the use of graft of septal extension, the pre and postoperative photos were compared by measuring the angle and projection of the nasal tip, together with the level of postoperative satisfaction of the patients. Descriptive statistics that included absolute and relative frequencies were used. Results: 56% belong to the female sex, 52% were placed spacer grafts, 8% needed an allotomy, 100% improved the nasolabial angle and only one patient presented septal hematoma at 10 days post surgery, it was resolved with drainage, the satisfaction survey of post-surgical patients showed a satisfactory result. Conclusions: The surgical technique with graft of septal extension is very useful, a correct definition, projection/rotation of the nasal tip and greater structural stability of the central tripod were achieved, with satisfactory harmonic results in its front and profile appearance, avoiding place grafts on the nasal tip.

Multiple solutions and numerical analysis to the dynamic and stationary models coupling a delayed energy balance model involving latent heat and discontinuous albedo with a deep ocean.

We study a climatologically important interaction of two of the main components of the geophysical system by adding an energy balance model for the averaged atmospheric temperature as dynamic boundary condition to a diagnostic ocean model having an additional spatial dimension. In this work, we give deeper insight than previous papers in the literature, mainly with respect to the 1990 pioneering model by Watts and Morantine. We are taking into consideration the latent heat for the two phase ocean as well as a possible delayed term. Non-uniqueness for the initial boundary value problem, uniqueness under a non-degeneracy condition and the existence of multiple stationary solutions are proved here. These multiplicity results suggest that an S-shaped bifurcation diagram should be expected to occur in this class of models generalizing previous energy balance models. The numerical method applied to the model is based on a finite volume scheme with nonlinear weighted essentially non-oscillatory reconstruction and Runge-Kutta total variation diminishing for time integration.

Numerical and analytical study of an atherosclerosis inflammatory disease model.

We study a reaction-diffusion mathematical model for the evolution of atherosclerosis as an inflammation process by combining analytical tools with computer-intensive numerical calculations. The computational work involved the calculation of more than sixty thousand solutions of the full reaction-diffusion system and lead to the complete characterisation of the ω-limit for every initial condition. Qualitative properties of the solution are rigorously proved, some of them hinted at by the numerical study.

Analysis of dental arch dimensions in three Colombian ethnic groups / Análisis de las dimensiones del arco dental en tres grupos étnicos colombianos

The purpose of this study was to compare dental arch transversal and anteroposterior dimensions in three ethnic groups from Colombia. A digital caliper was used to take 16 transversal and two sagittal measurements, 9 for the upper jaw and 9 for the lower jaw. The sagittal measure determining arch length was drawn from a mesial line traced from first right permanent molar to first left permanent molar, and a perpendicular line from the point of contact between central incisive teeth, both for the upper and lower jaw. The dimensions of upper dental arch in the three ethnic groups showed differences in intercanine distance, as well as between premolar and between molar teeth. The same differences were found for lower dental arches. The populations evaluated show distinctive characteristics in dental arch dimensions, thus the mestizo population had narrow arches while the natives had wide arches.

El propósito de éste estudio fue comparar las dimensiones transversal y anteroposterior del arco dental en tres grupos étnicos de Colombia. Se utilizó un calibrador digital para tomar 16 medidas transversales y dos sagitales, 9 maxilares y 9 mandibulares. La medida sagital para determinar la longitud del arco se elaboró a partir de una línea trazada desde mesial primera molar derecho permanente al primer molar izquierdo permanente, y una línea perpendicular desde el punto de contacto entre los incisivos centrales, tanto para el maxilar y mandíbula. Las dimensiones del arco dental maxilar en los tres grupos étnicos mostraron diferencias en la distancia intercanina, así como entre premolares y molares. Las mismas diferencias se encontraron en la mandíbula. Las poblaciones evaluadas presentan características distintivas en las dimensiones del arco dental, por lo que la población mestiza tuvo arcos estrechos, mientras que los nativos tuvieron arcos anchos.

[Neuro-Behçet: clinicopathological findings in an autopsy case]. / Neurobehçet: hallazgos clinicopatológicos de un caso de autopsia.

INTRODUCTION: Behçet's disease (BD) was first described by Hulusi Behçet in 1937 as a triad of oral aphthae, genital ulcers and uveitis. It affects most of tissues and organs without exception and has a prevalence of neurologic involvement between 5 and 30%. Histopathological research of autopsy cases is limited, even though the cause of death is confirmed in this study. CASE REPORT: A 30-years-old man without prior medical history of interest debuting with a BD with progressive neurological manifestations and fatal evolution. The autopsy showed, in gross examination, oral and scrotal ulcers. Moreover, the brain revealed a marked cerebral edema, opaque leptomeninges and hemorrhagic infarction of the left frontal lobule extended to the homolateral ventricular cavity. In the brain stem, multiples hemorrhagic infarctions and hemorrhage in the fourth ventricle. The microscopic examination showed a generalized perivascular lymphocytic and neutrophilic inflammation in small and medium vessels with intense diapedesis bleeding. This phenomenon was predominant in brain stem. CONCLUSIONS: The necropsy studies of patients with neuro-Behcet's disease are scarce. We report the clinicopathological findings in a patient with BD and neurological involvement, in which stands out a cerebral vascular affectation predominant in brain stem.

Neurobehçet: hallazgos clinicopatológicos de un caso de autopsia / Neuro-behçet: Clinicopathological findings in an autopsy case

Introducción. La enfermedad de Behçet (EB) la describió por primera vez en 1937 Hulusi Behçet como la tríada deúlceras orales, úlceras genitales y uveítis. Involucra a casi todos los tejidos y órganos sin excepción, y la tasa de afectación del sistema nervioso central es del 5 al 30%. Los estudios histopatológicos de casos de necropsias son escasos, a pesar de que la causa de muerte se constata en este estudio. Caso clínico. Varón de 30 años que comenzó con EB con afectación neurológicade evolución progresiva y fatal. El estudio autópsico mostró en el examen externo úlceras orales y escrotales. El encéfalo presentaba marcado edema cerebral, meninges opacas y un infarto hemorrágico frontal izquierdo con extensión hacia el ventrículo lateral homólogo, y el tronco del encéfalo, infartos hemorrágicos confluentes y hemorragia del cuarto ventrículo. En el examen de los órganos restantes destacaban múltiples infartos pulmonares bilaterales. El estudio histológico del encéfalo mostró, de forma generalizada, predominante en el tronco del encéfalo, vasos de pequeño y mediano calibre rodeados por una corona de linfocitos y neutrófilos, con intensa extravasación eritrocitaria perivascular. Conclusiones. Los estudios denecropsias de pacientes con neurobehçet son escasos. Presentamos los hallazgos clínicos y patológicos de un paciente con EB con afectación neurológica, en el que destaca una afectación vascular cerebral predominante en el tronco del encéfalo

Introduction. Behçet’s disease (BD) was first described by Hulusi Behçet in 1937 as a triad of oral aphthae, genital ulcers and uveitis. It affects most of tissues and organs without exception and has a prevalence of neurologic involvement between 5 and 30%. Histopathological research of autopsy cases is limited, even though the cause of death is confirmed in thisstudy. Case report. A 30-years-old man without prior medical history of interest debuting with a BD with progressive neurological manifestations and fatal evolution. The autopsy showed, in gross examination, oral and scrotal ulcers. Moreover, the brain revealed a marked cerebral edema, opaque leptomeninges and hemorrhagic infarction of the left frontal lobuleextended to the homolateral ventricular cavity. In the brain stem, multiples hemorrhagic infarctions and hemorrhage in the fourth ventricle. The microscopic examination showed a generalized perivascular lymphocytic and neutrophilic inflammationin small and medium vessels with intense diapedesis bleeding. This phenomenon was predominant in brain stem. Conclusions. The necropsy studies of patients with neuro-Behçet’s disease are scarce. We report the clinicopathological findings in a patient with BD and neurological involvement, in which stands out a cerebral vascular affectation predominant in brain stem

Safety and immunogenicity of the RTS,S/AS02A candidate malaria vaccine in children aged 1-4 in Mozambique.

BACKGROUND: The development of a malaria vaccine remains a public health priority for sub-Saharan Africa. RTS,S/AS02A candidate malaria vaccine has been shown to be safe and immunogenic in previous studies in adults and staggered dose-escalation studies in children in The Gambia. However, genetic features and the intensity of malaria transmission may modify the safety and immune response of a vaccine. OBJECTIVE: We carried out a phase I, double-blind randomized controlled trial in 60 children aged 1-4 in Mozambique to evaluate the safety, reactogenicity and immunogenicity of the paediatric vaccine dose (fixed 25 microg RTS,S in 0.25 ml) of RTS,S/AS02A, prior to undertaking a planned larger phase IIb proof-of-concept of efficacy study in the same population. METHOD: Children were randomized to receive either RTS,S/AS02A or Engerix-B vaccine. Monitoring of safety and reactogenicity included detailed clinical and laboratory analyses and assessment of adverse events (AEs). RESULTS: The RTS,S/AS02A was found to be safe and well tolerated. Serious adverse events were balanced between both groups and none was related to vaccination. The frequency of adverse events reported with RTS, S/AS02A was comparable to previous studies in children. Grade 3 AEs were infrequent (one case of pain, one of fever in each group and some swelling greater than 20 mm in diameter), transient and resolved without sequelae. RTS,S/AS02A was highly immunogenic for anti-circumsporozoite protein antibody response and induced a strong anti-hepatitis-B surface antigen response.

Safety and immunogenicity of the RTS, S/AS02A candidate malaria vaccine in children aged 1­4 in Mozambique

The development of a malaria vaccine remains a public health priority for sub-Saharan Africa. RTS,S/AS02A candidate malaria vaccine has been shown to be safe and immunogenic in previous studies in adults and staggered dose-escalation studies in children in The Gambia. However, genetic features and the intensity of malaria transmission may modify the safety and immune response of a vaccine. We carried out a phase I, double-blind randomized controlled trial in 60 children aged 1-4 in Mozambique to evaluate the safety, reactogenicity and immunogenicity of the paediatric vaccine dose (fixed 25 microg RTS,S in 0.25 ml) of RTS,S/AS02A, prior to undertaking a planned larger phase IIb proof-of-concept of efficacy study in the same population. Children were randomized to receive either RTS,S/AS02A or Engerix-B vaccine. Monitoring of safety and reactogenicity included detailed clinical and laboratory analyses and assessment of adverse events (AEs). The RTS,S/AS02A was found to be safe and well tolerated. Serious adverse events were balanced between both groups and none was related to vaccination. The frequency of adverse events reported with RTS, S/AS02A was comparable to previous studies in children. Grade 3 AEs were infrequent (one case of pain, one of fever in each group and some swelling greater than 20 mm in diameter), transient and resolved without sequelae. RTS,S/AS02A was highly immunogenic for anti-circumsporozoite protein antibody response and induced a strong anti-hepatitis-B surface antigen response.

[Discrepancies between clinical and pathological diagnosis in a polyvalent intensive care service]. / Discrepancias entre el diagnóstico clínico y el anatomopatológico en un Servicio de Cuidados Intensivos Polivalente.

OBJECTIVES: Analyze the frequency and spectrum of the most relevant diseases found in the necropsic study. Assess the association between stay in Intensive Care Unit (ICU) less than 24 hours and rate of diagnostic errors. MATERIAL AND METHODS: Retrospective, observational study during a 46 month period in a polyvalent ICU. The differences between the clinical and pathological diagnoses were established based on Goldman's classification. RESULTS: A total of 85 autopsies out of 520 exitus (16.3%) were done. Five patients were excluded due to incomplete information. Of the 80 cases, we found 30 patients with major errors, 21 with therapeutic and prognostic repercussion, 9 in which the therapeutic strategy had not been modified. The most frequently found diagnosis in type I error was bacterial infection followed by cardiovascular disease. Major error rate with therapeutic repercussion was superior in patients with a stay in the ICU less than 24 hours (40% vs 21%; p < 0.05). CONCLUSIONS: Autopsy continues to be a useful tool to assess quality of clinical diagnosis. The diagnostic errors with therapeutic repercussion are bacterial infections and cardiovascular disease. Patients with a stay less than 24 hours have a higher rate of type I diagnostic errors.

Discrepancias entre el diagnóstico clínico y el anatomopatológico en un Servicio de Cuidados Intensivos Polivalente / Discrepancies between clinical and pathological diagnosis in a Polyvalent Intensive Care Service

Objetivos. Analizar la frecuencia y espectro de las patologías más relevantes encontradas en el estudio necrópsico. Valorar la asociación entre estancia en la Unidad de Cuidados Intensivos (UCI) inferior a 24 horas y la tasa de errores diagnósticos. Material y métodos. Estudio retrospectivo observacional durante un período de 46 meses en una UCI polivalente. Las diferencias entre el diagnóstico clínico y anatomopatológico se establecieron en función de la clasificación de Goldman. Resultados. Se realizaron 85 autopsias de un total de 520 exitus (16,3%). Cinco pacientes fueron excluidos por información incompleta. De los 80 casos, encontramos 30 pacientes con errores mayores, 21 con repercusión terapéutica y pronóstica, y 9 en los que la estrategia terapéutica no se hubiera modificado. El diagnóstico más frecuentemente encontrado en el error tipo I fue la infección bacteriana seguida de la patología cardiovascular. La tasa de errores mayores con repercusión terapéutica fue superior en los pacientes con una estancia en UCI inferior a 24 horas (40% frente a 21%; p < 0,05). Conclusiones. La autopsia continúa siendo una herramienta útil para evaluar la calidad del diagnóstico clínico. Los errores diagnósticos con repercusión terapéutica son las infecciones bacterianas y la patología cardiovascular. Los pacientes con una estancia en la UCI inferior a 24 horas presentan una tasa mayor de errores diagnósticos tipo I

Objectives. Analyze the frequency and spectrum of the most relevant diseases found in the necropsic study. Assess the association between stay in Intensive Care Unit (ICU) less than 24 hours and rate of diagnostic errors. Material and methods. Retrospective, observational study during a 46 month period in a polyvalent ICU. The differences between the clinical and pathological diagnoses were established based on Goldman's classification. Results. A total of 85 autopsies out of 520 exitus (16.3%) were done. Five patients were excluded due to incomplete information. Of the 80 cases, we found 30 patients with major errors, 21 with therapeutic and prognostic repercussion, 9 in which the therapeutic strategy had not been modified. The most frequently found diagnosis in type I error was bacterial infection followed by cardiovascular disease. Major error rate with therapeutic repercussion was superior in patients with a stay in the ICU less than 24 hours (40% vs 21%; p < 0.05). Conclusions. Autopsy continues to be a useful tool to assess quality of clinical diagnosis. The diagnostic errors with therapeutic repercussion are bacterial infections and cardiovascular disease. Patients with a stay less than 24 hours have a higher rate of type I diagnostic errors

Aspectos clínicos del brote epidémico de dengue en el cono norte de Lima, 2005 / Clinical aspects of dengue outbreak in northern cone of Lima, 2005

En abril y mayo del 2005 se reportó una epidemia de dengue en el cono norte de Lima. Todos los casos fueron autóctonos. En el Hospital Sergio Bernales se estudiaron 31 casos. Fue más frecuente en el grupo de 17 a 34 años de edad (64.51%). Síntomas. Fiebre (100%), dolor de cabeza (77.42%), mialgia (51.61%), dolor retroocular (45.16%), artralgia (41.94%). Signos. Deshidratación (54.84%), rash cutáneo (51.61%), hipotensión arterial (41.93%), petequias (38.71%), congestión conjuntival (29.03%), congestión faríngea (22.58%). Análisis. Leucopenia (86.21%), trombocitopenia (65.52%), prueba de lazo positivo (68.96%). Formas clínicas. Síndrome de fiebre del dengue (35.49%) y síndrome de fiebre del dengue con manifestaciones hemorrágicas (64.51%). Ningún caso fue clasificado como dengue hemorrágico.

A novel subtilisin-like protease gene from Arabidopsis thaliana is expressed at sites of lateral root emergence.

Differential screening of a cDNA library for mRNA species that specifically accumulate during auxin-induced lateral root formation in Arabidopsis thaliana led to the isolation of the AIR3 cDNA clone. The corresponding single copy gene consists of 10 exons which encode a protein that possesses all the characteristics of subtilisin-like proteases. The promoter of the AIR3 gene was fused to the gusA (beta-glucuronidase) reporter gene and introduced into Arabidopsis. Expression was almost completely restricted to the outer layers of the parental root at sites of lateral root emergence and could be observed even before protrusion of the newly formed root tip. In the presence of external auxin, GUS activity was visible throughout the parts of the root that are competent for lateral root formation. By digesting structural proteins in the extracellular matrix of cells located above sites of lateral root formation, AIR3 might weaken cell-to-cell connections and thus facilitate lateral root emergence.

[Bacteremic urinary infection in men: comparative study with bacteremic pyelonephritis in women]. / Infección urinaria bacteriémica en el varón. Estudio comparativo frente a la pielonefritis bacteriémica femenina.

OBJECTIVE: To compare the clinic and microbiologic characteristics of the extrahospitalary bacteremic urinary infections (EBUI) between men and women assisted in a 200 bed community hospital. PATIENTS AND METHODS: A prospective study of the EBUI diagnosed in our hospital from January 1991 to April 1994 was carried out. Quantitative variables were evaluated with t Student analysis, chi 2 was used for the comparation of proportions. The logistic regression step-by-step model was used in order to find out which variables influenced that the microorganism causing EBUI was Escherichia coli. RESULTS: 107 episodes of EBUI were recorded, 39 men and 68 women, with the same microorganism in blood and urine. Significative diferences in age (70 +/- 17 years in men, 58 +/- 24 years in women); the presence of urinary tract alterations (49% men vs 12% women) and in the presence of indwelling urinary catheter (26% men vs 3% female) were found. E. coli was responsible in a major proportion (p = 0.03) of the EBUI in women that in men, but only age > 65 was selected as explaining variable with the logistic regression model. CONCLUSIONS: The EBUI appears in old men with urinary tract alterations and/or manipulations, clearly different from the EBUI in women. Age greater than 65 years is the only predisponent factor of EBUI in men by bacteria other than E. coli.

Diffraction efficiency dependence of holographic subtraction interferometry in Fe:LiNbO(3).

Experimental results on holographic subtraction interferometry in photorefractive lithium niobate crystals are presented. The dependence of the subtraction operation on the hologram diffraction efficiency has been measured for both single holograms and angularly multiplexed holograms. Example results from heat transfer and acoustics are presented.

[Efficacy of a rice-based beverage for the management of dehydration caused by acute diarrhea in children]. / Eficacia de una bebida a base de arroz en el manejo de la deshidratación por diarrea aguda en niños.

We tested the clinical efficacy of a rice-powder gruel (RPG) as an oral rehydration solution in a randomized clinical trial, comparing it with oral rehydration salts (ORS) prepared as recommended by WHO. RPG was prepared as mothers do it in a rural area, according to previous ethnographic work. RPG has sugar but no sodium or other electrolytes. Seventy patients under 5 years old with mild to moderate dehydration due to acute diarrhea were included in the trial. Ninety-two percent of children were successfully rehydrated with RPG and 91% of children were successfully rehydrated with ORS. Patients in the study group required less time to rehydrate and presented a reduction in fecal output as compared with the control group. We propose that the rice-powder gruel should find its place as a first line of treatment at the home level, when oral rehydration salts are not available, to prevent dehydration in the child affected with acute diarrhea, and that its use should be closely linked to no suspension or rapid reintroduction of oral feeding to provide an external source of sodium and other nutrients.