Biomarkers of endothelial dysfunction and atherosclerosis in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease associated with an increased prevalence of subclinical atherosclerosis and cardiovascular risk. Angiopoietin-2 (Ang-2), asymmetric dimethylarginine (ADMA), and osteoprotegerin (OPG) are molecules related to endothelial dysfunction (ED) and atherosclerosis, but also to disease severity in patients with chronic inflammatory disorders. In this case-control study, we aimed to investigate serum Ang-2, ADMA, and OPG levels in patients with HS, and to assess the potential relationship between these levels and disease severity. Seventy-five patients with HS and 60 controls were assessed. Serum Ang-2, ADMA, and OPG concentrations were determined in all participants. HS patients had significantly higher Ang-2 and ADMA levels than controls after adjusting for confounders. Besides, Ang-2 concentrations positively correlated with disease severity in the adjusted multivariable analysis. Nevertheless, serum OPG levels did not significantly differ between HS patients and controls. Our results indicate that serum Ang-2 and ADMA levels are significantly increased in patients with HS. Furthermore, Ang-2 might be a suitable marker of HS severity.

The potential role of imaging techniques in avoiding neck dissection during salvage surgery after head and neck carcinoma treated with bioradiotherapy.

OBJECTIVE: This study aimed to evaluate the effectiveness of computed tomography and positron emission tomography-computed tomography prior to salvage surgery after head and neck carcinoma treated with bioradiotherapy and to look at the role of neck dissection in this setting. METHOD: This study was a retrospective chart review of a series of consecutive patients with locally advanced head and neck squamous cell carcinoma treated with bioradiotherapy. Radiological and pathological stages were compared to evaluate the accuracy of computed tomography and positron emission tomography-computed tomography in detecting occult neck metastasis in the context of recurrence of primary tumour. In order to assess the impact of neck dissection on survival, Kaplan-Meier survival curves after salvage surgery with and without neck dissection were derived. RESULTS: A total of 268 patients were identified, of which 22 underwent salvage surgery. The negative predictive value of computed tomography and positron emission tomography-computed tomography was excellent. Neck dissection did not represent an improvement on overall, disease specific and regional recurrence free survival (p = 0.67, p = 0.91 and p = 0.62, respectively) amongst clinically and radiologically negative necks. CONCLUSION: Conservative treatment of the neck should be considered when dealing with patients with primary site recurrence or persistent disease after bioradiotherapy without evidence of neck disease.

Evaluation of serum omentin-1 and apelin concentrations in patients with hidradenitis suppurativa.

INTRODUCTION: Recent studies suggest a role of adipokines in the pathogenesis of hidradenitis suppurativa (HS). Omentin-1 and apelin are two recently identified adipokines that have been involved in the regulation of metabolic and inflammatory responses. AIM: To investigate serum omentin-1 and apelin levels in patients with HS and to assess their associations with metabolic parameters, disease severity and HS risk. MATERIAL AND METHODS: This case-control study included 139 non-diabetic individuals (78 HS patients and 61 ageand sex-matched controls). Serum concentrations of omentin-1 and apelin and the homeostasis model assessment of insulin resistance (HOMA-IR) were measured in all participants. RESULTS: Serum omentin-1 concentrations were significantly higher in HS patients compared to controls, whereas apelin serum levels did not significantly differ between both groups. These differences in omentin-1 concentrations remained significant even after adjusting for age, sex, and body mass index (BMI). The results of logistic regression analysis showed that increased omentin-1 plasma levels were an independent risk factor for HS. However, we found no association between serum levels of both omentin-1 and apelin with HS severity. CONCLUSIONS: Our results show that patients with HS have raised omentin-1 serum levels, which are associated with HS risk.

Association of retinol binding protein4 (RBP4) and ghrelin plasma levels with insulin resistance and disease severity in non-diabetic patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease associated with insulin resistance (IR). Retinol binding protein 4 (RBP4) and ghrelin are two bioactive proteins that have been involved in glucose metabolism and IR, but also in the regulation of immune and inflammatory processes. The aim of this study was to determine the serum levels of RBP4 and ghrelin in patients with HS, and to assess the possible relationship between these levels and IR, disease severity and HS risk. A total of 137 subjects (77 HS patients and 60 controls) without diabetes mellitus were enrolled in this cross-sectional study. Patients with HS had significantly higher RBP4 but lower ghrelin plasma levels than controls, independently of body mass index (BMI). Serum RBP4 levels were positively correlated to disease severity and IR in HS patients. However, we found no association between ghrelin levels and any clinical or laboratory parameters. Moreover, high serum RBP4 and low ghrelin levels were associated with an increased risk for HS. Our results suggest that high RBP4 levels may be a surrogate biomarker for IR in patients with HS. Moreover, increased RBP4 and decreased ghrelin levels could also be independent risk factors for the development of HS.

[Vascular reconstruction for limb preservation during sarcoma surgery: a case series and a management algorithm]. / Reconstrucción vascular durante la cirugía de sarcomas para la preservación de extremidades: serie de casos y algoritmo de manejo.

OBJECTIVE: To evaluate the results of vascular reconstruction in soft tissue sarcoma surgery and establish an algorithm based on current evidence. MATERIAL AND METHODS: We studied patients undergoing soft-tissue sarcoma in a tertiary hospital. A retrospective review of 8 cases was carried out, analysing the demographics, surgical planning, complications, disease-free survival and bypass patency. RESULTS: Successful limb preservation was observed in all patients, and the bypass remained patent in all cases. The mean follow-up was 38.4 months average, with 87.5% survival and no recurrences. CONCLUSIONS: The involvement of major vascular structures in soft tissue sarcomas of the limbs does not necessarily exclude resectability. In selected cases, resection is possible with vascular reconstruction and limb preservation. However, multidisciplinary planning is needed.

Indications of microsurgery in soft tissue sarcomas.

UNLABELLED: Sarcomas are uncommon tumors and free-margin surgical resection remains the single most important treatment in the curative therapy of soft tissue sarcomas. Refinements in surgical techniques have led to increased function preservation and limb salvage. PATIENTS AND METHODS: The records of patients (n = 41) who underwent microsurgical soft tissue reconstruction subsequent to resection of soft tissue sarcoma during the period 1998 to 2010 were reviewed and compared with a general nonmicrosurgery group (n = 188) in relation to clinicopathological characteristics, surgical procedures, postoperative complications, time until start of adjuvant radiation, functional outcome (Toronto Extremity Salvage Score, TESS), local recurrence, free survival, and disease-specific survival. RESULTS: Forty-one patients (age range: 23 to 95 years) received a total of 42 free flaps. When compared with the general nonmicrosurgery group, these patients presented significant differences with regard to location, histological grade, and neoadjuvant treatments. Complications were encountered in 10 cases, including 3 patients with complete flap loss and 1 patient with partial flap loss; other complications were cervical fistulae, knee arthritis, nonconsolidation, and wound infection. Extremity salvage was achieved in 90% (19/21) of limb sarcomas, with these patients showing adequate postoperative ambulation (TESS 77 ± 16) and adequate use of the upper extremity (TESS 66 ± 26). Two patients underwent amputation after recurrence. Disease-specific survival rates at 5 and 10 years were 79.49% and 76.93%, respectively. CONCLUSION: The microsurgical repair of sarcoma defects is a reliable option that, though not free of complications, is necessary in selected cases such as patients receiving neoadjuvant treatments and those with head and neck location and high-grade tumors. The procedure enables both adequate oncosurgical resection and function preservation. Our microsurgical sarcoma reconstruction data, based on an observation period of 12 years and presenting the results of 42 free tissue transfers in 41 patients, adds further evidence to the previously published smaller series.

Pyoderma gangrenosum in breast reconstruction.

We present two cases of immediate breast reconstruction that were diagnosed postoperatively with pyoderma gangrenosum. Given that the disease is uncommon and difficult to diagnose, the required treatment was delayed. Control was obtained after correct treatment and both cases healed.

Use of angioscanning in the surgical planning of perforator flaps in the lower extremities.

BACKGROUND: This is one of the few studies in the literature to describe angio-computed tomography (CT) as a planning tool in perforator flap surgery in the lower extremities. METHODS: Eighteen consecutive patients undergoing a perforator flap for lower-extremity reconstruction underwent preoperative CT angiography between September 2007 and November 2009. Eleven received propeller-type flaps, four medial sural artery perforator (MSAP) flaps, two lateral sural artery perforator (LSAP) flaps and one anterolateral thigh (ALT) flap. RESULTS: Preoperative CT angiography was highly specific (100%) and sensitive in mapping and visualising perforators in the lower limb. There were hardly any flap failures after angio-CT, and operative findings always correlated perfectly with preoperative imaging. Postoperative recoveries were uneventful except in three cases of peroneal artery perforator flaps that presented partial necrosis due to venous congestion. CONCLUSIONS: CT angiography is a valuable imaging tool for the preoperative assessment of the donor-site vascular supply for lower-extremity flaps. We recommend use of preoperative angio-CT for imaging vascular anatomy of the lower limb before defect reconstruction, especially in traumatic patients and patients with peripheral vascular disease. Its use can also reduce intra-operative dissection time and minimises surgical error in the identification of the vascular anatomy.

[Complications of craniofacial resection in anterior skull base tumors]. / Complicaciones de la cirugía craneofacial en tumores de base craneal anterior

INTRODUCTION: The development of new radiographic techniques and the refinement of microsurgery and reconstructive surgery have been the responsible of the establishment of craniofacial resection (CFR) as the standard treatment of anterior skull base tumors. Overall complication rates varies from 24-56%, according to a review of recently published series. OBJECTIVES: To describe the complications of CFR in a series of 41 patients and to analyze the management and final outcome. MATERIAL AND METHODS: From 1990 to 2002, 41 patients underwent CFR for tumors involving the anterior cranial base. The extent of the tumor was always assessed with craniofacial CT-scan and MRI. The objective of the surgical treatment was to achieve "on block" removal of the tumor. RESULTS: The average age was 57 years with a male preponderance (63.4%). Squamous cell carcinoma was the most frequent histopathological type of tumor. The tumors were localized in paranasal sinuses in 78% of the cases. Bifrontal craniotomy was performed in 85.4% and unilateral orbitofrontal craniotomy in 14.6% of the cases. The area of facial resection included: ethmoidectomy (60.9%), ethmoido-sphenoidectomy (24.3%), maxillectomy (39%) and orbital exenteration (14.6%). The reconstruction of the floor of the anterior cranial fossa was performed using pedicled pericranial flap (100%), local (34.1%) or microvascular free flaps (21.9%) and split calvarian graft (19.5%). 20 patients (48.7%) developed post-operative complications, CSF leaks (12.1%) and meningitis (7.3%) being the most frequent major complications. The mortality rate was 7.3%. CONCLUSIONS: CFR has become the standard approach for anterior cranial base tumors. Despite its widespread application, the complication's rate ranges between 24-50% and the procedure carries a risk of significant morbidity and even mortality. Improvement of specific aspects of surgical technique and more refined reconstructive methods will decrease the number of complications.

Complicaciones de la cirugía craneofacial en tumores de base craneal anterior / Complications of craniofacial resection in anterior skull base tumors

Introducción. Los recientes avances en radiología, técnica microquirúrgica y de reconstrucción han permitido que la cirugía craneofacial (CCF) se haya convertido en el tratamiento de elección de la patología tumoral de fosa craneal anterior. A pesar de esto, continua asociándose a una incidencia de complicaciones considerable (24-56%). Objetivos. Revisión, análisis y manejo de las complicaciones de la CCF en una serie de 41 pacientes. Material y métodos. 41 pacientes diagnosticados de patología tumoral infiltrativa de base craneal anterior, fueron intervenidos mediante CCF, entre 1990 y 2002. La extensión tumoral fue valorada en todos los casos con TC y RMN de la región craneo-facial. Tras determinar el volumen y extensión tumoral se diseñó un tratamiento quirúrgico radical, con el objetivo de conseguir una resección tumoral "en bloque". Resultados. El 63.4% de los pacientes eran varones con una mediana de edad de 57 años (18-73). La histología más frecuente de los tumores fue carcinoma escamoso y la localización habitual fue en los senos paranasales en el 78% (32 de 41 casos). En el 85.4% delos pacientes se realizó una craneotomía bifrontal basaly en el 14.6% restante craneotomía frontoorbitaria unilateral, en un sólo colgajo óseo. El área de resección facial incluía: etmoidectomía (60.9%), etmoido-esfenoidectomía (24.3%), maxilectomía unilateral (39%) y exenteración orbitaria (14.6%). Para la reconstrucción se utilizó: colgajo pediculado pericraneal (100%),colgajos locales (34.1%), colgajos libres microvascularizados (21.9%) e injerto óseo autólogo (19.5%). 20 pacientes (48.7%) presentaron complicaciones postoperatorias, entre las que destacan, como complicaciones mayores la fístula de LCR (12.1%) y la meningitis (7.3%). La mortalidad global fue del 7.3%.Conclusiones. La CCF continua asociándose a una elevada tasa de complicaciones, en general de tipo infeccioso. El perfeccionamiento de las técnicas de reconstrucción permitirán reducir la incidencia de las complicaciones más frecuentes y peligrosas

Introduction. The development of new radiographic techniques and the refinement of microsurgery and reconstructive surgery have been the responsible of the establishment of craniofacial resection (CFR) as the standard treatment of anterior skull base tumors. Overall complication rates varies from 24-56%, according to a review of recently published series. Objectives. To describe the complications of CFR in a series of 41 patients and to analyze the management and final outcome. Material and methods. From 1990 to 2002, 41 patients underwent CFR for tumors involving the anterior cranial base. The extent of the tumor was always assessed with craniofacial CT-scan and MRI. The objective of the surgical treatment was to achive "on block" removal of the tumor. Results. The average age was 57 years with a male preponderance (63.4%). Squamous cell carcinoma was the most frequent histopathological type of tumor. The tumors were localized in paranasal sinuses in 78% of the cases. Bifrontal craniotomy was performed in 85.4% and unilateral orbitofrontal craniotomy in 14.6% of the cases. The area of facial resection included: ethmoidectomy (60.9%), ethmoido-sphenoidectomy (24.3%), maxillectomy (39%) and orbital exenteration (14.6%). The reconstruction of the floor of the anterior cranial fossa was performed using pedicled pericranial flap (100%), local (34.1%) or microvascular free flaps (21.9%) and split calvarian graft (19.5%). 20 patients (48.7%) developed post-operative complications, CSF leaks (12.1%) and meningitis (7.3%) being the most frequent major complications. The mortality rate was 7.3%. Conclusions. CFR has become the standard approach for anterior cranial base tumors. Despite its widespread application, the complication's rate ranges between 24-50% and the procedure carries a risk of significant morbidity and even mortality. Improvement of specific aspects of surgical technique and more refined reconstructive methods will decrease the number of complications

Inertization of pyrite cinders and co-inertization with electric arc furnace flue dusts by pyroconsolidation at solid state.

The viability of a pyroconsolidation process to render pyrite cinders inert and to co-inert pyrite cinders with a hazardous polymetallic residue such as electric arc furnace flue dusts (EAF) containing Pb, Cu, Zn, As, Cr, Ni and Mo were investigated. The effects of pyroconsolidation temperature (800-1200 degrees C), milling pyrite cinders and additions of both CaO and EAF on the resulting microstructure of the pellets were determined. The microstructural changes were then compared with the results of the standard leaching tests. Full inertization of pyrite cinders was achieved after milling to < 100 micron followed by a pelletization and pyroconsolidation process at a temperature of 1200 degrees C. This process also allows co-inertization of pyrite cinders with controlled additions of EAF (up to approximately to 10%). Following pyroconsolidation at 1200 degrees C, the metallic elements were inert components in the four main phases: traces of Cr in hematite; Cr, Cu, Zn and Ni in spinel-phase; traces of Cr and Zn in calcium ferrites; and Pb and traces of Cu, Zn and Ba in K-Ca-Al-Fe glassy silicate.

Domain coarsening of stripe patterns close to onset.

We study domain coarsening of two-dimensional stripe patterns by numerically solving the Swift-Hohenberg model of Rayleigh-Bénard convection. Near the bifurcation threshold, the evolution of disordered configurations is dominated by grain-boundary motion through a background of largely immobile curved stripes. A numerical study of the distribution of local stripe curvatures, of the structure factor of the order parameter, and a finite size scaling analysis of the grain-boundary perimeter, suggest that the linear scale of the structure grows as a power law of time t(1/z), with z=3. We interpret theoretically the exponent z=3 from the law of grain-boundary motion.

Adiabatic elimination and reduced probability distribution functions in spatially extended systems with a fluctuating control parameter.

We obtain the stationary probability distribution functions of the order parameter near onset for the one-dimensional real Ginzburg-Landau and Swift-Hohenberg equations with a fluctuating control parameter. A perturbative expansion in the intensity of the fluctuations leads to a hierarchy of Fokker-Planck equations for conditional probability distribution functions that relate components of the order parameter that evolve in different time scales. Successive integration leads to a Fokker-Planck equation for the slowest mode, which we solve analytically for the models studied. In all cases, the probability distribution function above onset is of the form P(A0) approximately A(delta)(0)e(-gammaA20), where A0 is the slow component of the order parameter and the values of delta and gamma depend explicitly on the intensity of the fluctuations. Knowledge of P(A0) allows the calculation of an effective bifurcation threshold and of the moments of A0 above threshold.

Grain-boundary motion in layered phases.

We study the motion of a grain boundary that separates two sets of mutually perpendicular rolls in Rayleigh-Bénard convection above onset. The problem is treated either analytically from the corresponding amplitude equations, or numerically by solving the Swift-Hohenberg equation. We find that if the rolls are curved by a slow transversal modulation, a net translation of the boundary follows. We show analytically that although this motion is a nonlinear effect, it occurs in a time scale much shorter than that of the linear relaxation of the curved rolls. The total distance traveled by the boundary scales as epsilon(-1/2), where epsilon is the reduced Rayleigh number. We obtain analytical expressions for the relaxation rate of the modulation and for the time-dependent traveling velocity of the boundary, and especially their dependence on wave number. The results agree well with direct numerical solutions of the Swift-Hohenberg equation. We finally discuss the implications of our results on the coarsening rate of an ensemble of differently oriented domains in which grain-boundary motion through curved rolls is the dominant coarsening mechanism.

Interface and contact line motion in a two phase fluid under shear flow

We use a coarse grained description to study the steady state interfacial configuration of a two phase fluid under steady shear. Dissipative relaxation of the order parameter leads to interfacial slip at the contact line, even with no-slip boundary conditions on the fluid velocity. This relaxation occurs within a characteristic length scale l(0) = sqrt[xiD/V0], with xi the (microscopic) interfacial thickness, D an order parameter diffusivity, and V0 the boundary velocity. The steady state interfacial configuration is shown to satisfy a scaling form involving the ratio l(0)/L, where L is the width of the fluid layer, for a passive interface, and the capillary number as well for an active interface.

[Septic polyarthritis: treatment complications and results]. / Poliartritis sépticas: complicaciones y resultados del tratamiento.

OBJECTIVE: The rare polyarticular clinical presentation of peripheric septic arthritis has worst prognosis than monoarticular one. We studied 10 patients with polyarticular septic arthritis treated during the last 8 years, to evaluate functional result and complications after surgical treatment. MATERIAL AND METHODS: We studied 5 men and 5 women, with an average age of 46.5 years (range 18-75 years), they presented septic arthritis in two or more joints. We discuss aetiology, clinical presentation and treatment. RESULTS: Treatment was surgical debridement and parenteral antibiotic therapy. Functional result was poor in 54% of the joints treated, 50% of patients presented septic shock and three died.

oliartritis sépticas: complicaciones y resultados del tratamiento# / eptics poliarthritis: complications and results of the treatment#

Objetivo: Dentro de la artritis séptica periférica existe una forma poliarticular de presentación poco frecuente y de peor pronóstico que la forma monoarticular. En el presente trabajo estudiamos los casos de artritis séptica poliarticular (ASP) tratados en los últimos 8 años, para valorar el resultado funcional y las complicaciones que presentaron los pacientes. Material y Método: La serie consta de 5 hombres y de 5 mujeres con edad media de 46,5 años (18-75 años). Todos ellos presentaron artritis séptica en dos o más articulaciones (2,3). Se revisa la etiología, cuadro clínico y el tratamiento. Este último consistió en el desbridamiento quirúrgico y el tratamiento médico antibiótico así como de soporte de la situación de sepsis acompañante. Resultados: En cuanto a los resultados y complicaciones destaca un resultado funcional deficiente en un 54% de las articulaciones, la presentación de shock séptico en el 50% de los casos y el exitus de tres de diez pacientes de la serie (AU)

Amplitude equation and pattern selection in Faraday waves.

A nonlinear theory of pattern selection in parametric surface waves (Faraday waves) is presented that is not restricted to small viscous dissipation. By using a multiple scale asymptotic expansion near threshold, a standing wave amplitude equation is derived from the governing equations. The amplitude equation is of gradient form, and the coefficients of the associated Lyapunov function are computed for regular patterns of various symmetries as a function of a viscous damping parameter gamma. For gamma approximately 1, the selected wave pattern comprises a single standing wave (stripe pattern). For gamma<<1, patterns of square symmetry are obtained in the capillary regime (large frequencies). At lower frequencies (the mixed gravity-capillary regime), a sequence of sixfold (hexagonal), eightfold, ...patterns are predicted. For even lower frequencies (gravity waves) a stripe pattern is again selected. Our predictions of the stability regions of the various patterns are in quantitative agreement with recent experiments conducted in large aspect ratio systems.