Two auricular epithesis surgical cases retained by a custom titanium implant: result at four years.

INTRODUCTION: This article aims at describing the four-year outcome of a surgical procedure implanting a patient specific epithesis system in two patients. TECHNICAL NOTE: After virtual 3D reconstruction of the anatomy and mirroring of the healthy ear, the position of the three Locator® attachments were optimized in the software to embed them as accurately as possible in the planned episthesis antihelix. The personalized plate bearing the three Locator® implants was then manufactured. Ten osteosynthesis screws were placed around the abutments to ensure bone anchorage. Post-operative antibiotic therapy was prescribed for the duration of ten days. The episthesis was placed two months post-operatively. The follow-up for each patient was 65 and 57 months respectively with no complications to report. CONCLUSION: 3D planning assists the surgeon and eliminates several constraints related to the placement of bone implants. It assists the surgical procedure and improves both the aesthetics and functional result of the surgery.

Viabilidade da técnica de transposição uretral pré-púbica mediante secção peniana em cadáveres de cães / Viability of the prepubic urethral transposition technique by penile section in dog cadavers

Descreve-se a viabilidade da técnica cirúrgica de transposição uretral pré-púbica em cadáveres de cães machos, adultos, advindos de um hospital veterinário, a fim de se avaliar a manutenção da luz uretral a partir de um desvio uretral pré-púbico, descrevendo-se detalhadamente a abordagem e as estruturas anatômicas envolvidas. A técnica consistiu inicialmente da orquiectomia, seguida de celiotomia retroumbilical, tração vesical cranial, secção transversa da uretra membranosa a 1cm caudal à próstata, espatulação e reparo da borda livre. A seguir, divulsão e secção do pênis 1,5cm caudal ao osso peniano, espatulação da borda uretral peniana e transposição desta em direção à cavidade abdominal, fazendo-se anastomose por meio de sutura interrompida simples à uretra membranosa. Foi mensurado o comprimento uretral desde o meato externo até o início da uretra prostática em dois momentos: pré e pós-transposição. Ao final, avaliou-se, por meio de uretrografia retrógrada de contraste positivo, o diâmetro e o selamento na anastomose uretral e o fluxo do contraste até a bexiga. A transposição uretral pré-púbica é uma técnica cirúrgica exequível, anatomicamente compatível com a espécie canina e capaz de manter o diâmetro uretral e o fluxo do contraste de forma satisfatória, com manutenção estética externa idêntica a um cão macho orquiectomizado.(AU)

We describe the viability of the surgical technique of pre-pubic urethral transposition in cadavers of adult male dogs, coming from a veterinary hospital to evaluate the maintenance of urethral light from a prepubic urethral deviation, describing in detail the approach and anatomical structures involved. The technique consisted initially of orchiectomy, followed by retroumbilical celiotomy, cranial vesical traction, transverse section of the membranous urethra at 1cm caudal to prostate, spatulation and free edge repair. Next, the penis divulsion and section 1.5cm caudal to the penile bone, spreading the penile urethral border and transposing it towards the abdominal cavity, making an anastomosis of simple interrupted suture to the membranous urethra. The dogs had the urethral length measured from the external meatus to the beginning of the prostatic urethra at two moments: pre-transposition and post-transposition. Postoperative retrograde urethrography was used to evaluate the diameter and sealing of the urethral anastomosis and contrast flow to the bladder. In conclusion, the prepubic urethral transposition is a feasible surgical technique, anatomically compatible with the canine species and able to maintain the urethral diameter and contrast flow satisfactorily, with an external esthetic maintenance identical to an orchiectomized male dog.(AU)

Transposição e anastomose uretral pré-púbica em um cão macho com estenose extensa da uretra intrapélvica / Prepubic urethral transposition in a male dog with extensive stenosis of the pelvic urethra

We report the use of a new surgical technique in a male dog affected by extensive stenosis of intrapelvic urethra through a antepubic urethral deviation, as an alternative to prepubic urethrostomy and ablation of the external genitalia. The technique consisted initially of orchiectomy, followed by retroumbilical celiotomy, transverse section of the penis in the pre-scrotal region and transposition of this towards the abdominal cavity by making anastomosis to the prostatic urethra. The dog was evaluated clinically and by urethrography retrograde positive contrast for up to four years after the procedure without any clinical signs, changes in urine stream or stenosis image. It is concluded that the pre-pubic urethral transposition is a viable alternative treatment for this dog affected by extensive stenosis of the membranous urethra.(AU)

Necrosis avascular de cabeza femoral en pacientes tratados de leucemia. Evaluación de la necesidad de un protocolo diagnóstico / Avascular necrosis of the femoral head in patients treated for leukaemia. Assessment of the need for a diagnostic protocol

Objetivo. Valorar la incidencia de necrosis avascular de cadera (NAVC) en pacientes con leucemia sometidos a altas dosis de corticoides tratados en nuestro hospital para evaluar si es necesaria la creación de un protocolo de detección precoz. Material y métodos. Estudio observacional-descriptivo y retrospectivo de 2005 a 2016 de 253 pacientes diagnosticados de leucemia en edad pediátrica. Se identificaron los pacientes con patología osteomuscular y se analizaron los pacientes con necrosis avascular. Resultados. Un total de 26 pacientes (10%) presentaron síntomas osteomusculares. Se analizaron 3 pacientes con NAVC (1,2%). Una niña, de 7 años, se trató de forma conservadora con tracción-suspensión y descarga. Dos niños de 11 y 15,4 años, que desarrollaron una enfermedad de injerto contra huésped secundaria al trasplante de médula ósea, cuyo tratamiento incluye altas dosis de corticoides, desarrollaron necrosis avascular de cadera. Uno se trató con bifosfonatos y forage y el otro terminó con una artroplastia total de sustitución. Discusión. La aparición de síntomas musculoesqueléticos durante el tratamiento de la leucemia es diferente según la serie bibliográfica (0,43-12,6%). Algunos autores observan un incremento del riesgo en pacientes de sexo femenino entre los 10 y 17 años. Un estudio retrospectivo observa que existe una demora de 3,9 meses en el diagnóstico de la NAVC desde el comienzo del dolor. Otros autores relacionan la NAV con las articulaciones de carga, la edad y las altas dosis de corticoides. Conclusión. Basado en la baja incidencia de NAVC en nuestra población de pacientes menores de 14 años tratados de leucemia, pensamos que no es rentable la creación de protocolos de diagnóstico. Sin embargo, sí que es recomendable la vigilancia estricta de los pacientes con factores de riesgo potenciales reconocidos en la literatura (AU)

Objective. To evaluate the incidence of avascular necrosis of the hip in leukaemia patients treated in our hospital with high doses of corticosteroids in order to evaluate the necessity for an early detection protocol. Material and methods. Observational-descriptive and retrospective study from 2005 to 2016 of 253 patients diagnosed with paediatric leukaemia. Patients with musculoskeletal pathology were identified and patients with avascular necrosis were analysed. Results. A total of 26 patients (10%) had musculoskeletal symptoms. Three patients with avascular necrosis (1.2%) were analysed. One girl, 7 years old, was treated conservatively with traction - suspension and discharge. Two boys, an 11 and a 15.4 year-old,who developed graft-versus-host disease secondary to bone marrow transplantation, and whose treatment included high doses of corticosteroids, developed avascular necrosis of the hip. One was treated with bisphosphonates and forage and the other ended up with a total hip arthroplasty. Discussion. The occurrence of musculoskeletal symptoms during the treatment of leukaemia is different according to the bibliographic series (0.43 -12.6%). Some authors observe an increased risk in female patients between the ages of 10 and 17. A retrospective study reveals that there is a delay of 3.9 months in the diagnosis of CAP since the onset of pain. Other authors relate NAV to loading joints, age and high doses of corticosteroids. Conclusion. Based on the low incidence of avascular necrosis of the hip in our 14-year-old population treated for leukaemia, the creation of diagnostic protocols seems not to be necessary. However, close monitoring of patients with potential risk factors recognized in the literature, is advisable (AU)

Queratopatía neurotrófica corneal bilateral en paciente con amiloidosis familiar bilateral / Neurotrophic keratopathy in a patient with familial amyloidosis

Introducción: La amiloidosis familiar es una enfermedad caracterizada por el depósito extracelular de un material denominado amiloide que puede afectar a gran variedad de órganos, incluyendo el ojo. Caso clínico: Se presentan datos clínicos, pruebas complementarias e histológicas, así como el tratamiento y seguimiento de un paciente de 33 años con úlcera neurotrófica corneal bilateral, debida a una polineuropatía amiloidótica familiar. Discusión: Este caso no es la forma típica de presentación de la amiloidosis oftálmica, ya que la úlcera corneal es el resultado de la anestesia causada por la polineuropatía sistémica, aunque se encontraron depósitos de amiloide en el tejido conjuntival (AU)

Introduction: Familial amyloidotic polyneuropathy is a disease related to amyloid material deposits in the extracellular matrix that can affect many tissues, including the eye. Case report: This case includes clinical data, a full corneal study report, and histopathological findings, as well as the treatment and follow up of bilateral neurotrophic keratopathy in a 33 year-old patient with familial amyloidotic polyneuropathy. Discussion: Although amyloidotic deposits were also found in the conjunctival tissue, this is not a typical form of ophthalmic amyloidosis. The corneal wound in this case is a result of a corneal anaesthesia due to the systemic polyneuropathy (AU)

Avascular necrosis of the femoral head in patients treated for leukaemia. Assessment of the need for a diagnostic protocol. / Necrosis avascular de cabeza femoral en pacientes tratados de leucemia. Evaluación de la necesidad de un protocolo diagnóstico.

OBJECTIVE: To evaluate the incidence of avascular necrosis of the hip in leukaemia patients treated in our hospital with high doses of corticosteroids in order to evaluate the necessity for an early detection protocol. MATERIAL AND METHODS: Observational-descriptive and retrospective study from 2005 to 2016 of 253 patients diagnosed with paediatric leukaemia. Patients with musculoskeletal pathology were identified and patients with avascular necrosis were analysed. RESULTS: A total of 26 patients (10%) had musculoskeletal symptoms. Three patients with avascular necrosis (1.2%) were analysed. One girl, 7 years old, was treated conservatively with traction - suspension and discharge. Two boys, an 11 and a 15.4 year-old,who developed graft-versus-host disease secondary to bone marrow transplantation, and whose treatment included high doses of corticosteroids, developed avascular necrosis of the hip. One was treated with bisphosphonates and forage and the other ended up with a total hip arthroplasty. DISCUSSION: The occurrence of musculoskeletal symptoms during the treatment of leukaemia is different according to the bibliographic series (0.43 -12.6%). Some authors observe an increased risk in female patients between the ages of 10 and 17. A retrospective study reveals that there is a delay of 3.9 months in the diagnosis of CAP since the onset of pain. Other authors relate NAV to loading joints, age and high doses of corticosteroids. CONCLUSION: Based on the low incidence of avascular necrosis of the hip in our 14-year-old population treated for leukaemia, the creation of diagnostic protocols seems not to be necessary. However, close monitoring of patients with potential risk factors recognized in the literature, is advisable.

Neurotrophic keratopathy in a patient with familial amyloidosis. / Queratopatía neurotrófica corneal bilateral en paciente con amiloidosis familiar bilateral.

INTRODUCTION: Familial amyloidotic polyneuropathy is a disease related to amyloid material deposits in the extracellular matrix that can affect many tissues, including the eye. CASE REPORT: This case includes clinical data, a full corneal study report, and histopathological findings, as well as the treatment and follow up of bilateral neurotrophic keratopathy in a 33 year-old patient with familial amyloidotic polyneuropathy. DISCUSSION: Although amyloidotic deposits were also found in the conjunctival tissue, this is not a typical form of ophthalmic amyloidosis. The corneal wound in this case is a result of a corneal anaesthesia due to the systemic polyneuropathy.

Eliminação de Dioctophyme renale pela urina em canino com dioctofimatose em rim esquerdo e cavidade abdominal - Primeiro relato no Rio Grande do Sul / Elimination of Dioctophyme renale to urine in canines with dioctophymosis in the left kidney and abdominal cavity - First report in Rio Grande do Sul

Dioctophyme renale é um parasito que afeta tanto animais como humanos e tem como órgão de eleição o rim direito. Relata-se o caso clínico-cirúrgico de um paciente canino com histórico de eliminação de três exemplares de D. renale pela urina e presença de parasitos no rim esquerdo e na cavidade abdominal. No Hospital de Clínicas Veterinárias da Universidade Federal de Pelotas, foram realizados exames pré-cirúrgicos, entre eles a ultrassonografia abdominal, que identificou a localização dos nematódeos, e o exame de Doppler pulsado dos vasos intrarrenais, que demonstrou aumento nos índices resistivos nas regiões avaliadas. O paciente foi conduzido para a realização de laparotomia exploratória, sendo removidos 23 parasitos da cavidade abdominal. A presença de D. renale causa graves lesões nos rins e nos demais órgãos da cavidade abdominal, sendo essencial o diagnóstico precoce e a remoção dos nematódeos para recuperação do paciente.(AU)

Dioctophyme renale is a parasite that attacks animals as well as humans and has the right kidney as a preferred target organ. This document reports the case of a clinical-chirurgical canine patient with a history of elimination of three D. renale samples through its urine and presence of parasites at its left kidney and abdominal cavity. Pre-cirurgical exams were performed at the Veterinary Hospital of the Federal University of Pelotas. Among these exams, abdominal ultrasonography identified the nematode's location and the Pulse-Doppler of the intrarenal vessels showed an increase in the resistive indices of the evaluated areas. An Exploratory Laparotomy was conducted with the patient who had 23 parasites removed from its abdominal cavity. The presence of D. renale causes severe lesions at kidneys and other organs of the abdominal cavity, for this reason early diagnosis and nematode´s removal are essential for the patient's recovery.(AU)

Extensive emphysematous pyelonephritis in a renal allograft: case report and review of literature.

Emphysematous pyelonephritis (EPN) is an acute, severe necrotizing infection of the renal parenchyma and perirenal tissue, which results in the presence of gas within the renal parenchyma, collecting system, or perinephric tissue. EPN of renal allograft is rare, with only 23 cases reported in Western literature. Here, we report a patient treated successfully with surgery. We also review the literature, focusing on old and new suggested classification systems for EPN.

Linfoma cutáneo de células B de la zonamarginal y sarcoidosis: presentación simultánea / Cutaneous marginal zone B-cell lymphoma and sarcoidosis: simultaneous presentation

El síndrome sarcoidosis-linfoma es la asociación en un mismo paciente de sarcoidosis y un linfoma. Describimos un paciente de 32 años que acude por tres lesiones nodulares cuya biopsia es diagnóstica de linfoma cutáneo de células B de la zona marginal. Durante el estadiaje se detectaron adenopatías mediastínicas cuya biopsia mostró granulomas no necrotizantes compatibles con sarcoidosis. Este sería el primer caso descrito que asocia linfoma cutáneo B de la zona marginal con sarcoidosis de forma simultánea (AU)

The sarcoidosis-lymphoma syndrome is the coexistence of sarcoidosis and malignant lymphoproliferative disease in the same patient. We describe a 32-year-old man who presented with three cutaneous nodular lesions. Skin biopsies revealed marginal zone cutaneous B-cell lymphoma. Radiologic Studies showed hiliar lymphadenopathy that histologically revealed non-caseating granulomas consistent with sarcoidosis. This report is the first case of simultaneous ocurrente in the same patient of primary cutaneous marginal zone B cell lymphoma and sarcoidosis (AU)

Ulceraciones orales por alendronato / Mouth Sores Caused by Alendronate

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[Asian tiger mosquito bites: perception of the affected population after Aedes albopictus became established in Spain]. / Picaduras por mosquito tigre. Percepción de la población afectada tras el establecimiento de Aedes albopictus en España.

INTRODUCTION: The presence of Aedes albopictus was detected in Spain in 2004 and it has now become fully established, causing significant discomfort among the population in the affected areas. OBJECTIVES: The aim of this study was to investigate the impact of the arrival of A albopictus and its subsequent establishment on the population a year after being detected in Spain. MATERIAL AND METHODS: A survey questioned 309 users of the Valldoreix-Sant Cugat Healthcare Center about their knowledge of Aedes albopictus, the characteristics of bites by this insect, and their attitude to prevention and treatment. RESULTS: Ninety one percent of respondents knew about the tiger mosquito. Sixty-one percent (66 % of women and 53 % of men) had reported suffering bites attributed to this insect. The most common type of bite was a small swelling (78 %) and the most common site was the legs (93 %). Children had a greater number of lesions and a more generalized distribution. Blistering lesions were more frequent in women. Itching was very intense (65 %), particularly in women (71 %) and children (76 %). The majority of patients (80 %) did not seek attention from their health care services and 36 % consulted their pharmacist. Fifty percent (61 % of women and 47 % of men) treated their bites, mainly with topical corticosteroids (56 %) and antihistaminics (26 %). Forty-six percent of respondents mainly children reported use of insect repellents. CONCLUSION: The arrival of the Asian tiger mosquito has had a major impact on the population, with a lower quality of life and a deterioration in skin health, due to the numerous and irritating bites.

Picaduras por mosquito tigre. Percepción de la población afectada tras el establecimiento de Aedes albopictus en España / Asian tiger mosquito bites: perception of the affected population after aedes albopictus became established in Spain

Introducción. Aedes albopictus se identificó en España en el año 2004 y en la actualidad está plenamente establecido, causando un intenso malestar entre la población de las áreas afectadas. Objetivos. Estudiar el impacto de la llegada y el asentamiento de Aedes albopictus sobre la población un año después de su identificación en nuestra comunidad. Material y métodos. Encuesta a 309 usuarios del CAP Vall d’oreix-Sant Cugat acerca de los conocimientos sobre este mosquito, características de sus picaduras y actitud en cuanto a prevención y tratamiento. Resultados. El 91 % de los encuestados conocían el mosquito tigre. El 61 % referían haber sufrido picaduras (66% mujeres y 53% hombres), que atribuían a este insecto. El tipo de picadura más frecuente fue el habón (78 %) y la localización, las extremidades inferiores (93 %). Los niños mostraban mayor número de lesiones y una distribución más generalizada. Las lesiones ampollosas fueron más frecuentes en mujeres. El prurito fue muy intenso (65 %) sobre todo en mujeres (71 %) y niños (76 %). La mayoría de los pacientes (80 %) no consultó a los servicios médicos y un 36 % lo hizo al farmacéutico. Un 50 % realizó tratamiento (61% mujeres y 47% hombres), principalmente con corticoides tópicos (56 %) y antihistamínicos (26 %). Un 46 % de los encuestados afirmaba usar repelentes, sobre todo niños. Conclusión. La llegada del mosquito tigre ha tenido un gran impacto sobre la población, mermando la calidad de vida y empeorando su salud dermatológica debido a sus numerosas y molestas picaduras (AU)

Introduction. The presence of Aedes albopictus was detected in Spain in 2004 and it has now become fully established, causing significant discomfort among the population in the affected areas. Objectives. The aim of this study was to investigate the impact of the arrival of A albopictus and its subsequent establishment on the population a year after being detected in Spain. Material and methods: A survey questioned 309 users of the Vall d’oreix-Sant Cugat Healthcare Center about their knowledge of Aedes albopictus, the characteristics of bites by this insect, and their attitude to prevention and treatment. Results. Ninety one percent of respondents knew about the tiger mosquito. Sixty-one percent (66% of women and 53% of men) had reported suffering bites attributed to this insect. The most common type of bite was a smalls welling (78%) and the most common site was the legs (93%). Children had a greater number of lesions and amore generalized distribution. Blistering lesions were more frequent in women. Itching was very intense (65%), particularly in women (71%) and children (76%). The majority of patients (80%) did not seek attention from their health care services and 36 % consulted their pharmacist. Fifty percent (61% of women and 47% of men) treated their bites, mainly with topical corticosteroids (56%) and antihistaminics (26%). Forty-six percent of respondents—mainly children—reported use of insect repellents. Conclusion. The arrival of the Asian tiger mosquito has had a major impact on the population, with a lower quality of life and a deterioration in skin health, due to the numerous and irritating bites (AU)

Dermatofibrosarcoma protuberans congénito: descripción de un caso / Congenital dermatofibrosarcoma protuberans: a case report

El dermatofibrosarcoma protuberans es un tumor fibrohistiocitario de bajo grado poco común y que suele aparecer en adultos entre los 20 y 50 años de edad. Inicialmente se presenta como una mácula o placa violácea de aspecto vascular sobre la que aparecen posteriormente lesiones nodulares en la superficie. El diagnóstico es histológico y se trata de un tumor de células fusiformes que se disponen en fascículos cortos adoptando un patrón arremolinado característico. Es un tumor con una elevada tasa de recurrencias locales, aunque son raras las metástasis. El tratamiento es quirúrgico con amplios márgenes. Este tumor excepcionalmente afecta a niños menores de 16 años y todavía más raros son los casos congénitos, con sólo 27 casos descritos en la literatura. Se describe el caso de un niño de 10 años de edad con un dermatofibrosarcoma protuberans presente desde el nacimiento y sin signos de recurrencia en la actualidad

Dermatofibrosarcoma protuberans is a rare low-grade fibrohistiocytic tumor with onset normally at ages between 20 and 50 years. It presents as a violaceous plaque or macule with an appearance suggestive of vascular lesion, on which nodular lesions appear later. Histological diagnosis is based on the presence of a spindle-cell tumor arranged in small bundles in a characteristic cartwheel pattern. The local recurrence rate is high but metastases are rare. The treatment is surgical resection with wide margins. The tumor rarely affects children under 16 years of age and it is even less common at birth--only 27 congenital cases have been described in the literature. We describe the case of a 10-year-old boy with dermatofibrosarcoma protuberans present since birth and currently without signs of recurrence

[Congenital dermatofibrosarcoma protuberans: a case report]. / Dermatofibrosarcoma protuberans congénito: descripción de un caso.

Dermatofibrosarcoma protuberans is a rare low-grade fibrohistiocytic tumor with onset normally at ages between 20 and 50 years. It presents as a violaceous plaque or macule with an appearance suggestive of vascular lesion, on which nodular lesions appear later. Histological diagnosis is based on the presence of a spindle-cell tumor arranged in small bundles in a characteristic cartwheel pattern. The local recurrence rate is high but metastases are rare. The treatment is surgical resection with wide margins. The tumor rarely affects children under 16 years of age and it is even less common at birth--only 27 congenital cases have been described in the literature. We describe the case of a 10-year-old boy with dermatofibrosarcoma protuberans present since birth and currently without signs of recurrence.

Fracaso renal agudo inducido por ácido zoledrónico (zometa) / Zoledronic acid (Zometa)- induced acute renal failure

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