[The Revista Médica del IMSS in the 2017 Healthcare Book Fair]. / La Revista Médica del IMSS en la Feria del Libro de Ciencias de la Salud 2017.

On August, the second edition of the Healthcare Book Fair took place, sponsored by the Facultad de Medicina of UNAM. Again, the Revista Médica del Instituto Mexicano del Seguro Social participated with a stand where we promoted it, talked about the different indexes where our journal is included, explained its objective and scope, and finally talked about its nature as an open access journal, which is aimed to the clinical staff of the different health institutions of our country.

El pasado mes de agosto tuvo lugar la segunda edición de la Feria del Libro de Ciencias de la Salud, auspiciada por la Facultad de Medicina de la UNAM. En ella de nueva cuenta tuvo participación la Revista Médica del Instituto Mexicano del Seguro Social con un stand donde se difundió la revista, su indexación en los diferentes índices en los que tenemos participación, se explicitó su objetivo y alcance y se manifestó como una revista de acceso abierto, gratuita, dirigida al personal clínico de las diferentes instituciones de salud del país.

Hormonal content of plasma and endometrium of women taking oral contraceptives.

A total of 134 women were studied, 75 of whom were using cyclic steroid contraception (ethinyl estradiol, 0.05 mg plus norgestrel, 0.5 mg) and 59 of whom had normal ovaulatory cycles. By radioimmunoassay techniques simultaneous determinations were made of total estrogens (TE) and progesterone (P) in both plasma and endometrium and of FSH and LH in plasma, covering all days of the pseudomenstrual and true menstrual cycles. As expected, the ovulating women showed a midcycle peak of plasma TE and an increase in plasma P thereafter, while no cyclic variations were observed in the treated group. Correlations of endometrial concentrations of TE and P with plasma FSH and LH levels are discussed. In 13 of the 75 treated women elevations of endometrial P concentrations were present, presumably demonstrating the "escape phenomenon." The possible future value of endometrial hormone determinations is suggested.

A simultaneous assay to quantitate plasma and endometrial hormone concentrations.

A method for radioimmunoassay determination of hormones in both plasma and endometrium is presented. Total estrogen (TE) and progesterone (P) concentrations were measured simultaneously in plasma and endometrium in 59 women throughout the menstrual cycle. TE values in endometrium showed an increase of 0.45 ng/gm wet tissue weight on days 7 to 9, reaching a peak of 4.89 ng/gm wet weight at midcycle; values of 2.2 ng/gm wet weight were constant during the secretory phase. The endometrial P concentrations were 5.31 and 44.93 ng/gm wet weight during the proliferative and luteal phases, respectively. Plasma P levels during the proliferative phase were below 1 ng/ml, in comparison with values above 5.71 ng/ml during the luteal phase. The quadratic coefficients of correlation between plasma and endometrial concentrations of TE and P were 0.8 and 0.9, respectively, indicating that under such conditions modifications in the amount of circulating hormones are reflected in the target tissue. These simultaneous studies may permit further investigation of the role of circulationg hormones in local biologic phenomena.

Does double gloving protect surgical staff from skin contamination during plastic surgery?

In a randomized study, the effectiveness of double gloving in maintaining an intact barrier between the patient and the hands of the surgical staff during plastic surgery operations was tested. For 2 months, the surgical staff of a plastic surgery unit randomly wore single or double gloves during all elective surgical procedures. At the end of the operations, the gloves were tested by the water filling test. A total of 1092 gloves were examined. Twelve accidental injuries were noticed during the operations, and 67 unnoticed perforations occurred. The data suggest that the risk of perforation and exposure increases with the length and complexity of the procedures. It was concluded that double gloving is effective in plastic surgery, inasmuch as the barrier protection was maintained by the inner glove in two of three cases in which the outer glove was perforated inadvertently. Plastic surgeons must balance the improved security of double gloving with the possible discomfort or reduced sensitivity.

Nevus comedonicus: report of a case with genital involvement.

We report the case of a 6-year-old girl with a nevus comedonicus involving the left perineal region and ipsilateral labium majus. This lesion constitutes a rare hamartomatous malformation of the pilosebaceous apparatus, most frequently located on the face or trunk. Genital involvement has only very rarely been reported.

[Reconstruction of the nose using expanded forehead flap]. / Reconstrucción nasal utilizando un colgajo frontal expandido.

The history of using forehead flaps for nasal reconstruction is reviewed. A case of nasal reconstruction in a man who underwent amputation for squamous cell carcinoma is reported. The surface of the forehead flap was augmented by expanded tissues at the donor site. We describe the surgical procedure and its excellent results.

Orejas valgas: estabilización mediante colgajo dermo-graso-pericóndrico retroauricular / Prominent ears: stabilization with a retroauricular dermal-fat-perichondrium flap

El tratamiento quirúrgico para la corrección de las orejas prominentes o valgas se basa en crear una distancia de entre 17-21 mm entre el hélix y la mastoides, así como recrear unos pliegues auriculares anteriores bien definidos. Desde finales de 1800 hasta la actualidad se han descrito muchas técnicas para corregir las orejas despegadas, prominentes o valgas, cada una de ellas con sus propias características .En el presente trabajo describimos una técnica para estabilizar el resultado quirúrgico cuando se corrige esta entidad y evitar su recidiva. Se trata de un procedimiento de fijación mastoidea de la oreja mediante un colgajo dermo-graso-pericóndrico de sencillo diseño, útil, seguro y fácilmente reproducible. Hemos empleado esta técnica durante más de 15 años y creemos que ha resistido la prueba del tiempo (AU)

The treatment for the correction of prominent or valgusears, is to create a normal distance (17-21 mm) between the mastoid and the helix and a normal appearance of the anterior auricular folds. From late 1800 to the present, many surgical techniques for correcting prominentor valgus ears have been described, each one with its own characteristics. We describe a technique to stabilize the result and prevent recurrence. This technique stabilizes the correction of the ear fixing it to the mastoid fascia using a dermalfat-perichondrium flap of simple design, useful, safe and easily reproducible. We have used it over 15 years, and that makes us believe that has stood the test of time (AU)

Revisión bibliográfica de Implantología Bucofacial del año 2010. Primera Parte / Bibliographic review of Oral Implantology of year 2010. First Part

La gran cantidad de publicaciones que existen en las múltiples fuentes de información de la literatura científica junto a la baja disponibilidad de tiempo para consultarlas de la que disponen los profesionales de la Odontología, ha motivado a los autores de este artículo a efectuar una revisión de la literatura científica publicada a lo largo del año 2010 en el campo de la Implantología Bucofacial. Se han agrupado los diferentes trabajos en distintos temas (generalidades y plan de tratamiento, pacientes especiales, superficies y diseño, tejidos blandos, implantes inmediatos, carga inmediata, cirugía guiada y cirugía mínimamente invasiva y sobre dentaduras), con el fin de facilitar una buena puesta al día

The vast amount of publications existing in the multiple scientific literature information sources and the lack of available time to consult them, have encouraged the authors of this paper to carry out are view of the scientific literature published in year 2010 regarding Oral Implantology. Thus, we classified the articles into different topics (general aspects and treatment planning, special patients, surfaces and design, soft tissues, immediate implants, immediate loading, guided surgery and minimally invassive surgery and over dentures), so a more comprehensive updating can be made

Revisión bibliográfica de Implantología Bucofacial del año 2010. Segunda parte / Bibliographic review of Oral Implantology of year 2010. Second Part

La gran cantidad de publicaciones que existen en las múltiples fuentes de información de la literatura científica junto a la baja disponibilidad de tiempo para consultarlas de la que disponen los profesionales de la Odontología, ha motivado a los autores de este artículo a efectuar una revisión de la literatura científica publicada a lo largo del año 2010 en el campo de la Implantología Bucofacial. Se han agrupado los diferentes trabajos en distintos temas (regeneración ósea guiada, elevación del seno maxilar y otras técnicas especiales, factores de crecimiento, implantes cigomáticos, implantes ortodóncicos y complicaciones en la cirugía implantológica), con el fin de facilitar una buena puesta al día

The vast amount of publications existing in the multiple scientific literature information sources and the lack of available time to consult them, have encouraged the authors of this paper to carry out a review of the scientific literature published in year 2010 regarding Oral Implantology. Thus, we classified the articles into different topics (guided bone regeneration, sinus lift and other special techniques, growing factors, zigomatic implants, orthodontic implants and complications), so a more comprehensive updating can be made

Pioderma gangrenoso superficial como complicación de mamoplastia / Superficial granulomatous pypoderma gangrenosum as a complication in mammoplasty

El Pioderma Gangrenoso (PG) es una rara enfermedad de etiología desconocida, sospechándose que pudiera ser debida a trastornos de autoinmunidad. Presentamos 2 casos de PG Granulomatoso en el postoperatorio mediato(3-6 semanas) en pacientes sometidas a mamoplastia (mastopexia con prótesis). Ambos casos se solucionaron mediante tratamiento con corticoesteroides (AU)

Pyoderma Gangrenosum (PG) is a rare disease whose etiology is unknown, suspecting that could be due to autoimmune disorders. We present 2 cases of GranulomatousPG in mediate postoperatory (3-6 weeks) in patients undergoing mammoplasty (mastopexy with prosthesis).Both cases were solved by treatment with corticosteroids (AU)

Revisión bibliográfica de Implantología Bucofacial del año 2008. Segunda parte / Bibliographical review of Oral Implantology of the year 2008. Part two

La actividad asistencial de los profesionales de la Odontología tiene como consecuencia una baja disponibilidad de tiempo para dedicarse a la lectura de artículos científicos. Ante la dificultad de mantener un buen nivel de información en el campo de la Implantología Bucofacial, nuestro intereses exponer de forma sintética una revisión de la literatura científica publicada en las revistas más relevantes de la especialidad durante el año 2008. El lector interesado encontrará en este artículo algunos de los diferentes temas que integran esta disciplina, expuestos por apartados (regeneración ósea guiada, técnicas avanzadas, elevación del suelo del seno maxilar, mini implantes, plasma rico en plaquetas, factores de crecimiento, tejidos blandos y complicaciones) (AU)

The lack of the available time of the professionals involved in the Odontologic field and the difficulty to maintain a good level of information about Oral Implantology, arouses the interest of the authors to expose a synthetic review of the publications. Inside this article there are different aspects related to guided bone regeneration, advanced techniques, sinus lift, mini-implants, platelet rich plasma, growth factors, soft tissues and complications (AU)

«Doctor, tengo un bulto en la axila». Adenomegalias iliconomatosa postmamoplastia de aumento: a propósito de ocho casos / «Doctor I’ve a lump in the armpit». Silicone lymphadenopathy after breast augmentation: eight cases

La aparición de adenopatías axilares asociadas a mamoplastia de aumento mediante prótesis de silicona es un hecho infrecuente, no excepcional, y muy preocupante para paciente y cirujano. Hemos hecho una revisión de 1697 historias clínicas de pacientes sometidas a mamoplastia de aumento mediante prótesis de silicona al objeto de estudiar la relación entre roturas protésicas y adenopatías axilares Las 1697 pacientes se dividieron en grupos que cumplían 1, 2,3, 5 y 7 años de haber sido intervenidas. Revisamos sus historias clínicas y estudiamos las que con posterioridad a la cirugía habían consultado por sospecha de rotura protésica y adenopatías axilares. No encontramos roturas protésicas antes de los 5 años de haber efectuado el implante. El porcentaje de roturas fue de 1,2% en el 5º año y el 2,3% a los 7 años. La aparición de adenopatías siliconomatosas se produjo en el 55% de las roturas detectadas en el 5º año y en el 61,6% de las roturas detectadas en el 7º año. Diversos estudios han demostrado que los implantes mamarios se biodegradan con el paso del tiempo llevando, en un tiempo más o menos largo, hacia su rotura. En algunos casos, la rotura de las prótesis mamarias rellenas de gel de silicona conduce a la aparición de adenopatías axilares. En ocasiones el síntoma primario de la rotura de la prótesis, especialmente cuando están rellenas de gel de alta cohesividad, es la aparición de adenopatías. Los cirujanos deberíamos pensar en mantener a nuestras pacientes bajo revisiones periódicas y en un programa de recambio de las prótesis (AU)

Axillary lymphadenopathy associated with augmentation mammoplasty with silicone implants is a rare occurrence, not exceptional, and very worrying for patient and surgeon. Were viewed 1697 medical records of patients undergoing augmentation mammoplasty with silicone implants in order to study the relationship between implant rupture and axillary lymphadenopathy The 1697 patients were divided into groups having 1, 2, 3, 5 and 7 years after surgery. We reviewed the medical records and studied those who consulted for suspected implant rupture and axillary lymph nodes There were no implant rupture before 5 years after surgery. The percentage of rupture was 1.2% at 5 years and 2.3% at 7years. Silicon lymphadenopathy occurred in 55% of the ruptures detected at 5 years and 61.6% of the ruptures detected at 7years.Several studies have shown that breast implants will biodegrade over time leading in a more or less long time to rupture. In some cases rupture of the mammary implant filled with silicone gel, leads to the appearance of axillary lymphadenopathy. Sometimes the primary symptom of rupture, specially when they are filled with high cohesiveness gel, is the appearance oflymphadenopathy. Surgeons should think about keeping patients under periodic reviews and in an implants exchange program (AU)

A controlled, randomized, double-blind study of ketorolac for postoperative analgesia after plastic surgery.

The present study was designed to evaluate the efficacy and safety of ketorolac compared with metamizol (Nolotil) in the control of pain after plastic surgery. Almost no literature exists on postoperative pain control in this specialty. A multiple-dose, randomized, double-blind study of parallel design was carried out. One hundred patients received either ketorolac 30 mg intramuscularly (IM) every 8 hours or metamizol 2 g IM every 8 hours for postoperative analgesia during the first 48 postoperative hours. Pain severity was assessed using a visual analog scale. Adverse events were recorded. There were no significant differences between the groups in terms of pain scores or frequency of adverse events throughout the study. Two postoperative hemorrhages were recorded in the ketorolac group. Ketorolac and metamizol were found to be equally safe and effective in reducing postoperative pain after plastic surgery. It should be noted that 52% of patients in the ketorolac group and 48% in the metamizol group considered their postoperative analgesia to be very good. Nevertheless, for surgical procedures or for patients in whom postoperative hematoma formation is a particular concern, ketorolac probably should not be used.

Mondor's disease and aesthetic breast surgery: report of case secondary to mastopexy with augmentation.

Although the etiology of Mondor's disease remains obscure, trauma of some form is the most commonly cited cause. Surgical trauma has frequently been quoted, but references in the literature specifically implicating aesthetic breast surgery are scarce. In this article, we report a case of Mondor's disease secondary to mastopexy with concomitant augmentation mammaplasty.

Blood loss and hematological recovery following reduction mammaplasty and dermolipectomy: a prospective study.

A study was made to assess the impact of surgery on the hematological status and postoperative hematological recovery of 75 consecutive patients undergoing either reduction mammaplasty or dermolipectomy. Blood losses were estimated the morning after surgery, measuring decreases in hemoglobin level and hematocrit, while postoperative recovery was evaluated in terms of hemoglobin level and hematocrit at 10 weeks. The postoperative hemoglobin decrease was 2.69 g%, and the hematocrit dropped 7.25%. By 10 weeks, however, the patients had recovered their preoperative values. We found no significant differences in the evolution of hemoglobin level and hematocrit during the study between reduction mammaplasty and dermolipectomy patients. A significant positive correlation between surgical piece weight and postoperative reduction in hemoglobin concentration and hematocrit was observed. Conversely, at 10 weeks, a significant but negative correlation between surgical specimen weight and hemoglobin concentration and hematocrit was recorded. The anticipated weight of the surgical piece could thus be used as a predictor of intraoperative blood loss and of the speed of postoperative recovery. Since patients with surgical resection of > 3 kg remained anemic at 10 weeks, oral iron supplements could benefit this subset of patients.

[Variability of medical practice in sinusitis as a function of resource utilization]. / Variabilidad de la práctica médica ante una sinusitis en función del consumo de recursos.

OBJECTIVE: To find what factors linked to the doctor affect the variability of clinical practice. DESIGN: Cross-sectional descriptive study through a clinical interview with a fictitious complaint (sinusitis). SETTING: Asturias health centres. PARTICIPANTS: 132 doctors chosen through conglomerate sampling. MEASUREMENTS AND MAIN-RESULTS: Social and professional variables of the doctor (sex, age, years in practice, postgraduate training, courses, recycling courses and distance to the referral centre) were gathered. After the case was presented, the doctor's actions were noted and the cost in pesetas of each action was noted. Cost and the consumption of resources were related to the personal variables of the doctors through multivariate analysis. Mean total expenditure was 76,592 pesetas (minimum: 8958; maximum: 244,220), of which 55,550 were for short-term time off work (average of ten days off) and 15,261 for the consultations made. Average cost of treatment was 3762 pesetas. Through multiple linear regression, the only variable that showed significant effect on expenditure was distance to the referral centre (the greater the distance, the less expenditure). On transforming the total expenditure variable into a dichotomous variable (above and below the mean), the variables with significant effect on less expenditure were courses done, greater distance from the referral centre and being a woman. CONCLUSIONS: There is a very broad variability in decision-taking before the same clinical problem. The only variables that explain (and only partially) an expenditure trend are sex, distance to the referral centre and doing courses.

Doctor, quiero una talla 100 / Doctor, I want size 100

Cuando una paciente consulta al cirujano plástico con la intención de que éste le efectúe una mamoplastia de aumento es, en la mayoría de las ocasiones, difícil interpretar exactamente el volumen que desea. La determinación del volumen de la mama que posee la paciente y del volumen que quisiera tener se ve limitada por inconvenientes técnicos y por la poca precisión en la interpretación psicosocial de las mediciones y cálculos que se pueden hacer. El objetivo de este estudio ha sido desarrollar un sistema que partiendo de las medidas intrínsecas del sujetador permita relacionar el volumen de la mama de la paciente con el volumen de la copa del sujetador que desea y con la prótesis necesaria para conseguirlo. Tomamos medidas antropomórficas del tórax y de las mamas en100 mujeres de entre 18 y 32 años de edad, candidatas a una mamoplastia de aumento y evaluamos la talla del sujetador que usaban y el que deseaban usar tras la cirugía. Estudiamos los volúmenes de las copas de los sujetadores en función del sistema de calibración comercial de tallas. Se plantearon a las pacientes dos preguntas en relación con la talla del sujetador: ¿qué contorno y copa de sujetador usa? Y ¿qué contorno y copa de sujetador quiere usar? Las respuestas se relacionaron con sus medidas antropomórficas y se buscó implantar las prótesis mamarias que, complementando el volumen de su mama, consiguieran rellenar la copa del sujetador que deseaban. Conociendo el sistema de tallas de sujetadores, sabiendo el sujetador que usa la paciente y el que desea usar y tomando las medidas de contorno torácico, contorno mamario (o contorno tóraco-mamario),proyección, diámetro y contorno de la mama, podremos implantaren la paciente las prótesis mamarias del volumen adecuado para satisfacer sus expectativas (AU)

When a patient consults a plastic surgeon for breast augmentation with mammary implants, most of the times, is difficult to know exactly what breast volume does she want. The method to valuepatient´s breast volume and the one she would like to have is limited by technical problems and by the low accuracy in the psyco-social interpretation of measurements and calculation that can be done. The aim of this study was to find a way to relate patient´s breast volume, the bra that she uses and the bra that she wants to use, with the volume of the breast implant needed to get the desired cup bra. We collected anthropomorphic thoracic and breast measures in100 women between 18 and 32 years old candidates to a prosthetic breast augmentation and made an evaluation about the size of the bra they were wearing and the bra that they would like to use after surgery procedure. We studied the volume of the cup of the bras related to the calibration system of usual commercial measures. Patients were asked for two questions: ¿what volume of cup and contour bra does she use? and ¿what volume of cup and contour bra does she want to use?, and the responses were related to the previous measurements. We looked for that breast implant that, complementing the volume of the breast cup, could fill the cup of the desired bras. Knowing the commercial sizes of the bras, the bra size that the patients uses, which bra she would like to use, and knowing the measures of chest contour, breast contour (or thoracomammary contour),projection, diameter and mammary contour we can select the most adequate breast implant in every patient in order to get satisfactory results (AU)