[Cranberry juice and its role in urinary infections]. / El jugo de arándano y su papel en las infecciones de las vías urinarias.

The urinary tract infection is a worldwide health problem, with a ratio of 9 to 1 in women compared with men. In 80% of the cases, the causing bacteria is Escherichia coli. During reproductive life this infection represents a great amount of work disabilities, hence the need to insist on its prophylaxis. The red cranberry juice is an option to prevent urinary tract infection, a quality demonstrated in several recent publications which emphasize that its mechanism of action lies in the effect exerted by proantocyanidines, especially those of type A, in the urothelium that prevent Escherichia coli from adhering to this and exerts its antibacterial action, which is achieved with the ingestion of at least 300 mL of juice every day.

Fluctuations of the atrial cycle length and A-V delay with a universal (DDD) pacemaker.

The electronic characteristics of a new universal (DDD) pulse generator can result in significant shortening of the atrial cycle length (A-A interval) and shortening of the atrioventricular (A-V) interval beyond the programmed values. These pacemaker arrhythmias are entirely compatible with normal function and must not be interpreted as malfunctions.

Perforator-based flaps for low posterior midline defects.

A new type of flap is described based on unnamed perforators located near the midline of the lower back region. Such flaps combine the superior blood supply of the myocutaneous flap with the lack of donor-site morbidity of a skin flap. Five clinical cases are presented, showing how such perforators can augment skin flaps or create custom-designed island flaps. The dissection of the flap is described, and further possibilities for its use are suggested.

The skin tumor: a reconstructive challenge.

The type of reconstruction performed following skin tumor surgery is directly related to the type, extent, and site of the skin tumor. The skin tumors with which the plastic surgeon is most often confronted are the basal and squamous cell cancers and melanoma. It is well documented that the incidence of these tumors are increasing at an alarming rate. This is believed to be primarily due to excessive sun exposure and the thinning of the protective ozone layer. Under these circumstances, the plastic surgeon today must be well equipped to not only treat these tumors, as well as other rarer diseases, but also to reconstruct the sometimes challenging resulting defects. The guiding reconstructive principle is as Ralph Millard admonished: Replace lost tissue with like tissue. A skin graft at the tip of the nose can be very distracting due to its patch-like, depressed appearance. In contrast, a full-thickness skin flap would allow the reconstructive "material" to blend in with its surroundings for a more impressive result. The plastic surgeon has several items in his armamentarium to assist in the execution of this principle. Some of the techniques are based on age-old ideas, while others represent very recent, almost revolutionary advances. These advances include: 1. The introduction of the tissue expander: This concept has allowed the plastic surgeon to reconstruct defects that would would have normally required disfiguring skin grafts or free tissue transfers. 2. The elucidation of the vascular supply to the skin and underlying muscles and fascia: This knowledge has endowed the plastic surgeon with a tremendous pallet of reliable flaps to reconstruct a particular defect.

Delayed pedicle separation in forehead flap nasal reconstruction.

Nasal reconstructions with midline forehead flaps are often plagued by inadequate tip projection and excessively thick alar rims. These problems can be overcome by a combination of preliminary tissue expansion, which gains extra length, and delayed pedicle separation, which allows aggressive thinning of alar rims and shaping of the tip while its blood supply is still fully intact. Only when tip-shaping is completed is the pedicle divided and the reconstruction completed. In our experience this combination of increased flap length and improved tip shape has led to better tip projection and superior overall results. Three representative cases that demonstrate these principles are presented.

The morbidity of perineal wounds following abdominoperineal resection for rectal carcinoma.

The clinical charts of 44 patients who underwent an abdominoperineal resection for adenocarcinoma of the rectum at Roswell Park Memorial Institute were retrospectively reviewed. The morbidity of an open perineal wound versus the closed perineal wound were evaluated. All of the patients received a Nichol's bowel preparation and following the abdominal portion of the dissection reperitonealization of the pelvic floor was performed. The overall morbidity for the open perineal wounds was 21% compared to a morbidity of 63% for the perineal wounds that were closed primarily. The mean length of hospitalization from the time of abdominoperineal resection was 21 days for the open perineal group and 22 days for the closed perineal group. The inclusion of wound sinus tracts in our morbidity assessment may explain the higher complication rate of the closed wound group than previously reported in the literature. This retrospective review emphasizes that the morbidity of the open perineal wound following abdominoperineal resection has been overemphasized. One is trading a potentially increased incidence of septic wound complications in the closed perineum for a protracted wound closure in the open perineum.