Post-Transplant Lymphoproliferative Disorder, Monomorphic Type, in a Kidney Transplant Patient After Administration of Anti-Influenza Vaccine.

ABSTRACT: Post-transplant lymphoproliferative disorders (PTLD) are rare complications in solid organ transplant patients. Their pathogenesis is largely unknown and closely linked to low immunity, which allows uncontrolled lymphocyte proliferation. Although transplant patients receive annual influenza vaccination as a preventive protocol, we have not found any cases where the flu vaccine triggered a PTLD. We present the case of a 49-year-old female kidney transplant recipient who developed an Epstein-Barr virus-negative PTLD, CD30 + anaplastic monomorphic type, ALK-, which presented the day after a single dose of anti-influenza vaccine. The initial clinical presentation was subcutaneous, but imaging studies revealed multiorgan involvement.

Titanium mesh in reconstructive surgery of the nasal pyramid. Follow-up of our 11 initial cases.

BACKGROUND: Titanium mesh has been employed in neurosurgery, plastic surgery, and maxillofacial surgery as a bone replacement in diverse conditions. We first reported on its use as a substitute for osteocartilaginous nasal structure with satisfactory functional and aesthetic results in 2009. OBJECTIVES: To assess the utility and tolerance of titanium mesh as a substitute of the osteocartilaginous portion of the nose. MATERIALS AND METHODS: Eleven patients were identified who had a nasal reconstruction with titanium mesh. We retrospectively searched for infection, extrusion, nasal valve collapse, second surgery, and patient satisfaction in the patients' records. All patients presented with various types of non-melanoma skin cancer in the nasal pyramid. In the reconstruction of full-thickness nasal defects, local flaps were used, employing titanium mesh as a support structure. RESULTS: No mesh extrusions, infections, or collapse of the nasal valve were noted in patients with a mean follow-up of five years. Only one patient needed a second surgery to debulk the flap. Patient satisfaction achieved a mean score of 7.5 out of 9 in 10 patients. CONCLUSIONS: As cartilage grafts need a second surgical site, with consequent morbidity, the use of titanium mesh proves useful and safe in the reconstruction of nasal full-thickness defects. The results of our series of patients demonstrate the suitability of this material in the repair of nasal osteochondral defects, as well as its low rate of complications.

Reconstruction of full-thickness defect of the alar rim with a combined advancement chondro-mucous and bilobed myocutaneous flap.

BACKGROUND: The nasal pyramid is frequently affected by nonmelanoma skin cancer. In full thickness defects of the nose, reconstruction of all the layers results in better outcomes. METHODS: We present a case in which the combination of two flaps adequately reconstructs a full thickness defect of the nasal ala. RESULTS: The images provide proof of the excellent functional and aesthetic results. CONCLUSIONS: Our technique is a simple, one-stage procedure, with no distant donor site morbidity that achieves good coverage of the internal nasal lining with good external aesthetic result.