Clinical performance of a dermal filler containing natural glycolic Acid and a polylactic Acid polymer: results of a clinical trial in human immunodeficiency virus subjects with facial lipoatrophy.

Lipoatrophy is a condition that affects certain individuals, most commonly those who are infected with the human immunodeficiency virus.(1-3) Injectable fillers are used for the treatment of these dermal contour deformities to smooth dermal depressions formed by the loss of volume. These dermal fillers (also known as soft tissue augmentation devices) can correct contour deformities caused by lipoatrophy in patients who are human immunodeficiency virus positive or negative. The product used in this study is a patented, second-generation, injectable, dermal collagen stimulator that combines glycolic acid and polylactic acid. The glycolic acid used is not a polymer, but rather an acid derived from sugar cane. Its chemical structure corresponds to that of an alpha-hydroxy acid. Glycolic acid is a well-characterized agent that is present in a number of cosmetic products. Polylactic acid is a synthetic, biocompatible, biodegradable, inert, synthetic polymer from the poly a-hydroxy-acid family that is believed to stimulate fibroblasts to produce more collagen, thus increasing facial volume. Together, polylactic acid and glycolic acid act in concert to 1) stimulate collagen production and 2) hydrate the outer layers of the skin. A multicenter, clinical investigation authorized by the Mexican Secretariat of Health was conducted between September 20, 2002, and September 19, 2004. This clinical study was conducted in male patients between 32 and 60 years of age with lipoatrophy as a result of highly active antiretroviral therapy for human immunodeficiency virus infection. The study objective was to measure the improvement of contour deformities after the injection of a dermal collagen stimulator containing glycolic acid and polylactic acid. In addition to safety, this dermal filler was assessed when used to correct volume deformities caused by lipoatrophy in subjects who are human immunodeficiency virus positive. Thirty male subjects participated and were treated as follows: seven in two sessions, eight in three sessions, 14 in four sessions, and one in five sessions. Each treatment session was separated by approximately 20 days as per the manufacturer's instructions. The follow-up phase consisted of four observation periods over two years from the last injection. The primary efficacy endpoint was measurement of correction of human immunodeficiency virus highly active antiretroviral therapy induced facial lipoatrophy. Using a multipoint scale of facial divergence, correction was measured as a percentage of correction (diversion correction percentage) from baseline. A secondary endpoint was safety based upon the incidence and type of adverse events experienced. All 30 patients completed the active treatment phase with 100 percent (N=30) undergoing at least two treatments at Days 1 and 20 after entry into study. Seventy-four percent (n=23) underwent a third treatment at Day 60, and 50 percent (n=15) received a fourth treatment at Day 80. A single subject received a fifth treatment at Day 100. There were no serious adverse events and no adverse events noted during the study period. Histology through skin biopsy (2mm punch) was performed on 10 subjects, and all subjects had dermal skin thickness measured with ultrasound. Histology demonstrated a foreign body reaction with multinucleated giant cells with phagocytized lactate crystals. New collagen formation was demonstrated. United States measurements of dermal skin thickness increase ranged from 0.22cm to 0.37cm. All subjects were rated for expected injection events to include erythema, edema, ecchymosis, and hematoma. This dermal collagen stimulator containing glycolic acid and polylactic acid represents a tangible alternative in therapeutic and aesthetic medicine. More than four years of clinical trials have demonstrated that this dermal collagen stimulator helps to improve the exterior quality of the skin while restoring lost facial volumes. Patient satisfaction was high due to its effectiveness and long-lasting results, which in some cases have lasted more than two years.

Cardiotocografía anteparto en embarazos de riesgo elevado y su efecto sobre la morbimortalidad perinatal / Antepartum cardiotocography in high-risk pregnancies and its effect on perinatal morbidity and mortality

Se correlacionaron 2,635 registros cardiotocográficos prenatales con la mortalidad perinatal, en 1000 pacientes; se observó que en algunos casos hubo condiciones que intervinieron en la resolución obstétrica para incrementar la mortalidad como malformaciones congénitas; malas condiciones maternas para cirugía - crisis hipertensiva-, y demora en la cirugía. La mortalidad perinatal corregida fue de 9 x 1,000

Ultilidad del ultrasonido en la transfusión fetal: presentación de un caso / Usefulness of ultrasound in fetal transfusion

Se revisan algunos aspectos técnicos del uso del ultrasonido en la transfusión fetal en isoinmunización materno fetal al factor Rh, y se presenta un caso clínico ilustrativo. Se considera que la transfusión fetal intrauterina tiene sus indicaciones precisas, y se debe realizar por personal médico y técnico previamente adiestrado en las técncias involucradas en el procedimiento

Endarterectomía arteria descendente anterior, parche venoso y anastomosis de la arteria mamaria interna izquierda / Anterior descending artery endarterectomy, vein patch and left internal mammary anastomosis

Se evalúan los resultados quirúrgicos de la endarterectomía de la arteria coronaria descendente anterior, reparación con parche venoso y anastomosis de la arteria mamaria interna izquierda como procedimiento asociado a cirugía de revascularización miocárdica en 10 pacientes. Se evalúan las características clínicas de los pacientes. El estudio coronariográfico demostró lesiones críticas obstructivas y/o difusas de la ADA en todos los casos. Se describe en detalle la técnica utilizada, la cual se realizó en forma exitosa en todos los casos con mejoría de su capacidad funcional previa. La técnica utilizada es una alternativa quirúrgica segura en la reconstrucción de endarterectomías coronarias amplias de la ADA con baja morbilidad asociada