[Advanced Surgical Techniques in Forehead Feminization and Hairline Redefinition]. / Techniques chirurgicales avancées dans la féminisation du front et la redéfinition de la ligne des cheveux chez les patientes transgenres.

Facial Gender-Affirming Surgery (FGAS) has emerged as a transformative option for individuals who wish to align their external appearance with their asserted gender identity. This article delves into the surgical techniques employed in forehead feminization and hairline redefinition, highlighting the nuanced approaches used to modify specific facial characteristics to achieve the desired feminizing outcomes. Our extensive experience, encompassing over 2300 forehead feminization surgeries conducted over the past 16 years, provides a robust foundation for understanding the complexities and intricacies of these procedures. This knowledge is crucial for maxillofacial and plastic surgeons, as well as other healthcare professionals involved in comprehensive gender-affirming care, ensuring they are well-equipped to deliver optimal results for their patients.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Hernia perineal tras amputación abdominoperineal laparoscópica en cirugía de cáncer del recto / Perineal hernia after laparoscopic abdominoperineal resection in rectal cáncer surgery

Las hernias perineales son una enfermedad rara. Su incidencia se estima en un 1% después de la amputación abdominoperineal y en 3-10% de las resecciones pélvicas para los tumores malignos. Se puede definir como la protrusión del contenido intestinal a través del suelo pélvico. Las hernias perineales se clasifican como congénitas, primarias debido a defectos del piso pélvico o secundarias a la cirugía en la cavidad pélvica. Las hernias perineales secundarias tras amputación abdominoperineal para el cáncer rectal se describen por primera vez en 1939 por Yeomans. En 2007 Veenhof4 publicó un caso de hernia perineal secundaria a amputación abdominoperineal por laparoscopia. Presentamos el caso de un paciente en el postoperatorio temprano de una amputación laparoscópica abdominoperineal con una obstrucción secundaria a una hernia perineal

Perineal hernias are a rare disease. Its incidence is estimated at 1% after abdominoperineal amputation and in 3-10% of pelvic resections for malignant tumors. It can be defined as the protrusion of the intestinal contents through the pelvic floor. Perineal hernias are classified as congenital, primary due to pelvic floor defects or secondary to surgery in the pelvic cavity. Secondary perineal hernias after abdominoperineal amputation for rectal cancer is first described in 1939 by Yeomans. In 2007 Veenhof4 published a case of perineal hernia secondary to abdominoperineal amputation by laparoscopy. We present a case of a patient in the early postoperative period, of a laparoscopic abdominoperineal amputation, with an obstructive condition secondary to a perineal hernia

Histological and histochemical evaluation of human oral mucosa constructs developed by tissue engineering.

Reconstruction of large oral mucosa defects is often challenging, since the shortage of healthy oral mucosa to replace the excised tissues is very common. In this context, tissue engineering techniques may provide a source of autologous tissues available for transplant in these patients. In this work, we developed a new model of artificial oral mucosa generated by tissue engineering using a fibrin-agarose scaffold. For that purpose, we generated primary cultures of human oral mucosa fibroblasts and keratinocytes from small biopsies of normal oral mucosa using enzymatic treatments. Then we determined the viability of the cultured cells by electron probe quantitative X-ray microanalysis, and we demonstrated that most of the cells in the primary cultures were alive and had high K/Na ratios. Once cell viability was determined, we used the cultured fibroblasts and keratinocytes to develop an artificial oral mucosa construct by using a fibrin-agarose extracellular matrix and a sequential culture technique using porous culture inserts. Histological analysis of the artificial tissues showed high similarities with normal oral mucosa controls. The epithelium of the oral substitutes had several layers, with desmosomes and apical microvilli and microplicae. Both the controls and the oral mucosa substitutes showed high suprabasal expression of cytokeratin 13 and low expression of cytokeratin 10. All these results suggest that our model of oral mucosa using fibrin-agarose scaffolds show several similarities with native human oral mucosa.

Dependencia a benzodiacepinas / Dependence on benzodiazepines

Objetivo. Se presenta el caso clínico de una mujer adicta a benzodiacepinas que es ingresada en una Unidad de Hospitalización de Salud Mental con diagnóstico de trastorno depresivo. Material y método. Se estudia el caso clínico de una paciente de 33 años con antecedentes de abuso de sustancias así como los factores de riesgo intercurrentes para abuso de benzodiacepinas. Resultados. Después de describir la historia psiquiátrica y toxicológica de la paciente se realiza el diagnóstico principal y el de otros trastornos comórbidos según criterios DSM-IV-TR; así también, se mencionan las posibilidades de abordaje terapéutico. Conclusiones. La prescripción de benzodiacepinas debe hacerse bajo control y siguiendo las recomendaciones del Ministerio de Sanidad y Consumo para prevenir la dependencia o el consumo inadecuado de estos fármacos. Las estrategias de deshabituación exigen una detallada valoración del paciente para llegar a la recomendación más adecuada y aceptable para cada tipo de paciente AU)

Objective. The case of women addicted to benzodiacepines who is hospitalized in a Mental Health Inpatient Unit and diagnosed as depressive disorder, is presented. Material and methods. The clinical case of a 33-year-old female with personal history of substance abuse and risk factors of benzodiazepines abuse. Results. After describing the clinical and toxicological history of the patient, the main and comorbid diagnosis are done following DSM-IV-TR criteria. Different possibilities for treatment are mentioned. Conclusions. Benzodiazepines prescription must be following Ministry of Health recommendations to prevent drug-addictions and inadequate consumption. Strategies for suppression of the consumption require a precise assessment of the patient to achieve the most adequate recommendation for each patient (AU)

Complicaciones de la enfermedad diverticular del colon. tratamiento quirúrgico y su morbilidad / Complications of colonic diverticular disease. Surgical treatment and associated morbidity

Objetivo. Presentamos una revisión de las intervenciones y complicaciones que han presentado 50 pacientes intervenidos por enfermedad diverticular complicada entre el 1 de enero de 1989 y el 31 de diciembre de 1997. Pacientes y método. En todos ellos se han analizado: edad, sexo, localización, días de estancia hospitalaria, indicaciones, tipo de intervención, morbilidad y mortalidad. Resultados. Las indicaciones fueron: diverticulitis (76 por ciento), hemorragia digestiva (8 por ciento), obstrucciones (6 por ciento), fístula colovesical (6 por ciento) y fístula colocutánea (4 por ciento). De las 4 hemorragias, dos fueron intervenidas mediante resección segmentaria y dos mediante colectomía subtotal. Dos obstrucciones fueron intervenidas con procedimiento de Hartmann y otra mediante resección y anastomosis directa. También fueron intervenidas mediante la técnica de Hartmann 28 diverticulitis. A cuatro se les practicó colostomía asociada a lavado y drenaje, a tres lavado más drenaje, a uno se le practicó diverticulectomía de ciego y sutura, y a 2 resección y anastomosis. Una fístula enterocutánea fue tratada mediante resección del sigmoides y del trayecto, realizándose anastomosis. La otra obligó a una colectomía subtotal. Las 3 colovesicales fueron tratadas mediante resección del trayecto, cierre de la brecha y sutura cólica. La morbilidad en los pacientes con hemorragia fue: recidiva (25 por ciento), infección de herida (25 por ciento) y tromboembolismo (en el 25 por ciento). En los pacientes con obstrucción se produjo infección de la herida en el 33,33 por ciento. En los pacientes con diverticulitis hubo infección de la herida en el 36,84 por ciento, sepsis en el 21,05 por ciento, infección urinaria en el 18,42 por ciento, evisceración en el 13,15, tromboembolismo en el 13,15 por ciento, fístula enterocutánea en el 13,15 por ciento e infecciones respiratorias en el 13,15 por ciento junto a otras menos frecuentes. En los pacientes con fístulas se presentaron infección de la herida (20 por ciento), fístula intestinal (20 por ciento) sepsis (20 por ciento). La mortalidad fue del 16 por ciento, debido a sepsis (10 por ciento); tromboembolismo pulmonar (2 por ciento); hemorragia gástrica (2 por ciento), e insuficiencia cardíaca (2 por ciento). Conclusiones. La mayoría de los pacientes fueron intervenidos según técnica de Hartmann. Las complicaciones más destacadas fueron las de tipo infeccioso, relacionadas también con la prolongada estancia hospitalaria y con la mayor parte de los fallecimientos (AU)

Tumores del músculo liso del tracto digestivo / Smooth muscle tumors of the digestive tract

Propósito: Los tumores de estirpe muscular son raros en el tracto esofágico y gastrointestinal. En este trabajo presentamos nuestra experiencia reciente en su manejo. Material y métodos> Hemos incluido en nuestro estudio los pacientes tratados de estas neoplasias en el Servicio de Cirugía General y Digestiva del Hospital Virgen Macarena de Sevilla (Prof. Cantiliana Martinez) desde 1991 a 1996, analizando la clínica, los métodos diagnósticos empleados y la terapéutica utilizada (AU)