Treatment of Recurrent Tracheocutaneous Fistulas in the Irradiated Neck with a Two Layers-Two Flaps Combined Technique.

The development of a tracheocutaneous fistula (TCF) is a well-documented complication after tracheostomy, especially in chronic morbid patients, in whom tubes or cannulas are left in place over time, or in irradiated patients. Surgical treatments are therefore needed which range from simple curettage and dressings to local skin flaps, muscle flaps and, in the more complex cases, microsurgical free tissue transfers. We present a novel combined technique used to successfully treat recurrent TCFs in irradiated patients, involving a superiorly based turnover fistula flap and a sternocleidomastoid transposition flap.

A rapid genetic counselling and testing in newly diagnosed breast cancer is associated with high rate of risk-reducing mastectomy in BRCA1/2-positive Italian women.

BACKGROUND: Risk-reducing mastectomy (RRM) decreases breast cancer (BC) risk in BRCA1/2 mutation carriers by up to 95%, but the Italian attitude towards this procedure is reluctant. PATIENTS AND METHODS: This is an observational study with retrospective design, using quantitative and qualitative research methods, aimed at evaluating the attitude towards RRM by rapid genetic counselling and testing (RGCT), at the time of BC diagnosis, compared with traditional genetic counselling and testing (TGCT), after previous BC surgery. Secondary aims were to investigate patient satisfaction after RRM and the rate of occult tumour in healthy breasts. A total of 1168 patients were evaluated: 1058 received TGCT, whereas 110 underwent RGCT. RESULTS: In TGCT, among 1058 patients, 209 (19.7%) mutation carriers were identified, with the rate of RRM being 4.7% (10 of 209). Conversely in RGCT, among 110 patients, 36 resulted positive, of which, 15 (41.7%) underwent bilateral mastectomy at the BC surgery time, showing an overall good satisfaction, measured by interpretative phenomenological analysis 12 months after the intervention. CONCLUSIONS: Our study shows that RGCT in patients with a hereditary profile is associated with a high rate of RRM at the BC surgery time, this being the pathway offered within a multidisciplinary organization.

[Spotted fever in the municipality of Pedreira, PS, Brazil. Serologic survey]. / Febre maculosa no município de Pedreira, SP, Brasil. Inquérito sorológico.

Cases of Brasilian spotted fever (BSF) have been occurred since 1985, in the rural area of Pedreira town, situated 160 km away from the city of São Paulo (longitude 46 degrees 54'07", latitude 22 degrees 44'21"). Aiming at evaluating the prevalence of Brasilian spotted fever in this endemic area, single-serum samples were collected from 473 healthy persons, amongst city-dwellers and the local china industry workers. The obtained samples were tested by indirect immunofluorescence (IFA), in order to determine the antibodies titer for the group of Brasilian spotted fever. Twenty-five (5.3%) were considered positive (titer 3 1:64) and thirty-one (6.5%) were taken as "borderline" (titer 1:32). The results show a serologically positivity rate similar to other areas, known as endemic ones within the country.

[Sandflies (Diptera, Psychodidae) from the transmission area for American cutaneous leishmaniasis in the town of Itupeva, the southeastern region of São Paulo state, Brazil]. / Flebotomíneos (Diptera, Psychodidae) de área de transmissão de leishmaniose tegumentar americana, no município de Itupeva, região sudeste do Estado de São Paulo, Brasil.

The present study was effected aiming the verification of the seasonal, spatial and hourly of the phlebotominic species found in the county of Itupeva. Captures were performed fortnightly and 864 sand flies were collected between april/94 and march/95. 81.3% of the captured specimens belonged to 4 species: L. migonei (32.4%), L. whitmani (26.0%), L. intermedia (12.0%) e L. fischeri (10.9%). Such species showed larger densities during the cold and dry season of the year (from april to september/94) and were more active between the second and the fifth hour after twilight. L. migonei predominated almost in all the investigated surroundings being followed by L. whitmani and L. longipalpis in the domestic environments. In conclusion it is thought that in conjunction with L. intermedia, a suspect vector in the State of São Paulo, L. migonei and L. whitmani may have an important role in the transmission of cutaneous leishmaniasis in the area under study.

[American tegumentary leishmaniasis in the northeastern state of São Paulo-Brazil]. / Leishmaniose tegumentar americana na região nordeste do estado de São Paulo-Brasil.

An outbreak of American Cutaneous Leishmaniasis (ACL) occurring in the Northeast region of São Paulo state in 1992 is described. After the notification of the 12 human cases, a skin test survey of the local population was carried out in a rural area of the Itupeva municipality. The survey consisted of 144 interviews and 100 clinical examinations using the Montenegro skin test (MST). A prevalence of 34% positive MST was encountered. The predominant species of sandflies captured both in domestic and nearby areas of secondary vegetation were L. intermedia, L. whitmani and L. migonei. The presence of L. longipalpis in the nearby area of secondary vegetation was also registered.

Endoscopic forehead lift for ptosis of the brow caused by facial paralysis.

Twelve patients with ptosis of the brow caused by facial nerve paralysis were treated by endoscopic forehead lift. Four had an isolated paralysis of the temporal branch of the facial nerve and in eight the entire facial nerve was affected. In two of these patients the facial paralysis was bilateral, caused by Finnish hereditary amyloidosis. A standard subperiosteal endoforehead approach was used and the forehead was fixed by biodegradable pins (n = 8), anchor screws (n = 3), or a suture to the posterior scalp (n = 1). The procedure was a success in 10 patients, and failed in two after initially good results. The endoscopic brow lift is a good method of treating ptosis of the brow caused by paralysis of the temporal branch of the facial nerve.

[Congenital malaria in the county of Leme, SP]. / Malária congênita no município de Leme, SP.

Congenital malaria associated to Plasmodium vivax in a newborn baby (14 days old) is reported. The mother lived in a malaria-prone area, and came up to the county of Leme, São Paulo state, 40 days before baby's birth. Congenital malaria was classified through precocious symptoms, absence of malaria in the county and no history of blood transfusion or parenteral intervention of any sort. The case arises interest because of the necessity of malaria diagnoses suspicion on febrile newborns in non endemic areas, since the mother have lived or stayed in a malarious region.

Laser treatment of angiofibromas in tuberous sclerosis.

Tuberous sclerosis complex is an autosomal dominant disorder that can cause nonmalignant hamartomas in any organ. Angiofibromas are the most disturbing marker of the disease because they are conspicuously present on the face. We report the case of a 15-year-old girl affected by tuberous sclerosis, whose facial angiofibromas were satisfactorily treated by a green light vascular laser (532 nm).

Cross-sensitizations between azo dyes and para-amino compound. A study of 236 azo-dye-sensitive subjects.

Combined sensitizations to different azo dyes, probably based both on true cross-sensitization and on simultaneous positive reactions, have frequently been described. However, since azo dyes are included in the standard series in a minority of countries, the case studies considered comprise, with few exceptions, a small number of subjects. The aim of our study was to investigate cross-reactions between different azo dyes and para-amino compounds in azo-dye-sensitive subjects, to study the clinical aspects of azo dye dermatitis, to assess the relevance of sensitization to azo dyes, and to relate the pattern of cross-sensitizations to the chemical structure of the different dyes. Out of 6203 consecutively tested patients, 236 were sensitized to at least 1 of 6 azo compounds employed as textile dyes, included in our standard series. 107 subjects reacted to Disperse Orange 3 (DO3), 104 to Disperse Blue 124 (DB124), 76 to p-aminoazobenzene (PAB), 67 to Disperse Red 1 (DR1), 42 to Disperse Yellow 3 (DY3), and 31 to p-dimethylaminoazobenzene (PDAAB). Co-sensitizations to para-phenylenediamine were present in most subjects sensitized to DO3 (66%) and PAAB (75%), in 27% and 36% of DR1 and DY3-sensitive subjects, and only in 16% of subjects sensitized to DB124. Apart from the hands and the face, the neck and the axillae were the most frequently involved skin sites. Whereas the involvement of flexural areas was mainly connected with sensitization to DB124, in patients with hand dermatitis and in those working as hairdressers, sensitization to DO3 and PAAB was more frequent. Moreover, in the former patient group, a history of textile dye allergy was most frequently obtained. Out of 33 patients tested with an additional textile dye series, only 5 subjects reacted to anthraquinone dyes. Cross-sensitizations between azo dyes and para-amino compounds can partially be explained on the basis of structural affinities.

Treatment of Romberg's disease with parascapular free flap and polyethylene porous implants.

Romberg's disease is a rare condition characterized by progressive hemifacial atrophy. The atrophic process typically has its onset in the first or second decade of life, it continues for a few years (usually 2, but up to 10), and then it stops spontaneously. The subcutaneous tissue is the first to be involved by the disease, followed by muscles, bones, and, rarely, the skin. The etiology of the disease is unknown. The only available treatment is surgical. Several techniques have been reported in the literature, from fat transplant, to silicon prostheses, to the use of flaps. We present our experience in successfully treating six patients (3 males and 3 females) affected by Romberg's hemifacial atrophy of intermediate or severe degree. A technique including a free parascapular microvascular flap with the adjunct of porous polyethylene implants was used. Further correction was performed with remodeling or resuspension.

Leishmaniose tegumentar americana na regiäo nordeste do Estado de Säo Paulo - Brasil / American tegumentary leishmaniasis in the norheastern state of Säo Paulo - Brasil

Os autores descrevem um surto de leishmaniose tegumentar americana (LTA) instalado na regiao nordeste do Estado de Sao Paulo em 1992. Após a notificaçao de doze casos humanos em uma área rural do município de Itupeva, foi realizado um inquérito epidemiológico, destacando-se 34 por cento de positividade da populaçao à Reaçao Intradérmica de Montenegro. Constatou-se uma grande diversidade da fauna flebotomínica local, com predominância de L. migonei, L. intermedia e L. whitmani, tanto no domicílio, quanto na margem da mata. Ressalta-se a presença na margem da mata de L. longipalpis.