Colgajos Locales en Reconstrucción Facial. Alternativas de Tratamiento / Local Flaps in Facial Reconstruction. Treatment Alternatives

Los defectos faciales de piel son frecuentemente secuelas producto de carcinomas basoceulares, carcinomas espinocelulares, melanomas, grandes tumores benignos o traumatismos de tejidos blandos. Las unidades y subunidades estéticas de la cara, la textura y color de la piel, junto a otros parámetros deben ser considerados durante la planificación de la reconstrucción mediante colgajos locales. El objetivo de este artículo de revisión bibliográfica fue describir y definir las técnicas más relevantes en los de colgajos locales aplicados en la reconstrucción facial y sus algoritmos actuales, en relación con la unidad o subunidad facial involucrada; sus consideraciones estéticas y cirugía complementaria. Las unidades y subunidades estéticas de la cara se dividen en regiones de la frente, párpados, mejillas, nariz, labios y mentón. Los colgajos de rotación, en isla, de avance y transposición son la base para la mayoría de los colgajos faciales; los más conocidos según la zona donante son: el colgajo frontal, colgajo de rotación y avance de mejilla; colgajo cérvico-facial, y colgajos nasolabiales, entre otros. La elección del colgajo depende de la zona y la unidad estética facial involucrada, siendo importante elegir y usar las líneas, los surcos y márgenes de estas unidades cuando sea posible con el fin de mejorar los resultados estéticos y reducir la posibilidad de secuelas. La cirugía complementaria y los procedimientos estéticos pueden lograr un buen camuflaje de algunas complicaciones estéticas o secuelas.

Skin face defects are frequently sequels of basal cell carcinomas, squamous cell carcinomas, melanomas, and large benign tumors or soft tissue trauma. Aesthetics units and subunits of the face, texture, color, and other parameters must be considered in the local flaps reconstructive planning. This review article aims to describe and define the most relevant techniques of facial local flaps in facial reconstruction and their current algorithms, regarding the unit or subunit, involve, their aesthetics considerations and complementary surgery. The aesthetics units and subunits of the face are divided into forehead, eyelids, cheek, nasal, lips, and chin. There are several well-known concepts and flaps used in these proceedings as rotation, island, advancement, and transposition flaps, and they are the basis for facial local flaps; The most relevant are: forehead flap, cheek advancement, and rotate flap; rhomboid, cervicofacial and bilobed flap, nasolabial flaps. The flap election depends on the zone and unit involve; it is important to choose the lines, sulcus, and borders of these units when is possible to enhance these aesthetics outcomes. These concerning improve the aesthetics outcomes and reduce the aesthetics sequels. Complementary surgery and aesthetics proceedings may accomplish a good camouflage of some aesthetics complications or sequels.

Expression of Toll-like receptors 2 and 4 and its association with matrix metalloproteinases in symptomatic and asymptomatic apical periodontitis.

To determine Toll-like receptors (TLR)2 and TLR4 expression levels and associate them with matrix metalloproteinases (MMPs) in asymptomatic apical periodontitis (AAP), symptomatic apical periodontitis (SAP), and healthy controls. Apical tissue/lesion samples were obtained from chronic AAP (n = 35) and SAP (n = 29), and healthy periodontal ligament (HPL, n = 10) with indication of tooth extraction, respectively. mRNA expression levels of TLR2, TLR4, MMP-1, MMP-2, MMP-8, and MMP-13 were determined by real-time reverse-transcription polymerase chain reaction. The data were analyzed with Kruskal-Wallis and Dunn's pot hoc test (p < 0.05). The correlation coefficient was obtained using the Spearman correlation (p < 0.05). TLR2, MMP-1, MMP-2, and MMP-13 mRNA levels were the highest in SAP followed by AAP and controls (p < 0.05). TLR4 and MMP-8 were over expressed in AAP and SAP compared to HPL (p < 0.05). TLR2 positively correlated with TLR4, MMP-1, MMP-8, and MMP-13 in SAP (p < 0.05). TLR2 and TLR4 are overexpressed in apical lesions versus healthy periodontal ligament and correlate with collagenolytic MMPs. Particularly, TLR2 is overexpressed in SAP in association with MMP-1, MMP-8, and MMP-13. Our results suggest that the activation of TLR2 along with MMP overexpression might contribute to SAP clinical presentation and progression. TLRs, MMPs, and their interaction can explain the clinical presentations and evolution of apical periodontitis and might represent key targets for new diagnostic and treatment approaches.

Effect of curcumin on bone tissue in the diabetic rat: repair of peri-implant and critical-sized defects.

This study determined the effect of curcumin on bone healing in animals with diabetes mellitus (DM). One hundred rats were divided into five groups: DM+PLAC, DM+CURC, DM+INS, DM+CURC+INS, and non-DM (CURC, curcumin; PLAC, placebo; INS, insulin). Critical calvarial defects were created and titanium implants were inserted into the tibiae. Calvarial defects were analyzed histometrically, and BMP-2, OPN, OPG, RANKL, Runx2, Osx, ß-catenin, Lrp-5, and Dkk1 mRNA levels were quantified by PCR. The implants were removed for a torque evaluation, the peri-implant tissue was collected for mRNA quantification of the same bone-related markers, and the tibiae were submitted to micro-computed tomography. The DM+CURC+INS and non-DM groups exhibited greater closure of the calvaria when compared to the DM+PLAC group (P<0.05). Increased retention of implants was observed in the DM+CURC, DM+CURC+INS, and non-DM groups when compared to the DM+PLAC group (P<0.05). CURC improved bone volume and increased bone-implant contact when compared to DM+PLAC (P<0.05). In calvarial samples, CURC favourably modulated RANKL/OPG and Dkk1 and improved ß-catenin levels when compared to DM+PLAC (P<0.05). In peri-implant samples, Dkk1 and RANKL/OPG were down-regulated and BMP-2 up-regulated by CURC when compared to DM+PLAC (P<0.05). CURC reverses the harmful effects of DM in bone healing, contributing to the modulation of bone-related markers.

Hyperglycaemia is associated with impaired vasa vasorum neovascularization and accelerated atherosclerosis in apolipoprotein-E deficient mice.

OBJECTIVE: A direct correlation between blood glucose levels and the microvascular complications of diabetes is well established. However, the effects of hyperglycaemia on the vasa vasorum, a microvascular network which surrounds and supplies the walls of large arteries, is not known. The objective of this study is to investigate the effects of hyperglycaemia on the vasa vasorum and to examine correlations between these effects and the development of atherosclerosis in a mouse model. METHODS: The micro- and macrovascular effects of hyperglycaemia were examined in streptozotocin-injected apolipoprotein-E deficient (ApoE(-/-)) mice. Retina and aortic sinus were isolated from hyperglycaemic mice and normoglycaemic controls at 5-20 weeks of age. Retinal and vasa vasorum microvessel densities were quantified and correlated to atherosclerotic lesion development. The expression levels of pro-angiogenic factors including vascular endothelial growth factor (VEGF) and VEGF receptor 2 were examined. RESULTS: In normoglycaemic ApoE(-/-) mice atherogenesis is associated with vasa vasorum expansion, which likely corresponds to the increasing blood supply demands of the thickening artery wall. In hyperglycaemic ApoE(-/-) mice there is no significant neovascularization of the vasa vasorum, despite the fact that lesions are significantly larger. This defect may result from a localized deficiency in VEGF. CONCLUSIONS: These findings are the first evidence that hyperglycaemia alters the structure of the vasa vasorum. Such microvascular changes directly correlate, and may contribute to, the development and progression of atherosclerosis in hyperglycaemic ApoE-deficient mice.

Sensitivity of coccolithophores to carbonate chemistry and ocean acidification.

About one-third of the carbon dioxide (CO(2)) released into the atmosphere as a result of human activity has been absorbed by the oceans, where it partitions into the constituent ions of carbonic acid. This leads to ocean acidification, one of the major threats to marine ecosystems and particularly to calcifying organisms such as corals, foraminifera and coccolithophores. Coccolithophores are abundant phytoplankton that are responsible for a large part of modern oceanic carbonate production. Culture experiments investigating the physiological response of coccolithophore calcification to increased CO(2) have yielded contradictory results between and even within species. Here we quantified the calcite mass of dominant coccolithophores in the present ocean and over the past forty thousand years, and found a marked pattern of decreasing calcification with increasing partial pressure of CO(2) and concomitant decreasing concentrations of CO(3)(2-). Our analyses revealed that differentially calcified species and morphotypes are distributed in the ocean according to carbonate chemistry. A substantial impact on the marine carbon cycle might be expected upon extrapolation of this correlation to predicted ocean acidification in the future. However, our discovery of a heavily calcified Emiliania huxleyi morphotype in modern waters with low pH highlights the complexity of assemblage-level responses to environmental forcing factors.

Long-range transport of beech (Fagus sylvatica L.) pollen to Catalonia (north-eastern Spain).

Local and long-range transport of beech (Fagus sylvatica) pollen was analysed by using 23-year data (1983-2007) at six stations in Catalonia, Spain, and numerical simulations. Back trajectories and synoptic meteorology indicated a consistent north European provenance during beech pollen peak days. Specifically, the area from northern Italy to central Germany was the most probable source, as indicated by a source-receptor model based on back trajectories. For the event with the highest pollen levels (17 May 2004), back trajectories indicated a source in the Vosges (NE France) and the Schwarzwald (SW Germany) regions. By applying a mesoscale model (MM5) to this event, pollen transport could be further refined, allowing its entrance to Catalonia through the lower easternmost pass of the Pyrenees (the Alberes pass, 500 m a.s.l.) to be described. Hourly counts of Fagus pollen allowed the timing of pollen arrival during this episode to be matched with the model results regarding the above-mentioned passage. This study may help to interpret some results of modern beech genetic diversity and contribute to the understanding of paleopalynological records by taking long-range transport into consideration.

Age, menopausal status and homocysteine levels in women around menopause.

OBJECTIVE: To obtain data on the relation between age, menopause and homocysteine levels in women around menopause, we collected data for a sample of about 500 women attending a menopause clinic in Milan, Italy. STUDY DESIGN: Eligible for the study were all women aged 45-75 years, never HRT users consecutively observed for the first time at the Menopause Center of the 1st Obstetric Gynecological Clinic of the University of Milan. Fasting blood samples for total homocysteine plasma levels were collected during the visit. Of the 490 study subjects, 107 were pre-menopausal and 383 post-menopausal. RESULTS: In the total series, the mean homocysteine level was 8.3 micromol/L (S.D. 3.7, range 3.2-48.8). The values increased from 7.8 micromol/L in women aged <47 years to 9.0 micromol/L in those aged >59. Among pre-menopausal women the mean homocysteine level was 7.7 micromol/L compared to 8.3 micromol/L in post-menopausal women: this difference disappeared on the adjusted values. In post-menopausal women only, no clear relationship emerged between years since menopause and homocysteine levels. CONCLUSION: In our population, age, and not menopausal status, was the main determinant of homocysteine levels in women around menopause.

Clinical trends in ulcer diagnosis in a population with high prevalence of Helicobacter pylori infection.

BACKGROUND: It is unknown whether the incidence of peptic ulcer changes in areas with a high prevalence of Helicobacter pylori infection. AIM: To determine trends in peptic ulcer complications in a community with a high prevalence of H. pylori infection. METHODS: New endoscopic diagnoses of peptic ulcers and their complications from 1985 to 2000 were obtained. H. pylori infection in the adult population, the number of prescriptions for anti-secretory drugs and non-steroidal anti-inflammatory drugs were also evaluated. RESULTS: Although the global prevalence of H. pylori infection remains high in this population (>60%), a 41.4 to 25.4% decrease in the incidence of peptic ulcers and ulcer complications was observed. This was associated with a decrease in the prevalence of H. pylori infection in people under 65 years of age, a 3.5-fold increase in the number of prescriptions of proton-pump inhibitors and an increase in the number of prescriptions of non-steroidal anti-inflammatory drugs, especially coxibs. CONCLUSIONS: In an area with a high prevalence of H. pylori infection, the incidence of peptic ulcer and associated complications is declining rapidly. This was associated with a reduction of the prevalence of H. pylori infection in the young and a widespread use of proton-pump inhibitors. The increase in the use of non-steroidal anti-inflammatory drugs, especially coxibs, has not changed the tendency.

The boundary layer growth in an urban area.

The development and maintenance of the atmospheric boundary layer (ABL) plays a key role in the distribution of atmospheric constituents, especially in a polluted urban area. In particular, the ABL has a direct impact on the concentration and transformation of pollutants. In this work, in order to analyze the different mechanisms which control the boundary layer growth, we have simulated by means of the non-hydrostatic model MM5 several boundary layer observed in the city of Barcelona (Spain). Sensitivity analysis of the modelled ABL is carried out by using various descriptions of the planetary boundary layer (PBL). Direct and continuous measurements of the boundary layer depth taken by a lidar are used to evaluate the results obtained by the model.

Effect of oral or transdermal hormone replacement therapy on homocysteine levels: a randomized clinical trial.

OBJECTIVE: Aim of this randomized trial was evaluate the effect on homocysteine plasma levels of two different hormone replacement therapy (HRT) formulations in a group of late postmenopausal women. METHODS: Eligible for this study were women: in postmenopause since 5 years or more (confirmed from FSH level > or = 40 mIU/l); with body mass index (BMI) < or = 35; without endocrine, hepatic or renal diseases; not current users of vitamin B or folic acid supplements; not users of any lipid-lowering drugs and sex steroids in the 6 months before trial entry. Group A: oral estradiol valerate 2 mg per day per oral normegestrol acetate 2.5 mg per day (n = 98) for 12 months; Group B: a weekly patch releasing estradiol (50 microg per day) per oral normegestrol acetate 2.5 mg per day (n = 101) for 12 months. RESULTS: The mean values of the homocysteine levels in the group A and B at baseline, 3, 6 and 12 months were 7.9 and 9.1, 8.7 and 8.9, 9.3 and 10.2, 9.6 and 10.2, respectively, the differences between the two treatments were not statistically significant (time by treatment interaction, P = 0.32). Otherwise, the changes of homocysteine level at the four visits was statistically significant (P = 0.0001) in both groups. In particular, in the oral treatment group homocysteine levels increased from baseline of 10.5% at 3 months, of 17.2% after 6 months of therapy and of 21.9% at the end of the study; in the transdermal group, after a little decrease at 3 months (1.5%), the increases were of 12.1 and 12.9%, respectively. CONCLUSIONS: This study does not show any different effect of oral and transdermal treatment with estradiol plus normegestrol acetate on homocysteine levels. Further it does not support previous suggestion of a lowering effect of HRT on plasma homocysteine.

Thermal Rossby waves in a rotating annulus. Their stability.

Nonlinear thermal convection in a fast rotating annulus about its axis, with slightly inclined ends, radial gravity and heating, is studied numerically for a fluid of Prandtl number sigma=0.7 and different values of the radius ratio and rotation rate. The properties of the rotating waves that appear after the Hopf bifurcation of the conductive state are analyzed. Near the critical Rayleigh number, different types of solutions with the same wave number coexist, and they are classified as a function of their connection with the two types of modes identified in the linear analysis for this Prandtl number. For different rotation rates, the stability of the primary solutions as a function of the radius ratio is also studied. The shape of the stability regions and the type of dominant disturbances that limit these regions are very sensitive to the proximity to the value of the radius ratio for which the type of dominant mode changes.

Thermal and inertial modes of convection in a rapidly rotating annulus

The nature of the primary instabilities that arise in a fluid contained in a fast rotating cylindrical annulus with slightly inclined plane top and bottom boundaries, radial gravity, and internal heating is numerically analyzed. It is shown that for moderate and high Prandtl numbers, the onset of convection is described by a competition of azimuthal thermal modes with different radial structure, which dominate in different regions of the parameter space. By the combined effect of the inclined ends and rotation, there are modes that are attached to the heated wall and slanted to the prograde direction of rotation, and others which are straight and fill the convective layer. Nevertheless, for very small Prandtl numbers the velocity field of the dominant modes corresponds essentially to the inertial solution of the Poincare equation, and the temperature perturbation is forced by this velocity field. In addition, a detailed exploration of the critical Rayleigh numbers and precession frequencies of the convective modes versus the radius ratio and the Coriolis parameter, for different Prandtl numbers, is presented.

Immigration and health: the Italian National Focal Point experience.

This report is a description of the situation of migrant populations in Italy. It was written by a committed team of experts from public institutions, non-governmental organisations (NGO) and volunteer associations that for three years have been part of the Italian National Focal Point (NFP) within the European Project "AIDS & Mobility", which is being co-ordinated by the Netherlands Institute for Health Promotion and Disease Prevention (the Netherlands) and financed by the European Commission DG/V. This year the Italian National Focal Point, co-ordinated by the Telefono Verde AIDS of the Istituto Superiore di Sanità, has produced a second report (the first one was published in 1998) on health issues related to migrant populations. Besides providing an updated picture on the presence of foreigners in Italy, such report illustrates the present legislative situation within the sanitary area and some interventions regarding prevention, treatment and rehabilitation provided by each structure in the Italian NFP to foreign citizens. The initiatives carried out during the year 1999 by public institutions, NGO and volunteer associations are also reported in order to detect the psycho-social-sanitary needs of immigrants and target prevention programmes to their particular and specific needs.

Ovarian cancer risk and history of selected medical conditions linked with female hormones.

To investigate the role of selected medical conditions on the risk of ovarian cancer, we analysed data from a case-control study. Cases were 971 women below the age of 75 years with histologically confirmed epithelial ovarian cancer, admitted to a network of hospitals including the major teaching and general hospitals in the greater Milan area. Controls were 2758 women admitted to the same network of hospitals for acute, non-gynaecological, non-hormone related, non-neoplastic conditions. Obesity/severe overweight were inversely associated with the risk of ovarian cancer (multivariate relative risk, RR, 0.66, 95% confidence interval, CI, 0.52-0.85). Hyperlipidaemia was also inversely related to ovarian cancer risk, (RR 0.64, 95% CI 0.45-0.89). No relationship emerged between ovarian cancer risk and diabetes (RR 0.80, 95% CI 0.54-1.19), hypertension (RR 0.85, 95% CI 0.68-1.06), thyroid diseases (RR 0.89, 95% CI 0.63-1.13) and cholelithiasis (RR 0.86, 95% CI 0.66-1.12). A decreased frequency of ovarian cancer was seen in women with a history of uterine leiomyomas (RR 0.66, 95% CI 0.47-0.92) and benign ovarian cysts (RR 0.69, 95% CI 0.41-1.13).

Determinants of risk of spontaneous abortions in the first trimester of pregnancy.

Several factors, such as socioeconomic status, obstetrical and menstrual history, and contraceptive methods, have been associated with risk of spontaneous abortion. We conducted a hospital case-control study to analyze risk factors for spontaneous abortion during the first trimester. Cases were 782 women admitted for spontaneous abortion. Controls included 1,543 women who gave birth at term in the same hospitals. Adjusted odds ratios (ORs) for spontaneous abortion were 0.9 and 0.6, respectively, for women reporting 7-11 and > or = 12 years of schooling, compared with women reporting < 7 years of education. A history of pelvic inflammatory disease increased the odds ratio fivefold [OR = 5.1; 95% confidence interval (CI) = 1.0-26.2]. The OR for spontaneous abortion was 1.7 (95% CI = 1.4-2.1) in women reporting previous spontaneous abortions.

Coffee and alcohol intake, smoking and risk of multiple pregnancy.

We analysed the relationship between coffee and alcohol intake, smoking and risk of multiple pregnancies using data from a case-control study on risk factors for multiple births conducted in Italy. Cases were 133 women who delivered multiple births not related to treatment for infertility (33 monozygotic and 100 dizygotic twins). Controls were 395 women admitted for normal delivery at the same clinic where cases had been identified. The odds ratios (OR) of multiple pregnancy were 1.5[95% confidence interval (CI) 0.8-2.8] and 2.0 (95% CI 1.0-3.7) for women drinking respectively one to two or three or more cups of coffee per day in comparison with non-coffee drinkers. Considering separately dizygotic and monozygotic pregnancies, the estimated OR were respectively for women drinking three or more cups of coffee, 1.7 and 3.1 for dizygotic and monozygotic pregnancies. The risk of multiple pregnancy tended to be higher in women drinking >or= 15 alcohol drinks per week: in comparison with tea-totallers the estimated OR for drink > or = 15 glasses per week were 2.3 and 2.6 respectively for dizygotic and monozygotic pregnancies. Heavy smokers (> or = 10 cigarettes per day) were at increased risk of multiple pregnancy: in comparison with never smokers, the estimated OR for multiple pregnancy was 1.6 (95% CI 0.9-2.7). Considering separately the two groups of multiple pregnancy, the OR of dizygotic and monozygotic pregnancy were 1.4 (95% CI 0.8-2.5) and 2.4 (95% CI 0.9-6.1) for women smoking > or = 10 cigarettes/day, but the trend in risk with number of cigarettes smoked per day and duration of the habit was not significant.

Risk factors for functional ovarian cysts.

We evaluated risk factors for functional ovarian cysts using data from a case-control study conducted in Milan. Cases were 68 women with histologically confirmed functional cysts. Controls were 272 women admitted to hospital for acute conditions. Compared with women who were 11 years of age or younger at menarche, women who experienced menarche at 12-13 years or at 14 years or later had odds ratios (ORs) of 0.9 [95% confidence interval (CI) = 0.5-1.6] and 0.4 (95% CI = 0.2-0.9). In comparison with women reporting menstrual cycles lasting less than 26 days, the OR was 1.8 (95% CI = 0.7-5.0) in women reporting cycles lasting 26-30 days, 1.8 (95% CI = 0.4-7.4) in those reporting cycles greater than 30 days, and 1.9 (95% CI = 0.4-7.7) in those with totally irregular cycles. Body mass was inversely related to the risk of functional ovarian cysts: compared with women with a Quetelet index below 20, the OR was 0.9 (95% CI = 0.5-1.7) in those with an index in the range from 20-24 and 0.5 (95% CI = 0.2-1.2) in those with an index of 25 or more. We found little relation between the risk of functional ovarian cysts and education, smoking, marital status, or age at first marriage. For oral contraceptive use, we found an OR of 1.3 (95% CI = 0.7-2.6).