[Facial necrotizing fasciitis after mild trauma of the eyelid: role of nonsteroidal anti-inflammatory treatment]. / Fasciite nécrosante de la face après un traumatisme palpébral mineur: rôle des anti-inflammatoires.

Facial necrotizing fasciitis is a rare but potentially serious and fatal infection, especially in children. We report the case of a five-year-old girl who developed rapidly progressive necrotizing fasciitis of the face secondary to a mild trauma, with a small wound in the upper eyelid. She had received nonsteroidal anti-inflammatory treatment before she was referred to our hospital. Despite surgical debridement of necrotic tissues and intravenous antibiotic therapy, recurrence occurred. Final progression was satisfactory without sequelae. We discuss here the role of nonsteroidal anti-inflammatory drugs in the development of necrotizing fasciitis in cutaneous lesions, whether traumatic or not.

[Limbal-conjunctival autograft in pterygium surgery]. / L'autogreffe limbo-conjonctivale dans la prise en charge chirurgicale des ptérygions.

INTRODUCTION: The aim of this study was to estimate the efficacy of limbal-conjunctival autograft in the treatment of pterygium. MATERIAL AND METHODS: We conducted a retrospective study including 15 patients (16 eyes) operated on for pterygium by limbal-conjunctival autograft. The examination included the search for risk factors and visual acuity, as well as corneal astigmatism and pterygium measurement. The follow-up included an examination at day 8, 1 month, and 3 months and assessed the integration of the transplant on the eye's surface, the aesthetic aspect, and recurrence. We describe the patients' characteristics, visual acuity, and astigmatism before and after surgery. RESULTS: The mean age of the patients was 56 years (range, 31-81 years). Before surgery, irritative signs and astigmatism, were found in 37% and impaired visual acuity in 81%. The mean duration of the follow-up after surgery was 19 months. Visual acuity and astigmatism improved in 56% of our patients. All transplants and harvest sites had a satisfactory macroscopic aspect. However, one patient suffered from a corneal invasion by fibrovascular tissue, 7 months postoperatively, which remained stable at the end of follow-up. DISCUSSION/CONCLUSION: In our study, the limbal-conjunctival autograft was a safe and effective surgical treatment with a very low recurrence rate at long-term follow-up.

The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter.

PURPOSE: Fine-needle aspiration biopsy (FNAB) is a commonly performed procedure used in the evaluation of solitary thyroid nodules, in which the risk of malignancy is approximately 5% in most patients. Recently, the use of ultrasound (US) guidance in FNAB has been shown to enhance the diagnostic efficacy of this procedure. However, the risk of malignancy in thyroid nodules occurring within a multinodular goiter (MNG) has not been completely clarified, nor has the optimal means of investigating such nodules using FNAB. SUBJECTS AND METHODS: We performed a retrospective study of all patients seen over a 4-year period with a MNG that had one or more nodules who underwent FNAB under US guidance. The results from the history and physical examination, thyroid function and antibody tests, radionuclide studies, thyroid sonogram, cytology of aspirated nodules, and surgical pathology were recorded and analyzed. RESULTS: A total of 93 nodules were aspirated in 61 patients with MNG. Adequate material was obtained in 96% of aspirates on the first attempt. Sixty-seven aspirates in 44 patients yielded benign cytology and 22 aspirates in 15 patients yielded suspicious cytology. All patients with suspicious cytology underwent thyroid surgery. Thyroid cancer was found in 5 of these nodules, including 4 cases of papillary cancer and 1 case of Hürthle cell cancer, and 1 additional patient had occult papillary cancer discovered. The overall malignancy rate in thyroid nodules among the patients with MNG was approximately 5%. CONCLUSIONS: FNAB under US guidance is a useful diagnostic modality in the evaluation of thyroid nodules in selected patients with MNG. Because the risk of thyroid malignancy in these nodules is comparable to that which exists in solitary thyroid nodules, the possibility of thyroid malignancy should be considered in all patients with MNG.

[Cardiovascular risk factors in a rural population of Castilla-La Mancha]. / Factores de riesgo cardiovascular en una población rural de Castilla-La Mancha.

INTRODUCTION AND OBJECTIVES: To describe the prevalence of the main cardiovascular risk factors in a rural population in Spain. The results are compared with the MONICA-OMS study. METHODS: A random sample n = 1330 aged 25 to 74. MONICA-OMS based methodology is used (questionnaire, lipid measurement using enzymatic method with external quality control, blood pressure with quality certification and antropometric measurements). RESULTS: Prevalences obtained are: Hypercholesterolemia 14.4% males and 16.8% females; mean cholesterol (SD) 210.8 (39.8) males and 212.6 females; HDL-cholesterol 47.8 (10.9) males and 53 (11.3) females; hypertension (> or = 140 and/or 90 mmHg) 40.8% males and 42% females. Systolic/diastolic mean levels 135.5/77.8 males and 133.8/76.5 females; smokers 39.4% males and 13.7% females; male body mass index 27.2 kg/m2 and female BMI 28.9 kg/m2; 30% of males and 40% of females were absolutely free of major risk factors. CONCLUSION: Levels of cardiovascular risk factors are similar to other Spanish studies. Comparison of standardized results with MONICA-Europe centers by age shows that cholesterol is lower, but blood pressure is medium-high, tobacco use is higher in males and body mass index is high. This cardiovascular risk profile does not correspond to the low mortality and coronary heart disease incidence in Spain, which is very low and is not related with levels of classical risk factors. It is necessary to study the role of new risk and protecting factors through analytic studies based on coronary heart disease incidence which explain this paradox.