Use of cryopreserved human amniotic membrane in the treatment of skin ulcers secondary to calciphylaxis.

Calciphylaxis is a rare condition characterized by skin ulceration and necrosis as a result of vascular calcification of the small and medium blood vessels of skin and subcutaneous tissues. It mainly occurs in patients with advanced chronic kidney disease and sometimes leads to complications with a fatal outcome. In this report, we describe the case of a 67-year-old male patient with end stage renal disease presenting painful skin ulcers on his lower limbs. The lesions had progressively grown and were associated to severe pain and decreased quality of life. The ulcers did not respond to conventional treatments and the patient underwent skin biopsy of these lesions obtaining anatomopathological findings compatible with calciphylaxis. In this report, we present an innovative treatment for skin ulcers secondary to calciphylaxis using cryopreserved amniotic membrane (AM) as a dressing in order to promote epithelialization of the wounds. After four applications, healing of the main ulcer and reduction in pain was achieved. In summary, applying cryopreserved AM probed to be a promising strategy to reduce pain and to enhance epithelialization and healing of chronic non-responsive ulcers in calciphylaxis.

Evaluación del tratamiento de la lipoatrofia facial con gel de poliacrilamida / Evaluation of the facial lipoatrophy treatment with polyacrylamide gel

Antecedentes y Objetivo. La lipoatrofia facial es una complicación frecuente de los pacientes con VIH/SIDA, y se asocia al tratamiento antirretroviral. Consiste en una pérdida anómala de la grasa facial, lo que supone un grave problema personal, laboral y social para estos pacientes, pudiendo provocar falta de adherencia al tratamiento. Para corregirla, cuando está establecida, es preciso el tratamiento mediante infiltración de materiales de relleno. El objetivo de nuestro estudio es evaluar la efectividad y seguridad del tratamiento de la lipoatrofia facial con relleno de gel de poliacrilamida. Material y Método. Realizamos un estudio de seguimiento prospectivo de 1 año en 15 pacientes con lipoatrofia facial grados II-III. Recogemos los efectos secundarios presentados. Analizamos la permanencia del relleno facial medido mediante tomografía axial computarizada y la evolución en el grado de lipoatrofia facial, en el grado de afectación del paciente y en la satisfacción de este tras la intervención. Resultados. En el 100% de los pacientes de la muestra no observamos efectos adversos al año de seguimiento. No encontramos un descenso significativo del espesor del relleno facial ni en la satisfacción de los pacientes al mes y al año del tratamiento. Existió una reducción estadísticamente significativa en el grado de afectación de los pacientes y en su grado de lipoatrofia facial tras el tratamiento, al mes y al año de seguimiento con p < 0.0001. Conclusiones. Según nuestros resultados, el gel de poliacrilamida es un material de relleno seguro y efectivo para el tratamiento de la lipoatrofia facial en pacientes VIH+ en situación clínica estable (AU)

Background and Objective. Facial lipoatrophy is a frequent complication of patients with HIV/AIDS associated with antiretroviral therapy. It consists of an abnormal facial fat loss, which poses a serious personal, occupational and social problem for these patients resulting in a lack of adherence to the treatment. Treatment by infiltration of filling materials is required to correct the established facial lipoatrophy. The objective of this study is to assess the effectiveness and safety of the facial lipoatrophy treatment filled with polyacrylamide gel. Methods. A one-year prospective follow-up study is carried out in 15 patients with facial lipoatrophy grades II-III. Side effects are measured. The permanence of the facial filler is analyzed by TAC and the evolution in facial lipoatrophy grades, in the degree of involvement of the patient and its satisfaction after surgery. Results. A 100% of the sample did not portray any side effects in the year of monitoring. A significant decrease in the thickness of the facial filler or in the satisfaction of the patients could not be found a month and a year after the treatment. There is a statistically significant decline in the degree of involvement of the patient and the extent of facial lipoatrophy after treatment with p < 0.0001. Conclusions. Polyacrylamide gel is a safe and effective filling material for the facial lipoatrophy treatment of in HIV+ patients in stable clinical situation (AU)