Pseudoaneurisma Postraumático de Arteria Radial / Postraumatic pseudoaneurysm of the Radial Artery

Los aneurismas se clasifican en verdaderos o falsos (pseudoaneurismas) dependiendo del daño de la pared arterial. La mayoría de los aneurismas distales de la extremidad superior surgen de la arteria cubital. Las lesiones con origen en la arteria radial son poco comunes y casi siempre se deben a traumatismos penetrantes o lesiones iatrogénicas. La mayor parte se localizan a nivel distal, en la caravolar del antebrazo. La clínica de un pseudoaneurisma de arteria radial puede manifestarse horas después de la lesión o insidiosamente a los meses o años siendo a menudo mal diagnosticado. El diagnóstico y tratamiento se realiza por medios no invasivos en el momento actual, aunque de fallar estas opciones se puede recurrir a métodos invasivos, tanto en el diagnóstico (arteriografía) como en el tratamiento (cirugía), permitiendo lograr un resultado satisfactorio en ausencia de complicaciones isquémicas. Presentamos el caso de un varón de 25 años de edad que sufrió una herida penetrante en primera comisura de manoizquierda y que fue enviado 1 O días después de la lesión inicial, con una masa pulsátil a dicho nivel. Una vez realizado el diagnóstico, se intento la trombosis del mismo y tras fracasar esta opción se opto por la resección.Ocho meses después se encuentra sin recidiva (AU)

Aneurysms are classified as "true" or "false" (pseudoaneurysrns), depending upon the extent of arterial wall damage. Most distal upper extremity aneurysms arise from the ulnarartery. Rare lesions originating from the radial artery are almost always related either to penetrating trauma or to iatrogenic injury. Most of them are located on the volar aspect of the distal foreann. The clinical picture of a radial artery aneurysm may appear within hours following injury or insidiously over a period of months to years and frequently is misdiagnosed. Actually the diagnosis and treatment can be made by non­invasive methods, but in case of failure of these options, the invasive methods, as in diagnostic (arteriography) or in treatment (surgery), can be feasibles too, obtaining a satisfactory result in absent of ischemic complications. We report the case of a man 25 years old who presented a penetrating injury on the first web of the left hand and was sent 10 days after the original injury with a pulsatil mass at this level. After the diagnosis we tried to embolizate it without suc­ cess and then we had to remove it. Patient is in absent of recidiva eight rnonths later (AU)

Eficacia de la Linfadenectomía Ilio-Obturatriz en cirugía oncológica / Efficacy of Ilioobturator node dissection in oncologic surgery

La disección ilio-obturatriz ha sido utilizada como técnica electiva o terapeútica en cirugía oncológica. En un pequeño porcentaje de pacientes portadores de adenopatías en la cadena ilíaca, puede tener un fin curativo, si se aplican unas indicaciones muy selectivas basadas en los hallazgos clínicos, radiológicos e histopatológicos. Además, esta técnica proporciona un beneficio paliativo en el control de la recidiva ilíaca, al evitar la comprensión del uréter y de la vena ilíaca por el crecimiento de la adenopatía metastásica, sin aumentar significativamente la morbilidad con respecto a la linfadenectomía inguinal superficial. Otro de los beneficios de la linfadenectomía inguinal superficial. Otro de los beneficios de la linfadenectomía ilio-obturatriz es su ayuda al mejor estadiaje de la enfermedad con un fin pronóstico (AU)

Eccrine porocarcinoma. Report of nine cases.

BACKGROUND: Eccrine porocarcinoma is a rare malignancy of the eccrine sweat gland and usually has a long-standing growth on a lower extremity. OBJECTIVE: The aim of this review was to analyze clinical and histopathological findings of eccrine porocarcinoma. METHODS: We report nine cases of eccrine porocarcinoma that we have seen during last 10 years. RESULTS: Eccrine porocarcinoma affects elderly patients in both sexes and is usually found on the lower extremities, but in our review it is similar on the head. The mean size was 1.9 cm in our cases. Elective primary treatment was excision and we did not perform elective lymph node dissection. We have not found evidence of metastases in any of our cases.

[Reconstructive techniques in cutaneous defects of the nasal tip]. / Técnicas reconstructivas de los defectos cutáneos de la punta nasal.

Many techniques are used for repairing nasal tip defects. Our own guidelines are reviewed: Small defects often can be closed directly. Lesions of the nasal tip over 0.5 cm in diameter usually require a skin graft or flap. Postauricular, preauricular, and nasolabial full-thickness skin grafts may produce noticeable color or contour differences. The type of local skin flap used depends on defect size: Local rotation-transposition flaps or the nasalis myocutaneous sliding flap described by Rybka are used for defects 2 cm or less in diameter. Rieger and de Marchac frontonasal flaps are used for defects 2-3.5 cm in diameter. Forehead flaps are used for defects of 3.5 cm or more. We prefer Rybka's flap for nasal tip defects less of 2 cm because it has cosmetic advantages: incisions do not deform natural cutaneous crease lines and chronic edema and "dog ears" secondary to rotation-transposition pedicle flaps are avoided. For more extensive defects, we prefer frontonasal or forehead flaps.

[Prominent ears. Correction using a modified Chongchet technique]. / Orejas prominentes. Correccion mediante la tecnica de Chongchet modificada.

The authors describe their experience with the correction of prominent ears using a modified Chongchet technique. This method is based on the investigations of GIBSON and DAVIS (1958), who showed the tendency of cartilage to warp when one surface is cut. The prominent ear is folded back to produce the desired antihelix fold, which is outlined with methylene blue. An elliptical piece of retroauricular skin is excised. An incision is made through the whole thickness of the cartilage, following the posterior marked linea of the new antihelical fold, from the superior crus to the tail of antihelix. The anterior surface of the cartilage is dissected from the skin. A series of parallel incisions are made through the taut outer layer of the future fold. The tension on that side is released, and therefore it will bend towards the opposite side. The antihelical fold is corrected. This method was used in 192 patients with prominent ears. The results were satisfactory, with a normal-looking fold of antihelix. No recurrence of the deformity was seen.

[Endoscopic injection of autologous adipose tissue in the treatment of female incontinence]. / Inyección endoscópica de tejido graso autólogo en el tratamiento de la incontinencia femenina.

We describe a new procedure utilizing autologous fat instead of teflon injection in the treatment of female urinary incontinence that is equally useful in correcting postadenomectomy incontinence in the male and vesicoureteral reflux. We have used this new procedure over the past 4 months in 10 patients with urinary stress incontinence and no concomitant cystocele. The procedure is performed under spinal anesthesia. Small cylinders of subcutaneous abdominal fatty tissue are obtained by microliposuction. The fat graft in the form of four 10 ml. wheals is then injected in the vesical neck. We emphasize that this technique is simple and there are no complications. The low cost of this technique requiring a 24 h stay at the hospital affords additional advantages. Likewise, the procedure can be repeated or subsequent surgical procedures can be performed without difficulty in the event correction is unachieved.