The phosphaturic mesenchymal tumor as a cause of oncogenic osteomalacia. Three cases and review of the literature. / El tumor mesenquimal fosfatúrico como causa de osteomalacia oncogénica. A propósito de 3 casos y revisión de la literatura.

INTRODUCTION: The phosphaturic mesenchymal tumour (PMT) is a very uncommon cause of oncogenic osteomalacia (OO), which is a paraneoplastic syndrome with severe clinical osteomalacia. The PMT is a neoplasia that produces the fibroblast growth factor FGF23, resulting in reduced proximal tubular phosphate reabsorption leading to hyperphosphaturia and hypophosphatemia. Our aim is to present our experience and complications in diagnosis and treatment of PMT in three patients. MATERIAL AND METHODS: We propose an observational, descriptive and retrospective study of three cases of OO secondary to PMT found in our database of bone and soft tissue tumours. The inclusion criteria were: symptoms related with OO, presence of hyperphosphaturic hypophosphatemia, elevated levels of FGF23 in blood and pathological diagnosis of PMT. RESULTS: In all cases, the disease showed asthenia, non-specific bone pain, progressive functional weakness, and pathological fractures. The average delay time in diagnosis was 7 years. All presented with hyperphosphaturic hypophosphatemia, elevated levels of alkaline phosphatase as well as FGF23. The use of Octreoscan and PET-CT were essential to find the producing tumour and its subsequent biopsy. Treatment was surgery in two cases and one case was treated by CT-guided cryotherapy with neurophysiological control. Once the surgery was performed, the blood parameters normalized. There is no recurrence. CONCLUSIONS: Phosphaturic mesenchymal tumor is a very rare entity as part of bone and soft tissue tumors, it may occur in both tissues. The phosphate-calcium homeostasis is altered due to high serum levels of FGF23 because of PMT. Delay in diagnosis is usual, leading to renal and skeletal comorbidities. To avoid this, knowledge of this entity together with high diagnostic suspicion are critical. Surgical treatment leads to normalization of serum levels and systemic symptoms.

Molecular epidemiology and spatiotemporal analysis of hospital-acquired Acinetobacter baumannii infection in a tertiary care hospital in southern Thailand.

BACKGROUND: Acinetobacter baumannii is a major hospital-acquired pathogen in Thailand that has a negative effect on patient survival. The nature of its transmission is poorly understood. AIM: To investigate the genotypic and spatiotemporal pattern of A. baumannii infection at a hospital in Thailand. METHODS: The medical records of patients infected with A. baumannii at an 800-bed tertiary care hospital in southern Thailand between January 2010 and December 2011 were reviewed retrospectively. A. baumannii was identified at the genomospecies level. Carbapenemase genes were identified among carbapenem-resistant isolates associated with A. baumannii infection. A spatiotemporal analysis was performed by admission ward, time of infection and pulsed-field gel electrophoresis (PFGE) groups of A. baumannii. RESULTS: Nine PFGE groups were identified among the 197 A. baumannii infections. All A. baumannii isolates were assigned to International Clonal Lineage II. blaOXA-23 was the most prevalent carbapenemase gene. Outbreaks were observed mainly in respiratory and intensive care units. The association between PFGE group and hospital unit was significant. Spatiotemporal analysis identified 20 clusters of single PFGE group infections. Approximately half of the clusters involved multiple hospital units simultaneously. CONCLUSIONS: A. baumannii transmitted both within and between hospital wards. Better understanding and control of the transmission of A. baumannii are needed.

[Late presentation of traumatic diaphragmatic hernia]. / Presentación tardía de hernia diafragmática traumática.

Four years old male, who was operated four months ago to present chest injuries caused by a firearm projectile, where injuries in the diaphragm were not observed. Now is admitted because of an intestinal obstruction. By medial laparotomy, a defect of 3 cm in diameter was exposed in the left diaphragm, containing a transverse colonic segment of 5 cm and omentum. The treatment performed is described.

Varón de cuatro años de edad que hace cuatro meses fue intervenido por presentar lesiones en el tórax producidas por un proyectil de arma de fuego, sin que se observaran lesiones en el diafragma. Ahora ingresa por un cuadro de obstrucción intestinal. Por laparotomía media, se expuso un defecto de 3 cm de diámetro, en el diafragma izquierdo, que contenía un segmento de 5 cm de colon transverso y omento. Se describe el tratamiento efectuado.

[Aphallia associated to urethrorectal fistula: a case report]. / Afalia asociada a fístula recto-uretral: reporte de un caso.

Aphallia had an incidence of 1/30.000.000 newborn. This is a rare genitourinary anomaly derived from a faulty development of the genital tubercles. It usually coexists with series of other anomalies which are incompatible with normal life. This article presents a description of a 2 years old patient.

Otoplastia en orejas prominentes: alternativa quirúrgica / Otoplasty in prominent ears: surgical alternative

Las orejas prominentes o en asa son la deformidad congénita más frecuente del pabellón auricular. En estapatología es notoria la falta del antihélix y el aumento del ángulo mastoideoconchal, teniendo en cuenta que las dimensiones del área del pabellón auricular estén dentro de unos límites normales. Han sido descritas numerosas y diversas técnicas quirúrgicas para su corrección, buscando todas ellas cómo acortar el ángulo mastoideo conchal y crear un nuevo antihélix. Cada oreja tiene sus propias características en el contexto anatómico normal del paciente, por lo que es importante realizar una evaluación correcta para aplicarla técnica quirúrgica más adecuada a cada caso. En el presente trabajo describimos sistemáticamente los pasos quirúrgicos a seguir buscando la simplificación del procedimiento y sobre todo, demostrando que con una incisión mínima producida por una aguja calibre21G con punta angulada, mediante la que se realizan cortes de relajación en la superficie anterior del cartílago paralelos al eje vertical del pabellón auricular en el área que corresponde a la proyección del antihélix, se puede obtener una curvatura natural del neoantihélix (AU)

Prominent ear, is the most frequent congenital malformation of the auricular pavillion. In this pathology, the absence of the antihelix is notorious as well as the increase of the mastoid-conchal angle, considering that the dimensions of the area of the auricular pavillion are within the normal limits. Many techniques have been described, all of them trying to reduce the mastoid-conchal angle and to create a new antihelix. Each ear has its own characteristics within the normal anatomic context; so it is important to make a correct evaluation in order to apply the adequate surgical technique. The surgical steps to be followed are systematically described to simplify the procedure, and most of all, showing that with aminimum incision done with a 21G size angulated needle, over the anterior side of the auricular cartilage, we can perform relaxation cuts parallel to the vertical axe of the auricular pavillion, and obtain a natural curve of the neoantihelix (AU)