Intraorbital lymphatic-venous malformation in an adult patient: is sirolimus the key?

Intraorbital lymphatic-venous malformations are rare lesions that represent a therapeutic challenge given their location and high rate of recurrence, with only a few cases in adult patients having been published in the literature. We present the case of a 30-year-old male with a right intraorbital lymphatic-venous malformation treated with sirolimus at a dose of 4 mg/day with complete clinical and radiologic remission. Mild cold-like symptoms ensued during the first week of treatment and elevation of liver function enzymes and D-dimer occurred in the context of acute SARS-CoV-2 pneumonia. No major adverse effects were documented. After 18 months of treatment, the patient remains asymptomatic and ophthalmologic examinations including optical coherence tomography and visual field test are within normal values.

First Report of Neocucurbitaria unguis-hominis Keratitis.

Coelomycetous fungi are among the emerging causes of infections and have been involved in many kinds of infections, including keratitis and endophtalmitis. Here, we present the first case of keratitis caused by Neocucurbitaria unguis-hominis, a coelomycetous fungus belonging to the family Cucurbitariaceae. In this case report, we describe the clinical presentation of a 56-year-old woman, a regular contact lens wearer, who was treated for pain in her right eye and fixed spot vision after an injury with plant debris. On examination, a corneal ulcer was observed, the foreign body was removed, and topical eye-drop therapy was started. After an initial improvement, the patient returned three weeks later due to a recurrence of discomfort in her right eye, observing the persistence of the corneal ulcer. Corneal scrapings were taken for culture, growing a filamentous fungus after seven days, which was identified by sequencing the fungal internal transcribed spacer region. It should be noted that microbiological identification of the coelomycetes in the clinical laboratory is not easy because of their difficulty in sporulating, making molecular techniques based on the amplification and sequencing of appropriate phylogenetic markers essential. Identification of these fungi is mandatory in order to optimise treatment due to the difficulty in eradicating them with antifungal treatment, requiring surgery in 50% of cases.

Resultado quirúrgico y calidad de vida en reconstrucción auricular autóloga. Hospital General Dr. Manuel Gea González. México / Surgical outcomes and quality in autologous auricle reconstruction. Hospital General Dr. Manuel Gea González. México

INTRODUCCIÓN Y OBJETIVO: La microtia es un problema estético que conlleva una afección psicosocial en el desarrollo del paciente. La reconstrucción auricular mediante injerto costal autólogo es el procedimiento más usado. Determinamos los resultados quirúrgicos en nuestro hospital y el impacto en la calidad de vida de los pacientes con microtia sometidos a reconstrucción auricular con cartílago costal autólogo. MATERIAL Y MÉTODO: Estudio observacional, descriptivo, transversal y prolectivo en pacientes con diagnóstico de microtia uni o bilateral 1 año después de la reconstrucción. Evaluamos el resultado quirúrgico mediante cuestionario desarrollado y publicado por la primera autora, calificando características de apariencia estética de la oreja. Evaluamos la calidad de vida del paciente mediante cuestionario Glasgow Benefit Inventory, versión validada al español, en mayores de 15 años; para pacientes pediátricos utilizamos cuestionario Glasgow's Children's Benefit Inventory, versión traducida y validada por traductor especializado. RESULTADOS: Recogimos 83 pacientes con edad de 8 a 46 años. En la evaluación quirúrgica 13 pacientes (15.6%) tuvieron un resultado excelente, 27 (32.5%) bueno, 29 (34.9%) regular y 14 malo (16.8%). En la evaluación de calidad de vida encontramos en la escala total puntuación positiva en 78 pacientes (93.9%) y negativa en 5 (6%). CONCLUSIONES: El estudio presenta un panorama objetivo de las expectativas del cirujano sobre satisfacción y bienestar del paciente. Si bien solo encontramos resultados buenos y excelentes en el 48%, al revisar la escala de satisfacción encontramos puntaciones positivas, con bienestar en casi el 94%. Es importante que los pacientes conozcan nuestra preocupación por saber el impacto de la intervención y que podamos retroalimentar nuestra práctica quirúrgica. Hasta donde sabemos, este es el primer estudio en México que evalúa ambos aspectos

BACKGROUND AND OBJECTIVE: Microtia is not only an aesthetic problem but involves patient psychosocial development. The gold standard for auricular reconstruction is autologous costal cartilage. Our aim is to evaluate surgical outcomes and impact in quality of life after auricular reconstruction with autologous costal cartilage in microtia patients at our hospital. METHODS: Observational, descriptive, cross an prolective study on patients with uni or bilateral microtia 1 year after auricular reconstruction procedure. Surgical outcome was evaluated with a method previously published by the first author evaluating auricular aesthetic characteristics. Quality of life was evaluated with Glasgow Benefit Inventory, validated in Spanish, for over 15 years old patients; for pediatric patients we used the Glasgow's Children's Benefit Inventory, in a validated translated version. RESULTS: The study group was composed by 83 patients from 8 to 46 years old. Surgical outcome were excellent in 13 cases (15.6%), good in 27 (32.5%), regular in 29 cases (34.9%) and bad in 14 (16.8%). Quality of life had a positive total score in 78 cases (93.9%) and negative in 5 (6%). CONCLUSIONS: The study allows us an objective overview of surgeon's expectations regarding patient satisfaction and well-being. Although we only found good and excellent results in 48% of the patients, when reviewing the satisfaction scale we found positive scores in almost 94%. It`s important that patients know our concern about the impact of our intervention and to provide feedback on our surgical practice. As far as we know, this is the first study in Mexico evaluating both aspects

Surgical Site Infection Rate Drops to 0% Using a Vacuum-Assisted Closure in Contaminated/Dirty Infected Laparotomy Wounds.

Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C., & Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems.