BISHOP FLAP AND SIGMA FLAP TO REPAIR SURGICAL DEFECTS IN HIGH-TENSION ANATOMICAL REGIONS. / COLGAJO OBISPO Y COLGAJO SIGMA PARA DEFECTOS QUIRÚRGICOS EN ZONAS ANATÓMICAS DE ELEVADA TENSIÓN.

BACKGROUND: The reconstruction of surgical defects in high-tension anatomical regions is challenging due to the ischemia and subsequent necrosis associated with tension closure. Research on new flaps capable of closing these defects exerting less tension would be a tremendous advancement in dermatological surgery. PATIENTS AND METHODS: We conducted a multicenter, retrospective study that used 2 new flaps-the bishop and the sigma ones-to repair surgical defects in high-tension regions such as the scalp, lower extremities, and the nasal pyramid. The bishop flap was used in 9 patients, 5 of whom exhibited their lesion in the nasal pyramid, 2 in the legs and another 2 in the scalp. The sigma flap was used in 6 patients, 5 of whom exhibited scalp lesions and 1 leg lesion. RESULTS: Uneventful and excellent results were obtained in all 15 patients due to infection, dehiscence, or necrosis. CONCLUSIONS: Both the bishop and the sigma flaps are a good alternative to repair surgical defects in high-tension regions such as the scalp, lower extremities, or the nasal pyramid.

Cutaneous reactions after SARS-CoV-2 vaccination: a cross-sectional Spanish nationwide study of 405 cases.

BACKGROUND: Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are poorly characterized. OBJECTIVE: To describe and classify cutaneous reactions after SARS-CoV-2 vaccination. METHODS: A nationwide Spanish cross-sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face-to-face visit with a dermatologist, information on cutaneous reactions was collected via an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification. RESULTS: From 16 February to 15 May 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer-BioNTech; 40·2%), mRNA-1273 (Moderna; 36·3%) and AZD1222 (AstraZeneca; 23·5%) vaccines. Mean patient age was 50·7 years and 80·2% were female. Cutaneous reactions were classified as injection site ('COVID arm', 32·1%), urticaria (14·6%), morbilliform (8·9%), papulovesicular (6·4%), pityriasis rosea-like (4·9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13·8% of reactions. The COVID arm was almost exclusive to women (95·4%). The most reported reactions in each vaccine group were COVID arm (mRNA-1273, Moderna, 61·9%), varicella zoster virus reactivation (BNT162b2, Pfizer-BioNTech, 17·2%) and urticaria (AZD1222, AstraZeneca, 21·1%). Most reactions to the mRNA-1273 (Moderna) vaccine were described in women (90·5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment. CONCLUSIONS: Cutaneous reactions after SARS-CoV-2 vaccination are heterogeneous. Most are mild-to-moderate and self-limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.

Seguridad en los procedimientos dermatológicos: oclusión vascular por materiales de relleno / Safety in Dermatologic Procedures: Vascular Occlusion by Filling Materials

Las complicaciones más graves del tratamiento con los rellenos dérmicos para el rejuvenecimiento facial son las isquémicas, que pueden provocar un síndrome de Nicolau, una ceguera o, incluso, un ictus. Se describen las medidas preventivas que es conveniente aplicar cuando se realizan estos procedimientos y, en caso de que aparezcan, se proponen los pasos a seguir ante esta urgencia dermatológica. Es importante tener un amplio conocimiento de la anatomía facial. Son preferibles el uso de cánulas y las técnicas de infiltración retrógradas. Cuando aparece un evento isquémico cutáneo, usaremos hialuronidasa infiltrada preferiblemente con cánula. Si el evento isquémico ocurre a nivel ocular se trasladará al paciente a un medio hospitalario con código ictus (AU)

Ischemic events are the most serious complications of facial antiaging treatment with dermal fillers. Ischemia can cause Nicolau syndrome, blindness, or even stroke. This article discusses how to prevent ischemic complications and what steps to take should a dermatologic emergency develop. A thorough understanding of facial anatomy is important. Preferred procedural techniques involve the use of cannulas and retrograde injection. When ischemia is detected in the skin, hyaluronidase should be injected, preferably through a cannula. If ocular ischemia occurs, the patient should be transferred to a hospital with stroke code activation (AU)

Safety in Dermatologic Procedures: Vascular Occlusion by Filling Materials. / Seguridad en los procedimientos dermatológicos: oclusión vascular por materiales de relleno.

Ischemic events are the most serious complications of facial antiaging treatment with dermal fillers. Ischemia can cause Nicolau syndrome, blindness, or even stroke. This article discusses how to prevent ischemic complications and what steps to take should a dermatologic emergency develop. A thorough understanding of facial anatomy is important. Preferred procedural techniques involve the use of cannulas and retrograde injection. When ischemia is detected in the skin, hyaluronidase should be injected, preferably through a cannula. If ocular ischemia occurs, the patient should be transferred to a hospital with stroke code activation.

Método sensible para monitorizar la migración de las células madre mesenquimales de la médula ósea en modelos murinos / A sensitive method for monitoring the migration of mesenchymal stem cells from bone marrow in murine models

OBJETIVO: Las células madre mesenquimales (MSCs) son atractivas en la terapia regenerativa de patologías humanas. En los modelos murinos, en los que se trasplantan MSCs humanas, es muy importante poder distinguir el origen de las MSCs identificadas en los órganos de ratones. El objetivo de este estudio fue determinar el rendimiento del análisis basado en PCR de secuencias Alu humanas para detectar ADN humano después de la infusión de células madre de médula ósea humana (hBMSCs) en ratones inmunodeficientes. MATERIAL Y MÉTODO: Las hBMSCs se obtuvieron de la cabeza femoral de pacientes sometidos a cirugía de reemplazo de cadera. Se infundieron 106 hBMSCs por vía intravenosa mediante inyección en el seno retro-orbitario de ratones NOD/SCID. Después se evaluó la presencia de ADN humano en pulmón, hígado y hueso. RESULTADOS: En mezclas de ADN in vitro, el ADN humano se detectó fácilmente con una buena relación logarítmica-lineal. De manera similar, cuando se mezclaron osteoblastos humanos y de ratón, se detectaron fácilmente 1-10 células humanas entre 105 células de ratón. Asimismo, se detectó el ADN humano en los pulmones 1 y 7 días después de las infusiones celulares en ratones NOD/SCID. Sin embargo, el ADN humano se detectó de manera inconsistente en el hígado y los huesos. CONCLUSIÓN: La detección de secuencias Alu es un procedimiento eficaz para detectar ADN humano. Los resultados confirman que la mayoría de las hBMSCs inyectadas por vía intravenosa quedan atrapadas en los pulmones. Por lo tanto, de cara al tratamiento de trastornos esqueléticos, se necesitan procedimientos para aumentar la migración de dichas células al hueso

OBJETIVE: Mesenchymal stem cells (MSCs) are commonly used in regenerative therapy of human diseases. In murine models, in which human MSCs are transplanted, distinguishing the origin of the identified MSCs in the organs of mice is important. The objective of this study was to determine the performance of PCR-based analysis of human Alu sequences to detect human DNA after infusion of human bone marrow stem cells (hBMSCs) in immunodeficient mice. MATERIAL AND METHOD: HBMSCs were obtained from the femoral head of patients undergoing hip replacement surgery. 106 hBMSCs were infused intravenously by injection into the retro-orbital sinus of NOD/SCID mice. The presence of human DNA in lung, liver and bone was then assessed. RESULTS: In in vitro DNA mixtures, human DNA was easily detected with a good logarithmic-linear relationship. Similarly, when human and mouse osteoblasts were mixed, 1-10 cells were easily detected among 105 mouse cells. Likewise, human DNA was detected in the lungs 1 and 7 days after cell infusions in NOD/SCID mice. However, human DNA was inconsistently detected in the liver and bones. CONCLUSION: Detecting Alu sequences is an effective procedure to observe human DNA. The results confirm that most intravenously injected hBMSCs are trapped in the lungs. Thus, for the treatment of skeletal disorders, procedures are needed to increase the migration of these cells to the bone

Impacto funcional de polimorfismos del gen de la esclerostina sobre la metilación de ADN y la expresión génica / Functional impact of sclerostin gene polymorphisms on DNA methylation and gene expresión

INTRODUCCIÓN: Varios estudios de barrido genómico (GWAS) y otros focalizados en el gen de la esclerostina (SOST) han encontrado que algunos polimorfismos de SOST se asocian con la masa ósea y el riesgo de fracturas. El objetivo de este estudio fue analizar la relevancia funcional de ciertos polimorfismos de la región promotora de SOST, en relación con la expresión y la metilación de dicho gen. MATERIAL Y MÉTODO: Para ello, se determinaron los alelos de los polimorfismos rs851054, rs851056, rs10534024, rs1234612 y se analizó la metilación de ADN de 33 muestras de suero y de hueso, procedentes de pacientes intervenidos para colocar una prótesis de cadera, mediante pirosecuenciación tras conversión con bisulfito. Además, en el hueso se estudió la expresión de SOST. Por último, se clonaron diferentes alelos del promotor de SOST en vectores reporteros dobles con el gen de la luciferasa bajo dicho promotor y el gen de la fosfatasa alcalina bajo un promotor constitutivo. RESULTADOS: El análisis de metilación de la región promotora de SOST en ADN libre en suero y en ADN de hueso no reveló diferencias estadísticamente significativas en relación con los alelos de los polimorfismos analizados (p > 0,05). Sin embargo, las transfecciones con los vectores reporteros mostraron una elevada actividad transcripcional, independientemente del vector utilizado. CONCLUSIÓN: No hemos encontrado una asociación clara entre los distintos alelos y la metilación de ADN de la región promotora del gen SOST. Son necesarios más estudios para determinar los efectos funcionales de los polimorfismos sobre la metilación y expresión del gen de SOST y los efectos sobre la masa ósea

INTRODUCTION: Several genome‐wide association studies (GWAS) and others which focused on the sclerostin gene (SOST)have found that some SOST polymorphisms are associated with bone mass and risk of fractures. This study analyzes thefunctional relevance of certain polymorphisms of the SOST promoter region, and their relationship with the expressionand methylation of this gene. MATERIAL AND METHODS: Alleles of the rs851054, rs851056, rs10534024, rs1234612 polymorphisms and DNA methylationwere analyzed by pyrosequencing in serum and bone samples of 33 patients undergoing hip replacement. In addition,SOST expression was studied in bone samples. Also, different alleles of the SOST promoter were cloned into double reportervectors with the luciferase gene under this promoter and the alkaline phosphatase gene under a constitutive promoter. RESULTS: Methylation analysis of the SOST promoter region in serum free DNA and bone DNA revealed no statisticallysignificant differences across the alleles of the analyzed polymorphisms (p > 0.05). However, transfections with reportervectors showed high transcriptional activity, regardless of the vector used. CONCLUSION: We have not found a clear association between the different alleles and the DNA methylation of the SOSTpromoter region. Further studies are needed to determine the polymorphisms' functional effects on the methylationand expression of the SOST gene and the consequences on bone mass

Queratodermia palmoplantar lineal / Linear Palmoplantar Keratoderma

No disponible

Reconstrucción de lóbulo rasgado incompleto mediante media z plastia o colgajo en hamaca / Incomplete cleft earlobe reconstruction using a z-plasty or hammock flap

No disponible

Molecular identification of black-pigmented bacteria from subgingival samples of cats suffering from periodontal disease.

OBJECTIVES: To characterise the black-pigmented bacterial species found in the subgingival samples of cats with periodontal disease using molecular-based microbiological techniques. METHODS: Sixty-five subgingival samples obtained from 50 cats with periodontal disease were analysed by polymerase chain reaction amplified ribosomal DNA restriction analysis and cloning and sequencing of the 16S rRNA genes. RESULTS: Among the 65 subgingival samples, eight phylogenetic profiles were obtained, of which the most prevalent species were: Porphyromonas gulae (40%), P. gingivalis/P. gulae (36 · 9%), P. gulae/Porphyromonas sp. UQD 406 (9 · 2%), Odoribacter denticanis (6 · 2%), P. gulae/Porphyromonas sp. UQD 348 (1 · 5%) and P. circumdentaria (1 · 5%). When compared with the species resulting from biochemical diagnosis, the identification of P. gulae was congruent in 70% of the cases, while colonies identified as P. intermedia-like corresponded in 80% of cases to P. gulae. CLINICAL SIGNIFICANCE: The use of molecular-based microbiological diagnostic techniques resulted in a predominance of Porphyromonas spp. in the subgingival plaque of cats suffering from periodontal disease. Further characterisation of these bacteria identified P. gulae, O. denticanis and P. circumdentaria. The more frequently detected phylogenetic profiles corresponded to P. gingivalis and P. gulae.

[Choice of therapeutic approach in acute cholecystitis in the elderly]. / Elección de la conducta terapéutica en la colecistitis aguda del anciano.

BACKGROUND: Acute cholecystitis in elderly patients is a common disease characterized by a high mortality rate and serious complications. AIM: To compare conservative vs. surgical therapy for acute cholecystitis in the elderly. METHODS: This is a retrospective study including patients 70 years-old or older with the diagnosis of acute cholecystitis (AC) treated between 2003 and 2009. Epidemiological and clinical data, diagnostic approach, surgical variables and cost-effectiveness were analyzed. According to the first therapeutic intent, the analysis was performed among final treatment groups and among older than 80 years and younger cases. p < 0.05 was considered significant. Statistical analysis was performed with StatView(©) 5.0. RESULTS: During the six-year period 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with a mean age of 80.6 years (range 70-101). In 103 cases medical treatment was taken, with 82 cases of resolution of the clinical picture, 15 unexpected operations and 6 deceases. Other 70 cases were undergone surgery as first option, 78.5% of them through laparoscopy with a conversion rate of 19.7%. CONCLUSIONS: In our study, surgery and medical treatment get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy. We recommend performing emergency surgery in high-risk elderly patients rather than conservative therapy due to a tendency to increase morbidity with later approach.

[New diagnostic and surgical approach to Mirizzi syndrome]. / Nuevas posibilidades diagnósticas y terapéuticas en el síndrome de Mirizzi.

Mirizzi's syndrome is an unusual complication of gallstone disease, in which a stone impacting in the neck of the gallbladder (Hartmann s pouch) compresses the common bile duct. This mechanical obstruction leads to obstructive jaundice frequently followed by inflammatory changes and several complications. We present two patients affected by Mirizzi's syndrome whose diagnosis was correct in the preoperative period and approached by laparoscopy. A case was converted to open procedure due to adhesions in the Calot's triangle, and therefore, treated with subtotal cholecystectomy and choledochorrhaphy over a T tube. In the other case the laparoscopy access became successful. Both postoperative courses were uneventful. In this article, suitable diagnostic techniques are analyzed. On the other hand, we discuss what is the best therapeutic option, with a special attention to the relevance of endoscopic retrograde cholangiopancreatography and laparoscopic approach in the management of those patients.

Nuevas posibilidades diagnósticas y terapéuticas en el síndrome de Mirizzi / New diagnostic and surgical approach to Mirizzi syndrome

El síndrome de Mirizzi es una variante poco frecuente de colelitiasis en la que un cálculo impactado en la bolsa de Hartmann comprime la vía biliar desencadenando una ictericia obstructiva, frecuentemente seguida de fenómenos inflamatorios y de diversas complicaciones (colecistitis, colangitis, fístulas etc). Presentamos dos pacientes con síndrome de Mirizzi, correctamente diagnosticados en el preoperatorio e intervenidos por vía laparoscópica. Un caso fue convertido por adherencias en el triángulo de Calot y tratado con colecistectomía subtotal y coledocorrafia sobre tubo en T de Kher. En el otro enfermo se pudo completar con éxito el procedimiento. Ambos postoperatorios cursaron con normalidad. En el presente artículo, se analizan las técnicas diagnósticas que ayudan a una identificación precoz del síndrome y se discuten las opciones terapéuticas más adecuadas en el momento actual, prestando una especial atención al papel de la colangiopancreatografía endoscópica y del abordaje laparoscópico en el manejo de estos pacientes

Mirizzi’s syndrome is an unusual complication of gallstone disease, in which a stone impacting in the neck of the gallbladder (Hartmann’s pouch) compresses the common bile duct. This mechanical obstruction leads to obstructive jaundice frequently followed by inflammatory changes and several complications. We present two patients affected by Mirizzi’s syndrome whose diagnosis was correct in the preoperative period and approached by laparoscopy. A case was converted to open procedure due to adhesions in the Calot’s triangle, and therefore, treated with subtotal cholecystectomy and choledochorrhaphy over a T tube. In the other case the laparoscopy access became successful. Both postoperative courses were uneventful. In this article, suitable diagnostic techniques are analyzed. On the other hand, we discuss what is the best therapeutic option, with especial attention to the relevance of endoscopic retrograde cholangiopancreatography and laparoscopic approach in the management of those patients

[Influence of anxiety in diverse cutaneous diseases]. / Influencia de la ansiedad en diversas patologías dermatológicas.

INTRODUCTION: The objective of the current study is to determine the levels of anxiety in patients with dermatological diseases compared to healthy subjects and the degree of anxiety in the different cutaneous diseases. MATERIAL AND METHODS: It is a descriptive study of a case series where 152 patients are selected, 20 of whom are healthy controls and the other 132 are patients that attend a Dermatology clinic. The patients are divided into 5 groups based on the cutaneous disorder for which they attend the clinic: chronic urticaria, acute urticaria, plaque psoriasis, atopic dermatitis, and a miscellaneous group (includes several diagnoses such as seborrheic keratosis, follow-up of multiple nevi, carcinomas...) where, a priori, anxiety does not influence these disorders. Spielberger State-Trait Anxiety Inventory (STAI) is administered to the participating subjects and the differences in State Anxiety Inventory (SAI) and Trait Anxiety Inventory (TAI) for the different groups are analyzed. Patients were asked to report any stressful event in the six months prior to the appearance of the disease that might have been a trigger, and they were also asked about history of psychiatric disorders or atopy. RESULTS: We observed significant differences in the means obtained in SAI and TAI in healthy subjects compared to patients. We obtained higher mean scores in SAI in patients diagnosed of atopic dermatitis, that were significant when compared with patients with chronic urticaria or other diseases. Forty-eight percent of patients with psoriasis and 38.89 % of patients with atopic dermatitis report a stressful event in the past six months compared to 11.54% of patients from the group with miscellaneous diseases and, additionally, patients with psoriasis and atopic dermatitis have the highest mean scores in the anxiety tests. Twenty-one percent of the 132 patients with cutaneous diseases report a history of psychiatric disorders, showing statistically significant higher mean scores in STAI. CONCLUSION: The findings show the comorbidity of psychiatric disorders in patients with chronic cutaneous diseases and the high levels of state and trait anxiety, mainly in patients with psoriasis and atopic dermatitis.