Prevalencia de lesiones premalignas y carcinoma oculto en piezas de resección mamaria, estudio retrospectivo a 5 años / Prevalence of premalignant lesions and occult carcinoma in breast resection specimens, a 5-year retrospective study

Introducción y objetivo: El cáncer de mama es la neoplasia maligna con mayor incidencia y prevalencia mundial (excluyendo tumores cutáneos no melanoma), con cifras crecientes. Por ello, cualquier tejido extraído de la mama, con independencia del motivo, debe ser enviado a estudio anatomopatológico. El objetivo de este estudio es determinar la prevalencia de lesiones premalignas y carcinoma oculto en las piezas de resección de mamas intervenidas por motivos no oncológicos durante 5 años en el Servicio de Cirugía Plástica, Estética y Reparadora del Hospital Universitario Río Hortega de Valladolid, España. Material y método: Analizamos las piezas de resección mamaria de 253 pacientes sin diagnóstico clínico de cáncer de mama clasificadas previamente en grupos de riesgo teórico creciente de neoplasia asociada, con el objetivo de identificar la prevalencia de lesiones premalignas y carcinoma oculto en nuestra población. Resultados: La prevalencia de lesiones malignas mostró un incremento progresivo desde el grupo control (2.25%): pacientes sin antecedente personal de neoplasia mamaria ni factor de riesgo genético, a los grupos A (7.07%): pacientes con antecedente de neoplasia mamaria; B (11.43%): pacientes con factor de riesgo genético; y C (16.67%): pacientes con antecedente de neoplasia mamaria y factor de riesgo genético, con una edad media al diagnóstico de 48.11 años. Conclusiones: Los resultados obtenidos se correlacionan con la literatura existente y ponen de manifiesto que el hallazgo casual de lesiones premalignas y malignas en pacientes sin diagnóstico de cáncer de mama es una realidad relativamente común, especialmente en mujeres con factores de riesgo genético y/o diagnóstico de neoplasia mamaria previa.Nivel de evidencia científica 4b Diagnóstico

Background and objective: Breast cancer is the malignancy with the highest incidence and prevalence worldwide (excluding non-melanoma skin cancer), with growing rates. This is why any tissue removed from a breast (whatever the cause) must be properly analyzed. The aim of this study is to determine the prevalence of premalignant lesions and occult carcinoma in resected breast specimens operated for non-oncological reasons over a period of 5 years in the Plastic, Aesthetic, and Reconstructive Surgery Department at the Río Hortega University Hospital in Valladolid, Spain. Methods: We analyzed the breast resection specimens belonging to 253 patients without a clinical diagnosis of breast cancer, previously classified in groups of increasing theoretical risk of breast cancer, with the aim of identifying the prevalence of premalignant lesions and occult carcinoma in our population. Results: The prevalence of malignant lesions showed a progressive increase from the control group (2.25%): patients without personal history of breast neoplasia or genetic risk factor; to groups A (7,07%): patients with history of breast neoplasia; B (11.43%): patients with genetic risk factor; and C (16.67%): patients with history of breast neoplasia and genetic risk factor, with an average age at diagnosis of 48.11 years. Conclusions: The results correlate with the existing literature show that the casual finding of premalignant and malignant lesions in patients without a diagnosis of breast cancer is relatively common, especially in women with genetic risk factors and/or a prior diagnosis of breast cancer.(AU)

Bromelain-based enzymatic burn debridement: Spanish multidisciplinary consensus.

Background: Bromelain-based enzymatic debridement is gaining increased interest from burn specialists in the last few years. The objective of this manuscript is to update the previous, first Spanish consensus document from 2017 (Martínez-Méndez et al. 43:193-202, 2017), on the use of enzymatic debridement with NexoBrid® in burn injuries, adding the clinical experience of a larger panel of experts, integrating plastic surgeons, intensivists, and anesthesiologists. Methods: A consensus guideline was established by following a modified Delphi methodology of a 38-topic survey in two rounds of participation. Items were grouped in six domains: general indication, indication in critical patients, pain management, conditions for NexoBrid® application, NexoBrid® application technique, and post-debridement wound care. Results: In the first round, experts established consensus (strongly agree or agree) on 13 of the 38 statements. After the second round, a consensus was reached on 24 of the 25 remaining statements (97.2%). Conclusions: The present updated consensus document provides recommendations on the use of bromelain-based enzymatic debridement NexoBrid®, integrating the extensive clinical experience of plastic surgeons, intensivists, and anesthesiologists in Spain. Further clinical trials and studies are required to corroborate, modify, or fine tune the current statements.

Cold-Induced Injury Affecting 27% of TBSA: A Case Report.

Frostbite is a particularly severe form of cold-induced injury that most frequently causes tissular damage in acral parts (hands and feet) and usually involves a small extension of the TBSA. Here, we present a rare case of frostbite affecting a large area (27%), which was successfully treated in a similar way to a thermal burn injury.

Mano eléctrica quemada: casuística de 5 años en el Hospital Universitario Rio Hortega de Valladolid, España / Electrical burned hand: 5-year casuistry in Rio Hortega University Hospital, Valladolid, Spain

Introducción y Objetivos. Los pacientes con quemaduras eléctricos por alto voltaje suelen presentar importantes lesiones en extremidades distales. Entre las dificultades que presentan están la importante destrucción de tejidos en profundidad, la progresión o identificación tardía del daño tisular, las lesiones vasculares que dificultan la reconstrucción y las complicaciones infecciosas. El objetivo del presente trabajo es exponer los casos atendidos y la experiencia recogida durante los 5 primeros años del funcionamiento de la Unidad de Quemados del Hospital Universitario Rio Hortega de Valladolid, España. Material y Método. Presentamos una serie de 6 pacientes con 8 extremidades superiores afectas por alto voltaje, atendidos en nuestra Unidad de Grandes Quemados. Detallamos datos epidemiológicos así como el método reconstructivo empleado en cada caso y el momento en el que se llevó a cabo la cobertura. Citamos las alteraciones fisiológicas sufridas por estos pacientes. Resultados. Fueron necesarios 8 colgajos para reconstruir 6 extremidades y 2 amputaciones mayores a nivel de tercio medio de antebrazo. De los 8 colgajos empleados, 6 fueron colgajos libres, 1 colgajo local y 1 colgajo a distancia. Empleamos colgajos cutáneo/fasciocutáneos en 6 ocasiones y colgajos musculares en 2. El 100% de los pacientes tuvo un aumento de creatinfosfokinasa (CPK) debido a la destrucción muscular, necesitando 2 de ellos terapias de reemplazo renal. Conclusiones. Para conseguir la reconstrucción de extremidades con lesiones por alto voltaje el cirujano plástico debe emplear todas las técnicas reconstructivas a su alcance, desde injertos a colgajos libres, pasando por los cada vez más usados sustitutos cutáneos. Pese a todo, las amputaciones son frecuentes así como las secuelas neurológicas (AU)

Background and Objective: High voltage burn patients usually produce important distal limb injuries. Among challenges o to be faced there are the important destruction of deep tissues, the progress or late identification of tissue injuries, the vascular lesions that difficult the reconstruction and infections. Our aim is to expose the cases dealt with and the experience gained for the first 5 years of our Burn Unit in Universitary Hospital Rio Hortega in Valladolid, Spain. Methods. We present a 6 patients series with 8 upper limb injuries because of high voltage burns who were treated in our Burn Unit. We detail the epidemiological and reconstructive technique data and the timing in each case. We also detail the physiological disturbances of these patients. Results. Eight flaps to reconstruct the 6 upper limbs and 2 amputations in the middle of forearm were needed. We used 6 free flaps, 1 local flap and 1 distant flap. Cutaneous/fasciocutaneous flaps and muscular flaps were used 6 and 2 times respectively and 100% of the patients presented high levels of creatine phosphokinase (CPK) because of muscular damage, 2 of them needed renal replacement therapy. Conclusions. In order to achieve limb reconstruction after high voltage injuries, plastic surgeons have to use all the techniques, from skin grafts to free flaps, going through skin substitutes. However amputations and neurological alterations are frequent in these patients (AU)

Guía clínica de consenso en el uso de desbridamiento enzimático en quemaduras con NexoBrid(R) / Consensus guideline about the use of the enzymatic debridement in burn injuries with NexoBrid(R)

Introducción y Objetivo. El desbridamiento precoz es la base del tratamiento de las quemaduras. La retirada de la escara durante las primeras 72 horas es la mejor opción para reducir la estancia hospitalaria y los eventos infecciosos. Sin embargo, en muchas ocasiones se compromete la dermis viable necesaria para obtener los mejores resultados estéticos y funcionales, obligando a injertar el lecho. Hay numerosa evidencia acerca de la reducción de las tasas de injerto, la pérdida hemática y el número de intervenciones cuando se utiliza un desbridante enzimático, NexoBrid(R). El objetivo de esta publicación es establecer una guía clínica basada en la opinión de los expertos españoles. Material y Método. Se diseñó un panel de 7 expertos de las principales Unidades de Quemados españolas, con más de 350 pacientes tratados, que discutió las diferentes fases del tratamiento con NexoBrid(R) para obtener una guía clínica de consenso acerca de la indicación, uso y manejo del desbridamiento enzimático. Resultados. Se alcanzó un alto nivel de consenso, con más del 70% de acuerdo en cada una de las fases de tratamiento. Todos los aspectos del tratamiento con NexoBrid(R) fueron discutidos durante la reunión, así como las indicaciones y limitaciones de su uso, incluyendo todas las nuevas evidencias publicadas hasta el momento. También las diversas opciones utilizadas por los diferentes centros de quemados españoles, alcanzando una recomendación global sobre su uso. Conclusiones. Se redactó un documento como guía clínica preliminar sobre el uso de NexoBrid(R) hasta que se creen nuevas guías basadas en evidencia. No existe ningún otro consenso similar publicado hasta el momento (AU)

Background and Objective: Early debridement is considered the keystone of the burn injuries treatment. It is well known that the eschar removal during the first 72 hours is the best option to reduce the hospital stay and the infectious events. However this treatment compromise the preservation of viable dermis, needed to reach the best functional and aesthetic outcome, therefore grafting the wound bed is mandatory. There is increasing evidence that enzymatic debridement with NexoBrid(R) is showing a reduction in the grafting rate, the blood loss and the number of surgical excisions. The objective of this consensus meeting is providing guidelines based in Spanish experts experiences. Methods. A panel of 7 experts from the main Spanish Burn Units were design, with more than 350 patients treated by them, where the different statements were discussed, trying to get a consensus guideline of the indication, use and management of NexoBrid(R). Results. A high level agreement was stated. All the aspects of NexoBrid(R) treatment were discussed showing an agreement of 70%, as well as the indications and limitations of its use. All new evidence published so far this paper was included. Different treatment options used by the Spanish Burn Centers were discussed, showing a global recommendation in their use. Conclusions. A consensus document was created as a preliminary guideline for the NexoBrid(R) use until further guidelines are available. There is no other consensus guideline published so far this document (AU)

Infección nosocomial por Trichosporon asahii en un paciente quemado crítico / Nosocomial infection due to Trichosporon asahii in a critical burned patient

Antecedentes. La infección fúngica invasiva es una causa importante de morbimortalidad en los pacientes con quemaduras graves. Los avances en el tratamiento del paciente quemado crítico han llevado a una supervivencia mayor, pero, a su vez, a un aumento de las complicaciones sépticas, en especial de las infecciones fúngicas, con un incremento de las infecciones por diferentes especies de Candida. Sin embargo, algunos hongos oportunistas, como Trichosporon asahii, están emergiendo como causa importante de infección nosocomial. Caso clínico. Presentamos un caso de infección nosocomial por T. asahii en un paciente quemado crítico tratado de forma exitosa con voriconazol. El tratamiento de las infecciones fúngicas invasivas en el paciente quemado, desde su diagnóstico hasta la elección de la mejor opción terapéutica, continúa siendo un desafío. El diagnóstico y el tratamiento tempranos de estas se asocia a un mejor pronóstico. En la discusión del caso hacemos referencia a la experiencia publicada y a las pautas de tratamiento actual. Conclusiones. Debido a la dificultad para el diagnóstico de las micosis invasivas y su asociación con una alta mortalidad, en aquellos pacientes susceptibles de padecer una trichosporonosis se debe mantener un alto grado de sospecha y vigilancia clínica para el diagnóstico de esta infección, incluidos los pacientes quemados. Su presencia en las muestras clínicas de este tipo de pacientes debe ser tenida en cuenta porque puede preceder a una infección invasiva (AU)

Background. Invasive fungal infection is an important cause of morbimortality in patients with severe burns. The advances in burn care therapy have considerably extended the survival of seriously burned patients, exposing them to infectious complications, notably fungal infections, with increased recognition of invasive infections caused by Candida species. However, some opportunistic fungi, like Trichosporon asahii, have emerged as important causes of nosocomial infection. Case report. A case of nosocomial infection due to T. asahii in a severely ill burned patient successfully treated with voriconazole is presented. The management of invasive fungal infections in burned patients, from diagnosis to selection of the therapeutic protocol, is often a challenge. Early diagnosis and treatment are associated with a better prognosis. In this case report, current treatment options are discussed, and a review of previously published cases is presented. Conclusions. Due to the difficulty in the diagnosis of invasive mycoses and their high associated mortality rates, it is advisable to keep a high degree of clinical suspicion of trichosporonosis in susceptible patients, including burned patients. The isolation of T. asahii in clinical specimens of this type of host must raise clinical alert, since it may precede an invasive infection (AU)

[Nosocomial infection due to Trichosporon asahii in a critical burned patient]. / Infección nosocomial por Trichosporon asahii en un paciente quemado crítico.

BACKGROUND: Invasive fungal infection is an important cause of morbimortality in patients with severe burns. The advances in burn care therapy have considerably extended the survival of seriously burned patients, exposing them to infectious complications, notably fungal infections, with increased recognition of invasive infections caused by Candida species. However, some opportunistic fungi, like Trichosporon asahii, have emerged as important causes of nosocomial infection. CASE REPORT: A case of nosocomial infection due to T. asahii in a severely ill burned patient successfully treated with voriconazole is presented. The management of invasive fungal infections in burned patients, from diagnosis to selection of the therapeutic protocol, is often a challenge. Early diagnosis and treatment are associated with a better prognosis. In this case report, current treatment options are discussed, and a review of previously published cases is presented. CONCLUSIONS: Due to the difficulty in the diagnosis of invasive mycoses and their high associated mortality rates, it is advisable to keep a high degree of clinical suspicion of trichosporonosis in susceptible patients, including burned patients. The isolation of T. asahii in clinical specimens of this type of host must raise clinical alert, since it may precede an invasive infection.