Colgajo libre osteocutáneo escapular en el tratamiento diferido de herida por arma de fuego / Scapular osteocutaneous free flap in the deferred treatment of firearm wounds

Las heridas por arma de fuego de velocidad alta o intermedia, provocanimportantes pérdidas de tejido óseo y blando. El tratamiento diferido de estoscasos (tratamiento reconstructivo) requiere el aporte de tejido sano de regionesdistantes mediante técnicas microquirúrgicas en la mayoría de las ocasiones. Exponemosla utilidad del colgajo osteocutáneo escapular(COE) para la reconstrucciónde defectos óseos mandibulares laterales con amplio defecto cutáneomucoso. Citamosdetalles técnicos de la realización del colgajo ilustrados con la presentación deun caso clínico de un varón de 19 años con herida por arma de fuego en tercio inferiorde la región lateral izquierda. Pérdida ósea del cuerpo mandibular y cutánea dela mejilla y región yugal ipsilateral.El tratamiento inicial consistió en traqueotomía, desbridamiento de tejidos desvitalizados,ferulización dentaria, bloqueo intermaxilar, colocación de placa de reconstrucciónmandibular y colgajo de avance cervico-facial para cierre del defecto cutáneo.La necrosis del colgajo de avance cervicofacial produjo comunicación orofacial.La retracción cicatricial limitó la apertura oral a 0,8 cm. De forma diferida se procedióa colgajo osteomiocutáneo escapular-paraescapular del brazo izquierdo parareconstrución mandibular y de partes blandas intra y extraorales. Resultados satisfactoriosestética y funcionalmente. Complicaciones producidas: fístula salival, desinsercióndel brazo largo del tríceps, y dehiscencia de herida de zona donante escapularque necesitó intervención para cierre mediante colgajo local(AU)

Firearm wounds caused by high-velocity projectiles causeenormous losses of bone and soft tissue. The deferred treatment ofthese cases (delayed reconstruction) in most cases requires thetransfer of free tissue from other areas of the body. The use ofscapular and parascapular free flaps with scapular bone for thereconstruction of large lateral mandibular defects with extensivesoft-tissue avulsion is reported. The technical details of a free flapare offered with illustrations in the case report of a 19-year-old malewho was shot at close range in the lower third of the left lateralface. Avulsion of the left mandibular body and soft tissue occurredin the region from the cheek to the oral commissure. The initialtreatment was tracheostomy, cleaning of necrotic and devitalizedtissues, wiring of a mandible-to-maxilla arch bar and intermaxillaryfixation, rigid fixation with a reconstructive mandibular plate, anda regional cervical flap to close the skin wound. The cervical flapwas lost and a postoperative oral-cervical fistula appeared. Scarcontraction limited the mouth opening to 0.8 cm. In deferredtreatment, a scapular and parascapular free flap with scapular bonefrom the left shoulder was used to reconstruct the mandibular andintraoral-facial soft-tissue defects. The aesthetic and functionalresults were optimal. Some complications occurred: postoperativesalivary fistula, deinsertion of the long head of the brachial triceps,and scapular wound dehiscence, which will be closed surgically witha local flap(AU)

Administración de hierro intravenoso en niños. Aspectos prácticos / Intravenous iron therapy in childhood: a practical approach

El hierro es un nutriente esencial con un papel fisiológico muy importante para la vida. Su déficit ocasiona la anemia ferropénica, la enfermedad hematológica más frecuente en la infancia, cuyo tratamiento se fundamenta, por un lado, en la corrección de la causa que la origina y, por otro, en la administración de suplementos de hierro. En algunos casos en que el tratamiento con hierro oral no es posible, debe recurrirse a su administración parenteral. Esta vía de administración permite aportar el hierro más rápidamente, lo que supone mayor rapidez en la recuperación de la anemia, con los consiguientes beneficios. La disponibilidad de un preparado como el hierro sacarosa, con muy buen perfil de seguridad y eficacia, justifica su empleo en pacientes pediátricos ferropénicos(AU)

Iron is an essential nutrient that is involved in numerous biological reactions. Iron deficiency causes anemia, and iron-deficiency anemia is the most common type in children worldwide. Reversal of iron deficiency anemia usually cannot be accomplished by dietary means alone. Adequate therapy must not only correct the deficiency, but also treat its cause. In some cases, when oral therapy fails, it is necessary to administer iron parenterally. Intravenous iron therapy provides iron more rapidly and, thus, contributes to an earlier recovery from anemia. Iron sucrose is a safe and valuable parenteral iron preparation that may be used in pediatric patients with no response or intolerance to oral preparations(AU)

Granular cell tumors: Review of the parameters determining possible malignancy.

The granular cell tumor (GCT) is normally benign in behavior, but occasionally surprises us with local aggressiveness, and in 2% of cases with distant dissemination. Diagnosis of proven malignancy can only be confirmed by the presence of metastasis. We revised the parameters which give rise to a GCT being considered to have malignant behavior in the absence of metastasis, basing our account on a clinical case.

Reconstrucción oral mediante colgajos microvascularizados basados en la arteria subescapular / Oral reconstruction by means of microvascular free flaps based on the subescapular artery

La reconstrucción oral se ha beneficiado de la gran variedad de tejidos transferibles mediante técnicas microvasculares. Los coIgajos basados en la arteria subescapular proporcionan una amplia variedad de colgajos libres, incluyendo: el colgajo escapular y paraescapular cutáneos, el colgajo óseo lateral escapular, el colgajo de serrato anterior y el colgajo de músculo dorsal ancho. Podemos reconstruir grandes defectos orales combinando estos colgajos, que tienen pedículos vasculares independientes, lo que los hace fácilmente orientables para adaptarse al defecto tisular. Así, defectos orales complejos que necesitan hueso, tejido epitelial y tejido muscular, encuentran en este colgajo subescapular una indicación insustituible. Revisamos la anatomía de estos colgajos, explicamos nuestra técnica de obtención y presentamos trece pacientes reconstruidos mediante colgajos libres subescapulares: once con defectos orales complejos, uno con defecto cutaneomuscular occipitoparotídeo, y otro con defecto parotídeo preauricular. Hubo dos fallos de colgajo. La supervivencia global de los enfermos afectados por cáncer epidermoide oral se beneficia de la aplicación de estas técnicas, pero los resultados clínicos son mejores, especialmente los fucionales. Los colgajos subescapulares pueden considerarse como segunda opción en defectos de mediano tamaño orales, cuando no se pueden aplicar otros colgajos más habituales (antebraquial, peroné, y recto abdominal), y como primera elección en caso de grandes defectos complejos (AU)

Acyl lipid composition variation related to culture age and nitrogen concentration in continuous culture of the microalga Phaeodactylum tricornutum.

The influence of culture age and nitrogen concentration on the distribution of fatty acids among the different acyl lipid classes has been studied in continuous cultures of the microalga Phaeodactylum tricornutum. The culture age was tested in the range of 1.15-7 days, controlled by adjusting the dilution rate of fresh medium supplied. The effect of nitrogen concentration was tested from saturating conditions to starvation by modifying nitrate concentration in the fresh medium. Culture age had almost no influence on the fatty acid content; 16:0, 16:3 and 20:5 increased moderately wherein the level of 16:1 decreased when the culture age decreased. Culture age had no effect on the total fatty acid content that remained around 11% of dry weight. Conversely, culture age had a greater impact on lipid classes, producing changes in amounts of triacylglycerols (TAG) which ranged between 43% and 69%, and galactolipids (GLs) that oscillated between 20% and 40%. In general, the content of polar lipids of the biomass decreased with culture age. The other factor assayed, nitrogen content, affected the fatty acid profile. Saturated and monounsaturated fatty acids accumulated when the nitrogen concentration was decreased. The experiments regarding the effect of nitrogen concentration on lipid species were carried out with cells of an average age of 3.5 days. A decrease of the nitrogen concentration caused the GL fraction to decrease from 21 to 12%. Conversely, both neutral lipids (NLs) and phospolipids (PLs) increased from about 73 to 79% and from 6 to 8%, respectively. In these experiments, TAG was the lipid class with the highest increase, from 69 to 75%.

Microglia development in the quail cerebellum.

We used the QH1 antibody to study changes in the morphological features and distribution of microglial cells throughout development in the quail cerebellum. Few microglial precursors were present in the cerebellar anlage before the ninth incubation day (E9), whereas many precursors apparently entered the cerebellum from the meninges in the basal region of the cerebellar peduncles between E9 and E16. From this point of entry into the nervous parenchyma, they spread through the cerebellar white matter, forming a 'stream' of labeled cells that could be seen until hatching (E16). The number of microglial cells in the cerebellar cortex increased during the last days of embryonic life and first posthatching week, whereas microglial density within the white matter decreased after hatching. As a consequence, the differences in microglial cell density observed in the cerebellar cortex and the white matter during embryonic life diminished after hatching, and microglia showed a nearly homogeneous pattern of distribution in adult cerebella. Ameboid and poorly ramified microglial cells were found in developing stages, whereas only mature microglia appeared in adult cerebella. Our observations suggest that microglial precursors enter the cerebellar anlage mainly by traversing the pial surface at the basal region of the peduncles, then migrate along the white matter, and finally move radially to the different cortical layers. Differentiation occurs after the microglial cells have reached their final position. In other brain regions the development of microglia follows similar stages, suggesting that these steps are general rules of microglial development in the central nervous system.