Tunneled Island Flaps for the Reconstruction of Nasal Defects: A 21-Case Series.

(1) Background: The reconstruction of cutaneous defects following surgical procedures in the nasal pyramid presents a challenge due to the limited amount of available tissue. In cases of larger defects, skin from adjacent units is used. Traditionally, two-stage surgical flaps have been employed for reconstructing these defects. Tunnelized island flaps allow for the one-stage surgical reconstruction of nasal pyramid defects, using tissue from the forehead or cheek for the flap. (2) Methods: Descriptive retrospective study of 21 consecutive patients who underwent surgery for defects on the nasal pyramid using tunnelized island flaps. (3) Results: Surgical reconstruction was performed in 21 patients with basal cell carcinomas, 14 of them using the melolabial island flap and 7 using the paramedian forehead island flap. In all cases except one, clear histological margins were obtained. Immediate complications were mild and minor. It is worth noting the trapdoor effect complication, which improved over time in most cases, resulting in a satisfactory cosmetic outcome. No tumor recurrences were observed during an average follow-up period of 17.7 months. (4) Conclusions: Tunnelized island flaps allow for single-stage reconstruction of nasal pyramid defects, yielding excellent cosmetic results by utilizing adjacent skin. This procedure demands a certain level of skill but is associated with minimal complications, making it a valuable alternative in reconstructive dermatological surgery.

Frontal Fibrosing Alopecia: An Observational Single-Center Study of 306 Cases.

(1) Background: Frontal fibrosing alopecia (FFA) is a scarring alopecia that predominantly affects postmenopausal women; (2) Methods: A retrospective, observational, single-center study was conducted in the Hospital General Universitario in Ciudad Real, Spain, including all patients diagnosed with FFA between 2010 and 2021; (3) Results: A total of 306 patients (296 women and 10 men) were included in our study. The mean age of onset was 59.5 years. The severity of this disease was evenly distributed between mild (147 patients) and severe (149 patients) forms. There was a positive, statistically significant, medium correlation between the severity of the disease and its time of progression. Moreover, hypothyroidism was present in 70 patients (22.9%) and classic signs of concomitant lichen planopilaris were observed in just 30 patients (9.8%), while other forms of lichen planus were uncommon. The estimated prevalence in our population is 0.15% and the incidence is 15.47 new cases per 100,000 inhabitants; (4) Conclusions: The time of progression was positively correlated with the severity of FFA. However, the presence of clinical signs, such as inflammatory trichoscopic signs, was not associated with the progression of this condition.

Metastatic Melanoma Negative for 5 Melanocytic Markers, Complete Regressed Primary Cutaneous Melanoma, and Melanoma-Associated Leukoderma in the Same Patient.

Melanomas with complete histological regression have been seen very infrequently. On the other hand, the diagnosis of metastatic melanoma is based on the histopathology and positivity of markers such as S100, Melan-A, and HMB-45 whose sensitivity is 99%, 82%, and 76%, respectively. It is very rare that metastatic melanomas and even more primary melanoma are negative for all of these markers. In these rare cases, there is usually a known primary. We present the case of a 82-year-old woman with a erythematous mass in the left groin and a 1-cm black-bluish irregular nodule on the skin of the ipsilateral foot. This lesion was clinical and dermoscopically compatible with primary melanoma. In the histological evaluation of the skin, a dermis full of melanophages and hemosiderophages were found in a background of fibrosis, scarce lymphocytic infiltrate, and neovascularization. Any cells expressing melanocytic markers were observed. It was diagnosed as tumoral melanosis. Lymph nodes showed a proliferation of atypical epithelioid cells with eosinophilic cytoplasm. Mitosis was conspicuous. Tumoral cells were vimentin and CD99 positive, and S100, CD34, HMB-45, Melan-A, SOX 10, tyrosinase, C-KIT, CD45, and CKAE1/AE3 negative, and BRAF-V600 mutated was detected. During follow-up, atypical vitiligo-like lesions were discovered, suggesting the diagnosis of metastatic melanoma totally regressed in our patient.

¿Qué papel juega la actividad de la enfermedad en el riesgo cardiovascular de la artritis reumatoide? / What role does rheumatoid arthritis disease activity have in cardiovascular risk?

La artritis reumatoide (AR) presenta una mortalidad de 1,3 a 3 veces superior a la población general; la principal causa de muerte son las complicaciones cardiovasculares (40-50%). En el abordaje inicial se debe incluir la valoración del riesgo cardiovascular (RCV) mediante algoritmos adaptados para esta población. Si bien el SCOREm constituye un avance importante, hay datos que indican que podría infradiagnosticar la ateroesclerosis subclínica. Objetivo: Estimar la fuerza de asociación entre la ecografia carotídea y el SCOREm en esta población, así como la implicancia de la actividad de la enfermedad. Metodología: Estudio observacional, transversal y analítico, realizado en el Hospital General de Ciudad Real durante el periodo junio de 2013-mayo de 2014. Se realizó la valoración del RCV y según el SCOREm se dividió a la población en riesgo bajo y alto (medio, alto y muy alto). Se estudió la presencia de ateroesclerosis subclínica en los pacientes de riesgo bajo. Resultados: Del total de 119 pacientes con AR, el 73,1% presentaba factores de riesgo tradicionales. Se excluyeron 38 pacientes por evento cardiovascular previo, diabetes mellitus y nefropatía. Se objetivó placa ateromatosa en el 14,63% de la población de riesgo bajo. El factor con mayor asociación con la presencia de aterosclerosis subclínica fue el grado de actividad moderada/alta de la AR medida mediante el SDAI, con un OR de 4,95 (IC 95%: 1,53-16,01). Conclusiones: Aunque existe una aceptable asociación entre la presencia de aterosclerosis subclínica y el SCOREm, hay una proporción no despreciable de pacientes clasificados de riesgo bajo con placas ateromatosas. La actividad de la enfermedad fue el factor de riesgo más asociado al incremento del RCV

Rheumatoid arthritis (RA) is associated with a 1.3 to 3-fold increase in mortality, being the major cause of death from cardiovascular complications (40%-50%). Therefore, the initial approach should include cardiovascular risk (CVR) assessment using algorithms adapted for this population. Although, SCOREM is an important advance, there are data indicating that subclinical atherosclerosis may be underdiagnosed. Objective: To estimate the strength of association between carotid ultrasound and SCOREM in this population, as well as the implication of disease activity. Methodology: Cross-sectional, observational, analytical study performed at the General Hospital of Ciudad Real, Spain, between June 2013 and May 2014. The evaluation of CVR was performed and, according to SCOREM, the population was divided into low and high (medium, high and very high) risk. We studied the presence of subclinical atherosclerosis in low-risk patients. Results: Of the total of 119 RA patients, 73.1% had traditional risk factors. Thirty-eight patients were excluded because of a previous cardiovascular event, diabetes mellitus and/or nephropathy. Atheromatous plaque was observed in 14.63% of the low-risk population. The factor with the strongest association to the presence of subclinical atherosclerosis was a moderate or high activity of RA measured by the simplified disease activity index with an odds ratio of 4.95 (95% CI: 1.53-16.01). Conclusions: Although there was an acceptable correlation between the presence of subclinical atherosclerosis and SCOREM, there was a considerable proportion of atheromatous plaques in low-risk patients. Disease activity was the risk factor most closely associated with increased CVR

Artritis reumatoide, una enfermedad sistémica con un riesgo cardiovascular subestimado / Rheumatoid arthritis; a systemic disease with an under-estimated cardiovascular risk

RESUMEN Objetivo: Determinar el riesgo cardiovascular y la prevalencia de factores de riesgo cardiovascular (RCV) en los pacientes con artritis reumatoide. Materiales y métodos: Estudio observacional, descriptivo y transversal, realizado en el Hospital General de Ciudad Real, entre junio de 2013 y mayo de 2014. Se realizó una analítica completa, se elaboró un perfil clínico, se calculó el SCOREm y se estratificó el RCV. Finalmente, se determinó la presencia de aterosclerosis subclínica mediante la realización de una ecografía carotídea. Resultados: 119 pacientes aceptaron participar en el estudio. Hubo una prevalencia del 73,1% de los factores de riesgo tradicionales, 6,72% había presentado un evento cardiovascular al momento del estudio, 22,68% poseía un infradiagnóstico de diabetes mellitus o nefropatía. La distribución final del RCV fue: riesgo bajo 46 (38,7%), riesgo intermedio 33 (27,7%), riesgo alto 2 (1,7%), riesgo muy alto 38 (31,9%). Conclusiones: Existe una alta prevalencia de factores de RCV y riesgo elevado infradiagnosticado en esta población. Por lo que si bien la artritis reumatoide se manifiesta de forma más aparente a nivel articular, ha de considerarse una enfermedad sistémica asociada a una mayor incidencia de eventos cardiovasculares.

ABSTRACT Objective: To determine the cardiovascular risk and the prevalence of cardiovascular risk (CVR) factors in patients with rheumatoid arthritis. Material and methods: Observational, descriptive and cross-sectional study performed in the General Hospital of Ciudad Real from June 2013 to May 2014. A complete laboratory analysis was performed, a clinical profile was prepared, the Systematic Coronary Risk Evaluation (SCOREm) was calculated, and the CVR was stratified. Finally, the presence of sub-clinical atherosclerosis was determined by performing a carotid ultrasound. Results: 119 patients accepted to participate in the study. There was a prevalence of 73.1% of traditional risk factors; 6.72% having had a cardiovascular event at the time of the study, and 22.68% had an underdiagnosis of diabetes mellitus and/or nephropathy. The final distribution of the CVR was: Low risk 46 (38.7%), intermediate risk 33 (27.7%), high risk 2 (1.7%), very high risk 38 (31.9%). Conclusions: There is a high prevalence of CVR factors and an elevated risk of underdiagnosis in the rheumatoid arthritis population. Therefore, although rheumatoid arthritis manifests itself more in the joints, it should be considered a systemic disease associated with a higher incidence of cardiovascular events.

What role does rheumatoid arthritis disease activity have in cardiovascular risk? / ¿Qué papel juega la actividad de la enfermedad en el riesgo cardiovascular de la artritis reumatoide?

Rheumatoid arthritis (RA) is associated with a 1.3 to 3-fold increase in mortality, being the major cause of death from cardiovascular complications (40%-50%). Therefore, the initial approach should include cardiovascular risk (CVR) assessment using algorithms adapted for this population. Although, SCOREM is an important advance, there are data indicating that subclinical atherosclerosis may be underdiagnosed. OBJECTIVE: To estimate the strength of association between carotid ultrasound and SCOREM in this population, as well as the implication of disease activity. METHODOLOGY: Cross-sectional, observational, analytical study performed at the General Hospital of Ciudad Real, Spain, between June 2013 and May 2014. The evaluation of CVR was performed and, according to SCOREM, the population was divided into low and high (medium, high and very high) risk. We studied the presence of subclinical atherosclerosis in low-risk patients. RESULTS: Of the total of 119 RA patients, 73.1% had traditional risk factors. Thirty-eight patients were excluded because of a previous cardiovascular event, diabetes mellitus and/or nephropathy. Atheromatous plaque was observed in 14.63% of the low-risk population. The factor with the strongest association to the presence of subclinical atherosclerosis was a moderate or high activity of RA measured by the simplified disease activity index with an odds ratio of 4.95 (95% CI: 1.53-16.01). CONCLUSIONS: Although there was an acceptable correlation between the presence of subclinical atherosclerosis and SCOREM, there was a considerable proportion of atheromatous plaques in low-risk patients. Disease activity was the risk factor most closely associated with increased CVR.

Neoplasia de celulas dendriticasblastica plasmocitoide.

Plasmacytoid blast dendritic cell neoplasia (NCDBP) is an uncommon malignant neoplasm, presenting clinically with cutaneous involvement and subsequent lymph node and bone marrow extension. It characteristically expresses the markers: CD56, CD4, and CD123. There is no optimal treatment, relapses are frequent, and the survival time is short. We present the case of an elderly patient with NCDBP who initially presented with cutaneous lesions, but experienced rapid systemic progression and did not, respond to treatment.

Amiloidosis cutánea primaria del oído externo: una entidad peculiar, inusual y benigna / Primary cutaneous amyloidosis of the external ear: A peculiar, unusual and benign entity

No disponible

Carcinoma basocelular umbilical / Umbilical basal cell carcinoma

No disponible

Paniculitis asociada a dermatomiositis amiopática / Panniculitis associated with amyopathic dermatomyositis

Las manifestaciones cutáneas clásicas de la dermatomiositis son bien conocidas, pero no así las lesiones de paniculitis en el contexto de esta conectivopatía. Desde su primera descripción no hay más de 17 casos de dermatomiositis con lesiones de paniculitis, y ninguno de ellos corresponde a una dermatomiositis amiopática. Se presenta el caso de una paciente mujer de 61 años diagnosticada de dermatomiositis amiopática que desarrolló lesiones de paniculitis a los 3 años del primer diagnóstico. Destacamos la buena evolución clínica de la paciente durante 7 años de seguimiento en los que no se han observado enfermedades subyacentes. Parece que la presencia de paniculitis en el contexto de una dermatomiositis implica mejor pronóstico, tanto en la respuesta al tratamiento como en la menor frecuencia de procesos malignos asociados (AU)

Celulitis atípica asociada a bacteriemia por Campylobacter jejuni en un paciente con hipogammaglobulinemia ligada al cromosoma X / Atypical cellulitis associated with bacteremia from Campylobacter jejuni in a patient with X-linked hypogammaglobulinemia

Un paciente varón de 18 años de edad, con antecedentes de agammaglobulinemia ligada al cromosoma X o de Bruton, presentó simultáneamente lesiones atípicas de celulitis, en ambas piernas y brazo izquierdo, y bacteriemia por Campylobacter jejuni, sin sintomatología intestinal previa.Tanto C. jejuni como los bacilos del género Helicobacter o Flexispira deben ser considerados causa de septicemias/bacteriemias, celulitis, abscesos, uveítis, artritis y osteomielitis en pacientes con cualquier tipo de inmunodeficiencia, incluida la agammaglobulinemia ligada al X (AU)

Lipodistrofia parcial adquirida / Partial acquired lipodystrophy

La lipodistrofia es un trastorno infrecuente en que el tejido adiposo está disminuido o ausente. Puede ser congénita o adquirida, y generalizada o localizada. Presentamos el caso de un varón de 7 años con adelgazamiento de las mejillas sin otra sintomatología asociada. De entre las pruebas realizadas destaca una hipercolesterolemia y un descenso del factor C3 del complemento. La lipodistrofia parcial adquirida es la forma de presentación más frecuente. En estos pacientes hay que descartar una resistencia insulínica y dislipemias, así como los niveles de factor C3 del complemento y la función renal por la posibilidad de asociación con glomerulonefritis. Desde el punto de vista estético no hay ninguna terapia eficaz (AU)