Metastasis to the nasal cavity from primary rectal adenocarcinoma.

We describe a rare case of metastasis to the pa ra - na sal sinuses. The lesion had an immunohistochemical (positivity for cytokeratin 20, negativity for cytokeratin 7, overexpression of p53) and in situ hybridisation profile (neither lesions showed deletion for p53) consistent with metastasis from the earlier rectal adenocarcinoma. The correct typification of intestinal-type neoplasms requires a combination of morphological, immunohistochemical and, sometimes, molecular analysis.

Treatment of "stable" vitiligo by Timedsurgery and transplantation of cultured epidermal autografts.

OBJECTIVE: To optimize melanocyte/keratinocyte co-cultivation and to evaluate the effectiveness of autologous cultured epidermal grafts in the surgical treatment of stable vitiligo. DESIGN: After optimization of melanocyte/keratinocyte cultures, achromic lesions were disepithelialized by means of programmed diathermosurgery (Timedsurgery) and covered with autologous epidermal grafts prepared from secondary cultures. Melanocyte content was evaluated by dopa reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system. SETTING: A biosafety level 3 cell culture facility and a dermatological department in a hospital. PATIENTS: Thirty-two patients carrying different types of vitiligo were admitted to the study and treated with autologous cultured epidermal grafts. Inclusion criteria were (1) failure of at least 2 standard medical approaches; (2) no therapy for at least 12 months; (3) absence of progression of old lesions, absence of appearance of new lesions, and absence of Koebner phenomenon within the past 18 months; and (4) absence of autoimmune disorders. RESULTS: One hundred five achromic lesions (a total of 6078.2 cm(2)) were treated. The average percentage of repigmentation, evaluated after 12 to 36 months of follow-up, was 77%. Independent of the type of vitiligo, average percentages of repigmentation of extremities and periorificial sites were 8% (31.8 cm(2) repigmented/420.5 cm(2) transplanted) and 35% (17.6 cm(2) repigmented/50.0 cm(2) transplanted), respectively. Percentages of repigmentation of all other body sites ranged from 88% to 96% (4329.7 cm(2) repigmented/4675.2 cm(2) transplanted). Color matching was good and scar formation was not observed. CONCLUSION: Cultured epidermal grafts can be considered a real therapeutic surgical alternative for "stable" but not lip-tip vitiligo.

Surgical thimble for use in augmentation mammaplasty.

A conveniently formed thimble has been created for use in dissection during augmentation mammaplasty and gynecomastia operations which forms a rigid extension to the surgeon's finger. With the aid of this instrument, which is fitted onto the third and partly onto the second phalanx of the index finger, the delicacy and maneuverability characteristics of digital dissection are on the whole retained and the surgeon avoids the use of traditional dissection instruments gripped in the hand, with which it is easy to exceed the desired limits of dissection creating nervous lesions and unequal pockets.

Morphometric study and anatomical variations of the medial ligament of the talocrural joint / Estudio morfométrico y variaciones anatómicas del ligamento medial de la articulación talocrural

The aim of this study was to perform a descriptive study of the morphology, anatomical variations and morphometry of medial talocrural (or deltoid) ligament. We dissected 27 lower limbs obtained from amputations without histories of age, sex or disease. The measurements were made with a caliper, compass and ruler, expressing the results in millimeters. We described the superficial layer morphology of the medial ligament, measuring the size and ligament's thickness. For the deep layer we described and measured the length (l), width (w) and thickness (t). Results: Superficial layer: trapezoid form=66.7 percent (anterior margin=30.5 mm; posterior margin=27.6 mm; top margin=22.6 mm; bottom margin=50.5 mm), rectangular form=19 percent (anterior margin=19.3 mm; posterior margin=27.2 mm; top margin=24.4 mm; bottom margin=29.8 mm), triangular form=14.3 percent (anterior margin=37 mm; posterior margin=37.8 mm; bottom margin=48.3 mm). The average thickness of the superficial layer was 3.6 mm. Deep layer of the medial ligament: l=6.9 mm, w=11 mm, t=5.7 mm; presented rectangular form in 100 percent. In 76.2 percent of the specimens, the deep layer was covered completely by the superficial layer; however, in 23.8 percent the coverage is incomplete, showing the deep layer by posterior angle. The literature is contradictory regarding the anatomy and variations of the medial ligament of the ankle. There are important differences in morphology, attachments, subdivisions and relationships between the two layers of the deltoid ligament. Conclusions: We found significant anatomical variations in the morphology and the relationship between the superficial and deep layers of the deltoid ligament.

El objetivo fue realizar un estudio descriptivo de la morfología, variaciones anatómicas y la morfometría del ligamento talocrural medial (o deltoídeo). Se disecaron 27 miembros inferiores obtenidos de amputaciones sin antecedentes de edad, sexo, ni morbilidad. Las mediciones se realizaron con un pie de metro, regla y compás, expresando los resultados en milímetros. Se describió la morfología del ligamento medial en su capa superficial, midiendo el tamaño y grosor del ligamento. Para la capa profunda se describió y midió la longitud (l), ancho (a) y espesor (e). Resultados: En la capa superficial se observó: forma trapezoidal = 66,7 por ciento (margen anterior = 30,5 mm; margen posterior = 27,6 mm; margen superior = 22,6 mm; margen inferior = 50,5 mm), forma rectangular= 19 por ciento (margen anterior = 19,3 mm; margen posterior = 27,2 mm, margen superior = 24,4 mm; margen inferior = 29,8 mm), forma triangular = 14,3 por ciento (margen anterior=37 mm, margen posterior = 37,8 mm; margen inferior = 48,3 mm). El espesor promedio de la capa superficial fue de 3,6 mm. La capa profunda del ligamento medial: l = 6.9 mm, a = 11 mm, e = 5,7 mm, presentó forma rectangular en el 100 por ciento de los casos. En el 76,2 por ciento de las muestras, la capa profunda estaba completamente cubierta por la capa superficial, sin embargo, en 23,8 por ciento la cobertura fue incompleta, mostrando la capa profunda por el ángulo posterior. La literatura es contradictoria respecto a la anatomía y variaciones del ligamento medial del tobillo. Existen importantes diferencias en su morfología, inserciones, subdivisiones y las relaciones entre las dos capas del ligamento deltoídeo. Conclusiones: Se encontraron importantes variaciones anatómicas en la morfología y la relación entre las capas superficial y profunda del ligamento deltoídeo.

Estudio morfométrico y variaciones anatómicas del ligamento talocrural lateral / Morphometric study and anatomical variations of lateral talocrural ligament

Las lesiones del ligamento talofibular lateral son un problema común en traumatología. Éstas corresponden a la mayoría de los esguinces de tobillo, siendo el ligamento talofibular anterior el de mayor frecuencia, seguido del calcáneo fibular. Mediante nuestro estudio intentaremos describir la anatomía de estos ligamentos, teniendo así una herramienta para su enfrentamiento quirúrgico. Se realizó un estudio descriptivo morfométrico sobre los ligamentos talocrurales laterales, obteniéndose un promedio de sus medidas y frecuencia de variaciones anatómicas. Se disecaron 27 miembros inferiores obtenidos de amputaciones sin antecedentes de edad, sexo y morbilidad. Los ligamentos fueron medidos con un pie de metro, compás de puntas secas y regla milimetrada, expresando los resultados en milímetros. Se midió el largo(l), ancho(a), espesor(e), área de origen(ao) y área de inserción(ai). Se describieron las variaciones anatómicas que presentaron estos ligamentos. Los resultados fueron: Lig. calcáneo fibular (l=30,3mm; a=5,46mm; e=2,4mm; ao=46,17mm²; ai=66,59mm²). No presentó variaciones anatómicas. Lig. talofibular posterior (l=25,74mm; a=6,37mm; e=4,35mm; ao=40,1mm²; ai=80,19mm²). En 22,2 por ciento se describe una proyección de fibras accesorias (fascículo ascendente o tibial) que nacen del origen del ligamento, dirigiéndose hacia superior para insertarse en la caraarticular de la tibia. Lig. talofibular anterior (l=20,01mm; a=10,2mm; e=2,3mm; ao=60,03mm²; ai=66,96mm²). En 57 por ciento de los casos fue único, en 43 por ciento bifurcado y 0 por ciento trifurcado. Un 46,15 por ciento posee fibras arciformes que unen los orígenes de los ligamentos fibulotalar anterior y fibulocalcáneo. En conclusión se encontraron importantes variaciones anatómicas que no son aisladas, sino forman distintos grupos anatómicos de cada ligamento.

The lateral talofibular ligament injuries are a common problem in trauma. These correspond to the majority of ankle sprains, anterior talofibular ligament being the most frequent, followed by the calcaneal fibular. Through our study we will try to describe the anatomy of these ligaments, thus having a surgical tool for confrontation. A descriptive study was conducted on the morphometric lateral talocrural ligaments, resulting in an average of their measurements and frequency of anatomical variations. Were dissected 27 limbs from amputation with no history of age, sex and morbidity. The ligaments were measured with a tube foot, dry dividers and millimeter ruler, expressing the results in millimeters. We measured the length (l), width (a), thickness (e), area of origin (o) and insertion site (i). Described the anatomic variations presented these ligaments. The results were: fibulocalcaneal ligaments (l = 30.3 mm, a = 5.46 mm, e = 2.4 mm, ao = 46.17 mm²; ai = 66.59 mm²). No anatomic variations presented. Posterior talofibular ligament (l = 25.74 mm, a = 6.37 mm, e = 4.35 mm, ao = 40.1 mm²; ai = 80.19 mm²). In 22.2 percent described a projection accessory fiber (fascicle up or fibular) arising from the origin of the ligament, superior heading to attach to the articular surface of the fibula. Anterior talofibular ligament (l = 20.01 mm, a = 10.2 mm, e = 2.3 mm, ao = 60.03 mm²; ai = 66.96 mm²). In 57 percent of cases was unique, bifurcated in 43 percent and 0 percent triple-barbed. A 46.15 percent have arcuate fibers connecting the origins of the anterior fibulotalar and fibulocalcaneal ligaments. In conclusion important anatomical variations were found are not isolated, but form distinct anatomical groups each ligament.

Timed surgery for treatment of angiofibromas in tuberous sclerosis.

Angiofibromas are neoformations frequently occurring on the face of patients affected by tuberous sclerosis. Traditional methods of treating angiofibromas, such as curettage, dermabrasion, chemical peeling, cryosurgery, and laser are not entirely successful as they frequently lead to scarring and pigmentary change. We report the successful use of timed surgery, a novel electrosurgical procedure, in treating multiple angiofibromas. The technique is easy to use and very cost effective.

Sonographic appearance of a retained surgical sponge in the neck.

We report the sonographic appearance and clinical course of a retained surgical sponge in the neck beginning 6 months after a partial thyroidectomy. Sonograms showed a subcutaneous curvilinear hyperechoic interface with marked acoustic shadowing obscuring the left side of the neck. Three months later, a fistulous tract could be seen. Surgical exploration revealed a florid foreign tissue reaction due to a retained surgical sponge. Early diagnosis of retained sponges is important to enable expeditious removal before complications develop.

Metastasis to the nasal cavity from primary rectal adenocarcinoma

We describe a rare case of metastasis to the pa ra - na sal sinuses. The lesion had an immunohistochemical (positivity for cytokeratin 20, negativity for cytokeratin 7, overexpression of p53) and in situ hybridisation profile (neither lesions showed deletion for p53) consistent with metastasis from the earlier rectal adenocarcinoma. The correct typification of intestinal-type neoplasms requires a combination of morphological, immunohistochemical and, sometimes, molecular analysis (AU)

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Prevalencia de obesidad en escolares de enseñanza básica / Prevalence of obesity among basic school children

La obesidad en el niño produce a mediano y largo plazo graves trastornos metabólicos y en forma inmediata tiene serias consecuencias psicológicas. Este estudio se realizó con el propósito de describir la prevalencia de obesidad en la población escolar, comparando sexo, edad y nivel socioeconómico (NSE). Se estudiaron 1.219 niños de un colegio de la comuna de las Condes (colegio A) y 1.030 niños de un colegio de la comuna de San Miguel (colegio B). En todos se registró peso, talla, edad, que varió entre 5,5 y 15,5 años. El estado nutricional se evaluó mediante tablas NCHS peso/edad y talla/edad, calculando el índice peso talla según Durant, definiendo obesidad por un índice igual o mayor a 120. E1 NSE determinado mediante escala de Graffar modificada, aplicada a 83 niños del colegio A y a 129 del colegio B, fue significativamente mejor en el colegio A (p<0,01). La prevalencia de obesidad del colegio A fue 12,63 por ciento y la del colegio B 9,03 por ciento (p<0,05). Se encontró que las mujeres del colegio A en el rango 5,5 a 8,5 años eran las mas obesas. Al comparar los hombres de ambos colegios se encontró un porcentaje mayor de obesidad en el rango de 9 a 12 años en el colegio A (p<0,05). Respecto a la edad, sólo se encontró tendencia a la disminución de la obesidad con la edad, pero esta no fue significativa. Puesto que la obesidad en la edad escolar está fuertemente asociada a la del adulto, este grupo constituye un objetivo adecuado para la prevención y tratamiento de ella