[Paramedian forehead flap for the reconstruction of extensive nasal defects]. / Colgajo fronto-nasal paramedial en la reconstrucción de defectos nasales extensos.

BACKGROUND: The Department of Dermatology at Hospital Universitario de Guadalajara in Spain is a referral center for Mohs micrographic surgery. Consequently, we are regularly faced with the problem of repairing large surgical defects on the nose. The paramedian forehead flap is currently one of the techniques of choice for the repair of such defects. MATERIALS AND METHODS: We review our experience in the repair of nasal defects using the paramedian forehead flap over the period from 2004 to 2008. We describe the surgical technique, complications, and final results. RESULTS: Ten patients (mean age, 75.1 years) were treated using this flap. Two patients also required cartilage grafts and reconstruction of the internal nasal lining. The most common complications were bleeding (60%) and partial necrosis (10%). The final cosmetic and functional results were considered good or excellent in 90% of cases. CONCLUSIONS: The forehead flap continues to be one of the best options for the closure of surgical defects of the nasal pyramid larger than 2 cm. Adequate knowledge and careful application of the technique allows excellent results to be obtained with few complications.

Psychotic symptoms in COVID-19 patients. A retrospective descriptive study.

Psychotic symptoms have been related to other coronavirus infections. We conducted a single-centre retrospective and observational study to describe new-onset psychotic episodes in COVID-19 patients. Ten patients infected by the novel coronavirus with psychotic symptoms and no previous history of psychosis were identified by the emergency and liaison psychiatry departments. Nine of the cases presented with psychotic symptoms at least two weeks after the first somatic manifestations attributed to COVID-19 and receiving pharmacological treatment. Structured delusions mixed with confusional features were the most frequent clinical presentations. Hence, COVID-19 patients can develop psychotic symptoms as a consequence of multiple concurrent factors.

[Erythrocyte levels of ALA-dehydrase and uro-synthetase in chronic renal insufficiency (author's transl)]. / Estudio de los niveles eritrocitarios de ala-dehidrasa y uro-sintetasa en la insuficiencia renal crónica.

Erythrocyte levels of ala-dehydrase and uro-synthetase as well as hematocrit, hemoglobin, iron levels and serum iron binding capacity were studied in a group of 28 patients with chronic renal failure in hemodialysis and compared to those of a control group. As is usual, hematocrit, hemoglobin an iron levels were significantly decreased, as were ala-dehydrase levels, while uro-synthetase levels were within normal levels. These results are interpreted as a blockade of the biosynthetic pathway of the protoporphyrins, which lends support to the hypothesis of an existing defect in hemoglobin synthesis in patients with chronic renal failure.

[Multicentre study of infection incidence in knee prosthesis]. / Estudio multicéntrico sobre la incidencia de infección en prótesis de rodilla.

OBJECTIVE: To determine the incidence of surgical site infection in knee prosthesis surgical procedure for a follow-up period of one year in twelve hospitals in Madrid region. MATERIAL AND METHOD: A prospective study was carried out from January to December 2009 using a national surveillance system called Indicadores Clínicos de Mejora Continua de Calidad. Primary and revision knee joint replacements in patients operated on in the previous year were included. Criteria used to define surgical site infection and patient risk index categories were those established by the Centers for Disease Control and Prevention and National Nosocomial Infections Surveillance. The incidence rates were worked out crude and adjusted by hazard ratio. RESULTS: 2,088 knee prosthesis procedures were analyzed. The overall incidence of surgical site infection was 2.1%. Sixty-five percent of the infections were organ/space. Sixty percent of the infections were identified in the early postoperative period. Of all surgical site infections, 41.9% were microbiologically confirmed. Antibiotic prophylaxis was implemented correctly in 63.3% of the cases. The most important cause of inappropriate prophylaxis was an unsuitable duration in 85.7% of the cases. The presurgical preparation was carried out correctly in 50.3% of surgical operations. The incidence of knee arthroplasty infection was twice as high as in the National Healthcare Safety Network and similar to national rates. DISCUSSION: In this study, the incidence of infection was within the range of infection rates in other published European studies. Surveillance and control strategies of health care for associated infections allow us to assess trends and the impact of preventive measures.