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Blanco MD, de la Torre M, Lorca C, Del Cañizo A, Bada I, Monje S, García-Casillas MA, Villa Á, de Tomás E, Berenguer B. Use of pedicled flaps after oncologic resections in pediatric patients. Pediatr Surg Int 2024; 40:64. [PMID: 38433161 DOI: 10.1007/s00383-024-05654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
The aim of this study is to review the indications of pedicled flaps and analyze the results. A observational retrospective study of under 18-year-old oncology patients who required reconstructive surgery with pedicled flaps between 2011 and 2022 was performed. Demographic and clinical variables, indications, complications, and outcomes were collected. 236 patients were reviewed and 13 met inclusion criteria, eight girls and five boys (mean age: 10.6 years). Indications were Ewing's sarcoma (5), osteosarcoma (5), neuroblastoma, desmoid tumor, and neurofibroma. Preoperative PET-CT, MRI and bone scintigraphy were performed. The flaps were used on costal and extremity reconstruction: latissimus dorsi (5), pectoralis (2), medial gastrocnemius (2), combined latissimus dorsi, trapezius and serratus muscle, biceps femoris, fascio-neuro-cutaneous saphenous and cutaneous advancement-rotation. Two were performed on allograft and eight on prosthesis. All allowed immediate and complete closure. Six patients received intraoperative radiotherapy. One flap infection and two vascular complications were reported, a total necrosis, which required a new flap, and a partial necrosis, treated with a local plasty. Chemotherapy was resumed after 21 days (15-31). Mean follow-up time was 5.34 years. Flaps are an effective therapeutic option allowing reconstruction of large defects after pediatric oncologic surgeries. The most frequent complication was vascular.
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Affiliation(s)
- María Dolores Blanco
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Department of Pediatric Surgery, Hospital Materno Infantil Gregorio Marañón, C/O'Donnell, 48, 28009, Madrid, Spain.
| | - Manuel de la Torre
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Lorca
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Agustín Del Cañizo
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Isabel Bada
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sara Monje
- General and Thoracic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ángel Villa
- Pediatric Traumatology Department Hospital General, Universitario Gregorio Marañón, Madrid, Spain
| | - Elena de Tomás
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Beatriz Berenguer
- Plastic Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Viñas MJ, Galiotto-Barba F, Cortez-Lede MG, Rodríguez-González MÁ, Moral I, Delso E, González-Meli B, Lobo F, López-Cedrún JL, Neagu D, Garatea J, Garatea A, Berenguer B, Lorca-García C, Delgado MD, Martí E, Gutiérrez JM, Hernández C, Murillo-González J, Martínez-Álvarez C, Martínez-Sanz E. Craniofacial and three-dimensional palatal analysis in cleft lip and palate patients treated in Spain. Sci Rep 2022; 12:18837. [PMID: 36336749 PMCID: PMC9637697 DOI: 10.1038/s41598-022-23584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022] Open
Abstract
Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.
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Affiliation(s)
- María José Viñas
- grid.4795.f0000 0001 2157 7667Facultad de Odontología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Francesca Galiotto-Barba
- grid.4795.f0000 0001 2157 7667Facultad de Odontología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - María Gabriela Cortez-Lede
- grid.419058.10000 0000 8745 438XHospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, 30120 Murcia, Spain
| | - María Ángeles Rodríguez-González
- grid.419058.10000 0000 8745 438XHospital Clínico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, 30120 Murcia, Spain
| | - Ignacio Moral
- grid.438293.70000 0001 1503 7816Hospital Universitario Miguel Servet, Servicio Aragonés de Salud, 50009 Zaragoza, Spain
| | - Elena Delso
- grid.438293.70000 0001 1503 7816Hospital Universitario Miguel Servet, Servicio Aragonés de Salud, 50009 Zaragoza, Spain
| | - Beatriz González-Meli
- grid.410361.10000 0004 0407 4306Hospital Universitario Infantil Niño Jesús, Servicio Madrileño de Salud, 28009 Madrid, Spain
| | - Fernando Lobo
- grid.410361.10000 0004 0407 4306Hospital Universitario Infantil Niño Jesús, Servicio Madrileño de Salud, 28009 Madrid, Spain
| | - José Luis López-Cedrún
- grid.420359.90000 0000 9403 4738Complejo Hospitalario Universitario A Coruña, Servizo Galego de Saúde, 15006 A Coruña, Spain
| | - David Neagu
- grid.420359.90000 0000 9403 4738Complejo Hospitalario Universitario A Coruña, Servizo Galego de Saúde, 15006 A Coruña, Spain
| | - Joaquín Garatea
- grid.419060.a0000 0004 0501 3644Complejo Hospitalario de Navarra, Servicio Navarro de Salud, 31008 Pamplona, Spain
| | - Amaia Garatea
- grid.419060.a0000 0004 0501 3644Complejo Hospitalario de Navarra, Servicio Navarro de Salud, 31008 Pamplona, Spain
| | - Beatriz Berenguer
- grid.410361.10000 0004 0407 4306Hospital General Universitario Gregorio Marañón, Servicio Madrileño de Salud, 28009 Madrid, Spain
| | - Concepción Lorca-García
- grid.410361.10000 0004 0407 4306Hospital General Universitario Gregorio Marañón, Servicio Madrileño de Salud, 28009 Madrid, Spain
| | - María Dolores Delgado
- grid.410361.10000 0004 0407 4306Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud, 28041 Madrid, Spain
| | - Eunate Martí
- grid.410361.10000 0004 0407 4306Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud, 28041 Madrid, Spain
| | - José Manuel Gutiérrez
- grid.459669.10000 0004 1771 1036Hospital Universitario de Burgos, Sanidad de Castilla y León, 09006 Burgos, Spain
| | - Carlos Hernández
- grid.459669.10000 0004 1771 1036Hospital Universitario de Burgos, Sanidad de Castilla y León, 09006 Burgos, Spain
| | - Jorge Murillo-González
- grid.4795.f0000 0001 2157 7667Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Concepción Martínez-Álvarez
- grid.4795.f0000 0001 2157 7667Facultad de Odontología, Universidad Complutense de Madrid, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Elena Martínez-Sanz
- grid.4795.f0000 0001 2157 7667Facultad de Odontología, Universidad Complutense de Madrid, 28040 Madrid, Spain ,grid.4795.f0000 0001 2157 7667Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Abstract
AIM Ectopic breast tissue (EBT) includes a spectrum of disease that entails other entities based on the presence of glandular tissue, nipple, or areola. The diagnosis in adolescents is infrequent. METHODS A retrospective study was performed including girls with axillary EBT (class IV or V of Kajava's Classification) operated in 2006-2020. Imagining studies, clinical and surgical reports, and histopathology were reviewed. RESULTS Eleven girls from 13 to 16 years old were included. Two patients (18.2%) presented bilateral EBT. The most frequent clinical manifestation was 2-5 cm mass (100%), associating cyclic pain with menstruation (45%) and fluctuating volume (36%). Bilateral axillary ultrasonography allowed preoperative diagnosis. All of them were treated by open excision, through small incisions located in an axillary y fold. Clinical and aesthetic results were self-assessed as "very good", with normalization of the axillary y hollow and imperceptible scars. No recurrences were observed after one year of follow-up. An immediate postoperative hematoma was reported, which did not require drainage. Histopathology showed mature breast tissue without atypia. CONCLUSIONS Axillary accessory breasts must be included in differential diagnosis of pediatric axillary masses. Bilateral ultrasonography is recommended for the preoperative diagnosis. Excision through minimal incision at this age seems to be safe and effective.
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Affiliation(s)
- M De la Torre
- Division of Plastic Pediatric Surgery, Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, c/O'Donnell, 52, 28007, Madrid, Spain.
| | - C Lorca-García
- Division of Plastic Pediatric Surgery, Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, c/O'Donnell, 52, 28007, Madrid, Spain
| | - E de Tomás
- Division of Plastic Pediatric Surgery, Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, c/O'Donnell, 52, 28007, Madrid, Spain
| | - B Berenguer
- Division of Plastic Pediatric Surgery, Pediatric Surgery Department, Hospital General Universitario Gregorio Marañón, c/O'Donnell, 52, 28007, Madrid, Spain
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Pignatti M, D'Arpa S, Roche N, Giorgini FA, Lusetti IL, Lorca-Garcia C, De Santis G, Berenguer B. Surgical treatment of pressure injuries in children: A multicentre experience. Wound Repair Regen 2021; 29:961-972. [PMID: 34473875 PMCID: PMC9293131 DOI: 10.1111/wrr.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/22/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Pressure injuries (PI) are infrequent in paediatric patients, prevalence estimates ranging from 1.4% to 8.2%, and reaching values as high as 43.1% in critical care areas. They can be associated with congenital neurological or metabolic disorders that cause reduced mobility or require the need for medical devices. In children, most pressure injuries heal spontaneously. However, a small percentage of ulcers that is refractory to conservative management or is too severe at presentation (Stage 3 or 4) will be candidates for surgery. We retrospectively reviewed the clinical history of paediatric patients affected by pressure injuries from four European Plastic Surgery Centres. Information was collected from clinical and radiology records, and laboratory reports. An accurate search of the literature revealed only two articles reporting on the surgical treatment of pressure injuries in children. After debridement, we performed surgical coverage of the pressure injuries. We report here our experience with 18 children aged 1–17 years, affected by pressure injury Stages 3 and 4. They were successfully treated with pedicled (17 patients) or free flaps (1 patient). The injuries involved the sacrum (6/18 patients), lower limb (3/18 patients), thoracic spine (2/18 patients), ischium (3/18 patients, bilateral in one patient), temporal area (3/18 patients), hypogastrium (1/18 patients) and were associated to medical devices in three cases. Flaps were followed for a minimum of 19 months and up to 13 years. Only two patients developed true recurrences that were treated again surgically. Pressure injuries are infrequent in children and rarely need surgical treatment. Pedicled flaps have a high success rate. Recurrences, contrary to what is reported in the literature, were rare.
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Affiliation(s)
- Marco Pignatti
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola di Bologna, Bologna.,DIMES, University of Bologna, Palermo
| | - Salvatore D'Arpa
- Plastic and Reconstructive Surgery, La Maddalena Cancer Center, Palermo, Italy
| | - Nathalie Roche
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Federico A Giorgini
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola di Bologna, Bologna.,Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, Modena, Italy
| | - Irene Laura Lusetti
- Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, Modena, Italy
| | | | - Giorgio De Santis
- Plastic Surgery, University of Modena e Reggio, Policlinico di Modena, Modena, Italy
| | - Beatriz Berenguer
- Pediatric Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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5
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Klassen AF, Rae C, Bulstrode NW, Berenguer B, Cui C, Fisher DM, Kasrai L, Li Y, Lloyd M, Panchapakesan V, Pusic A, Reinsch J, Stewart K, Todd A, Frank R, Tsangaris E, Wang Y, Wong Riff KW, Zhang R, Cano S. An international study to develop the EAR-Q patient-reported outcome measure for children and young adults with ear conditions. J Plast Reconstr Aesthet Surg 2021; 74:2341-2348. [PMID: 33637465 DOI: 10.1016/j.bjps.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/06/2021] [Accepted: 01/24/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is currently a lack of patient-reported outcome measures for ear reconstruction. We developed the EAR-Q to measure ear appearance and post-operative adverse effects from the patient perspective. METHODS Field-test data were collected from children and young adults in eight countries between 13 May 2016 and 12 December 2019. Rasch measurement theory (RMT) analysis was used to refine the scales and to examine their psychometric properties. RESULTS Participants had microtia (n = 607), prominent ears (n = 145) or another ear condition (n = 111), and provided 960 assessments for the Appearance scale (e.g., size, shape, photos), and 137 assessments for the Adverse Effects scale (e.g., itchy, painful, numb). RMT analysis led to the reduction of each scale to 10-items. Data fit the Rasch model for the Appearance (X2(80) = 90.9, p = 0.19) and Adverse Effects (X2(20) = 24.5, p = 0.22) scales. All items in each scale had ordered thresholds and good item fit. There was no evidence of differential item function for the Appearance scale by age, gender, language, or type of ear condition. Reliability was high for the Appearance scale, with person separation index (PSI) and Cronbach alpha values with and without extremes ≥0.92. Reliability for the Adverse Effects scale was adequate (i.e., PSI and Cronbach alpha values ≥0.71). Higher scores (liked appearance more) correlated with higher scores (better) on Psychological, Social and School scales. INTERPRETATION The EAR-Q can be used in those 8-29 years of age to understand the patient perspective in clinical practice and research, and in addition, can be used to benchmark outcomes for ear reconstruction internationally.
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Affiliation(s)
- Anne F Klassen
- Dept of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Charlene Rae
- Dept of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Neil W Bulstrode
- Dept of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
| | - Beatriz Berenguer
- Division of Pediatric Plastic Surgery, Hospital General Universitario Gregorio Maranon, Calle de O´Donnell 48, 28009, Madrid, Spain
| | - Chunxiao Cui
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China.
| | - David M Fisher
- Dept of Surgery, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1 × 8, Canada.
| | - Leila Kasrai
- Department of Surgery, St Joseph's Health Centre, University of Toronto, 30 The Queensway, Toronto, ON M6R 1B5, Canada.
| | - Yiyuan Li
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China
| | - Mark Lloyd
- Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Ln, Birmingham B4 6NH, UK.
| | - Vivek Panchapakesan
- Dept of Surgery, William Osler Health System, 101 Humber College Blvd, Etobicoke, ON M9V 1R8, Canada
| | - Andrea Pusic
- Dept of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA.
| | - John Reinsch
- Dept of Pediatric Plastic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ken Stewart
- Dept of Plastic Surgery, Royal Hospital for Sick Children 9 Sciennes Rd, Edinburgh EH9 1LF, UK.
| | - Anna Todd
- Section of Plastic Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada
| | - Ryan Frank
- Section of Plastic Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada.
| | - Elena Tsangaris
- Dept of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Yi Wang
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City SG6 4ET, UK.
| | - Karen Wy Wong Riff
- Dept of Surgery, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1 × 8, Canada.
| | - Ruhong Zhang
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China.
| | - Stefan Cano
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City SG6 4ET, UK.
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6
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Berenguer B, García T, San Basilio M. Life-Threatening Acute Angioedema, a Rare Complication After Secondary Blepharoplasty. Aesthet Surg J 2021; 41:NP1244-NP1246. [PMID: 33787857 DOI: 10.1093/asj/sjab093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Teresa García
- Plastic Surgery Unit, Hospital Universitario La Luz, Madrid, Spain
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Santanelli di Pompeo F, Sorotos M, Clemens MW, Firmani G, Athanasopoulos E, Arctander K, Berenguer B, Bozikov K, Cardoso A, Nord ÅE, Filip C, Georgeskou Romania A, Heitman C, Kaarela O, Kolenda M, Hamdi M, Lantieri L, Lumenta D, Mercer N, Ruegg E, Santanelli di Pompeo F, Stanec Z, Van Der Hulst R, Vranckx JJ. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Review of Epidemiology and Prevalence Assessment in Europe. Aesthet Surg J 2021; 41:1014-1025. [PMID: 33022037 DOI: 10.1093/asj/sjaa285] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) epidemiologic studies focus on incidence and risk estimates. OBJECTIVES The aim of this study was to perform a thorough literature review, and to provide an accurate estimate of BIA-ALCL prevalence in Europe. METHODS We searched PubMed, Web of Science, SCOPUS, and Google Scholar databases to identify publications reporting BIA-ALCL epidemiology. Research was conducted between November 2019 and August 2020. European prevalence was assessed as the ratio between pathology-confirmed cases and breast implant-bearing individuals. The Committee on Device Safety and Development (CDSD) collected data from national plastic surgery societies, health authorities, and disease-specific registries to calculate the numerator. The denominator was estimated by combining European demographic data with scientific reports. RESULTS Our research identified 507 articles: 106 were excluded for not being relevant to BIA-ALCL. From the remaining 401 articles, we selected 35 that discussed epidemiology and 12 reviews. The CDSD reported 420 cases in Europe, with an overall prevalence of 1:13,745 cases in the 28 member states of the European Union (EU-28). Countries where specific measures have been implemented to tackle BIA-ALCL account for 61% of the EU-28 population and actively reported 382 cases with an overall prevalence of 1:9121. CONCLUSION Countries where specific measures have been implemented show a higher prevalence of BIA-ALCL compared with the European mean, suggesting that these countries have improved the detection of the condition and reduced underreporting, which affects the numerator value. Other nations should adopt projections based on these measures to avoid underestimating how widespread BIA-ALCL is. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry, PhD School of Translational Medicine of Development and Active Ageing, Università degli Studi di Salerno, Salerno, Italy
| | - Mark W Clemens
- Department of Plastic Surgery, M.D. Anderson Cancer Center, TX, USA
| | - Guido Firmani
- School of Medicine and Psychology, Sapienza University, Rome, Italy
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8
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Berenguer B, García T, Lorca-García C, San-Basilio M. Aesthetic forehead reduction in female patients: Surgical details and analysis of outcome. J Plast Reconstr Aesthet Surg 2021; 75:407-414. [PMID: 34305024 DOI: 10.1016/j.bjps.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/04/2021] [Accepted: 06/02/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Primary aesthetic hairline lowering, also known as forehead reduction, is a relatively unexplored procedure, and the perceived satisfaction with outcome has not been previously discussed in scientific literature. The objectives of this study were to review the surgical technique and to analyze outcome assessing objective reduction, improvement of facial balance, patient satisfaction, and complications. PATIENTS AND METHODS This was a prospective cohort study of patients seeking aesthetic forehead reduction since 2010. Inclusion criteria were as follows: women with a high but stable hairline. We excluded smokers, those seeking combined surgery, and those who had history of scalp surgery or hair loss. All patients were operated following the same protocol. Forehead reduction was measured comparing the pre- and postoperative distance from the glabella to the trichion. Improvement in facial balance was assessed comparing the pre- and postoperative quotient between the upper and middle thirds of the face. The forehead FACE-Q tool and the Vancouver Scar Scale were used to assess patient satisfaction. All complications were registered with a minimum follow-up of 6 months. RESULTS Twenty-six women aged 16 to 56 years were included. The average reduction was 2.03 cm. The facial balance quotient improved from 1:1.44 preoperatively to 1:1.05 postoperatively (p < 0.01). Both the forehead FACE-Q and the Vancouver Scar Scale showed significantly positive results. Complications included transient scalp numbness in 23 subjects, small areas of scar widening in 3 patients, and minor seroma in 1 patient. CONCLUSION With meticulous execution, aesthetic forehead reduction in female patients is effective and safe, resulting in high patient satisfaction. The FACE-Q is owned by the Memorial Sloan Kettering Cancer Center (MSKCC) and was used with permission for this research.
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Affiliation(s)
| | - Teresa García
- Unit of Plastic Surgery, Hospital la Luz, Madrid, Spain
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9
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Berenguer B, Lorca-García C, San-Basilio M, Campos M, Lancharro A, Agra C. Successful treatment of giant lymphatic malformation with symptomatic cutaneous vesicles by surgical excision and coverage with Integra®. Eur J Plast Surg 2020. [DOI: 10.1007/s00238-020-01752-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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Berenguer B, Lorca-García C, Lancharro A, DeTomás E. Pediatric tumors of the buccal fat pad: lipoma and hemangioma. Acta Chir Belg 2020; 120:341-343. [PMID: 30722729 DOI: 10.1080/00015458.2019.1570743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The buccal fat pad (BFP) has prompted numerous publications in anatomy, reconstructive and aesthetic surgery over the years; however, description of surgical treatment of pathologic conditions affecting this space is rare, especially in children. An extensive search of the English literature retrieved only five lipomas and one hemangioma in this age group.Methods: The authors report on two of these exceptional pediatric tumors of the BFP: one lipoma and one hemangioma referred to the outpatient clinic for diagnosis and treatment.Results: Both children had a similar clinical presentation and a characteristic MR image. The two lesions were excised through an intraoral approach, which proved to be a fast, safe and effective technique.Conclusions: Being extremely rare, tumors of the BFP in children have an indicative clinical presentation and radiologic image. A detailed intraoral approach is described and proposed as effective and safe surgical treatment.
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Affiliation(s)
- B. Berenguer
- Section of Pediatric Plastic Surgery, Gregorio Marañón University Hospital, Madrid, Spain
| | - C. Lorca-García
- Section of Pediatric Plastic Surgery, Gregorio Marañón University Hospital, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - A. Lancharro
- Department of Pediatric Radiology, Gregorio Marañón University Hospital, Madrid, Spain
| | - E. DeTomás
- Section of Pediatric Plastic Surgery, Gregorio Marañón University Hospital, Madrid, Spain
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11
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San Basilio M, Lobo Bailón F, Berenguer B, Martí Carrera E, Bayet B, Taylor JA, Núñez Villaveiran T, Patel NV, Murthy AS, Mulliken JB. Techniques and results of palate fistula repair following palatoplasty: a 234-case multicenter study. Cir Pediatr 2020; 33:137-142. [PMID: 32657098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Palate fistula is the most frequent complication following palatoplasty. The objectives of this study were: to describe the most widely used repair techniques; to study results and recurrence rate; to analyze potentially predictive recurrence variables; and to assess whether a specific technique is superior according to fistula size and location. MATERIALS AND METHODS Retrospective study of patients undergoing palate fistula repair in 7 healthcare facilities from 2008 to 2018. All facilities had at least 20 new cases of cleft lift and palate annually (range: 20-80), with a fistula incidence of 14% (range: 1.5-20%). Minimum follow-up was 1 year. 8 variables were collected for statistical analysis purposes. RESULTS 234 fistula patients underwent surgery. Most fistulas occurred in complete bilateral cleft lift and palate (Veau type IV). The most frequent location was the hard palate (Pittsburgh types IV and V (63.2%)), and fistulas were mostly large (42.1%) and medium (39.5%). The most frequent repair technique was re-palatoplasty (34.2%). Recurrence rate was 22%. The multivariate analysis demonstrated more recurrences in re-palatoplasty repaired type III fistulas in patients over 3 years old. CONCLUSION A tendency towards using flap repair in large hard palate fistulas, re-palatoplasty in medium hard palate and soft and hard palate junction fistulas, and local flaps or re-palatoplasty in small fistulas at any location was observed. However, it could not be statistically demonstrated whether a specific repair technique was superior in different clinical situations.
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Affiliation(s)
- M San Basilio
- 6th grade Medicine student. San Pablo University Study Center (CEU). Madrid (Spain)
| | - F Lobo Bailón
- Pediatric Plastic Surgery Department. Niño Jesús University General Hospital. Madrid (Spain)
| | - B Berenguer
- Pediatric Plastic Surgery Department. Gregorio Marañón University General Hospital. Madrid (Spain)
| | - E Martí Carrera
- Pediatric Plastic Surgery Department. 12 de Octubre University General Hospital. Madrid (Spain)
| | - B Bayet
- Pediatric Plastic Surgery Department. Saint-Luc University Clinics. Brussels (Belgium)
| | - J A Taylor
- Division of Plastic Surgery. Children's Hospital of Philadelphia (CHOP). Philadelphia (USA)
| | - T Núñez Villaveiran
- Pediatric Plastic and Reconstructive Surgery. Akron Children's Hospital, Akron (USA)
| | - N V Patel
- Pediatric Plastic and Reconstructive Surgery. Akron Children's Hospital, Akron (USA)
| | - A S Murthy
- Pediatric Plastic and Reconstructive Surgery. Akron Children's Hospital, Akron (USA)
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12
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Valdivielso-Ramos M, Torrelo A, Martin-Santiago A, Hernández-Nuñez A, Azaña JM, Campos M, Berenguer B, Garnacho G, Moreno R, Colmenero I. Histopathological hallmarks of cutaneous lesions of capillary malformation-arteriovenous malformation syndrome. J Eur Acad Dermatol Venereol 2020; 34:2428-2435. [PMID: 32124491 DOI: 10.1111/jdv.16326] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/06/2020] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is a recently described syndrome with distinctive cutaneous lesions. Very little is known about the histopathology of these lesions. OBJECTIVE The purpose of the study was to evaluate the histopathological characteristics of the pink macules of the CM-AVM syndrome and to investigate if these pink macules could be classified as capillary malformations or arteriovenous malformations based on their histopathological features. DESIGN-SETTINGS-PARTICIPANTS We conducted a retrospective multicenter study involving eight hospitals in Spain. Fifteen biopsies from pink macules of the CM-AVM syndrome were analysed and compared with five biopsies of diverse capillary malformations and three stage I arteriovenous malformations. RESULTS Pink macules' biopsies of the CM-AVM syndrome showed similar features including a high vascular density encompassing capillaries and numerous thick-walled arterioles mainly located in the superficial dermis, a predominance of elongated over round vessels, scarce or absent erythrocytes within the lumina and discrete perivascular inflammation. CMs were characterized by an increased number of capillary-type vessels mostly rounded and located in the upper dermis. AVMs were composed by highly increased numbers of vessels with a branching pattern involving the full thickness of the dermis, without erythrocytes within the lumina. Wilms tumour 1 protein was positive in the endothelial cells both in pink macules of the CM-AVM and in arteriovenous malformations. CONCLUSIONS AND RELEVANCE Pink macules of the CM-AVM syndrome seem to be different from capillary malformations. Our results suggest that histologically and immunohistochemically they are closer to incipient arteriovenous malformations than to capillary malformations. A deepened knowledge about the nature of these skin lesions will contribute to the better understanding of capillary malformation-arteriovenous malformation syndrome, and will open the possibility of new and more specific treatments in the future.
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Affiliation(s)
| | - A Torrelo
- Dermatology Department, Hospital Niño Jesus, Madrid, Spain
| | | | | | - J M Azaña
- Dermatology Department, Hospital Albacete, Albacete, Spain
| | - M Campos
- Dermatology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - B Berenguer
- Plastic Surgery Department, Hospital Gregorio Marañón, Madrid, Spain
| | - G Garnacho
- Dermatology Department, Hospital Reina Sofia, Córdoba, Spain
| | - R Moreno
- Dermatology Department, Hospital del Henares, Madrid, Spain
| | - I Colmenero
- Pathology Department, Hospital Niño Jesus, Madrid, Spain
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13
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Lorca-García C, Berenguer B, de Tomás E. Corrigendum to: "Use of innovative negative pressure therapy for cartilage exposure in microtia reconstruction" [Journal of Plastic, Reconstructive & Aesthetic Surgery 72(2) 2019 e3-e4]. J Plast Reconstr Aesthet Surg 2020; 73:809. [PMID: 32094058 DOI: 10.1016/j.bjps.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Concepción Lorca-García
- Pediatric Plastic Surgery Department, Hospital General Universitario Gregorio Marañón, C/ de O'Donnell, 48, 28009 Madrid, Spain; Doctoral Student, Universidad Complutense de Madrid, Pza. Ramón y Cajal, s/n, Ciudad Universitaria, 28040 Madrid, Spain.
| | - Beatriz Berenguer
- Pediatric Plastic Surgery Department, Hospital General Universitario Gregorio Marañón, C/ de O'Donnell, 48, 28009 Madrid, Spain
| | - Elena de Tomás
- Pediatric Plastic Surgery Department, Hospital General Universitario Gregorio Marañón, C/ de O'Donnell, 48, 28009 Madrid, Spain
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14
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Tsangaris E, Riff KWYW, Berenguer B, Bulstrode NW, Celerier C, Cugno S, Fanous A, Mazeed AS, Marchac A, Stotland MA, Klassen AF. Translation and cultural adaptation of the EAR-Q into Arabic, Chinese, French and Spanish for use in an international field-test study. Eur J Plast Surg 2019. [DOI: 10.1007/s00238-019-01585-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Cajozzo M, Berenguer B, Lorca-García C, Darriba Alles JV, García Leal R, de Tomás E. Management of congenital midline nasofrontal dermoid cysts in two identical twins: Case report. Pediatr Dermatol 2019; 36:745-746. [PMID: 31355485 DOI: 10.1111/pde.13940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Midline dermoid cysts are uncommon lesions that can lead to severe complications when an intracranial extension exists. We report the cases of two twin sisters referred to surgery for removal of the masses and the intracranial extension. They represent an additional example of familial nasal dermoid cysts, providing further support for a genetic basis for the disorder.
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Affiliation(s)
- Marta Cajozzo
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Beatriz Berenguer
- Pediatric Plastic Surgery Department, Hospital General Universitario "Gregorio Marañon", Madrid, Spain
| | - Concepción Lorca-García
- Pediatric Plastic Surgery Department, Hospital General Universitario "Gregorio Marañon", Madrid, Spain
| | | | - Roberto García Leal
- Department of Neurosurgery, Hospital General Universitario "Gregorio Marañon", Madrid, Spain
| | - Elena de Tomás
- Pediatric Plastic Surgery Department, Hospital General Universitario "Gregorio Marañon", Madrid, Spain
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16
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Hernández García I, Hidalgo I, Barragán L, Berenguer B, Lorca-García C, Mantilla I. Endotracheal intubation through laryngeal Ambu® Auragain™ mask airway mask in paediatric patients affected by congenital infiltrating lipomatosis. ACTA ACUST UNITED AC 2019; 66:222-225. [PMID: 30686492 DOI: 10.1016/j.redar.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022]
Abstract
Congenital defects that affect paediatric airway could lead to several difficulties for effective ventilation, intubation, or even both, increasing the risk of hypoxaemia. It is essential for the paediatric anaesthesiologist to have accurate knowledge of the anatomy of patient́s airway, as well as judicious preoperative planning. Increasingly, more devices have been designed for the control of difficult airway in the paediatric patient. This case report describes the application of a third-generation laryngeal mask (- Ambu® Auragain ™) for endotracheal intubation of a child with anticipated difficult airway, secondary to congenital diffuse infiltrating facial lipomatosis.
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Affiliation(s)
- I Hernández García
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - I Hidalgo
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Barragán
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - B Berenguer
- Departamento de Cirugía Plástica Infantil, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Lorca-García
- Departamento de Cirugía Plástica Infantil, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - I Mantilla
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
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17
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Lorca-García C, Berenguer B, de Tomás E. Use of innovative negative pressure therapy for cartilage exposure in microtia reconstruction. J Plast Reconstr Aesthet Surg 2018; 72:e3-e4. [PMID: 30470674 DOI: 10.1016/j.bjps.2018.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/28/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Concepción Lorca-García
- Pediatric Plastic Surgery Department, Hospital General Universitario Gregorio Marañón, C/ de O'Donnell, 48, 28009 Madrid, Spain; Doctoral Student, Universidad Complutense de Madrid, Pza. Ramón y Cajal, s/n, Ciudad Universitaria, 28040 Madrid, Spain.
| | - Beatriz Berenguer
- Pediatric Plastic Surgery Department, Hospital General Universitario Gregorio Marañón, C/ de O'Donnell, 48, 28009 Madrid, Spain
| | - Elena de Tomás
- Pediatric Plastic Surgery Department, Hospital General Universitario Gregorio Marañón, C/ de O'Donnell, 48, 28009 Madrid, Spain
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18
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Berenguer B, Lorca-García C, Agra C, Lancharro A, Tomás E. [Fibrous hamartoma in childhood. A case description of large size and review of the literature]. Cir Pediatr 2018; 31:52-55. [PMID: 29419960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Fibrous hamartoma of infancy is a rare soft tissue tumour that usually appears before 2 years of age, typically in the upper extremities of male infants. CASE REPORT We report the case of a 2 year old boy with a large and rapidly growing tumour in the upper extremity. COMMENTS We describe the case, its differential diagnosis and the immunhistological characteristics, and we discuss the non-aggressive surgical treatment, based on the benign behaviour of this tumour.
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Affiliation(s)
- B Berenguer
- Servicio de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - C Lorca-García
- Servicio de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - C Agra
- Servicio de Anatomía Patológica. Hospital General Universitario Gregorio Marañón. Madrid
| | - A Lancharro
- Servicio de Radiología Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - E Tomás
- Servicio de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
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19
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Pinto C, Lorca-Garcia C, Berenguer B, De Tomás Palacios ME. Bleomycin-induced flagellate erythema after venous malformation sclerosis-Case report and brief review. Pediatr Dermatol 2018; 35:e5-e8. [PMID: 29159988 DOI: 10.1111/pde.13297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bleomycin-induced flagellate erythema is a rare but typical skin toxicity of bleomycin. We report the case of a boy with a left foot venous malformation who developed this skin rash after two sessions of bleomycin intralesional injection. We discuss the mechanism and characteristics of this reaction to bleomycin, which is usually benign and self-limited. We conclude that, although rare, flagellate pigmentation can occur when bleomycin is used as a sclerosant in children.
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Affiliation(s)
- Cristina Pinto
- Department of Plastic and Reconstructive Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho and Hospital da Prelada, Porto, Portugal
| | - Concepción Lorca-Garcia
- Pediatric Plastic Surgery Section, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Beatriz Berenguer
- Pediatric Plastic Surgery Section, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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20
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García KF, Berenguer B, Quintana LO, De Tomás Vicente E, Pérez-Pacheco RF, De León Luis JA. Prenatal diagnosis and management of Van der Woude syndrome. Case Reports in Perinatal Medicine 2016. [DOI: 10.1515/crpm-2015-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
We report the postnatal diagnosis of Van der Woude syndrome (VWS) in a foetus found to have an isolated right cleft lip and palate by ultrasound examination. After prenatal genetic counselling, the parents declined further evaluation by amniocentesis. At delivery, the infant was also found to have labial pits in the lower lip in addition to the cleft lip and palate identified by ultrasound consistent with VWS. Although VWS is rare, its autosomal dominant inheritance and variable penetrance should prompt additional modalities to more thoroughly evaluate the extent of other organ system and more extensive craniofacial anomalies.
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Affiliation(s)
- Karla Ferreres García
- Gynecology and Obstetrics Department, General Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Beatriz Berenguer
- Pediatric Plastic Surgery Department, General Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Luis Ortiz Quintana
- Gynecology and Obstetrics Department, General Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Elena De Tomás Vicente
- Pediatric Plastic Surgery Department, General Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | | | - Juan Antonio De León Luis
- Gynecology and Obstetrics Department, General Hospital Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
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21
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Pacheco YD, Lorca-García C, Berenguer B, De Tomás E. [Isolated bilateral macrostomia: case report and literature review]. Cir Pediatr 2016; 29:41-44. [PMID: 27911070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The macrostomia is a facial abnormality also called transverse facial cleft or Tessier cleft number 7. Macrostomia is a rare condition with an incidence from 1/80,000 to 1/300,000 live births. The left commisure is more commonly affected. Bilateral macrostomia is extremely rare, with only 10 to 20% of all cases of macrostomia, and 50% of bilateral cases are associated with different syndromes. To date just over 20 cases of isolated bilateral macrostomia have been described in the literature. CLINICAL OBSERVATION We report the case of a patient with isolated bilateral macrostomia solved by surgery and with good aesthetic and functional results. COMMENTS The treatment of bilateral macrostomia is surgical and should be done early. Although there are many techniques, the key is to recreate a new and correct commisure through a good reorientation of the orbicularis oris.
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Affiliation(s)
- Y D Pacheco
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - C Lorca-García
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - B Berenguer
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - E De Tomás
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
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22
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Pacheco YD, Lorca-García C, Berenguer B, De Tomás E. [Preaxial polydactyly of the hand: 15 years of experience]. Cir Pediatr 2015; 28:188-192. [PMID: 27775296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Preaxial polydactyly is one of the most common congenital malformations of the hand. The treatment is surgical and should be done early, between 6 and 12 months old. The purpose of this paper is to review our experience in terms of casuistry, treatment and functional and aesthetic results of duplicity of thumb, since 2000 until today. MATERIAL AND METHODS A retrospective study of patients with diagnosis of preaxial polydactyly from 2000 to january 2016 was performed. RESULTS Thirty patients with duplicity of thumb and thirty one bifid thumbs were diagnosed. No difference was found in terms of gender. The right hand was the most affected. Wassel type IV was the most common, followed by type II. Age at time of surgery had a median and mode of 12 months. All were treated surgically, using the model of preservation of the dominant thumb in 97% of the cases. According to Tada system, our postoperative results were good in 26 cases (83.8%). Our most frequent complication was slight radial clinodactyly, which was found in 5 cases. CONCLUSIONS Preaxial polydactyly of the hand is one of the most common congenital malformations. It is usually unilateral and without gender predominance. Surgical treatment provides good results. The most common technique for reconstruction is the model of preservation of the dominant thumb. Clinodactyly is the most common complication after surgery, however its presence is more aesthetic than a functional problem.
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Affiliation(s)
- Y D Pacheco
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - C Lorca-García
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - B Berenguer
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - E De Tomás
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
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Berenguer B, González-Meli B, Bernabeu T. Cirugía Plástica Infantil en campaña humanitaria en Guinea Ecuatorial. Cir plást iberolatinoam 2015. [DOI: 10.4321/s0376-78922015000300015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lorca-García C, Berenguer B, de Tomás Palacios E, Marín Molina C. [Periorbital lymphatic malformations: Report of two cases]. Cir Pediatr 2015; 28:148-152. [PMID: 27775310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Periorbital lymphatic malformations are a rare entity in which diagnosis and treatment could be a challenge for surgeons. Management may be conservative, or they can be treated by sclerotherapy, surgery or combination of both. CLINICAL OBSERVATION We present two cases of periorbital lymphatic malformations treated by sclerotherapy (OK-432 or bleomycin) and surgery in which we achieve good results with minimum morbidity. COMMENTS Surgery combined with sclerotherapy is a good option of treatment for periorbital lymphatic malformations because surgery can be more conservative and therefore, sequelae are lower.
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Affiliation(s)
- C Lorca-García
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - B Berenguer
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - E de Tomás Palacios
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
| | - C Marín Molina
- Sección de Cirugía Plástica Infantil. Hospital General Universitario Gregorio Marañón. Madrid
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25
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Berenguer B, Simal I, Marín MC, Riquelme O, García Martín A, González JL. [Gluteal artery based perforator flaps for sacral pressure sore reconstruction in children]. Cir Pediatr 2014; 27:183-188. [PMID: 26065111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Children have much lower incidence of pressure sores (PS) than adults and furthermore, they are diagnosed in earlier stages. Therefore, the reported experience with surgical treatment of advanced pediatric PS is scarce. MATERIAL AND METHODS We present the surgical treatment of 2 chronic PS stage IV in children aged 11 and 14 years, by means of perforator flaps based on the gluteal arteries: in the first case we used a free-style flap based on a left medial gluteal perforator and in the second a large reusable rotation-advancement flap based on both right superior and inferior gluteal artery perforators. RESULTS In both patients we achieved a rapid cure with 100% survival of the flaps and a stable cover over a 6 month and 1 year follow-up respectively. CONCLUSIONS Gluteal artery perforator flaps can produce excellent and durable results in the reconstructive treatment of sacral pressure sores in children. These flaps carry lower morbidity than musculocutaneous flaps and are more reliable than traditional fasciocutaneous flaps. Furthermore they preserve more reconstructive options in case of recurrence during the children's lifetime.
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Paradas-Lara I, Casado-Gómez I, Martín C, Martínez-Sanz E, López-Gordillo Y, González P, Rodríguez-Bobada C, Chamorro M, Arias P, Maldonado E, Ortega R, Berenguer B, Martínez-Álvarez C. Maxillary growth in a congenital cleft palate canine model for surgical research. J Craniomaxillofac Surg 2013; 42:13-21. [PMID: 23434237 DOI: 10.1016/j.jcms.2013.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/04/2013] [Accepted: 01/15/2013] [Indexed: 11/29/2022] Open
Abstract
We have recently presented the Old Spanish Pointer dog, with a 15-20% spontaneous congenital cleft palate rate, as a unique experimental model of this disease. This study aimed to describe the cleft palate of these dogs for surgical research purposes and to determine whether congenital cleft palate influences maxillofacial growth. Seven newborn Old Spanish Pointer dogs of both sexes, comprising a cleft palate group (n = 4) and a normal palate group (n = 3), were fed using the same technique. Macroscopic photographs and plaster casts from the palate, lateral radiographs and computer tomograms of the skull were taken sequentially over 41 weeks, starting at week 5. The cleft morphology, the size and the tissue characteristics in these dogs resembled the human cleft better than current available animal models. During growth, the cleft width varies. Most of the transverse and longitudinal measures of the palate were statistically lower in the cleft palate group. The cleft palate group showed hypoplasia of the naso-maxillary complex. This model of congenital cleft palate seems suitable for surgical research purposes. A reduced maxillofacial pre- and post-natal development is associated to the congenital cleft palate in the Old Spanish Pointer dog.
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Affiliation(s)
- Irene Paradas-Lara
- Departamento de Anatomía y Embriología Humana I, Facultad de Medicina, Facultad de Odontología, Universidad Complutense de Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Inmaculada Casado-Gómez
- Departamento de Estomatología IV, Facultad de Odontología, Universidad Complutense de Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Conchita Martín
- Departamento de Estomatología IV, Facultad de Odontología, Universidad Complutense de Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Elena Martínez-Sanz
- Servicio Aragonés de Salud, Atención Primaria, Sector Zaragoza III, 50500 Tarazona, Spain
| | - Yamila López-Gordillo
- Departamento de Anatomía y Embriología Humana I, Facultad de Medicina, Facultad de Odontología, Universidad Complutense de Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Pablo González
- Departamento de Medicina y Cirugía Experimentales, Hospital Universitario Clínico San Carlos, Profesor Martín Lago s/n, 28040 Madrid, Spain
| | - Cruz Rodríguez-Bobada
- Departamento de Medicina y Cirugía Experimentales, Hospital Universitario Clínico San Carlos, Profesor Martín Lago s/n, 28040 Madrid, Spain
| | - Manuel Chamorro
- Policlínica Veterinaria, Centro Militar de Veterinaria, Ministerio de la Defensa de España, Darío Gazapo 3, 28024 Madrid, Spain
| | - Pablo Arias
- Policlínica Veterinaria, Centro Militar de Veterinaria, Ministerio de la Defensa de España, Darío Gazapo 3, 28024 Madrid, Spain
| | - Estela Maldonado
- Departamento de Anatomía y Embriología Humana I, Facultad de Medicina, Facultad de Odontología, Universidad Complutense de Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Ricardo Ortega
- Departamento de Estomatología III, Facultad de Odontología, Universidad Complutense de Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Beatriz Berenguer
- Servicio de Cirugía Plástica Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Concepción Martínez-Álvarez
- Departamento de Anatomía y Embriología Humana I, Facultad de Medicina, Facultad de Odontología, Universidad Complutense de Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain.
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Lima Sánchez J, Berenguer B, Aránguez G, González Meli B, Marín Molina C, de Tomás Palacios E. [Extruded cochlear implant magnet covered with a temporoparietal fascial flap. A case report]. Cir Pediatr 2013; 26:48-51. [PMID: 23833928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Complications are infrequent after cochlear implant surgery but they might occur despite careful preoperative planning and meticulous surgical technique. Among the most commonly encountered problems are those associated with the postauricular flap. An exposed, and therefore contaminated, device requires immediate attention and intervention. Cochlear implantation revision surgery is justified by two main reasons, the high price of these devices and the difficulty of reimplantation, due to cochlear fibrosis and ossification after its removal. There are multiple options in cochlear implantation revision surgery with infected device. However, the temporoparietal fascia flap is highly vascularized and provides some advantages over other alternatives. We report a case of a 5 year old boy with bilateral sensor neural hearing loss, who suffered a device extrusion three years after its implantation.
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Affiliation(s)
- J Lima Sánchez
- Servicio de Cirugia Plástica, Hospital de Gran Canaria Dr Negrín, Hospital Universitario Gregorio Marañón, Madrid
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Gilabert Rodríguez R, Berenguer B, González Meli B, Marín Molina C, de Tomás Palacios E, Buitrago Weiland G, Aguado del Hoyo A. [Intraparotid first branchial arch cyst: complex diagnostic and therapeutic process]. Cir Pediatr 2013; 26:44-47. [PMID: 23833927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
First branchial arch cysts are uncommon. Therefore, together with its variable clinical and age presentation they are often misdiagnosed at first. The treatment is surgical, requiring a correct procedure to avoid future recurrences. In this paper we describe a typical case of first branchial arch cyst in which as described in other reports, we first made several misdiagnoses and therefore an inadequate treatment and lastly, with the correct diagnosis, we performed a meticulous complete excision under facial nerve monitoring.
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Affiliation(s)
- R Gilabert Rodríguez
- Cirugía Pladstica, Estética y Reparadora, H.U. Virgen del Rocío, H.U. Gregorio Marañón
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29
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Quílez A, Berenguer B, Gilardoni G, Souccar C, de Mendonça S, Oliveira LFS, Martín-Calero MJ, Vidari G. Anti-secretory, anti-inflammatory and anti-Helicobacter pylori activities of several fractions isolated from Piper carpunya Ruiz & Pav. J Ethnopharmacol 2010; 128:583-589. [PMID: 20152892 DOI: 10.1016/j.jep.2010.01.060] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/23/2010] [Accepted: 01/29/2010] [Indexed: 05/28/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The leaves of Piper carpunya Ruiz & Pav. (syn Piper lenticellosum C.D.C.) (Piperaceae), are widely used in folk medicine in tropical and subtropical countries of South America as an anti-inflammatory, anti-ulcer, anti-diarrheal and anti-parasitical remedy as well as an ailment for skin irritations. AIMS OF THE STUDY To study the anti-inflammatory, anti-secretory and anti-Helicobacter pylori activities of different fractions isolated from an ethanolic extract of the leaves of Piper carpunya, in order to provide evidence for the use of this plant as an anti-ulcer remedy. Moreover, to isolate the main compounds of the extract and relate their biological activity to the experimental results obtained with the fractions. MATERIALS AND METHODS Sixteen fractions were obtained from the ethanolic extract (F I-XVI) and 16 pure compounds were isolated and identified from these fractions. We studied the effects of the fractions (0.1-400microg/mL) on the release of myeloperoxidase (MPO) enzyme from rat peritoneal leukocytes, on rabbit gastric microsomal H(+), K(+)-ATPase activity and anti-Helicobacter pylori anti-microbial activity using the microdilution method (MM). The main compounds contained in the fractions were isolated and identified by (1)H- and (13)C NMR spectra analysis and comparison with the literature data. RESULTS Eight fractions showed inhibition of MPO enzyme (F I-IV, X, XII, XIV and XV). The highest inhibition was observed with F XIV (50microg/mL, 60.9%, p<0.001). F X and XII were the most active ones, inhibiting the gastric H(+), K(+)-ATPase activity with IC(50) values equal to 22.3microg/mL and 28.1microg/mL, respectively. All fractions, except F XV, presented detectable anti-Helicobacter pylori activity, with a diameter of inhibition zones ranging from 11mm up to 50mm. The best anti-Helicobacter pylori activity was obtained with F III and V. Both fractions killed Helicobacter pylori with lowest concentration values, about 6.25mug/mL. Sixteen pure compounds were isolated, five of them are flavonoids that possess strong anti-oxidant and free radical scavenging activity, e.g. vitexin, isovitexin, and rhamnopyranosylvitexin. Terpenoids like sitosterol, stigmasterol and phytol, which have shown gastroprotective activity, and dihydrochalcones, like asebogenin, with anti-bacterial activity, were also isolated. Furthermore, the rare neolignan 1, that is a DNA polymerase beta lyase inhibitor, and (6S, 9S)-roseoside, that shows strong anti-bacterial activity, were isolated, for the first time, from the genus Piper. CONCLUSIONS We suggest that the flavonoids isolated from F I and II (vitexin, isovitexin, rhamnopyranosylvitexin and isoembigenin) contribute to the anti-MPO activity, as well as to their anti-Helicobacter pylori activity. These flavonoids may also be responsible for the important inhibition of H(+), K(+)-ATPase activity. Also the phytosterols and phytol obtained from F XIV and XV could be involved in these gastroprotective activities. These results encourage us to continue phytochemical studies on these fractions in order to obtain full scientific validation for this species.
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Affiliation(s)
- A Quílez
- Department of Pharmacology, Faculty of Pharmacy, University of Seville, Calle Prof. García González, 2, 41012 Seville, Spain
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Berenguer B, González Meli B, Marín Molina C, de Tomás Palacios E. [Rapidly involuting congenital hemangioma (RICH) that simulates a minimal cleft lip]. Cir Pediatr 2010; 23:130-133. [PMID: 21298927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hemangiomas are frequent tumors that manifest in variable forms. Rapidly Involuting Congenital Hemangiomas (RICH) are a rare subtype, only recently described, which, in contrast to the typical infantile hemangioma, undergo accelerated involution, sometimes within days. Their different initial appearance and posterior evolution may cause confusion with other tumors of infancy or even with congenital malformations. We present a case of RICH in the upper lip that after rapid involution produced a morphologic sequel that resembled a microform cleft lip. The authors review the specific characteristics of this rare tumor and describe the technical detail of surgical correction in this patient.
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Affiliation(s)
- B Berenguer
- Sección de Cirugía Plástica, Hospital General Universitario Gregorio Marañón, Madrid.
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de la Cruz L, Berenguer B, García T. Correction of nasojugal groove with tunnelled fat graft. Aesthet Surg J 2009; 29:194-8. [PMID: 19608068 DOI: 10.1016/j.asj.2009.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 02/18/2009] [Accepted: 02/18/2009] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pronounced nasojugal sulcus (tear trough deformity) is a frequent and distressing symptom in aesthetic palpebral surgery. The sliding fat technique using the transcutaneous or transconjunctival approach has proven to be considerably useful in patients with clinically evident fat bags. In the absence of fat bags, commonly used techniques can lead to unpredictable (and frequently less than optimal) results. OBJECTIVE The authors report their experience with correcting the nasojugal groove in the absence of palpebral fat bags by use of a one-piece, free fat graft as an alternative to autologous fat injections or the placement of alloplastic materials. METHODS The authors conducted a retrospective study of a consecutive series of 34 patients (33 women and one man) between 42 and 57 years of age. In all cases, small, free fat grafts harvested from the medial fat compartment of the upper eyelid were placed precisely under the depression through two stab incisions in the suborbicularis plane, filling in the groove. RESULTS Results were considered excellent in 24 out of the 34 patients. Results in the remaining 10 patients were rated as good, in most cases because of mild undercorrection. All patients expressed a high degree of satisfaction. Recovery time was very short and no eye or eyelid complications were observed. CONCLUSIONS Correction of the nasojugal groove with a tunnelled fat graft causes minimal tissue trauma and allows exact placement of the graft. The upper palpebral fat has unique characteristics that render it an ideal graft material for correction of the nasojugal groove in patients with no concomitant lower fat bags. This procedure offers more predictable results and a lower incidence of adverse effects than more commonly used techniques.
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Espinosa R, Berenguer B, de Salamanca JE, Meli BG, Urcelay PR, Calderón R, Rollán V. [Mammary reconstruction in Poland's syndrome]. Cir Pediatr 2008; 21:19-22. [PMID: 18444385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Poland's syndrome is considered to be a polimalformative entity with different degrees of severity. We retrospectively reviewed our patients with Poland's syndrome diagnosis, treated between 2000 and 2006. The aim of our study is to assess the different choices of surgical treatment for mammary reconstruction according to the importance of malformation and taking into account our own experience and literature references. A total o f 13 patients (5 males and 8 females) were studied and only 6 of them (1 male and 5 females) underwent surgery. Surgical indication was based on Foucras's classification, considering 3 grades of severity. We propose a surgical approach adapted to each stage, as well as surgical refinements to improve the aesthetic aspect. Most of our patients were very satisfied with final results even though they underwent complex procedures with a considerable rate of complications.
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Affiliation(s)
- R Espinosa
- Servicio de Cirugia Pediátrica, Hospital Infantil Niño Jesús, Madrid.
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33
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Berenguer B, Trabadela C, Sánchez-Fidalgo S, Quílez A, Miño P, De la Puerta R, Martín-Calero MJ. The aerial parts of Guazuma ulmifolia Lam. protect against NSAID-induced gastric lesions. J Ethnopharmacol 2007; 114:153-60. [PMID: 17884315 DOI: 10.1016/j.jep.2007.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 07/02/2007] [Accepted: 07/18/2007] [Indexed: 05/17/2023]
Abstract
Guazuma ulmifolia Lam., a member of the Sterculiaceae family, is used in folk medicine because of its antioxidant, antimicrobial and antihypertensive properties. Most of the research work carried out on this plant has focused on the bark because of its high concentration of antioxidant proanthocyanidins. The flowers and leaves of Guazuma ulmifolia, though less studied, are also used as a remedy for different conditions, such as kidney and gastrointestinal diseases, fever and diabetes. The aim of this study was to assess the gastroprotective effects of an aqueous suspension of the ethanolic extract from leaves and flowers of Guazuma ulmifolia in a model of acute gastric ulcer induced by diclofenac as ulcerogenic agent, using the proton pump inhibitor omeprazole as a protection reference. Therefore, the extract was administered two times orally to three groups of Wistar rats at doses of 500, 250 and 125mg/kg, with a 24-h interval between doses. Diclofenac (100mg/kg) was given 1h after the last administration of the extract. Pretreatment with Guazuma ulmifolia or omeprazole decreased the ulcerated area in a dose-dependent way. Myeloperoxidase activity as a marker of neutrophil infiltration was slightly reduced in vivo, whereas in vitro, anti-inflammatory activity was clearly inhibited in a dose-dependent way. The lowest doses of the extract significantly decreased the levels of lipoperoxides, and superoxide dismuthase activity increased to a similar extent as with omeprazole (P<0.001). Examination of glutathione metabolism reflected a significant rise in glutathione peroxidase activity at the highest dose of Guazuma ulmifolia. Finally, there was a faint elevation in prostaglandin E(2) levels with all doses, though the depletion induced by diclofenac could not be reverted. We conclude that the aerial parts of Guazuma ulmifolia protect gastric mucosa against the injurious effect of NSAIDs mainly by anti-inflammatory and radical-scavenging mechanisms.
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Affiliation(s)
- B Berenguer
- Department of Pharmacology, Faculty of Pharmacy, University of Seville, Professor García González Street 2, 41012 Sevilla, Spain
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Calderón R, Miralles G, Rodríguez Urcelay P, Berenguer B, González Meli B, Enríquez de Salamanca J, Cervera J. [Complications and sequelae after nasal trauma]. Cir Pediatr 2007; 20:125-8. [PMID: 17650726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Septal haematoma after nasal trauma is a complication that can lead to septal abscess if unrecognized or early intervention is not performed. It can cause compression and thereby necrosis that evolve to a septal abscess in which cultures reveal saprophyte bacteria. Cartilage necrosis and destruction can produce impaired breathing and aesthetic deformities with collapse of the dorsum and the tip of the nose. We present a 10 year old masculine infant, that suffered a nasal fracture with a septal haematoma that remained undiagnosed. The patient developed a septal abscess that required drainage and resulted in nasal sequelae with collapse of dorsum and cranial displacement of tip and columella. Functional and aesthetic reconstruction was performed using rib cartilage grafts. No complications occurred. Functional and aesthetic improvement was observed. Result after 2 months of follow-up is considered favourable.
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Affiliation(s)
- R Calderón
- Servicio de Cirugía Plástica, Hospital Infantil Universitario Niño Jesús, Madrid.
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35
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Landin L, Cavadas P, Navarro C, Carrera A, Fontdevila J, de Francia S, Berenguer B. Comparative anatomy of the facial/scalp flap of a range of mammals. J Plast Reconstr Aesthet Surg 2007. [DOI: 10.1016/j.bjps.2007.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Landin L, Gonzalez E, Cavadas P, Berenguer B. The mystacial pad flap: First sensorimotor facial subunit transplantation in rats. J Plast Reconstr Aesthet Surg 2007. [DOI: 10.1016/j.bjps.2007.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Perez JS, Berenguer B, de Salamanca JE, Escorial V, Garcia RG, Gonzalez FD. P.348 Extra-articular ankylosis of the coronoid process to the skull base. A case report. J Craniomaxillofac Surg 2006. [DOI: 10.1016/s1010-5182(06)60853-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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38
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Berenguer B, Sánchez LM, Quílez A, López-Barreiro M, de Haro O, Gálvez J, Martín MJ. Protective and antioxidant effects of Rhizophora mangle L. against NSAID-induced gastric ulcers. J Ethnopharmacol 2006; 103:194-200. [PMID: 16182483 DOI: 10.1016/j.jep.2005.08.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 06/21/2005] [Accepted: 08/04/2005] [Indexed: 05/04/2023]
Abstract
The bark of Rhizophora mangle, the red mangrove, has been used traditionally in folk medicine of Caribbean countries due to its antiseptic, astringent, haemostatic and antifungal properties. Aqueous extracts are rich in tannins and have been proven experimentally to possess antibacterial, wound healing and antiulcerogenic effects. This work was designed to determine the gastroprotective effect of Rhizophora mangle in a model of diclofenac-induced ulcers in rats and to study the mechanisms involved, using the proton pump inhibitor omeprazole as a comparison. The lyophilized extract was given by oral gavage (125 and 62.5mg/kg) three times at 12h intervals before administering diclofenac 100mg/kg. Pretreatment with the extract resulted in a significant decrease of the ulcerated area (P<0.01). Rhizophora mangle induced a recovery of PGE(2) levels, which had been depleted by diclofenac. No anti-inflammatory effect was observed ex vivo or in vitro. The highest dose of the extract provoked a marked increase in glutathione peroxidase and superoxide dismutase activity, which was comparable to omeprazole. Furthermore, lipid peroxidation levels were inhibited in a dose-dependent manner. These results suggest that the gastroprotective effect of Rhizophora mangle in this experimental model appears through an antioxidant and prostaglandin-dependent way.
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Affiliation(s)
- B Berenguer
- Department of Pharmacology, Faculty of Pharmacy, Profesor García González Street No. 2, 41012 Seville, Spain
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Berenguer B, de la Cruz L, Rodríguez Urcelay P, González Meli B, Enríquez de Salamanca J, de la Plaza R. [Liposuction in children: clinical utility]. Cir Pediatr 2005; 18:188-91. [PMID: 16466145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Liposuction has become one of the most frequent aesthetic procedures. The "typical" patient is a young female with fat deposits in the trochanteric region. Gradually the safety of the technique together with the high satisfaction rate of the patients have contributed to the widening of its indications to other pathologies of the adipose tissue in different age populations. However, there is scarce literature regarding liposuction in childhood. The authors present their experience with liposuction as the treatment of congenital as well as acquired lipodystrophies in the paediatric age. Some particular details of the technique are described and the advantages of liposuction versus open surgery in these cases are analyzed.
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Abstract
Since the concept of Pharmaceutical Care was introduced from United States about twenty years ago, this initiative has become a dominant form of practice for thousands of pharmacists around the world. Currently, pharmaceutical care is understood as the pharmacists' compromise to obtain the maximum benefit from the pharmacological treatments of the patients, being therefore responsible of monitoring their pharmacotherapy. As the profession has moved from a product orientation (dispensing medications) to a patient focus, clinical training requirements have expanded. This is a slow but ongoing process, which started from a philosophical point of view, in order to transform the concept of Pharmacy from commodity-based, mercantile operations into a clinical profession in the community pharmacies. Since its introduction, there has been an ample debate on the definition of pharmaceutical care due to differences in Pharmacy systems and in health care structure among the different countries. Moreover, several implementation barriers exist, which are attributable to problems in education, skills, resources and environment. Indeed, an awareness of the problem resulting from the use of medicines exists and numerous studies reflect that drug use control is necessary since there is an important relationship between morbidity / mortality and pharmacotherapy. Thus, it is possible to evaluate the benefits of pharmaceutical care on patients' health and ultimately on society. Many studies have been conducted, which show that the provision of pharmaceutical care has its value in common pathologies such as diabetes, hypertension, asthma, hyperlipidemia, chronic pain, rheumatic diseases or psychiatric disorders, as well as in polymedicated patients. A large amount of data is currently being published in biomedical journals, in an effort to establish the clinical, economic and humanistic viability of pharmaceutical care. Thus, the aim of this review is to study the evolution of this practice from its beginning until nowadays. Furthermore, we have analyzed a number of implementation programs performed in countries of Europe, the United States and Latin America, focusing on clinical, economical and humanistic outcomes, and also, on the current concept of drug therapy problems (DTP) considered as failures in drug therapy. We conclude that the positive outcomes obtained with different programs of pharmaceutical care are making a beneficial change in patients' health but still more research projects should be conducted to support this change.
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Affiliation(s)
- B Berenguer
- Department of Pharmacology, Faculty of Pharmacy, University of Seville, Prof. García Gonzalez street 2, 41012 Seville, Spain
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Marín-Gutzke M, Sánchez-Olaso A, Berenguer B, González B, Rodríguez P, De Salamanca JE, De Prada I. Basal cell carcinoma in childhood after radiation therapy: case report and review. Ann Plast Surg 2005; 53:593-5. [PMID: 15602259 DOI: 10.1097/01.sap.0000136972.23991.07] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe 2 patients who received ionizing radiation as part of a curative regimen for childhood malignancy which later developed basal cell carcinoma at an early age. They do not occur within the context of well-defined syndromes, such like basal cell nevus syndrome, albinism, or xeroderma pigmentosum. Basal cell carcinomas appears on radiated areas in older individuals, less often in younger patients, in which the period of latency between exposure to radiation and the appearance of basal cell carcinomas is shorter than in older patients. Our 2 cases presented a period of latency of 11 and 10 years. Radiated skin areas must be explored as part of the follow-up in children who received radiotherapy and should probably be maintained for life. The basal cell carcinoma in childhood is best treated by excision.
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Berenguer B, Gallo H, Rodríguez Urcelay P, Marín Guztke M, González Meli B, Enríquez de Salamanca J. [Free fat flap for the treatment of Parry-Romberg disease in children]. Cir Pediatr 2005; 18:49-51. [PMID: 15901111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Progressive hemifacial Atrophy (PHA) or Romberg's Disease is a rare entity of unknown etiology, which most often affects only one side of the face and can include all tissue planes in different grades of severity. Of the several treatments proposed, pedicled or free flaps seem to achieve the best cosmetic results in severe cases. In mild to moderate cases, free autologous fat transplant may obtain optimal results with lower complexity, cost and morbidity. The presence of multiple adipoblasts might increase the possibilities of graft take, particularly in children. Furthermore, refinements in the processes of extraction, preparation and reintroduction of the fat have contributed to improve the results that may be long lasting. We present 2 cases of PHA in 2 girls (11 and 13 years old), that were treated by lipofilling. No complications occurred. In both cases we observed a small reduction in the volume of the initial graft. Thus the procedure was repeated 6 months later to improve facial symmetry. Results have been excellent in one year follow-up.
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Affiliation(s)
- B Berenguer
- Sección de Cirugía Plástica, Hospital Niño Jesús, Madrid
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Berenguer B, González B, Marín M, Rodríguez P, Seguel F, Enríquez de Salamanca J, de Prada I. [Intramuscular juvenile xantogranuloma]. Cir Pediatr 2004; 17:49-51. [PMID: 15002727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Deep or intramuscular juvenile xanthogranuloma (JXG) is very rare. There are, however, some clinical and histological similarities between the case we present and the few cases that have been published in the literature. Although most of them will need histologic confirmation to establish the final diagnosis, surgeons who are operating tumors of infancy should consider it in the differential diagnosis of well circumscribed, rapidly growing dorsal masses in children under 3 years of age. Macroscopic appearance upon excision can help to support the diagnosis. Knowledge of this variant of JXG may avoid aggressive diagnostic or therapeutic procedures.
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Affiliation(s)
- B Berenguer
- Sección de Cirugía Plástica, Hospital Niño Jesús, Madrid
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Berenguer B, Mulliken JB, Enjolras O, Boon LM, Wassef M, Josset P, Burrows PE, Perez-Atayde AR, Kozakewich HPW. Rapidly involuting congenital hemangioma: clinical and histopathologic features. Pediatr Dev Pathol 2003; 6:495-510. [PMID: 15018449 DOI: 10.1007/s10024-003-2134-6] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We define the histopathologic findings and review the clinical and radiologic characteristics of rapidly involuting congenital hemangioma (RICH). The features of RICH are compared to the equally uncommon noninvoluting congenital hemangioma (NICH) and common infantile hemangioma. RICH and NICH had many similarities, such as appearance, location, size, and sex distribution. The obvious differences in behavior served to differentiate RICH, NICH, and common infantile hemangioma. Magnetic resonance imaging (MRI) of the three tumors is quite similar, but some RICH also had areas of inhomogeneity and larger flow voids on MRI and arterial aneurysms on angiography. The histologic appearance of RICH differed from NICH and common infantile hemangioma, but some overlap was noted among the three lesions. RICH was composed of small-to-large lobules of capillaries with moderately plump endothelial cells and pericytes; the lobules were surrounded by abundant fibrous tissue. One-half of the specimens had a central involuting zone(s) characterized by lobular loss, fibrous tissue, and draining channels that were often large and abnormal. Ancillary features commonly found were hemosiderin, thrombosis, cyst formation, focal calcification, and extramedullary hematopoiesis. With one exception, endothelial cells in RICH (as in NICH) did not express glucose transporter-1 protein, as does common infantile hemangioma. One RICH exhibited 50% postnatal involution during the 1st year, stopped regressing, was resected at 18 months, and was histologically indistinguishable from NICH. In addition, several RICH, resected in early infancy, also had some histologic features suggestive of NICH. Furthermore, NICH removed early (2-4 years), showed some histologic findings of RICH or were indistinguishable from RICH. We conclude that RICH, NICH, and common infantile hemangioma have overlapping clinical and pathologic features. These observations support the hypothesis that these vascular tumors may be variations of a single entity ab initio. It is unknown whether the progenitor cell for these uncommon congenital vascular tumors is the same as for common infantile hemangioma.
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Affiliation(s)
- Beatriz Berenguer
- Division of Plastic Surgery, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Berenguer B, De Salamanca JE, González B, Rodríguez P, Zambrano A, Higueras AP. Large involuted facial hemangioma treated with syringe liposuction. Plast Reconstr Surg 2003; 111:314-8. [PMID: 12496594 DOI: 10.1097/01.prs.0000035780.55330.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Beatriz Berenguer
- Division of Plastic Surgery and the Department of Dermatology, Hospital Niño Jesús, Madrid, Spain.
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Abstract
Liposuction has become the most frequent aesthetic procedure, and its indications continue to expand to different areas of plastic surgery. In this article the authors present their experience with liposuction in the treatment of nine cases termed "atypical," for not being purely aesthetic. Included are four congenital lipodystrophies-occult spinal disraphism, osteogenesis imperfecta, congenital lipomatosis difusa, and Klinefelter syndrome-and five acquired ones-posttraumatic lipoma, posttraumatic asymmetry, insulinic hypertrophic lipodystrophy, adiposis dolorosa, and TRAM flap. Particular features of each lipodystrophy are reviewed and details of fat distribution and density are described. We also review some specific details of the technique. On the other hand, we wish to point out the importance of recognizing and correctly diagnosing some specific lipodystrophies that are part of defined clinical patterns and that require an integral therapeutic approach.
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Abstract
Klinefelter syndrome is the most frequent sex chromosome anomaly. Affected men characteristically present a tall stature, eunuchoid contours with feminine fat distribution, gynecomastia, hypogonadism, infertility, and behavioral and psychiatric disorders. Diagnosis is confirmed by karyotype, which demonstrates an extra X chromosome. Treatment is mainly directed toward appropriate defeminization. Current treatment consists of testosterone replacement therapy and surgical correction of gynecomastia.
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Affiliation(s)
- B Berenguer
- Division of Plastic Surgery, Clinica La Luz, Madrid, Spain
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Berenguer B, Burrows PE, Zurakowski D, Mulliken JB. Sclerotherapy of craniofacial venous malformations: complications and results. Plast Reconstr Surg 1999; 104:1-11; discussion 12-5. [PMID: 10597669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Of all vascular anomalies, venous malformations are the most common, and they have a propensity for the head and neck. The authors retrospectively analyzed 40 patients with craniofacial venous malformations who underwent sclerotherapy between October of 1994 and June of 1996 to determine (1) the results of sclerotherapy with ethanol and/or sodium tetradecyl sulfate, (2) the types and rate of complications, and (3) whether outcome correlated with age, sex, location, size, tissues involved, morphology (lobular or varicose), venous outflow, or number of sclerotherapy sessions. The authors also reviewed the results after sclerotherapy and contour resection (n = 18). Comparisons between the results with ethanol and sodium tetradecyl sulfate and between sclerotherapy alone and sclerotherapy and resection combined were not done. The study was composed of three parts. They were (1) a review of records and imaging studies, (2) a panel evaluation of pretreatment and posttreatment photographs, and (3) a questionnaire that determined the patient's (or parent of the patient's) impression of therapy. Interrater and intrarater agreement were analyzed. Sclerotherapy was performed in an angiographic suite, under general anesthesia, using absolute ethanol and/or sodium tetradecyl sulfate. Complications of the treatment included acute blistering (50 percent), hemoglobinuria (28 percent), deep ulceration (13 percent), and nerve injury (7.5 percent). Two patients suffered transient facial paresis, and one had permanent unilateral vocal cord paralysis. Thirty patients (75 percent) were rated as having marked improvement or as being cured by all three members of the panel; 10 patients (25 percent) were rated as having no change or only slight improvement by one or more members of the panel. Interrater reliability was moderately positive, and intrarater reliability was highly positive. Thirty-seven patients or parents of patients (93 percent) responded to the questionnaire. The outcome was considered to be marked improvement or cured in 28 patients (76 percent), and nine respondents (24 percent) described only minor improvement or no change. Logistic regression analysis revealed that only male sex and number of sclerotherapeutic procedures were significant multivariate predictors of outcome. Size, location, tissues involved, morphology, or venous outflow were not determinant. In conclusion, sclerotherapy with ethanol or sodium tetradecyl sulfate is an effective and safe treatment for craniofacial venous malformations. Often, sclerotherapy has to be repeated. For extensive perioral malformations, combined sclerotherapy and resection give the best result.
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Affiliation(s)
- B Berenguer
- Department of Radiology, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA
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