Clasificación de las anomalías vasculares (tumores y malformaciones). Características clínicas e historia natural

Vascular anomalies are divided into tumours and malformations. Haemangiomas are the most frequent amongst the former. Not normally present at birth, except in a premonitory form, they grow for 10-12 months due to hyperplasia, to subsequently undergo a progressive involution for a period that might last from ten to twelve years. They have an incidence of up to 12% in newborns; they are more common amongst girls; and are divided into superficial, deep and compound. Congenital haemangiomas and those that do not undergo involution are considered to be rare entities. Vascular malformations, with a lower incidence than haemangiomas, are always present at birth, they grow by hypertrophy and never undergo involution. According to the classification of the ISSVA, vascular malformations are divided - depending on the vessel affected - into capillary or venular (port-wine stain), venous, lymphatic, arteriovenous and combined or complex. Each of these has certain defining clinical and haemodynamic peculiarities. Within the final group are included some with a low flow, such as the Klippel-Trenaunay syndrome (venous and lymphatic venular vascular malformation associated with the muscularskeletal hypertrophy of an extremity), and others with a high flow, such as the Parkes-Weber syndrome

Protocolo de actuación ante hemangiomas y/o malformaciones vasculares

When facing any vascular lesion present in the first moments of life, it is necessary to determine whether one is dealing with a tumour or a vascular malformation, given the different evolution of both processes and, hence, the different treatments they require. Diagnosis is basically clinical, based on a correct anamnesis and a detailed physical exploration. The first thing is to establish whether the lesion was present at birth and has changed size significantly, which would lead one to think of a haemangioma or, on the contrary, whether it is congenital and of very slow growth, such as vascular malformations. Facing dubious lesions, it is recommendable to carry out a biopsy with immunohistochemistry for the GLUT-1 antibody, specific to haemangiomas. Amongst the image tests, the first choice is usually ecography-Doppler, which makes it possible to determine whether the lesion is of high or low flow and to distinguish whether one is dealing with a haemangioma or a vascular malformation. Depending on the type of lesion, its localisation and degree of affectation it might be necessary to carry out radiography, magnetic resonance, phlebography, angio-resonance, arteriography or lymphoscintigraphy to complete the study. In more particular cases, such as multiple haemangiomatosis, it is necessary to carry out an hepatic echography, blood concealed in faeces, gastroscopy and colonoscopy, as well a determination of thyroid hormones; and in venous or combined extensive malformations, a haemogram and coagulation tests. On the other hand, the possible repercussions on other organs make a multidisciplinary approach essential, with the participation of different specialists. Due to the wide spectrum covered by vascular anomalies, treatment must be individualised

Actualización en malformaciones venosas

Venous malformations represent 2/3rds of all vascular malformations and are frequently much more complex than they appear to be. Patients with large venous malformations require a deep analytical and radiological study, as well as specific treatment to control any possible localised intravascular coagulation. If the lesions are extensive, especially in the lower member, a study should be made to detect the presence of an underlying osteoporosis with the idea of preventing pathological fractures. Equally, a check must be made for arthropathy, and an early prophylactic synovectomy must be considered when the radiological extension makes this advisable, with the idea of avoiding irreversible damage to the joints with the passage of time. Currently, microfoam scleropathy is favoured as the treatment of choice for low-flow vascular malformations. In the not too distant future, the use of selective antiangiogenic medicines, besides low-molecularweight heparins

Tipificación y caracterización de granjas cinegéticas de faisán (Phasianus colchicus) en España

This research typified and characterised the pheasant (Phasianus colchicus) game farms in Spain using structural and marketing variables. A structured survey was given to 25 private-owned farms in May 2010. A categorical principal components analysis performed to typify the farms yielded two dimensions. First dimension explained 50.5% of the variance and included the variables “number of females in the breeding flock”, and “the farm is of complete-cycle or not”. Second dimension explained 32.3% of the variance and included the variables “age of the farm” and “the farm advertises its activity in the game press”. A cluster analysis differentiated four farm typologies. Farm type 1 included 28% of the farms, being recent (established between 1990 and 2003), complete-cycle and medium-sized (breeding flock of 15 to 300 females), with low advertising activity in the game press and without a hunting preserve. Farm type 2 included 28% of the farms, being the most recent (established between 1994 and 2008), without breeding flock, with low advertising activity, and most have hunting preserve. Farm type 3 included 20% of the farms, being old (established between 1983 and 1992), without breeding flock and with high advertising activity; 40% of them have hunting preserve. Farm type 4 included 24% of the farms, being old (established between 1980 and 1995), complete-cycle and high-sized (breeding flock of 50 to 1,000 females), with high advertising activity; most have hunting preserve. In conclusion, this is an alternative poultry sub-sector consolidated in Spain, despite being only three decades old.Se tipificaron y caracterizaron granjas cinegéticas de faisán (Phasianus colchicus) en España usando variables de estructura y comercialización obtenidas mediante encuesta a 25 granjas privadas en 2010. Un análisis de componentes principales categóricos realizado para tipificar las granjas generó dos dimensiones. La primera dimensión explicó el 50,5% de la varianza e incluyó las variables “número de hembras reproductoras” y “la granja es de ciclo completo o no”. La segunda dimensión explicó el 32,3% de la varianza e incluyó las variables “edad de la granja” y “la granja se publicita en prensa cinegética”. Un análisis de conglomerados subsiguiente diferenció cuatro tipologías de granjas. La tipología 1 incluyó al 28% de las granjas, siendo recientes (fundadas entre 1990 y 2003), de ciclo completo y tamaño medio (15 a 300 hembras reproductoras), con baja actividad publicitaria en prensa cinegética y sin coto de caza. La tipología 2 incluyó un 28% de las granjas, siendo las más recientes (fundadas entre 1994 y 2008), sin reproductores, con baja actividad publicitaria y la mayoría con coto. La tipología 3 incluyó un 20% de las granjas, siendo antiguas (fundadas entre 1983 y 1992), sin plantel reproductor y con elevada actividad publicitaria; el 40% tienen coto. La tipología 4 incluyó un 24% de las granjas, siendo antiguas (fundadas entre 1980 y 1995), de ciclo completo y gran tamaño (50 a 1.000 hembras reproductoras), con elevada actividad publicitaria y la mayoría con coto. Con sólo tres décadas de existencia este subsector avícola alternativo está consolidado en Españ

Linear basal cell carcinoma of the lower eyelid: Reconstruction with a musculocutaneous transposition flap

Linear basal cell carcinoma (LBCC) is a rare morphologic variant of basal cell carcinoma. It is defined as a basal cell carcinoma that grows following a linear pattern, with a longitudinal diameter longer that its width. This entity was first reported by Lewis in 1985,1 and since then approximately 50 new cases have been described. LBCC characteristically spreads following relaxed skin tension lines, and the most frequent site is the lower eyelid. Currently, some controversy exists regarding the most appropriate surgical approach and reconstructive technique for LBCC. For this reason, we present 2 cases recently managed in our center

Simplifying forehead and temple reconstruction: a narrative review

The forehead and temporal region are frequent areas of skin cancer development. After tumor removal, reconstruction must be performed, maintaining the frontal-temporal line of the scalp and symmetry of the eyebrows in an attempt to hide the scars within these marks or natural folds and wrinkles. Second wound healing and skin grafts generally do not produce an acceptable cosmetic result. When direct closure is not possible, the technique of choice is skin flaps. In the midfrontal line continuation of the glabella, there is a remnant of skin to be used as a donor area for local flaps; similarly, it occurs in the preauricular cheek, which can move toward the temple. In addition to the classic advancement and rotation flaps, the frontalis myocutaneous transposition flap is an excellent technique for closing defects which are wider than higher on the forehead. Its design is very versatile and can be performed between the two pupil lines at different heights depending on the location of the defect. On the other hand, the preauricular skin advancement flap with an infralobular Burow's triangle is also an excellent option for reconstructing tumors in the temporal area

Length of the artificial incubation in red-legged partridge (Alectoris rufa)

La incubación artificial de los huevos es una fase del manejo clave para la viabilidad de las granjas cinegéticas de perdiz roja (Alectoris rufa). Sin embargo, la duración de la incubación artificial y la dispersión de las eclosiones no han sido previamente cuantificadas en esta especie. Con este objetivo se analizaron cuatro ensayos de incubación artificial de huevos de perdiz roja procedentes de tres granjas cinegéticas del sur de España realizados incluyendo variabilidad de factores de manejo de los reproductores y de la incubación. La duración media de la incubación fue de 23,4 días, difiriendo entre ensayos (P = 0,004), con un valor modal de 23 días y finalizando la mayoría de las eclosiones (percentil 95) el día 24,5 de incubación. La eclosión mostró una distribución asimétrica positiva y leptocúrtica, como corresponde al patrón de eclosión de las especies precociales. Las eclosiones, que pueden comenzar el día 21,5 y finalizar el día 26 de incubación, se extendieron en promedio durante cuatro días, periodo mayor que el descrito en la literatura divulgativa probablemente porque en el presente estudio los huevos no estuvieron en contacto entre sí, lo que pudo limitar la sincronía en la eclosión. Los resultados de este estudio son útiles para conocer la distribución de la eclosión en las granjas cinegéticas de perdiz roja, posibilitando la mejora del manejo de los lotes de huevos en la nacedoraThe artificial incubation of the eggs is a key management phase for the feasibility of the red-legged partridge (Alectoris rufa) game farms. However, the length of the artificial incubation and the spreading pattern of the hatching have not been previously quantified in this species. To this end, four trials of artificial incubation of eggs from three red-legged partridge game farms located in southern Spain were analised. The trials included a wide range of variability with regard to management of breeders and incubation process. The average length of the incubation period was 23.4 days, with differences among trials (P = 0,004), showing a modal value of 23 days. Most of the chicks (percentile 95) hatched before 24.5 days of incubation. The distribution of the hatch was leptokurtic and showed positive asymmetry, fitting with the hatching pattern of the precocial species. The hatching, that can start on day 21.5 and finish on day 26 of incubation, were spread over four days on average. This period was longer than that described in the informative literature, probably because in the present study the eggs were not in contact with each other, which could have limited the hatching synchrony. The results of the present study are useful to understand the distribution of hatching in the red-legged game farms, enabling improved management of the batches of eggs in the hatchery

Differential modulation of IL-8 and TNF-α expression in human keratinocytes by buflomedil chlorhydrate and pentoxifylline

Pentoxifylline (PTX) is a methylxanthine derivative used in a wide range of dermatoses. As well as its hemorrheologic activity, PTX has anti-inflammatory properties. Buflomedil chlorhydrate (BC) is another hemorrheological drug with peripheral vasodilatory action, whose clinical uses are similar to those of PTX. Both drugs increase intracellular levels of cAMP, either secondary to phosphodiesterase inhibition (PTX) or adenyl-cyclase stimulation (BC). Long-term cultures of normal human keratinocytes were prepared in a free-serum medium, and stimulated with 1 mg/ml of phorbol 12-myristate 13-acetate (TPA) and PTX or BC (100-1000 micrograms/ml). Levels of TNF-alpha, IL-1 alpha, IL-1 beta, IL-8 and TGF-beta 1 using ELISA and Northern blot or RT-PCR techniques were measured. TPA-induced TNF-alpha and IL-8 release from keratinocytes. TPA did not induce IL-1 alpha or IL-1 beta release of keratinocytes. TPA increased RNA expression of the TNF-alpha, IL-1 alpha, IL-1 beta, IL-8 and TGF-beta 1. BC diminished TPA-induced TNF-alpha and IL-8 release from keratinocytes; in the case of IL-8 it is possible that this inhibition occur to transcriptional level. Moreover PTX was unable to inhibit TNF-alpha and IL-8 synthesis and expression. PTX and BC reduced TPA-induced IL-1 alpha and beta expression. It is possible that BC action is specifically exerted on keratinocytes, because we did not find similar results with TNF-alpha and IL-8 synthesis in mononuclear peripheral blood cells