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La gota es el trastorno del metabolismo de las purinas que se caracteriza por acumulación de ácido úrico por aumento de su producción o por disminución de su excreción. Con el paso del tiempo, el exceso de urato monosódico permite que se deposite en diferentes tejidos del organismo; siendo particularmente infrecuente la presentación de tofos a nivel facial. Paciente masculino adulto de 56 años, con antecedente de gota hace 38 años y presencia de tofos gotosos a nivel de miembros superiores e inferiores que acude por cuadro de 4 años de evolución de lesión indurada, levemente dolorosa a nivel de tercio medio de dorso nasal que ha ido aumentando de tamaño, que causa deformidad de pirámide nasal y leve sensación de obstrucción nasal bilateral por lo que se planifica resolución quirúrgica. El análisis histopatológico de las muestras enviadas bajo exéresis quirúrgica confirma que tejido enviado corresponde a tofo gotoso. Los tofos gotosos pueden aparecer en diferentes tejidos, como cartílagos, membranas y líquido sinovial, superficies articulares, siendo excepcionalmente raro, en el miocardio, válvulas mitral y aórtica, ojos, nariz y médula espinal. El lugar de presentación puede ser muy variable, al igual que su tamaño

Gout is a purine metabolism disorder characterized by accumulation of uric acid due to increased production or decreased excretion. Over time, excess monosodium urate allows it to be accumulated in different body tissues, although the occurrence in the facial area is particularly infrequent. A 56- year-old male patient with a gout antecedent from 38 years ago that presented gouty tophi at the level of the upper and lower limbs seek medical advice due to an indurated slightly painful lesion at the level of the middle third of the nasal dorsum that started 4 years before and has been increasing in size. The lesion was causing nasal pyramid deformity and a slight sensation of bilateral nasal obstruction, for which surgical resolution is planned. The histopathological analysis of the samples sent under surgical exeresis confirms that the tissue sample corresponds to gouty tophi. Gouty tophi can appear in different tissues, such as cartilage, membranes and synovial fluid, joint surfaces, being exceptionally rare in the myocardium, mitral and aortic valves, eyes, nose and spinal cord. The place of presentation can be very variable, as well as its size

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Abstract Introduction Augmentation rhinoplasty depends mainly on intact stable bony and cartilaginous parts. Many trials have used different materials as a graft to perform the operation and support the nose. Debate exists whether alloplastic or autogenic grafts are more appropriate. Common available alloplastic grafts include silicone, medpor, and gore-tex. Autogenic grafts are usually derived from costal cartilages. Warping, infection, and hypertrophic scars are the main complications of the procedure. Yet no subgroup analysis has been performed to investigate the effect of different risk factors. Objective To investigate the effect of different types of grafts and the association of the income level of the country on surgery complications. Methods A comprehensive literature search of articles was conducted in PubMed, Cochrane Library, Web of Science, and SCOPUS databases through October 2019. We included articles that used autologous or alloplastic grafts in nasal dorsum reconstruction surgery. We performed subgroup analysis according to the type of graft used, region, and income level of the country. A meta-regression analysis model was carried out from the period of 1999-2018, to study the incidence of these complications over time. Results The overall complication rate was 7.1%, which was higher in the alloplastic group (7.8%) than the autogenic group (6.9%). The most common complications were secondary surgery for re-correction (4.1%), infection (2.1%), warping (1.6%), and hypertrophic scars (1.6%). All outcomes were homogeneous (I2 < 50%). Conclusion Patients with autogenic grafts are less liable to develop complications than their peers reconstructed with alloplastic grafts. Moreover, Asian patients are less susceptible to overall rhinoplasty complications. Attention should be noted for low-income countries in which surgical complications are more prone to occur.

Resumo Introdução A feitura de uma rinoplastia de aumento depende principalmente das partes ósseas e cartilaginosas intactas. Muitos estudos usaram enxertos de diferentes materiais para a feitura da cirurgia e como apoio da estrutura nasal. Ainda existem controvérsias em estudos prévios sobre quais tipos de enxertos, se materiais aloplásticos ou autogênicos, seriam os mais adequados. Os enxertos aloplásticos comuns incluem silicone, medpor e gore-tex. Os enxertos autogênicos são geralmente derivados de cartilagens costais. Deformações, infecção e cicatrizes hipertróficas são as principais complicações do procedimento. No entanto, nenhuma análise de subgrupo foi feita para investigar o efeito de diferentes fatores de risco. Objetivo Investigar o efeito de diferentes tipos de enxertos e o nível de renda do país nas complicações cirúrgicas Método Uma pesquisa abrangente de artigos na literatura foi feita nas bases de dados PubMed, Cochrane Library, Web of Science e SCOPUS até outubro de 2019. Foram incluídos artigos que usaram enxertos autólogos ou aloplásticos em cirurgias de reconstrução do dorso nasal. Foi feita uma análise de subgrupos de acordo com o tipo de enxerto usado, região e nível de renda do país. Um modelo de análise de metarregressão foi feito de 1999 a 2018, para estudar a incidência dessas complicações ao longo do tempo. Resultados A taxa global de complicações foi de 7,1%, a qual foi maior no grupo aloplástico (7,8%) do que no grupo autogênico (6,9%). As complicações mais comuns foram cirurgia secundária para recorreção (4,1%), infecção (2,1%), deformidade (1,6%) e cicatrizes hipertróficas (1,6%). Todos os resultados foram homogêneos (I2 < 50%). Conclusão Os pacientes com enxertos autogênicos são menos propensos a desenvolver complicações, em comparação com seus pares com enxertos aloplásticos. Além disso, pacientes asiáticos são menos suscetíveis a complicações gerais da rinoplastia. Merece atenção o fato de que em países de baixa renda as complicações cirúrgicas são mais propensas a ocorrer.

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INTRODUCTION: Augmentation rhinoplasty depends mainly on intact stable bony and cartilaginous parts. Many trials have used different materials as a graft to perform the operation and support the nose. Debate exists whether alloplastic or autogenic grafts are more appropriate. Common available alloplastic grafts include silicone, medpor, and gore-tex. Autogenic grafts are usually derived from costal cartilages. Warping, infection, and hypertrophic scars are the main complications of the procedure. Yet no subgroup analysis has been performed to investigate the effect of different risk factors. OBJECTIVE: To investigate the effect of different types of grafts and the association of the income level of the country on surgery complications. METHODS: A comprehensive literature search of articles was conducted in PubMed, Cochrane Library, Web of Science, and SCOPUS databases through October 2019. We included articles that used autologous or alloplastic grafts in nasal dorsum reconstruction surgery. We performed subgroup analysis according to the type of graft used, region, and income level of the country. A meta-regression analysis model was carried out from the period of 1999-2018, to study the incidence of these complications over time. RESULTS: The overall complication rate was 7.1%, which was higher in the alloplastic group (7.8%) than the autogenic group (6.9%). The most common complications were secondary surgery for re-correction (4.1%), infection (2.1%), warping (1.6%), and hypertrophic scars (1.6%). All outcomes were homogeneous (I2 < 50%). CONCLUSION: Patients with autogenic grafts are less liable to develop complications than their peers reconstructed with alloplastic grafts. Moreover, Asian patients are less susceptible to overall rhinoplasty complications. Attention should be noted for low-income countries in which surgical complications are more prone to occur.

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RESUMEN: El músculo extensor corto de los dedos (ECD) se sitúa junto con el músculo extensor corto del hallux (ECH) en la región dorsal del pie y están encargados de colaborar con la acción agonista de los músculos extensor largo de los dedos (ELD) y extensor largo del hallux (ELH), en la extensión de los cuatro dedos mediales en las articulaciones metatarsofalángicas. Esta condición complementaria permite su transferencia quirúrgica hacia otras regiones receptoras sin afectar la funcionalidad extensora de los dedos del pie motivo por el cual durante las últimas décadas se ha convertido en un tejido importante para la reconstrucción de lesiones tisulares, sin embargo, son escasos los estudios biométricos que lo describan en detalle. El objetivo de esta investigación fue establecer la longitud, ancho y área de extensión de estos músculos acompañada de la determinación de las distancias de éstos respecto a la cuña medial y la base del quinto metatarsiano para su uso quirúrgico. Sumado a lo anterior y posterior a la descripción de las variantes musculares encontradas se determinó los puntos motores de inervación de estos dos músculos. Para ello se estudiaron 36 miembros inferiores formolizados de individuos adultos brasileños pertenecientes a la Universidad Federal de Alagoas (UFAL), Maceió, Brasil. Las mediciones se realizaron con un cáliper marca Mitutoyo de 0,01 mm de precisión obteniendo una longitud, ancho y área de 6,89 ± 1,64 cm, 3,81 ± 0,42 cm y 31,98 ± 7,60 cm2 en el lado derecho de 6,91 ± 1,64 cm, 3,68 ± 0,46 cm y 30,75 ± 7,61 cm2 en el izquierdo respectivamente. En el 17 % de los casos hay presencia de tendones accesorios para el músculo ECD. La distancia desde el margen medial del músculo ECH respecto a la cuña medial y del margen lateral del músculo ECD a la base del quinto metatarsiano fue de 1,97 ± 0,43 y 1,72 ± 0,41 al lado derecho y de 2,01 ± 0,62 y 1,87 ± 0,36 al lado izquierdo respectivamente. Los puntos motores (Pm) predominaron en un 64 % en el tercio medio del músculo ECH y en un 64 % en el tercio proximal del músculo ECD. Estos resultados son un aporte significativo, tanto para quienes realizan cirugía ortopédica como para el conocimiento detallado de la anatomía dorsal del pie.

SUMMARY: The extensor digitorum brevis muscle (EDB) is located along with the extensor hallucis brevis (EHD) in the dorsal region of the foot and are responsible for collaborating with the agonist action of the extensor digitorum longus muscles (EDL) and extensor hallucis longus (EHL) in the extension of the four medial fingers in the metatarsophalangeal joints. This complementary condition allows its surgical transfer to other receptor regions without affecting the extensor functionality of the toes, which is why during the last decades it has become an important tissue for the reconstruction of tissue injuries, however, there are few studies biometrics that describe it in detail. The objective of this investigation was to establish the length, width and area of extension of these muscles accompanied by the determination of their distances from the medial wedge and the base of the fifth metatarsal for surgical use. In addition to the above and after the description of the muscle variants found, the innervation motor points of these two muscles were determined. To do this, 36 formalized lower limbs of Brazilian adult individuals belonging to the Federal University of Alagoas (UFAL), Maceió, Brazil, were studied. Measurements were made with a 0.01 mm precision Mitutoyo caliper obtaining a length, width and area of 6.89 ± 1.64 cm, 3.81 ± 0.42 cm and 31.98 ± 7.60 cm2 on the right side of 6.91 ± 1.64 cm, 3.68 ± 0.46 cm and 30.75 ± 7.61 cm2 on the left, respectively. In 17 % of cases there is presence of accessory tendons for the EDB muscle. The distance from the medial margin of the EHB muscle with respect to the medial wedge and the lateral margin of the EDB muscle to the base of the fifth metatarsal was 1.97 ± 0.43 and 1.72 ± 0.41 on the right side and 2,01 ± 0.62 and 1.87 ± 0.36 on the left side respectively. Motor points (Pm) predominated in 64 % in the middle third of the EHB muscle and in 64 % in the proximal third of the EDB muscle. These results are a significant contribution both for those who perform orthopedic surgery and for detailed knowledge of the dorsal foot anatomy.

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Geographical distribution of color phenotypes and associations with ecological predictors remains poorly understood. An important geographic pattern concerning this topic is Gloger's rule, which predicts the increase of pigmentation in endothermic animals from cold and dry to warm and wet environments. Didelphid marsupials exhibit a variety of color patterns, ranging from light and dark uniform to more complex colorations. However, surprisingly little is known about the adaptive significance of dark coloration in this singular group of mammals. Using a phylogenetic comparative approach, we investigated whether coloration in different body regions of didelphids (i.e., dorsum and face) is associated with variables representing heat and humidity of the environment, as predicted by Gloger's rule. We demonstrated that Gloger's rule explains the interspecific color variation in American marsupials, especially when considering the facial region. Thus, dark coloration was more frequent among didelphid species occupying warm and wet environments than cold and dry environments. We also discuss the selective forces that can potentially explain coat color variation in didelphid marsupials, including camouflage, pathogen resistance, and pleiotropy hypotheses.

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Abstract Introduction: In rhinoplasty, the nasal dorsum has important relevance regarding the esthetic and functional aspects of the surgery. Its reduction should be performed with maximum accuracy and controlled resection to prevent or minimize potential complications. The septum pyramidal adjustment and repositioning consists of a conservative surgical technique of the nasal dorsum, which does not require the detachment of the upper lateral cartilages of the nasal septum, allowing the remodeling of the nasal dorsum while maintaining esthetic lines and nasal function, potentially reducing frequent complications in more traditional surgeries. Objective: To describe the septum pyramidal adjustment technique in detail, presenting its advantages and disadvantages in relation to the other surgical approaches, as well as to disclose results of this surgical procedure in patients submitted to primary rhinoplasty in a specific hospital. Methods: The medical records of all patients submitted to surgery from 2011 to 2015 through this surgical technique were evaluated by the same team. Of these cases, certain variables were analyzed such as gender, age, indication for reoperation and surgical complications. Results: 153 patients underwent rhinoplasty through septum pyramidal adjustment. Of these, 13 patients experienced an indication for a second surgery and four had some type of postoperative complication. Conclusion: The septum pyramidal adjustment surgical technique is a simple procedure, as it does not require the reconstruction of the nasal dorsum. It has a low number of complications and preserves the anatomical structures.

Resumo Introdução: Na rinoplastia, o dorso nasal tem importante relevância no quadro estético e funcional. A sua redução deve ser realizada com máxima precisão e ressecção controlada a fim de prevenir ou minimizar complicações potenciais. O termo septum pyramidal adjustment and repositioning consiste em uma técnica cirúrgica conservadora do dorso nasal, que não requer a desinserção das cartilagens laterais superiores do septo nasal, que permite remodelar o dorso nasal, manter as linhas estéticas e a função nasal, reduz potencialmente complicações frequentes nas cirurgias mais tradicionais. Objetivo: Descrever em detalhes o septum pyramidal adjustment, expor suas vantagens e desvantagens em relação às outras abordagens cirúrgicas, bem como apresentar resultados desse procedimento cirúrgico em pacientes submetidos à rinoplastia primária em um hospital específico. Método: Foram avaliados os registros médicos de todos os pacientes operados de 2011 a 2015 por essa técnica cirúrgica, pela mesma equipe. Desses casos, foram analisadas algumas variáveis, como: sexo, idade, indicação de reoperação e complicações cirúrgicas. Resultados: Foram submetidos 153 pacientes à rinoplastia por septum pyramidal adjustment. Desses, 13 tiveram segunda indicação cirúrgica e quatro apresentaram alguma complicação pós-operatória. Conclusão: A técnica cirúrgica septum pyramidal adjustment apresenta-se como um procedimento de fácil realização, pois não exige a reconstrução do dorso nasal. Apresenta baixo número de complicações e preserva as estruturas anatômicas.

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Abstract Introduction: Following nasal hump removal during septorhinoplasty, the middle vault should be reconstructed to avoid functional and esthetic problems. Middle vault reconstruction, however, may result in widening of the middle vault and may need a camouflage graft to cover dorsal irregularities. Objective: To present the results of reconstructing the middle vault with a technique that covers the nasal dorsum with upper lateral cartilage, from the viewpoint of patient satisfaction. Methods: Retrospective study of patients who underwent septorhinoplasty that included nasal dorsum closure with upper lateral cartilage from December 1, 2014 to January 31, 2016. Those with postoperative follow-up of less than 3 months were excluded. The final study group included 39 patients. The same surgeon performed all septorhinoplasties. The dorsum was closed using an "upper lateral closing" technique that approximated upper lateral cartilages to each other over the septum. Postoperative patient satisfaction was determined using a visual analog scale and the rhinoplasty outcomes evaluation questionnaire. The questionnaire evaluates patient esthetic and functional satisfaction with the operated nose. High scores indicate improved esthetic results. Results: No dorsal irregularities were seen at postoperative follow-up evaluation of the patients. For esthetic nasal appearance, the median visual analogue scale scores was 86%, and the mean for the questionnaire was 77.03%. Conclusion: The natural dome-shaped anatomy of the nasal dorsum was achieved by approximating the upper lateral cartilages to each other. Closing the dorsum with this technique also covers any dorsal irregularities and results in a smooth dorsum. Patients expressed satisfaction with the esthetic and functional aspects of the smooth, attractive nasal dorsum.

Resumo Introdução: Após a remoção da giba nasal durante a rinosseptoplastia, a abóbada deve ser reconstruída para evitar problemas funcionais e estéticos. A reconstrução da abóboda entretanto, pode resultar em alargamento dorsal e pode necessitar de um enxerto para camuflar irregularidades dorsais. Objetivo: Avaliar a satisfação dos pacientes com os resultados da reconstrução da abóboda com uma técnica que utiliza a cartilagem lateral superior para recobrir o dorso nasal. Método: Estudo retrospectivo de pacientes submetidos a rinosseptoplastia, que incluiu fechamento do dorso nasal com cartilagem lateral superior, realizado de 1º de dezembro de 2014 a 31 de janeiro de 2016. Foram excluídos aqueles com acompanhamento pós-operatório de menos de 3 meses. O grupo final do estudo incluiu 39 pacientes. O mesmo cirurgião realizou todas as rinosseptoplastias. O dorso foi fechado com uma técnica de "fechamento lateral superior" que aproxima as cartilagens laterais superiores de cada lado sobre o septo. A satisfação pós-operatória dos pacientes foi determinada através de uma escala visual analógica e o questionário Rhinoplasty Outcomes Evaluation. O questionário avalia a satisfação estética e funcional do paciente com o nariz. Escores altos indicam percepção de melhoria estética. Resultados: Não foram observadas irregularidades dorsais na avaliação pós-operatória de seguimento dos pacientes. Em relação à aparência nasal estética, o escore médio da escala visual analógica foi 86% e o escore médio do questionário foi 77,03%. Conclusões: A anatomia natural em forma de domo do dorso nasal foi conseguida através da aproximação das cartilagens laterais superiores entre si. O fechamento do dorso com essa técnica também abrange todas as irregularidades dorsais e resulta em um dorso liso. Os pacientes expressaram satisfação com os aspectos estéticos e funcionais do dorso nasal liso e atraente.

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INTRODUCTION: In rhinoplasty, the nasal dorsum has important relevance regarding the esthetic and functional aspects of the surgery. Its reduction should be performed with maximum accuracy and controlled resection to prevent or minimize potential complications. The septum pyramidal adjustment and repositioning consists of a conservative surgical technique of the nasal dorsum, which does not require the detachment of the upper lateral cartilages of the nasal septum, allowing the remodeling of the nasal dorsum while maintaining esthetic lines and nasal function, potentially reducing frequent complications in more traditional surgeries. OBJECTIVE: To describe the septum pyramidal adjustment technique in detail, presenting its advantages and disadvantages in relation to the other surgical approaches, as well as to disclose results of this surgical procedure in patients submitted to primary rhinoplasty in a specific hospital. METHODS: The medical records of all patients submitted to surgery from 2011 to 2015 through this surgical technique were evaluated by the same team. Of these cases, certain variables were analyzed such as gender, age, indication for reoperation and surgical complications. RESULTS: 153 patients underwent rhinoplasty through septum pyramidal adjustment. Of these, 13 patients experienced an indication for a second surgery and four had some type of postoperative complication. CONCLUSION: The septum pyramidal adjustment surgical technique is a simple procedure, as it does not require the reconstruction of the nasal dorsum. It has a low number of complications and preserves the anatomical structures.

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INTRODUCTION: Following nasal hump removal during septorhinoplasty, the middle vault should be reconstructed to avoid functional and esthetic problems. Middle vault reconstruction, however, may result in widening of the middle vault and may need a camouflage graft to cover dorsal irregularities. OBJECTIVE: To present the results of reconstructing the middle vault with a technique that covers the nasal dorsum with upper lateral cartilage, from the viewpoint of patient satisfaction. METHODS: Retrospective study of patients who underwent septorhinoplasty that included nasal dorsum closure with upper lateral cartilage from December 1, 2014 to January 31, 2016. Those with postoperative follow-up of less than 3 months were excluded. The final study group included 39 patients. The same surgeon performed all septorhinoplasties. The dorsum was closed using an "upper lateral closing" technique that approximated upper lateral cartilages to each other over the septum. Postoperative patient satisfaction was determined using a visual analog scale and the rhinoplasty outcomes evaluation questionnaire. The questionnaire evaluates patient esthetic and functional satisfaction with the operated nose. High scores indicate improved esthetic results. RESULTS: No dorsal irregularities were seen at postoperative follow-up evaluation of the patients. For esthetic nasal appearance, the median visual analogue scale scores was 86%, and the mean for the questionnaire was 77.03%. CONCLUSION: The natural dome-shaped anatomy of the nasal dorsum was achieved by approximating the upper lateral cartilages to each other. Closing the dorsum with this technique also covers any dorsal irregularities and results in a smooth dorsum. Patients expressed satisfaction with the esthetic and functional aspects of the smooth, attractive nasal dorsum.

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RESUMEN Introducción: La rinoseptoplastía es una cirugía compleja y desafiante. Permite resolver problemas estéticos y funcionales de la nariz. Objetivo: Describir la experiencia en rinoseptoplastías realizadas en el Comité de Nariz en nuestro centro. Material y método: Estudio descriptivo de pacientes sometidos a rinoseptoplastía entre 2013 y 2015. Resultados: Se operaron 265 pacientes en 3 años, 164 (61,8%) fueron mujeres y la edad promedio fue de 29 años (rango 13-73). Las cirugías fueron principalmente primarias (secundarias: 2,6%). El abordaje más utilizado fue abierto (92,5%). Se realizó trabajo de punta nasal en 253 (95,5%) pacientes; resección del dorso osteocartilaginoso en 252 (95,1%), y aumento de éste en sólo 5 (1,9%). Las osteotomías fueron frecuentes: paramedianas en 229 (86,4%), percutánea lateral bilateral en 217 (81,9%) y percutánea lateral unilateral en 17 (6,4%). El vástago columelar fue el injerto de punta más frecuentemente utilizado, en 241 (90,9%) pacientes, seguido del escudo en 69 (26,0%). En el dorso, se utilizaron autoespaciadores en 124 (46,7%) pacientes, y espaciadores en 109 (41,1%). Conclusiones: El abordaje abierto fue el más frecuente, demostrando ser favorable en nuestro centro por la exposición y aprendizaje de nuestros residentes. Se constató 2,6% de cirugías secundarias. Se destaca el uso de vástago columelar para otorgar soporte a la punta nasal dada la alta prevalencia de nariz hispana en nuestro centro.

ABSTRACT Introduction: Rhinoseptoplasty is a complex and challenging surgery. It addresses nasal aesthetics and functionality. Aim: To describe the experience in rhinoseptoplasty performed by the Nose Committee at our medical center. Material and method: Descriptive study, of the all rhinoseptoplasties performed by the Nose Committee between 2013 and 2015. Results: 265 patients underwent surgery in the 3-year period; 164 (61.8%) were women and the mean age was 29 years (range 13-73). Most were primary surgeries (secondary: 2.6%). An external approach was most commonly used (92.5%). Nasal tip surgery was performed in 253 (95.5%) patients; osteocartilaginous dorsum reduction in 252 (95,1%), and augmentation in only 5 (1,9%). Osteotomies were frequent: paramedian in 229 (86.4%), bilateral percutaneous lateral osteotomies in 217 (81.9%) and unilateral percutaneous lateral in 17 (6.4%). Regarding nasal tip grafts, columellar strut was most often used, in 241 (90,9%) patients, followed by the shield graft in 69 (26,0%). For the dorsum, autospreaders were used in 124 (46.7%), and spreader grafts in 109 (41.1%). Conclusions: Open rhinoseptoplasty was the most commonly used approach. This has shown favorable for residents due to better exposition of nasal anatomy. Only 2.6% were secondary rhinoseptoplasties. We emphasize the use of the columellar strut for nasal tip support as we frequently encounter hispanic noses at our center.

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Despite the frequent clinical hyper- or hypothermia cases, thermal-dependence of the endogenous pain modulation system at the spinal cord is not well understood. We evaluate spinal dorsal horn neuronal network responses during mechanical heterotopic noxious stimuli (HNS) at three different body temperatures (34; 37 or 40°C) by measuring lumbar cord dorsum potentials activated by electrical stimulation of the ipsilateral sural nerve in adult thiopental anesthetized rats. A noxious clamp was applied randomly to the tail, right hindpaw, right forepaw, muzzle and left forepaw. HNS induced a decrease of the N wave amplitude and duration at 37°C. This effect was reduced at 40°C for both amplitude (-18.2% for 37-40°C; P<0.0005) and duration (-16.4% for 37-40°C; P<0.0001). P wave did not show neither amplitude nor duration changes at neither 3 tested temperatures. Clinical range changes of temperature could modify pain sensation, moreover, hyperthermia increases nociceptive sensory input to dorsal horn, and could exacerbate pain sensation in individuals with fever.

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Anatomical variations in the shape and dimension of the dorsum sellae and posterior clinoid process are common. Most textbooks describe its shape as a median rectangular plate, a square plate, or a transverse ledge on a slope behind the sella turcica (hypophyseal fossa). This work aims to study the dorsum sellae of human skull. One hundred and twenty five dried adult human skulls, irrespective of age, were used for the study. Detailed features of the dorsum sellae were noted and classified into five types: crest like, thin plate, frail quadrilateral plate, heavy square plate, thick elongated plate. Fusion of the posterior and middle clinoid processes in one (unilateral) and all the clinoid processes (anterior, middle, and posterior) in three skulls (unilateral in one, bilateral in two) were also noticed. Findings are discussed in the light of the literature.

Son frecuentes las variaciones anatómicas de la forma y dimensión de dorsum sellae y de los procesos clinoides posteriores. La mayoría de los textos describen su forma como una placa rectangular mediana, una placa cuadrada, o un plano transversal en una pendiente detrás de la sella turcica (fosa hipofisaria). Este trabajo tiene como objetivo estudiar el dorsum sellae en cráneo humano. Para el estudio se utilizaron 125 cráneos humanos adultos secos, de diferentes edades. Se observaron características detalladas de dorsum sellae y se clasificaron en cinco tipos: cresta, al igual que la placa delgada, lámina cuadrilátera, placa cuadrada gruesa, placa alargada gruesa. En tres cráneos se observó fusión de la parte posterior y los procesos clinoides intermedios (unilateral) y los procesos clinoides (anterior, medio y posterior) (unilateral en uno de ellos, bilateral en dos). Los resultados se discuten en consideracion de la literatura.

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SUMMARY Scleredema of Buschke (SB) is a rare disorder of connective tissue characterized by diffuse non-pitting induration of the skin, mainly on the cervical, deltoid and dorsal regions. It is a cutaneous mucinosis of unknown etiology and is associated with bacterial or viral infections, hematological disorders and diabetes mellitus. Histopathological examination shows thickened dermis with wide collagen bundles separated by gaps that correspond to mucopolysaccharide deposits, visualized using special staining. Several treatments are reported in the literature without well-established results. We report a case of SB in a patient with type 2 diabetes mellitus.

RESUMO Escleredema de Buschke (EB) é doença rara do tecido conjuntivo caracterizada por endurecimento difuso e não depressível da pele, principalmente nas regiões cervical, deltoideanas e dorso. Enquadrado no grupo das mucinoses cutâneas, tem etiologia desconhecida e associação com: infecções bacterianas ou virais, alterações hematológicas e diabetes mellitus. O exame histopatológico evidencia derme espessada com fibras colágenas calibrosas separadas por fendas que correspondem a depósito de mucopolissacárides, observados por colorações especiais. Diversos tratamentos são relatados na literatura sem resultados bem definidos. Descrevemos caso de EB em paciente com diabetes mellitus tipo 2.

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Palpable irregularities along the nasal dorsum are a frequent complication of dorsal handling in rhinoplasty because resection techniques are used. This is often a result of improper management of the dorsum after resection. The surgical technique for handling of dorsal irregularities following dorsal resection is described. The key steps to avoid irregularities are diamond rasps, autospreader and morselized cartilage as camouflage. Following resection of the hump, the anatomy of the nasal dorsum should be adequately restructured; thereby we achieve an adequate aesthetic result and ideally preventing irregularities on palpation.

Las complicaciones de un inadecuado manejo del dorso nasal son frecuentes, destacando entre estas la palpación de irregularidades, debido a que en el manejo de la giba nasal se utilizan técnicas resectivas. Se describe una técnica quirúrgica para el manejo del dorso nasal, con énfasis en evitar irregularidades. Los pasos claves para evitar la palpación de irregularidades son: el uso de raspa diamantada, autoespaciador y lámina de cartílago morcelizado como camuflaje. Posterior a la resección de la giba se debe reestructurar de forma adecuada la anatomía del dorso nasal, de esta forma lograremos un resultado estético adecuado e idealmente evitar irregularidades a la palpación.

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Introducción: La dificultad en el adecuado manejo del dorso nasal radica en su pérdida de soporte, razón por la cual el injerto espaciador (spreader graft) ocupa un lugar destacado en rinoplastía, proveyendo amplitud al techo dorsal, a la vez que incrementa el ángulo de la válvula nasal interna, generando una optimización en los resultados estéticos y funcionales de la cirugía nasal. El autoespaciador mantiene estos mismos principios, utilizando el propio cartílago lateral superior. Objetivo: Describir la técnica del autoespaciador, beneficios y la experiencia de los autores en 80 casos de pacientes sometidos a rinoplastía por abordaje abierto y cerrado. Material y método: Trabajo retrospectivo descriptivo, de los pacientes intervenidos quirúrgicamente por autor principal utilizando la técnica señalada. Resultados: Casuística de 80 pacientes, de los cuales 70% sexo femenino, siendo el promedio de edad 30 años. Abordaje abierto en el 50%. No se reportaron complicaciones intraoperatorias, no existieron obstrucciones anatómicas ni funcionales a nivel de la válvula nasal interna, así como tampoco deformaciones estéticas en "V" invertida tras un seguimiento reportando entre 6 y 24 meses. Conclusión: El autoespaciador al igual que el injerto espaciador clásico, previene problemas funcionales manteniendo el ancho del dorso nasal y optimizando el adecuado funcionamiento de la válvula interna, al tiempo que incrementa el éxito estético de la cirugía, pareciendo a los autores, más simple y fisiológico respecto a su predecesor, el injerto espaciador clásico.

Introduction: The difficulty in the proper handling of the nasal dorsum is its loss of support, hence the spreader graft plays an important role in rhinoplasty, providing width to the dorsal ceiling, while increasing the angle of internal nasal valve, generating an optimization in the aesthetic and functional results of nasal surgery. The autospreader maintains these same principles, using the upper lateral cartilage itself. Aim: To describe the technique of autospreader, benefits and the experience of the authors in a series of patients undergoing open and closed rhinoplasty approach. Material and method: A retrospective descriptive study of patients operated on by primary author using the indicated technique. Results: Casuistry of 80 patients, of whom 70% female, average age being 30 years. Open approach 50%. No intraoperative complications were reported, there were no anatomical or functional obstruction at the level of internal nasal valve, neither aesthetic deformities like inverted "V" after a follow reporting between 6 and 24 months. Conclusions: The autospreader, like the classic spreader graft prevents functional problems maintaining the width of the nasal dorsum and optimizing the proper functioning of the internal valve, while increasing the aesthetic success of surgery, seeming to authors more simple and physiological over its predecessor, the spreader graft.

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INTRODUCTION: This study focuses on an anatomic variation in which the lateral antebrachial cutaneous nerve (LACN) innervates the radial border of the dorsum of the hand and thumb in addition to, or replacing, the superficial radial nerve (RSN). Here, we propose a technique of nerve conduction that identifies this variation. METHODS: We studied nerve conduction in 200 upper limbs of two series of 50 volunteers. We sought evidence of the aforementioned variation on the dorsum of the hand and in the thumb. RESULTS: We found eight occurrences of this variation on the dorsum of the hand and 11 variants on the thumb within the two respective series of 100 upper limbs studied. DISCUSSION: The RSN-LACN anatomic variation can be studied using nerve conduction. The knowledge of this variation is particularly important for the evaluation of proximal radial nerve injury.

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Introducción: Un dorso recto es uno de los principales objetivos para los pacientes que se realizan una rinoseptoplastía. Sin embargo, una resección dorsal excesiva puede traer consecuencias estéticas y funcionales. Objetivos: Describir la experiencia del Departamento de Otorrinolaringología del Hospital Clínico de la Pontificia Universidad Católica de Chile en el manejo del dorso nasal. Material y método: Estudio retrospectivo descriptivo. Se revisaron los protocolos quirúrgicos de los pacientes sometidos a una rinoseptoplastía entre enero de 2010 y junio de 2011. Resultados: Se recopiló un total de 153 pacientes, 67% mujeres. La edad promedio fue de 27,5 años. El abordaje fue abierto en el 78%%. Más del 95%% requirió resección dorsal osteocartilaginosa y osteotomías. El injerto espaciador fue el injerto dorsal más frecuente (51%%). En 101 mujeres y 47 hombres se realizó trabajo de punta nasal (p <0,05). Discusión: En nuestra experiencia el abordaje abierto nos permite obtener una visión más clara de la anatomía. La septoplastía, importante en el manejo de la obstrucción nasal, nos permite además obtener injertos de buena calidad. En pacientes de riesgo de colapso valvular, es importante una resección dorsal conservadora y considerar los injertos espaciadores.

Introduction: A right dorsum is one of the main objectives for patients who undergoes to rhinoseptoplasty. However, excessive dorsal resection can bring aesthetic and functional consequences. Aim: To describe the experience in the management of the nasal dorsum by the Hospital Clínico de la Pontificia Universidad Católica de Chile, ENT Department. Material and method: Retrospective study. All patient's surgical protocols of rhinoseptoplasty between January 2010 and June 2011 were reviewed. Results: 153 patients were collected, 67%% of them were women. The average age was 27.5 years. The open approach was performed in 78%%. Over 95%% of patients required dorsal osteocartilaginous resection and osteotomies. The spreader graft was the most commonly used dorsal graft (51%%). In 101 women and 47 men, nasal tip work were performed (p <0.05). Discussion: In our experience the open approach allows us to obtain a clear vision of the nasal anatomy. Septoplasty is important in the management of the nasal obstruction, and it permits to obtain good quality grafts. In patients at risk of valvular collapse is important a conservative dorsal resection and spreader grafts.

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INTRODUCCIÓN: Las lesiones en dorso de mano son urgencias frecuentes de un hospital. Estudiar la relación existente entre la clínica inicial y la afectación tendinosa subyacente en heridas localizadas en esta región. Así como valorar la localización exacta, tipo, y etiología de ellas, por medio de un estudio observacional. MÉTODOS: Se realizó un estudio transversal, en el que se valoran 51 pacientes con 55 heridas en dorso de mano y antebrazo, tratadas en urgencias de nuestro hospital durante el periodo de junio a diciembre de 2009. RESULTADOS: La exploración inicial nos ofrece una especificidad y un valor predictivo positivo del 100 por ciento, pero una sensibilidad del 17,14 por ciento y un valor predictivo negativo del 40,81 por ciento con respecto a la presencia de lesión tendinosa. CONCLUSIÓN: Ante la falta de correlación entre la clínica inicial con una posible lesión tendinosa extensora recomendamos la exploración quirúrgica de las heridas en dorso de mano, por su sencillez y aprovechamiento del acto quirúrgico(AU)

INTRODUCTION: Injuries in hand dorsum are frequent hospital emergences. It is necessary to study the relation between initial clinics and the tendinous injuries underlying in wounds present in this region, as well to assess its exact location, the type and etiology through observational study. METHODS: A cross-sectional study was conducted to assess 15 patients presenting with wounds in the hand dorsum and forearm, treated in emergency room of our hospital from June to December, 2009. RESULTS: The initial screening offer us a specificity and a positive predictive value of the 100 percent, but a sensitivity of 17,4 percent and a negative predictive value of 40,81 percent regarding the presence of the tendinous injury. CONCLUSION: Due to a lack of correlation between the initial clinics and a possible extensor tendinous injury, it is recommended the surgical exploration of hand dorsum injuries due to its simplicity and use of surgical act(AU)

INTRODUCTION: Les lésions du dos de la main sont des urgences fréquentes d'un hôpital. Le but de cette étude est d'étudier la relation existant entre la clinique initiale et l'affection tendineuse sous-jacente des blessures localisées à cette région, et d'évaluer la localisation exacte, le type et l'étiologie par une étude observationnelle. MÉTHODES: Une étude transversale, portant sur 51 patients atteints de blessures (55) au dos de la main et l'avant-bras, et traités au service des urgences de notre hôpital entre juin et décembre 2009, a été réalisée. RÉSULTATS: L'exploration initiale nous montre une spécificité et une valeur pronostique positive de 100 percent, mais une sensibilité de 17,14 percent et une valeur pronostique négative du 40,81 percent par rapport à la présence des lésions tendineuses. CONCLUSIONS: Devant l'absence de corrélation entre la clinique initiale et une possible lésion du tendon extenseur, il est conseillé de faire une exploration chirurgicale des blessures du dos de la main, car elle est simple et très utile(AU)

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Introdução: A redução do dorso nasal largo é um passo crítico na rinoplastia porque trabalha na área da válvula nasal com o desafio de um resultado estético favorável sem dano funcional. Método: Foi utilizado um método modificado de redução da cartilagem lateral superior, através de excisão em elipse, com o objetivo de reduzir a largura do terço médio nasal. A estrutura da válvula nasal interna, a relação das cartilagens laterais superiores (CLS) com o septo nasal e o excesso de CLSs são avaliados. O excesso de CLS é marcado para permitir remoção exata em forma de elipse no sentido longitudinal da cartilagem. A largura da elipse é determinada de acordo com a estrutura e o excesso de cartilagem nasal. CLS é exposta e resseca-se a elipse em sentido horizontal seguindo a projeção lateral da cartilagem, à meia distância da sua largura para não interferir na válvula nasal. A avaliação do tamanho da elipse a ser ressecada deve ser feita de forma meticulosa e cuidadosa para evitar estenose da válvula nasal. Os autores operaram 25 casos durante um período de três anos. Resultados: Em todos os casos os resultados foram satisfatórios. Nenhuma revisão foi necessária. Conclusões: Este método é uma boa alternativa às técnicas tradicionais no dorso largo. Em relação ao terço médio nasal largo, a remoção em elipse das CLSs é uma alternativa útil quando bem-indicada. Cuidado deve ser tomado em indivíduos com comprometimento da válvula nasal interna, que pode ser agravado.

Introduction: The reduction of the large nasal dorsum is a critical step for rhinoplasty because it works in the nasal valve area with the challenge of a favorable aesthetic result without functional damage. Method: We used a modified method of reduction of the upper lateral cartilage, through elliptic excision, aiming to reduce the width of the nasal middle third. The inner nasal valve structure, the relationship of the upper lateral cartilages (ULC) with the nasal septum and the excess of ULC are evaluated. The ULC excess is marked to allow the exact removal in form of ellipsis in the longitudinal direction of the cartilage. The ellipsis width is determined according to the structure and the excess of nasal cartilage. ULC is exposed and the ellipsis is dried in the horizontal direction following the lateral projection of the cartilage, at a half distance of its width to prevent from interfering with the nasal valve. The evaluation of the ellipsis size to be dried must be carried out meticulously and carefully in order to avoid stenosis of the nasal valve. The authors operated 25 cases during a period of three years. Results: In all cases the results were satisfactory. No review was needed. Conclusions: This method is a good choice to the traditional techniques in the large dorsum. As for the nasal large middle third, the elliptic removal of the ULCs is a useful option when well indicated. Care must be taken of individuals with the inner nasal valve commitment, which may be aggravated with such maneuver.

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