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Valoramos la eficacia de un apósito autoadhesivo para prevenir las cicatrices hipertróficas sobre un grupo de pacientes sometidas a cirugía de reducción mamaria. Tras la curación de las heridas, aplicamos en todas las pacientes un protocolo preventivo mediante compresión y apósito adhesivo: 66 pacientes (35,6±10,8 años de edad) utilizaron Trofolastin® reductor de cicatrices como adhesivo (sujetos) y 47 pacientes (38,7±12 años de edad) fueron tratadas con otros adhesivos (controles). En el grupo control, el 23,4 % de los casos presentó cicatrices hipertróficas, mientras que en el grupo de sujetos el porcentaje fue sólo del 9,1 % (p < 0,05). Por otra parte, 27 casos del grupo control (56,5 %) tuvieron una puntuación igual o superior a 4 en la escala de Vancouver, frente a sólo 6 casos (9,1 %) en el grupo de sujetos (p < 0,0001). Concluímos que el uso profiláctico de Trofolastin® reductor de cicatrices, una vez finalizado el proceso de curación de la herida, disminuye significativamente el riesgo de cicatrización hipertrófica (riesgo relativo 6,32 [95 % IC 2,83-14,09], según la prueba exacta de Fisher). Our goal is to evaluate the efficacy of a polyurethane self-adhesive dressing in preventing hypertrophic scars in a group of patients undergoing breast reduction surgery. After the initial wound healing period, all patients were submitted to the preventive procedure with compression and adhesive dressing: 66 patients (35.6±10.8 years old) used Trofolastin® reduction scar as adhesive (subjects) and 47 patients (38.7±12 years old) were treated with other adhesives (controls). In the control group, 23.4 % of patients presented hypertrophic scars, whereas this percentage was only 9.1 % in subjects (p < 0.05). Moreover, 27 patients of the control group (56.5 %) presented scars with a Vancouver score equal or higher than 4 in contrast with only 6 cases (9.1 %) in the group of subjects (p < 0.0001). In conclusion, the prophylactic use of Trofolastin® reduction scar, once the initial wound healing period is complete, significantly reduces the risk of hypertrophic scars (relative risk 6.32 [95 % CI 2.83-14.09], according the Fisher's exact test).

Presentamos nuestra experiencia en el tratamiento de los queloides mediante resección quirúrgica y radioterapia inmediata posterior. La radioterapia transforma el queloide en un tejido hipocelular, hipovascular e hipóxico, impidiendo la excesiva migración de fibroblastos. Si se administra la dosis adecuada de radiación, se consigue un equilibrio entre la formación de cicatriz y la proliferación excesiva de tejido, evitando la formación de queloide, sin impedir la cicatrización normal. Nuestro protocolo se divide en dos fases: la primera consiste en la exéresis del queloide mediante una incisión que sigue el trayecto del mismo, con un cuidadoso cierre en dos planos siendo siempre el superficial una sutura intradérmica. La segunda fase será la radioterapia, con dos modalidades posibles de tratamiento: 1- Braquiterapia (tratamiento a corta distancia), requiere la colocación de un catéter bajo la sutura, a través del cual se introduce una fuente radiactiva, normalmente Ir192. Se emplea especialmente en heridas longitudinales. 2- Radioterapia externa con electrones de baja energía. Se emplea en heridas complejas o extensas. Generalmente, dosis de 20 Gy. en 4 fracciones de 500 cGy, ofrecen excelentes resultados con mínimas secuelas o efectos secundarios. El volumen blanco debe incluir la herida quirúrgica más un margen de 4 mm. alrededor de ella. Con este procedimiento, hemos observado unos excelentes resultados, con un índice de recidivas inferior al 4%, y una mejora en los síntomas clínicos en el 100% de los casos. Como efectos secundarios observamos telangiectasias (15,4 %) o cambios en la pigmentación cutánea (5,9%). We present our experience in treatment of keloid scars with surgical resection and immediately postoperative radiotherapy. Radiotherapy changes keloid into an hypocellular, hypovascular and hypotoxic tissue, avoiding the excessive migration of fibroblasts. If the suitable dose of radiation is delivered, balance between the formation of the scar and the excessive proliferation of the tissue is achieved avoiding the formation of the keloid but keeping normal scarring. Our protocol is divided in two phases: the first one is the surgical treatment. The exeresis of the keloid is carried out through an incision that follows its own line and a careful closure in two planes; superficial one is always an intradermic suture. The second part will be radiotherapy, with two possible treatments: 1) Brachitherapy (treatment at a short distance), placing a catheter under the suture, through which a radioactive source is introduced, usually Ir192. It is used, specially in longitudinal wounds. 2) External radiotherapy with electrons of low energy. It is used in complex or large wounds. A dose of 20 Gy., in 4 fractions of 500 cGy, usually offers excellent results with minimum sequelae or side effects. The area to be irradiated should include the surgical wound, and a margin of 4 mm. around it. With this procedure, we have observed excellent results with a recidive rate lower tan 4% and an improvement in the clinical symptoms in 100% of cases. As a side effect, we have observed telangiectasies (15,4%) or changes in the cutaneous pigmentation (5,9%).

Semantic interoperability between electronic health record systems and other information systems in the health domain implies agreement about the structure and the meaning of the information that is communicated. There are still a number of similar but different EHR system approaches. Some of the newer approaches adopt the two-layer model approach where a generic reference model is constrained by archetypes into valid clinical concepts which can be exchanged. The meaning of the concepts that are represented by an archetype can be conveyed by embedding codes from a commonly recognised terminology at appropriate points in the archetype. However, as the number of archetypes multiply it will become necessary to match archetypes from different sources to facilitate interoperability. This paper describes an approach that supports semantic interoperability between heterogeneous two-level health information systems by identifying similarities between archetypes. The approach identifies relationships between ontological terms which have been embedded in pairs of archetypes as a means of matching these terms. The matched terms can then in turn be used to identify similarities between archetypes. The limited contextual scope of an archetype simplifies this matching process.

The standard abdominal lipectomy is a risky procedure with respect to where the first incision (i.e., the transverse suprapubic incision) is located. Failure to place the incision successfully may distort the whole procedure, resulting in an overly tight abdominal wall, hypertrophy, and upward displacement of the scar along with the pubic hair, and also excessive tension causing skin necrosis of the abdominal flap. Advantages of our reversed technique are emphasized.

The two-level model based specifications for electronic health record communication EHRcom (ISO 13606) and openEHR both support the embedding of terminological references in Archetypes. This terminological binding can be created manually by a health terminology expert during Archetype design, and the binding is assessed during Archetype evaluation. There has also been some recent work on using lexical queries to generate term sets to represent concepts in Archetypes. This work created an information construct which we call a Terminological Shadow that links Archetype nodes to sets of candidate concepts from a terminology system. The coding scheme used for this work is SNOMED-CT. The proposed Shadows can be used to facilitate the mapping between an Archetype information model and terminological systems. A framework, which also acts as an analysis tool, has been created to construct Shadows from Archetypes. The work also demonstrates how the framework can be used to evaluate different searching algorithms by comparing the search results to the existing bound SNOMED codes.