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1. Verfasser:	F. Vélez Bernal
Format:	Artículo científico
Sprache:	es
Veröffentlicht:	Sociedad Española de Cirugía Plástica, Reparadora y Estética 2013
Schlagworte:	Medicina Leishmaniasis mucosa Reconstrucción nasal Leishmania panamensis
Online-Zugang:	https://www.redalyc.org/articulo.oa?id=365533929010
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Inhaltsangabe:

Reconstrucción quirúrgica tras destrucción nasal por Leishmania Panamensis F. Vélez Bernal J.A. Vélez Trujillo I.D. Vélez Bernal Medicina Leishmaniasis mucosa Reconstrucción nasal Leishmania panamensis Algunas especies de Leishmania del subgénero Viannia, especialmente Leishmania braziliensis y Leishmania panamensis, pueden invadir la mucosa naso-orofaríngea al diseminarse por vía linfática y sanguínea a partir de una lesión cutánea y ocasionar lesiones en el tabique nasal, paladar blando, úvula, pilares amigdalinos, laringe, faringe, dorso nasal, labios y pómulos, que pueden conducir a la desfiguración. La mucosa más frecuentemente afectada es la del tabique nasal, principalmente en su parte anterior. La invasión de la mucosa puede ocurrir simultáneamente con lesiones cutáneas activas, aunque más frecuentemente aparecen 1 o 2 años después de la lesión en la piel; sin embargo, en el 16% de los casos no hay antecedentes de lesiones cutáneas, lo que sugiere que con la picadura del insecto vector se produjo una infección primaria asintomática u oligosintomática y luego se produjo la diseminación del parasito a la mucosas. En este artículo presentamos 2 casos clínicos de leishmaniosis mucosa producidos por L. panamensis y los procedimientos quirúrgicos reconstructivos que se realizaron. Se hace además un recuento de los diagnósticos diferenciales en tejidos oronasales. 2013 artículo científico 0376-7892 https://www.redalyc.org/articulo.oa?id=365533929010 es http://www.redalyc.org/revista.oa?id=3655 Cirugía Plástica Ibero-Latinoamericana application/pdf Sociedad Española de Cirugía Plástica, Reparadora y Estética Cirugía Plástica Ibero-Latinoamericana (España) Num.1 Vol.39

if (filemtime($filename) + $maxlifetime < time()) { unlink($filename); $count++; } } return $count; } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ protected function saveSession($sessId, $data): bool { $sessFile = $this->path . '/sess_' . $sessId; if ($handle = fopen($sessFile, 'w')) { $return = false; // Lock the file for exclusive access to avoid issues with multiple // processes writing session simultaneously: if (flock($handle, LOCK_EX)) { $return = fwrite($handle, $data); // Make sure that there's no trailing data by truncating the file to // the correct length: ftruncate($handle, strlen($data)); fflush($handle); flock($handle, LOCK_UN); } fclose($handle); if ($return !== false) { return true; } } // If we got this far, something went wrong with the file output... // It is tempting to throw an exception here, but this code is called // outside of the context of exception handling, so all we can do is // echo a message.

// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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