To evaluate four years of preoperative lymphoscintigraphy experience and the accuracy of sentinel lymph node biopsy in our institution in melanoma patients with various tumor thicknesses. An ...additional aim was to evaluate the recurrence rate related to pathohistological findings.
During the period from February 2002 to November 2005, 201 patients underwent sentinel node biopsy. Lymphoscintigraphy for identification of sentinel nodes was performed four to six hours prior to operation of the patient. Sentinel lymph node biopsy using an intraoperative hand-held gamma probe was performed in all patients, together with wide local excision of biopsy wound or primary lesion (N=56). Immediate complete basin dissection was performed in patients with sentinel node metastases. In four patients delayed complete lymph node dissection was performed after definitive histopathologic examination of sentinel nodes. The accuracy of sentinel node biopsy was determined by comparing the intraoperative rates of sentinel node identification and the subsequent development of nodal metastases in regional nodal basins in patients with tumor-negative sentinel nodes and in those with tumorpositive sentinel nodes.
Using preoperative lymphoscintigraphy, we identified sentinel nodes in all but one of the 201 patients (99.0%), and in 248 nodal basins (1.2/patient) we observed 372 sentinel nodes (1.52 sentinels/basin; 1.8 sentinels/patient). The highest number of sentinel nodes was noticed in the groin of patients with melanoma on the lower extremities (1.5/patient), followed by the axilla (1.3/patient). Anomalous lymphatic drainage patterns were observed in 15.0% of all patients. The identification rate of sentinel nodes was 99.0% overall: 100% for the groin basins, and 98.0% for the axilla and head and neck basin. Forty-two patients (20.8%) had tumor-positive sentinel nodes. Ten patients (5.0%) had local or distant recurrences during a median follow-up of 23.1 months (range 2-46). The rate of false-negative lymphatic mapping and sentinel node biopsy as measured by nodal recurrence in patients with tumor-negative sentinel nodes was 1.3%. During the follow-up period, three of 201 patients died from other diseases and three patients died as the result of melanoma metastases, with a median follow-up of 13.5 months (range 12-22).
Preoperative lymphoscintigraphy is a sensitive, inexpensive and essential method for the identification of drainage basins, determination of the number and position of sentinel nodes and their location outside the usual nodal basins. Scintigraphic findings may lead to changes in surgical management due to the unpredictability of lymphatic drainage. The low incidence of regional disease recurrence in patients with tumor-negative sentinel nodes supports the use of preoperative lymphoscintigraphy and sentinel node biopsy as a safe and accurate procedure for staging the regional nodal basin in patients with malignant melanoma.
Reconstruction of the saddle nose may involve the use of different augmentation materials, from autogenous bone and cartilage to alloplastic materials. The most important problems when considering ...the choice of reconstructive technique, besides underlying pathology and expected result, include: long-term stability, donor morbidity, tendency of the implant to infection, extrusion, and resorption. The use of the lateral crura of the lower lateral cartilages as dorsal onlay was reserved for the corrections of minor supratip depressions (flying wing and alar swing procedure). The authors suggest the use of pedicled flaps of cephalic portions of lateral crura as dorsal septal strut, which may increase the profile line more than dorsal onlay. Reconstruction is performed using open rhinoplasty approach. Pedicled flaps of the cephalic portions of lateral crura are transfixed in the sagittal plane and, following separation of upper lateral cartilages and medial crura, placed on the dorsum of nasal septum. Upper laterals are sutured to newly formed cartilaginous dorsum, or a new bridge is created using conchal cartilage. Columellar strut may be formed of the septal cartilage. Authors have performed such corrections in 15 patients with good long-term functional and aesthetic results.
Vibrant Soundbridge (VSB) predstavlja nov pristup poboljšanju oštećenog sluha aktivnim ugradbenim uređajem za srednje uho. Taj uređaj zaobilazi zvukovod i bubnjić, za razliku od standardnih slušnih ...pomagala kod kojih povećani volumen zvuka ide kroz njih i izaziva direktne vibracije lanca slušnih košćica. Zahvaljujući svom dizajnu nijedan dio VSB-a nije u zvukovodu. VSB je odobrila FDA kao siguran postupak u liječenju odraslih osoba koje imaju zamjedbeno, provodno ili mješovito oštećenje sluha i koje žele čuti bolje nego sa standardnim slušnim pomagalima. Ovaj rad je pregled djelovanja aktivnog ugradbenog implantata srednjega uha VSB-a koji je ugrađen na Klinici za otorinolaringologiju i kirurgiju glave i vrata KBCa Sestre milosrdnice, Referentnom centru Ministarstva zdravlja za kohlearnu implantaciju i kirurgiju nagluhosti i gluhoće.
The development of the Guidelines for perioperative prophylactic use of antimicrobial agents (further on Guidelines) was initiated by the Interdisciplinary Section for Antibiotic Resistance Control ...(ISKRA) of the Croatian Ministry of Health and Social Welfare in accordance with the principles of AGREE (Appraisal of Guidelines for Research and Evaluation) methodology which means that the guidelines are the result of a consensus between all involved professional societies. Guidelines were composed in order to improve antibiotic use in surgical professions. Data obtained from observational studies have shown that the use of antimicrobials in surgical professions is unsatisfactory, and since around 50% of all prescribed drugs in surgical professions refer to perioperative prophylaxis, such guidelines could significantly improve current negative trend and reduce the occurrence of infections in surgical patients as well as slow down the selection of resistant bacteria. In the introductory part of the guidelines, principles of perioperative prophylaxis are presented. The advantages and risks of prophylaxis are listed as well as factors that determine prophylaxis effectiveness. For easier orientation, surgical professions have been divided into basic surgical fields. In each field, the specificity of the field has been described followed by uniform structured tables and with every listed surgical procedure there is the most probable cause of infection, the drug of choice for prophylaxis, alternative drug, remark for particular surgical procedure and finally the grade of recommendation. The Guidelines do not cover perioperative prophylaxis in immunocompromised patients nor perioperative prophylaxis in children. The Guidelines do not cover all possible surgical interventions, but can be used as a basis for most surgical procedures performed in our hospitals. At the very end of these Guidelines, a comprehensive list of references enables all those interested to find further information and details about this topic. The revision of the Guidelines is planned in three years' time.
Among many oncological patients we can notice a substantial loss of body weight, fat and proteins with significant proinflammatory activity at the time of diagnosis. This wasting condition is well ...known as cancer cachexia syndrome. Anorexia is important part of this syndrome. Because cancer cachexia reduces tumor response to treatment and it is an indicator of poor prognosis, we need to start correcting these nutritional deficits at once. In the presence of cancer cachexia it is extremely difficult to achieve protein anabolism and stop the body wasting by standard nutritional formulas only. During the last few years, the use of eicosapentaenoic acid (EPA) and megestrol acetate (MA) as anticahectic agents has been tested. These guidelines are intended to give evidence-based recommendations for the use of eicosapentaenoic acid and megestrol acetate in cancer cachexia syndrome. These guidelines have been developed by interdisciplinary expert group of Croatian clinicians. Based on relevant literature, we have concluded that the use of metabolic modulators such as eicosapentaenoic acid and megestrol acetate for 8 weeks may help to improve nutritional status in cachectic patients.
The aim of the study was to evaluate morphological changes of maxillary sinus mucosa and to compare them with the levels of tryptase, myeloperoxidase (MPO) and eosinophil cationic protein (ECP) in ...sinus lavage, and also with subjective outcomes in patients with chronic rhinosinusitis after endosinusal treatment. Thirty patients with the symptoms of chronic rhinosinusitis were recruited for the study. Inclusion criteria were sinusitis symptoms persisting for more than 3 months and maxillary sinus mucosa thickening by >6 mm, considered as maxillary sinusitis. Patients with asthma, polyposis, recent infection, systemic steroid therapy or previous sinus surgery were excluded. Patients were treated endosinusally with 2 mg dexamethasone and 40 mg gentamicin per maxillary sinus daily for 5 days. Patients rated their nasal/ chronic rhinosinusitis disease-specific symptoms and completed a self-administered questionnaire concerning sinusitis symptoms at inclusion and after 30 days. Sinus lavage with 5 ccm of saline was obtained prior to the first endosinusal treatment. Tryptase, MPO and ECP were determined from lavage fluid. Biopsy specimens of maxillary sinus mucosa were obtained by biopsy forceps during sinusoscopy through the inferior meatus in local anesthesia. Fifteen (50%) patients showed improvement and symptom alleviation after the treatment (responders), and 15 (50%) were unchanged or worsened (IR <1) after the treatment (nonresponders). The pretreatment and post-treatment sinusitis symptom scores and improvement rate of sinusitis symptom scores showed no correlation with any of the histologic parameters. Significant improvement was noted for the overall sinusitis symptoms score (p<0.01) in the study group as a whole. There was a significant difference in the baseline levels of MPO and ECP in sinus lavage (p<0.01), and a difference in the number of mononuclears and eosinophils in biopsy specimens of maxillary sinus mucosa (p>0.05) between the responders and nonresponders. Responders had a higher level of MPO and ECP in sinus lavage and higher number of mononuclears and eosinophils in biopsy specimens of maxillary sinus mucosa than nonresponders. There was no statistical difference in tryptase and other histologic parameters (number of mononuclears, edema, fibrosis, seromucous glands and goblet cell density) between responders or nonresponders. Eosinophilia in maxillary sinus mucosa specimens showed close correlation with ECP level in sinus lavage and inverse correlation with fibrosis (p<0.05). Other inflammatory cells (mononuclears and neutrophils) in maxillary sinus mucosa specimens did not correlate with the level of any cytokine in sinus lavage or with other histologic parameters. Globlet cell density correlated with ECP level (p<0.05) and inversely with MPO level in sinus lavage (p<0.01). Fibrosis showed close correlation with tryptase (p<0.01) and MPO (p<0.05) levels in sinus lavage and inversely with edema (p<0.01). Study results indicated higher levels of MPO and ECP in sinus lavage and higher number of mononuclears and eosinophils in biopsy specimens of maxillary sinus mucosa to predict better response to endosinusal steroid/ antibiotic treatment.
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Imprinting analyses of
IGF2
and
H19
, loss of heterozygosity (LOH) analyses of
IGF2R
and
CTCF
and
Helicobacter pylori
detection, were performed on 35 human laryngeal squamous cell carcinomas (LSCC). ...Forty-six percent of the tumors were heterozygous for
IGF2
, and 54% were informative for the
H19
. Biallelic expression of
IGF2
was observed in 33% (5 out of 15) of the tumors and in 27% (4 out of 15) of adjacent non-tumorous laryngeal tissues.
H19
loss of imprinting (LOI) was observed in 24% (4 out of 17) of the tumors. For
IGF2R
and
CTCF,
71% (25 out of 35) and 50% (17/34), respectively, of the samples were heterozygous, and LOH was detected in 12% (3 out of 25) and 6% (1 out of 17), respectively, of the tumors.
H. pylori
was found in 26% (9/35) of these tumors. Among them, four were informative for the imprinting analysis. The presence of
H. pylori
had no effect on
IGF2/H19
imprinting. Only the
H. pylori
detection was further broadened with an additional 47 laryngeal tumors, resulting in a total final positivity of close to 16% (13 out of 82). This study represents the largest comprehensive
IGF2/H19
imprinting study done to date on well-defined samples of human laryngeal carcinomas and corresponding non-tumorous tissue. For the first time, the analyses of
IGF2/H19
imprinting have been broadened with LOH analyses of
IGF2R
and
CTCF
, with both of these genes acting as modulators of
IGF2
and
H19
activity. Although there were indications that
H. pylori
may be present in LSCC, we are the first to show its presence in LSCC by two direct techniques: Giemsa staining and nested-PCR.
Transplantacija larinksa Shejbal, Dražen; Ivkić, Mirko; Bedeković, Vladimir ...
Libri oncologici,
12/2003, Letnik:
31, Številka:
1-3
Journal Article
Recenzirano
Odprti dostop
Transplantacija larinksa nije neka nova zamisao. Pokusi s reinervacijom, revaskularizacijom, imunosupresijom i očuvanjem započeli su još kasnih 1950-ih. Nakon prve uspješno obavljene transplantacije ...stekao se dojam da su sve očekivane komplikacije svladane i da se očekivani nedostatci nisu pojavili. U ovom radu razmatrit ćemo etička i tehnička pitanja transplantacije larinksa te opasnost pojave recidiva raka zbog imunosupresije. Transplantacija larinksa najviše obećava kad je riječ o očuvanju kvalitete života bolesnika koji su ostali bez funkcije larinksa.
Postoji niz metoda za rekonstrukciju hipofarinksa, a odabir ovisi o veličini defekta sluznice. Metode rekonstrukcije uključuju primarno zatvaranje, lokalne režnjeve, regionalne aksijalne režnjeve, ...regionalne režnjeve probavnog sustava i slobodne režnjeve koji sadrže kožu ili sluznicu probavnog sustava. Optimalna metoda rekonstrukcije trebala bi biti praćena minimalnim poslijeoperacijskim komplikacijama koje ako nastaju produljuju broj dana provedenih u bolnici, i trebala bi uključivati brz oporavak funkcije. Cilj ove nerandomizirane retrospektivne studije bio je prikazati rezultate rekonstrukcija bolesnika s defektom hipofarinksa tipa II. U razdobolju od 10 godina u Klinici za otorinolaringologiju i kirurgiju glave i vrata, KBC “Sestre milosrdnice” operiran je 31 bolesnik (27 muškaraca i četiri žene). Za procjenu ishoda rekonstrukcije upotrebljene su sljedeće mjere: rane poslijeoperacijske komplikacije (propadanje režnja, postojanje fistule, komplikacije donorskog mjesta), duljina boravka u bolnici i procjena funkcije gutanja nakon 14 dana, jednog mjeseca i šest mjeseci. Bolesnici su podijeljeni u sljedeće skupine: devet bolesnika s radijalnim režnjem (RFFF), sedam bolesnika s režnjem jejunuma i 15 bolesnika s tzv. gastric tube rekonstrukcijom. U tri bolesnika skupine RFFF režanj je propao; u skupini s režnjem jejunuma nije bilo komplikacija donorskog mjesta, dok su u skupini s gastric tube rekonstrukcijom tri bolesnika imala manju dehiscijenciju rane trbušnog zida. Od tri uspoređivane rekonstrukcijske metode bolesnici u skupini RFFF imali su najveći broj komplikacija. Prosječna duljina boravka u bolnici iznosila je 22,6 dana, s najkraćim boravkom u skupini RFFF. Nije nađeno razlika u ranoj gluticijskoj funkciji između uspoređivanih skupina. Odabir pojedine metode rekonstrukcije trebao bi ovisiti o opsegu resekcije, općem stanju bolesnika, donorskom mjestu i očekivanoj funkciji. Naši rezultati upućuju na superiornost rekonstrukcije upotrebom “jejunalnog režnja” i gastric tube rekonstrukcije u usporedbi s radijalnim režnjem.
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