Background. Breasts are an important symbol of physical beauty, feminity, mothering and sexual desire through the entire history of mankind. Lost of the whole or part of the breast is functional and ...aesthetic disturbance for woman. It is understandable, that the woman, who is concerned over breast loss, is as appropriate as another person´s concern over the loss of a limb or other body part. Before the 1960, breast reconstruction was considered as a dangerous procedure and it was almost prohibited. Considering the psychological importance of the breast in modern society, the possibility of breast reconstruction for the woman about to undergo a mastectomy is a comforting alternative. We can perform breast reconstruction with autologous tissue (autologous reconstruction), with breast implants and combination of both methods. For autologous reconstruction we can use local tissue (local flaps), or tissue from distant parts of the body (free vascular tissue transfer). Tissue expansion must be performed first, in many cases of breast reconstructions with breast implants. Conclusions. Possibility of breast reconstruction made a big progress last 3 decades. Today we are able to reconstruct almost every defect of the breast and the entire breast. Breast reconstruction rise the quality of life for breast cancer patients. Breast reconstruction is a team work of experts from many medicine specialites. In Slovenia we can offer breast reconstruction for breast cancer patients in Ljubljana, where plastic surgeons from Clinical Department for Plastic Surgery and Burns cooperate with oncologic surgeons. Ten years ago a similar cooperation between plastic surgeons and surgeons of the Centre for Breast Diseases was established in Maribor.
Pred projektante prometne infrastrukture stavlja se zahtjevan zadatak da pomire suprotstavljene ciljeve razvoja prometne infrastrukture prema prometnoj potražnji, a da svojim rješenjima smanje ...negativne učinke operacionalizacije sustava. Ovaj rad analizira primjenjivost mikrosimulacijskog prometnog modeliranja za analizu ekoloških i ekonomskih parametara koji se, uz funkcionalne parametre, ubrajaju u standardne kriterije ocjene varijantnih rješenja izgradnje i rekonstrukcije prometne infrastrukture. Studija slučaja napravljena je na primjeru rekonstrukcije raskrižju u urbanoj prometnoj mreži grada Osijeka. Rezultati pokazuju primjenjivost mikrosimulacija za ocjenu ekoloških i ekonomskih parametara u ocjeni varijantnih rješenja rekonstrukcije raskrižja, a brojčani pokazatelji pokazuju da se poboljšanjem funkcionalnih pokazatelja raskrižja mogu smanjiti i emisije ispušnih plinova od prometa.
Transport infrastructure designers are faced with the demanding task of balancing the conflicting goals of transport infrastructure development according to traffic demand andreducing the negative effects of the system operationalization with their solutions. This paper analyzes the applicability of microsimulation traffic modeling for the analysis of ecological and economic parameters, which, along with functional parameters, are included in the standard criteria for the evaluation of various solutions for the construction and reconstruction of traffic infrastructure. The case study was made on the example of the reconstruction of an intersection in the urban traffic network of the city of Osijek. The results show the applicability of microsimulations for the evaluation of ecological and economic parameters in the evaluation of variant solutions for the reconstruction of the intersection, and the numerical indicators show that air pollution from traffic can be reduced by improving the functional indicators of intersections.
Rad se bavi semantičkom rekonstrukcijom praslovenske riječi koprъ, koja se u modernim slovenskim jezicima javlja u značenju „kopar” (Anethum graveolens). Na osnovu povezanih oblika (na primjer, ...*kopъtь, *kopьno), osnovno značenje bilo bi „topao vazduh”, „para”. U tom pogledu, moguće je revidirati porijeklo slovenskih naziva za koprivu (Urtica), kao što su *kopriva, odnosno *kropiva. Naime, *kopriva je derivat glagola *koprěti/*kopriti, u značenju „tretirati toplom vodom”, dok je *kropiva derivat glagola *kropiti, u značenju „vreti”. U oba slučaja korijen riječi označava žareću biljku. U cilju dokazivanja tvrdnje, rad nudi brojne sinonime koji se javljaju u različitim slovenskim jezicima i koji nastaju u skladu sa istim semantičkim modelima i pravilima tvorbe riječi.
Cilj: Anatomska tehnika rekonstrukcije predstavlja zlatni standard pri operacijskom liječenju lezija prednjeg križnog ligamenta. Kod postavljanja femoralnog tunela glavni orijentir predstavlja ...lateralni interkondilarni greben. Greben se nalazi uz prednji rub hvatišta ligamenta i tuneli se postavljaju ispod njega, u centar hvatišta ligamenta. Cilj ove studije je opisati položaj grebena u odnosu na intaktno femoralno hvatište. Materijali i metode: U studiji je korišteno 10 svježe smrznutih kadaveričnih zglobova koljena. Nakon što je uklonjen medijalni kondil femura, vizualno i uz palpaciju analizirano je područje femoralnog hvatišta ligamenta, i to najprije uz očuvan bataljak prednjeg križnog ligamenta, a zatim nakon uklanjanja čitavog hvatišta. Rezultati: Uz održani ligament, u 70 % preparata niti jedan dio lateralnog interkondilarnog grebena nije bio vidljiv izvan hvatišta. U 20 % preparata greben je bio vidljiv samo iznad posterolateralnog snopa prednjeg križnog ligamenta. Nakon što smo odstranili sva vlakna hvatišta prednjeg križnog ligamenta, u jednom preparatu nismo sa sigurnošću mogli odrediti postojanje grebena. Zaključak: U 90 % ispitivanih preparata lateralni interkondilarni greben bio je unutar hvatišta prednjeg križnog ligamenta. Navedeno bi trebalo uzeti u obzir prilikom anatomske rekonstrukcije ovog ligamenta.
Aim: The lateral intercondylar ridge (LIR) represents the main bony landmark for determining the ACL femoral footprint and for placing the tunnel in the center of the native femoral footprint below the LIR. This study aimed to describe the relationship between the LIR and the intact femoral insertion of the anterior cruciate ligament. Materials and Methods: Ten fresh-frozen, cadaveric knee specimens were obtained for this study. The medial femoral condyle was removed with the aim of finding any protrusion or ridge on the medial wall of the lateral femoral condyle. The exposed areas were carefully analyzed, visually and by palpation. Analyses were performed with ACL stump and after removing the whole ACL from the femoral insertion. Results: In 70% of specimens the ridge was not visible while the ligament was attached to its femoral insertion. In 20% of specimens the ridge was observed outside the fibrous insertion, but only above posterolateral bundle. After removing all ligament fibers in one specimen we could not find bone ridge. Conclusion: In 90% of specimens the LIR was an integral part of the femoral insertion. This observation must be taken into account during ACL reconstructive surgery.
Rad obrađuje problematiku otvorenosti šuma mrežom primarne šumske prometne infrastrukture te dinamiku građenja, održavanja i rekonstrukcije šumskih cesta u Federaciji BiH od 2005. do 2020. godine. ...Otvorenost šuma u Federaciji BiH još je značajno ispod potrebne minimalne (15 m/ha za brdsko-planinska područja) za racionalno gospodarenje šumskim resursima. Građenje je novih šumskih cesta imperativ za šumarske tvrtke, međutim dinamika izgradnje novih cesta daleko je ispod potrebne razine. Također, rekonstrukcija postojećih šumskih cesta koje su većinom građene 70-ih i 80-ih godina prošloga stoljeća, a čija nosivost nije usklađena sa zahtjevima suvremenih kamionskih skupova, gotovo pa u potpunosti izostaje. Jedan od osnovnih problema za provođenje predmetne analize jest prikaz podataka šumarskih poduzeća u Federaciji BiH, koja rekonstrukciju, održavanje i redovitu sanaciju daju kao jedan podatak, zbog čega realne pokazatelje stvarno izvršenih radova za pojedinačne vrste radova nije moguće na pravi način opisati. Uz kvantitativne podatke koji su dani u radu, također su iskazani i financijski pokazatelji planiranih i realiziranih radova.
The need for the construction of new roads, as well as the maintenance and reconstruction of existing roads in the Federation of Bosnia and Herzegovina, is constantly present. The paper analyzes the period from 2005 to 2020, primarily on the basis of regular annual information on forest management in the Federation of Bosnia and Herzegovina, and from survey questionnaires that were conducted in forest enterprises for the preparation of the Forest Transport Infrastructure Development Study (2011) and the Forest Transport Infrastructure Development Master Plan (2020). Activities related to forest truck roads in the forestry of the Federation of Bosnia and Herzegovina have unfortunately shown a delayed trend for many years. The completion of construction works of new roads, as well as regular, periodic maintenance and reconstruction over a period of years, has mostly been below the plan, which specifically refers to the construction of new roads. Based on the analyzed data, a significant difference is noticeable between the planned and built forest truck roads in the analyzed period, where a total of 1213.9 km were planned for construction, while only 592.9 km or 48.84 % of the planned roads were completed. Also, when it comes to invested financial resources, a significantly smaller amount was spent than planned. The planned funds amounted to 41.85 million euro, and 14.75 million euro or 35.25 % of the planned amount was spent. The average investment was 24,879 euro/km. The lowest average costs were in 2014, amounting to 8029.5 euro/km, and the highest in 2009, amounting to 42,297.2 euro/km. There are significant differences when it comes to the openness of forests in FB&H based on data collected in different periods and based on different sources. According to Sokolović and Bajrić (2011), the openness is 10.8 m/ha, according to the data of the Master Plan for the Development of Forest Transport Infrastructure (2020), the openness is 7.83 m/ha, while according to the latest available data from the Information on forest management for the year 2020 and plans for the year 2021, the openness of the forests is 11.3 m/ha. The different results lie primarily in the fact that there is no single criterion for calculating the openness of forests in the Federation of Bosnia and Herzegovina. The openness of all forests in FB&H is not uniform, with the highest average in high forests and according to data from the Information on forest management for 2020 and plans for 2021, the same amount is 16.0 m/ha, in forest plantations it is 9.6 m/ha and in coppice forests 11.2 m/ha. When it comes to the funds invested in regular annual and periodic maintenance, as well as the reconstruction of forest truck roads, they are not shown in the correct way in the forestry operation (all works are shown as a single cost), so it is not possible to give a high-quality analysis of these costs.
Background. For one third of all women urinary incontinence is a health problem. Different strategies of treatment have been used, namely surgical, medical and physiotherapy. To this armamentarium a ...new method – adult stem cells therapy – has been added. Methods. The source of adult autologues multipotent stem cells consists of muscle-derived stem cells, adipose-derived stem cells and mesenchymed bone marrow cells. In facilities for stem cells with processing and in the presence of specific inducing factors, muscle derived stem cells can be differentiated to striated or smooth muscles. Clinical work is based on animal models that with immunohistochemical analysis demonstrated new skeletal-muscle fiber formation at the site of injection of stem cells. In stress urinary incontinence (SUI) autologues bioptic material is obtained by using a musle needle biopsy device. From the biopsy speciment with dissociation muscle-derived stem cells are isolated and injected under local anaesthesia in the middle urethra and/or external urethral sphincter. Initial results of SUI treatment with adult muscle-derived stem cells suggest that perspectives of this method are encouraging. Conclusions. Stem cell therapy is promising to become minimally invasive method for reconstruction of the muscles and connective tissue of urethra and external urethral sphincter.
Rekonstrukcija dojke Milas, Ivan; Zore, Zvonimir; Roth, Andrej ...
Libri oncologici,
12/2014, Letnik:
42, Številka:
1-3
Journal Article
Recenzirano
Odprti dostop
Karcinom dojke je načešći maligni tumor kod žena u Hrvatskoj. On je i vodeći uzrok smrti kod žena oboljelih od malignih bolesti. Njegovo liječenje izaziva jedan od najvećih strahova kod žena a to je ...gubitak jedne ili obje dojke. Tako se radi pogubnog psihološkog učinka ove bolesti sve veći broj žena odlučuje za rekonstrukciju. Zadnjih dvadesetak godina pratimo izraziti napredak u rekonstrukcijskim tehnikama, bilo vlastitim tkivom bilo ugradbenim materijalima. Ovaj članak nam daje kratki povjesni razvoj i današnji pregled o mogućnostima rekonstrukcije. Također, pregled prednosti i nedostataka
rekonstrukcijskih tehnika, koje nam mogu pomoći u izboru, vremena i načina rekonstrukcije. Krajnji cilj rekonstrukcije dojke treba biti, onkološki siguran zahvat kojime je žena zadovoljna.
Obstaja veliko možnosti za kritje vrzeli po onkološki kirurgiji na glavi in vratu. Najpogosteje se uporablja prosti fasciokutani radialni reženj, prosti anterolateralni stegenski reženj in vezani ...mišičnokožni reženj, t. i. pectoralis maior.Fasciokutani otočni reženj supraklavikularne arterije (SCAIF) je vsestranski reženj s področja nad ključnico in ramena. Baziran je na supraklavikularni arteriji, katere odcepišče od žile arteria transversa colli se nahaja v trikotniku na vratu, ki ga omejuje posteriorni rob sternokleidomastoidne mišice s ključnico in z žilo, poimenovano vena iugularis externa. Dolžina 26 cm, širina 6–7 cm in lok obrata omogočajo kritje kožnih vrzeli lateralno na vratu in na parotidnem področju ter v izjemnih primerih kritje temporalnih vrzeli. Na drugi strani je SCAIF uporaben za rekonstrukcijo vrzeli na sluznici ustne votline, žrela, požiralnika in za kritje fistul po operaciji.Opisujemo primer uporabe SCAIF pri bolnici z lokalno napredovalim karcinomom zunanjega sluhovoda in pri bolniku z obsežno metastazo v obušesni slinavki.Dvig SCAIF je kirurško nezahteven in hiter. SCAIF je zanesljiv, varen, ima malo zapletov in dobre funkcionalne in estetske rezultate, zato je široko uporaben za rekonstrukcijo različnih mehkotkivnih vrzeli na glavi in vratu.
Mišić plantaris je mali mišić površnog stražnjeg odjeljka noge karakteriziran najdužom tetivom u ljudskom tijelu. Istraživanja ukazuju da je plantaris rudimentarni mišić sa zanemarivom biomehaničkom ...funkcijom. Tetiva mišića plantarisa odavno je prepoznata kao lako dostupan presadak kod raznih rekonstruktivnih zahvata u ortopediji. Anterolateralni ligament koljena predstavlja važan čimbenik uspostave rotacijske stabilnosti kod koljena kojem nedostaje funkcija prednjeg križnog ligamenta. Tetiva mišića plantarisa ima odlična biomehanička svojstva za rekonstrukciju anterolateralnog ligamenta. U ovom kratkom preglednom radu prikazana je nova operacijska tehnika zajedničke rekonstrukcije prednjeg križnog ligamenta i anterolateralnog ligamenta koljena uz presatke tetiva mišića semitendinozusa i plantarisa.
Plantaris muscle is a fusiform muscle of the superficial posterior leg compartment. It is characterized by the longest tendon in humans. Reports suggest that plantaris muscle is rudimentary with a minor biomechanical function. Plantaris tendon is a well known and accessible graft for various reconstructive procedures. The anterolateral ligament has recently been recognized as an important structure in restoring the rotational stability of the anterior cruciate ligament deficient knee. Plantaris tendon has excellent biomechanical properties for anterolateral ligament reconstruction. The present study describes a new combined anterior cruciate ligament and anterolateral ligament reconstruction technique using plantaris tendon and semitendinosus tendon
Izhodišče: Raztrganje rotacijske manšete (RM) je med najpogostejšimi vzroki za artroskopsko operacijo rame (AOR). Bistveno za uspešno okrevanje je gibanje uda, ki je odvisno od dobro nadzorovane ...pooperacijske bolečine (PB). Preverjali smo učinkovitost medskalenske blokade brahialnega pleteža (angl. Interscalene Brachial Plexus Block, ISB) pri lajšanju PB v domačem okolju predvsem med gibanjem. Raziskava nas bo opozorila na pomanjkljivosti metode ter morebitno potrebo po prilagoditvi zdravljenja bolečine po operaciji. Metode: Retrospektivno smo analizirali dokumentacijo 150 bolnikov po artroskopski rekonstrukciji RM. Z ultrazvočno vodeno ISB so prejeli 12–30 mL levobupivakaina z deksametazonom. Stopnjo PB so ocenjevali z vizualno analogno lestvico (VAS). Preučili smo demografske in klinične značilnosti bolnikov, trajanje ISB ter porabo protibolečinskih zdravil. Primerjali smo vrednosti VAS v mirovanju in med gibanjem do 90 ur po operaciji ter s tem ocenili vpliv gibanja na stopnjo PB. Zanimalo nas je tudi zadovoljstvo bolnikov s posegom. Pri primerjavi vrednosti VAS med opisnimi spremenljivkami smo uporabili Wilcoxonov test vsote rangov. Pri analizi meritev pri istem bolniku smo uporabili dvosmerno analizo varianc (ANOVA) za ponovljene meritve. Za mejo statistične značilnosti smo upoštevali p < 0,05.Rezultati: ISB je v povprečju trajala 24–36 ur. Skupno so bolniki v prvih treh dneh po operaciji, tj. pooperacijskih dneh (POD), potrebovali 77 dodatnih odmerkov opioidnih in 104 dodatnih odmerkov neopioidnih analgetikov. Mediana vrednost VAS zgodnje PB je bila tako v mirovanju kot med gibanjem 0. PB je bila na prvi POD med gibanjem 0,5 in v mirovanju 1, na drugi POD 2 in 3, na tretji POD 2 in 2. Med PB v mirovanju in med gibanjem nismo ugotovili značilnih razlik (p > 0,05; ANOVA za ponovljene meritve). Bolniki so počutje med operacijo, na oddelku in doma največkrat označili kot sproščeno.Zaključek: ISB je učinkovita pri lajšanju PB po artroskopski rekonstrukciji RM zunaj bolnišnice in zagotavlja več kot 24-urno analgezijo. Predpisano protibolečinsko zdravljenje zadostuje pri nadzoru PB. Vrednosti VAS so zadovoljive in med gibanjem primerljive z ocenami v mirovanju. ISB je zanesljiva in učinkovita, bolniki so zadovoljni, zato ocenjujemo, da je najprimernejša metoda pri artroskopski operaciji rame (AOR) in po njej.