Congenital thumb duplication is estimated to occur between 0.08 and 7.6 times per 1,000 live births; however its cause is still undetermined. In this report, we present a case of Wassel type VI thumb ...polydactyly. clinical examination revealed an optimal functional position and an aesthetically pleasing shape of the ulnar thumb as well as a superior nail and pulp. However, preoperative X-ray indicated a well formed carpometacarpal joint of the radial thumb compared to an underdeveloped CMC joint of the ulnar thumb. Through surgical procedure we combined the best parts of both thumbs with on-top plasty to achieve the most optimal outcome. In conclusion, it is important to determine an adequate treatment strategy for a patient based on both clinical and radiological assessments.
While basal cell carcinoma is the most common type of skin cancer in humans, its subepidermal presentation is extremely rare. The risk factors for basal cell carcinoma development are well-known, but ...it remains unclear in which setting the tumor restricts itself to the dermal compartment. We present the fifth known case of subepidermal basal cell carcinoma. However, this particular presentation is unique due to arising beneath a capillary malformation. The patient had previously undergone multiple laser treatments which yielded no success. Initially, the vascular malformation was removed and sent for histopathological diagnosis. After the discovery of basal cell carcinoma, wide surgical resection was performed. The patient had no recurrence up to the last follow-up at 18 months postoperatively. This case demonstrates a new presentation of a very rare condition, but also highlights the importance of histopathological examination and the need for future research on any possible association between laser therapy and carcinogenesis.
Invasive breast carcinoma is the most common oncologic disease worldwide. The existing diagnostic methods use morphologic changes in the breast to diagnose a carcinoma when it has reached a certain ...size. Therefore, it is important to augment the morphologic diagnostic examinations with a new method that focuses on characteristics other than morphology such as electromagnetic changes produced by cancer. 50 adult female patients with confirmed ductal carcinoma following a core biopsy due to a suspicious breast mass were included in the study. They underwent breast thermography using a specially designed infrared camera. The data collected was statistically analyzed to determine how the presence of a tumor and its histologic characteristics influence breast thermographic properties. Twenty eight 56 % patients in the study had an abnormal thermogram. Following statistical analysis, it was found that temperature of the diseased breast was directly correlated to tumor volume
p
=0.009 and negatively correlated to depth of tumor
p
=0.042. Tumors that were ER+ and PR+ tumors produced warmer temperatures
p
=0.017 and
p
=0.038 respectively than tumors without these receptors. HER2 status and Ki-67 index had no statistical correlation with breast temperature. Tumor size, distance from the skin surface and receptor status cause changes in breast thermographic properties. Despite technical advances in the field of thermography, there are still contradictory results associated with thermography. Its diagnostic abilities are generally poorer than conventional methods and its use in breast cancer screening or as an adjunctive tool for diagnostic purposes is not recommended.
Dear Editor, The main challenge in the treatment of subungual melanoma in situ is obtaining adequate oncological resection while preserving the aesthetics and functionality of the affected digit (1). ...Traditionally, subungual melanoma in situ was treated with amputation of the distal phalanx of the digit, but management has recently become more conservative, attempting to preserve the full length of the digit (1). Although many recent studies support more conservative treatment by demonstrating successful results of the digit salvaging approach for both in situ and invasive subungual melanoma (1-3), there is still no agreed consensus in terms of the optimal surgical approach for this condition (1). It is the deep resection margin that is not uniformly accepted in the recent literature reports. Some authors recommend resection to the level of the periosteum (3,4), some include the periosteum (1), and some even perform a shave resection of the dorsal cortex of the distal phalanx (1). The reconstructive procedures also vary between authors, ranging from simple full thickness grafts (1,3,4) to toe free flaps (5). Reconstruction with a full thickness skin graft sometimes leads to complications, such as inclusion cysts and persistent hypersensitivity (1,3). These complications occur due to positioning the skin graft directly on the bone. A 31-year old women with a subungual melanoma in situ on her left thumb, diagnosed after several nail matrix biopsies, underwent a 5 mm margin resection of the entire nail complex with the distal part of the fingertip, including the distal phalanx periosteum. After intraoperatively confirming adequate tumor free margins, the residual defect measured 2×3 cm with exposed distal phalanx and without the distal fingertip (Figure 1). We reconstructed the defect using a pedicled innervated fasciocutaneous Foucher's flap (6) from the dorsum of the index proximal phalanx (Figure 2). Based on the first dorsal metacarpal artery and innervated by a branch of the superficial radial nerve, it provided stable soft tissue cover to the exposed bone, as well as fingertip sensation (Figure 3). The donor site was covered with a full-thickness skin graft taken from the volar side of the elbow. Postoperative course was uneventful with primary healing of all the wounds. Definite pathohistological analysis confirmed the diagnosis of in situ melanoma with adequate tumor resection margins. At three months follow-up, all the wounds were fully healed, there were no signs of local or regional recurrences, the hand was fully functional, and the patient was very satisfied with the appearance of the thumb (Figure 4, a and b). The patient achieved full sensory cortical reorientation. Although the finger sparing resection procedures for the treatment of subungual melanoma have not been clearly defined, we believe that the inclusion of the periosteum in the resection enhances the likelihood of obtaining tumor-free margins, especially the base, which is the most critical area due to the thinness of the nail matrix. Inclusion of the periosteum also ensures the complete removal of previous matrix biopsy scars. This extent of the resection necessitates reconstruction with an adipofascial or fasciocutaneous flap, preferably innervated if the fingertip is included in the resection. The defect in our patient was a full-thickness soft tissue defect extending to the level of the cortical bone, which included the distal fingertip due to the presence of pigmentation on the fingertip. Therefore, the ideal reconstructive option had to provide adequate soft tissue cover and be innervated to provide sensation to the fingertip. Foucher's flap is a reliable option for the cover of the thumb fingertip, and although traditionally used to resurface the thumb pulp, it provides excellent innervated cover for the thumb dorsum in cases like this, with minimal donor morbidity.
Breast carcinoma is the most common malignant disease in women in the majority of developed countries. The development of depression as well as the quality of life (QoL) in these patients depends not ...only on the result of oncologic treatment, but on the cosmetic outcome as well. The primary aim of this prospective study was to investigate the changes in QoL and depressive symptoms among patients undergoing surgical treatment for breast cancer.
We conducted a prospective study that included 100 female patients (mean age 60.26 years) who underwent surgical and oncological treatment for breast carcinoma at the University Hospital Center Zagreb, Croatia. The patients were photographed before and after treatment and were required to fill out a standardized quality of life questionairres QLQ - C30 and QLQ - BR23, Beck Depression Inventory (BDI) and a questionnaire on breast asymmetry.
Our results show that patients had significantly higher QoL levels compared with their pre-surgical results. Statistical trend of a lower degree of depression was also observed. A worse cosmetic outcome (i.e., postoperative assymetry) was associated with a lower QoL, but there was no association with depression. Depression was significantly related to the level of pain and lower financial status.
QoL improved after surgical treatment of breast cancer and was dependant on postoperative asymmetry, whereas the findings for depressive symptoms remained less clear. Future research should investigate more factors that may contribute to the QoL and degree of depression in this patient population.
Conjoined twining is a rare medical phenomenon, with an overall prevalence of 1.47 per 100 000 births. This report describes a successful separation of xypho-omphalopagus conjoined twins complicated ...by unbalanced blood shunting through the porto-systemic anastomoses within the shared liver parenchyma. Significant extrauterine twin-twin transfusion syndrome caused by unbalanced shunting is an extremely rare, and probably under-recognized, hemodynamic complication in conjoined twins necessitating urgent separation. Progressive deterioration with a poor outcome can be prevented if the condition is recognized in a timely manner.
Abstract Objectives Breast sensation following autologous breast reconstruction impacts patients’ quality of life. Although spontaneous reinnervation in free flaps was documented by many authors, ...there are efforts to further improve restoration of breast sensation. Interestingly, animal studies indicated that trastuzumab has several beneficial effects on transected peripheral nerves. Our aim was to compare spontaneous sensory recovery after free TRAM flap breast reconstruction between patients who were and were not treated with trastuzumab. Methods The study included 14 subjects who underwent tactile sensation examination in 5-year period after noninnervated free muscle-sparing TRAM flap breast reconstruction at the University Hospital Centre Zagreb, Croatia. Small and large flap skin islands and contralateral healthy breasts were tested with Semmes-Weinstein type monofilaments. Three sensory scores were created to more accurately compare breast sensation. Results In subjects receiving trastuzumab, sensory recovery earlier extended to at least four of five large skin island regions and was always present in the central flap area in comparison with subjects who were not administered trastuzumab (p=0.0476). As indicated by total sensory scores, trastuzumab-treated subjects restored sensation better resembling healthy control breasts (54 vs. 39 % in large skin islands; 95 vs. 71 % in small skin islands). Conclusions To the authors’ knowledge, the current study for the first time demonstrated trastuzumab’s potential to improve sensory outcomes in human. Our results support the strategy that accelerated nerve regeneration is a key to more successful reinnervation. HER2 and EGFR inhibitors emerge as new candidates for pharmacological interventions in peripheral nerve injury treatment.
E-cadherin, a transmembrane adhesion molecule, is implicated in the development of many solid tumors as well as in the acquisition of metastatic potential of epithelial tumors. Its clinical use has ...yet to be established.
The prognostic value of E-cadherin expression in 134 invasive ductal breast carcinoma patients over a 10-year follow-up period was investigated. Additionally, the correlation between E-cadherin expression and other traditional prognostic factors was investigated.
A statistically significant influence on overall survival was found for estrogen receptor, tumor size, histological and nuclear grade, HER2, lymph node involvement, vascular invasion, proliferative index, and E-cadherin. E-cadherin expression had a significant impact on overall survival and development of metastases in the group of patients not receiving chemotherapy, while it had no such effect in the group of patients who received chemotherapy.
We conclude that determination of E-cadherin expression can be used as an adjunct in selecting patients who may benefit from adjuvant chemotherapy in the presence of otherwise favorable prognostic factors.
Škljocavi palac u djece Pavljak, Lucija; Bulić, Krešimir; Antabak, Anko
Liječnički vjesnik,
05/2019, Volume:
141, Issue:
3-4
Journal Article
Peer reviewed
Open access
Prirodan tijek bolesti kod škljocavog palca u djece još je predmet neslaganja, a sukladno tomu i preporuke za liječenje znatno se razlikuju te ne postoje jasne i široko prihvaćene smjernice. Ovim ...radom pokušali smo dati trenutačni literaturni pregled spoznaja o tijeku bolesti te dijagnostičkim i terapijskim mogućnostima s naglaskom
na konačnom ishodu liječenja. Škljocavi palac jedna je od najčešćih anomalija dječje šake i uglavnom se vidi u djece predškolske dobi. Karakteristično je otežano klizanje tetive fleksora policisa longusa kroz njezinu ovojnicu, što je posljedica anatomskog nesklada njihovih veličina. Tipičan klinički nalaz jest palac fiksiran u fleksijskoj kontrakturi, na razini interfalangealnog zgloba. Prvi opis dao je Notta, čije ime i danas nosi palpabilna masa tetive fleksora policisa longusa u području A1 pulleya. Dijagnoza se obično postavlja temeljem anamneze i fizikalnog pregleda, uz ultrazvuk kao korisno rano dijagnostičko sredstvo. Škljocavi palac dijagnostički treba razlučiti od dislokacije,
frakture ili anomalije poznate kao deformacija palca u dlanu. Klinička istraživanja poboljšala su razumijevanje i benignost prirodnog tijeka bolesti. Terapijski postupak ovisi o izboru roditelja i liječnika. On može biti konzervativan, s pomoću udlage i izvođenjem vježba pasivne ekstenzije, ili kirurški, presijecanjem A1 pulleya, što pouzdano vraća pokretljivost interfalangealnog zgloba palca. Spontani oporavak može trajati godinama, no on pruža obiteljima voljnim čekanja mogućnost izbjegavanja stresa hospitalizacije i operacijskog liječenja.
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