Scar quality after an open decompression of median nerve

Sindrom karpalnog kanala (SKT) je kronična kompresivna neuropatija nervusa medijanusa u ručnom zglobu te obuhvaća 90% svih perifernih kompresivnih neuropatija. Najčešće nastupa u srednjim godinama, češće u žena. Najvažniji predisponirajući faktori rizika su spol, dob te genetički i antropometrijski faktori. U najvećem broju slučajeva sindrom karpalnog kanala je idiopatska bolest čiji simptomi perzistiraju mjesecima pa čak i godinama. U ispravnom postavljanju dijagnoze najvažniji je EMNG nalaz koji pokazuje usporenu motoričku i osjetnu provodnost u području ručnog zgloba u ranoj fazi bolesti, za razliku od kasne faze u kojoj mišići pokazuju jasne znakove denervacije. Zbog toga, iako postoje mogućnosti konzervativnog oblika liječenja, većina rezistentnih bolesnika se na kraju odlučuje za kirurški tretman koji u više od 95% slučajeva dovodi do trajnog olakšanja simptoma. Danas se najčešće izvodi tzv. otvorena operacija koja se sastoji u presijecanju transverzalnog karpalnog ligamenta. Ovim radom pokušali smo dokazati kako kratki uzdužni rez rezultira funkcionalnim i estetski prihvatljivim ožiljkom. Analizirali smo preoperativne i postoperativne simptome te kvalitetu ožiljka kod 33 bolesnika operirana zbog sindroma karpalnog kanala. Dobiveni podaci ukazuju da se upotrebom kratke uzdužne incizije postiže dugoročno adekvatna dekompresija nervusa medijanusa uz prihvatljivu kvalitetu postoperacijskog ožiljka.Carpal Tunnel Syndrome (CTS) is a chronic compressive neuropathy of the median nerve in the wrist and encompasses 90% of all peripheral compressive neuropathies. Most commonly occurs in middle age, more often in women. The most important predisposing risk factors are sex, age and genetic and anthropometric factors. In most cases, carpal tunnel syndrome is an idiopathic illness whose symptoms persist for months and even years. In the correct diagnosis setting, the most important is the EMNG finding that shows slow motor and sensory conductance in the wrist area at an early stage of the disease, unlike the late phase in which the muscles show clear signs of denervation. Therefore, although there are opportunities for conservative treatment, most resistant patients are ultimately selected for surgical treatment that in more than 95% of cases leads to permanent relief of symptoms. Today, the most commonly performed is the so-called open operation consisting in the transection of the transverse carpal ligament. With this work we tried to prove how short longitudinal cut results in a functional and aesthetically acceptable scarring. We analyzed preoperative and postoperative symptoms and scarring quality in 33 patients operated due to carpal tunnel syndrome. The obtained data indicate that adequate long-term decompression of median nerve is achieved by using the short-long incision with acceptable postoperative scarring quality

Scar quality after an open decompression of median nerve

Sindrom karpalnog kanala (SKT) je kronična kompresivna neuropatija nervusa medijanusa u ručnom zglobu te obuhvaća 90% svih perifernih kompresivnih neuropatija. Najčešće nastupa u srednjim godinama, češće u žena. Najvažniji predisponirajući faktori rizika su spol, dob te genetički i antropometrijski faktori. U najvećem broju slučajeva sindrom karpalnog kanala je idiopatska bolest čiji simptomi perzistiraju mjesecima pa čak i godinama. U ispravnom postavljanju dijagnoze najvažniji je EMNG nalaz koji pokazuje usporenu motoričku i osjetnu provodnost u području ručnog zgloba u ranoj fazi bolesti, za razliku od kasne faze u kojoj mišići pokazuju jasne znakove denervacije. Zbog toga, iako postoje mogućnosti konzervativnog oblika liječenja, većina rezistentnih bolesnika se na kraju odlučuje za kirurški tretman koji u više od 95% slučajeva dovodi do trajnog olakšanja simptoma. Danas se najčešće izvodi tzv. otvorena operacija koja se sastoji u presijecanju transverzalnog karpalnog ligamenta. Ovim radom pokušali smo dokazati kako kratki uzdužni rez rezultira funkcionalnim i estetski prihvatljivim ožiljkom. Analizirali smo preoperativne i postoperativne simptome te kvalitetu ožiljka kod 33 bolesnika operirana zbog sindroma karpalnog kanala. Dobiveni podaci ukazuju da se upotrebom kratke uzdužne incizije postiže dugoročno adekvatna dekompresija nervusa medijanusa uz prihvatljivu kvalitetu postoperacijskog ožiljka.Carpal Tunnel Syndrome (CTS) is a chronic compressive neuropathy of the median nerve in the wrist and encompasses 90% of all peripheral compressive neuropathies. Most commonly occurs in middle age, more often in women. The most important predisposing risk factors are sex, age and genetic and anthropometric factors. In most cases, carpal tunnel syndrome is an idiopathic illness whose symptoms persist for months and even years. In the correct diagnosis setting, the most important is the EMNG finding that shows slow motor and sensory conductance in the wrist area at an early stage of the disease, unlike the late phase in which the muscles show clear signs of denervation. Therefore, although there are opportunities for conservative treatment, most resistant patients are ultimately selected for surgical treatment that in more than 95% of cases leads to permanent relief of symptoms. Today, the most commonly performed is the so-called open operation consisting in the transection of the transverse carpal ligament. With this work we tried to prove how short longitudinal cut results in a functional and aesthetically acceptable scarring. We analyzed preoperative and postoperative symptoms and scarring quality in 33 patients operated due to carpal tunnel syndrome. The obtained data indicate that adequate long-term decompression of median nerve is achieved by using the short-long incision with acceptable postoperative scarring quality

Karakteristike raka dojke ovisno o statusu mutacija u genima BRCA1 i BRCA2 u Hrvatskoj

Breast cancer (BC) represents 25% of all malignancies in Croatian women, and in 18.8% of cases, it is diagnosed before the age of 50. Croatia launched BRCA testing of people at increased family risk. Hereditary BC is mainly caused by a pathogenic mutation in the BRCA1 or BRCA2 gene and is a significant risk factor for developing breast and ovarian cancer. The present study included 127 women diagnosed with BC, with a strong family history of BC and the known status of the germline mutations in the BRCA1/BRCA2 genes. The majority of women were BRCA1/2 mutation non-carriers, while 15.7% were BRCA1/2 mutation carriers, and 4% had a variant of unknown significance (VUS). BRCA1/2 mutation carriers were younger than non-carriers (median 38.5 years vs. 44 years) (P=.01) and had tumors of higher histological grade (P<.001). The intrinsic subtype of BC differs significantly depending on the type of mutation (P<.001). Triple-negative BC prevailed (87.5%) in BRCA1 mutation carriers, and 12.5% had a luminal B/HER2-negative BC. Four patients were BRCA2 mutation carriers, and two of them had luminal B/HER2-positive BC. Most BRCA1/2 non-carriers (69.2%) and all VUS-carriers have luminal B/HER2-negative BC. Our results show that BRCA1/2 mutation testing is essential for women with a family history burden. It is a piece of valuable information in breast cancer risk assessment and contributes to early diagnosis.Rak dojke predstavlja 25% svih zloćudnih bolesti u žena u Hrvatskoj, a u 18,8% slučajeva dijagnosticira se prije 50. godine života. Nasljedni rak dojke uglavnom je uzrokovan patogenom mutacijom u genima BRCA1 ili BRCA2 te predstavlja glavni čimbenik rizika za razvoj raka dojke i jajnika. Stoga je Hrvatska pokrenula testiranje mutacija u genima BRCA1 i BRCA2 kod osoba koje, prema smjernicama za genetičko testiranje, imaju povećani obiteljski rizik. Ovo retrospektivno istraživanje obuhvatilo je 127 žena s pozitivnom obiteljskom anamnezom i utvrđenim statusom mutacija u genima BRCA1 i BRCA2, kojima je dijagnosticiran rak dojke. Većina žena nisu bile nositeljice mutacija u genima BRCA1 ili BRCA2 (BRCA1/2), dok je 15,7% bilo nositeljica mutacije BRCA1/2, a 4% je imalo varijantu nepoznatog značaja (VUS). Nositeljice mutacije BRCA1/2 bile su mlađe od ne-nositeljica (medijan 38,5 godina u odnosu na 44 godine) (P=.01) te su imale tumore višeg histološkog gradusa (P<.001). Intrinzični podtip raka dojke značajno se razlikuje ovisno o tipu mutacije (P<.001). Trostruko negativni podtip raka dojke prevladao je u nositeljica mutacija u BRCA1 (87,5%), a 12,5% imalo je luminalni B/HER2-negativni podtip. Četiri bolesnice bile su nositeljice mutacija u BRCA2 genu, od kojih dvije s luminalnim B/HER2-pozitivim rakom dojke. Većina bolesnica (69,2%) koje nisu nositeljice patoloških mutacija BRCA1/2 i sve one s VUS imale su luminalni B/HER2-negativni podtip raka dojke. Naši rezultati pokazuju da je testiranje mutacija u genima BRCA neophodno za žene s opterećenom obiteljskom anamnezom jer može igrati vitalnu ulogu u procjeni rizika od raka dojke i doprinjeti ranoj dijagnozi

Primarni hiperparatireoidizam i serumski kalcij u bolesnica s rakom dojke tijekom procjene niske koštane mase - iskustvo jednog centra

The bone health guidelines for breast cancer (BC) patients recommend bone mineral density (BMD) testing. Patients with low BMD and elevated serum calcium levels (SCLs) are further evaluated for primary hyperparathyroidism (PHPT). We aimed to determine the prevalence of PHPT in treated BC patients with low BMD and analyze the association of SCLs with histopathologic tumor features and cancer treatment. This retrospective study included postmenopausal BC patients examined at Osteoporosis Clinic between 2013 and 2020. Clinical and BMD data were collected from patient medical records. Patients with biochemical suspicion of PHPT underwent standard parathyroid imaging procedures. Nine out of 137 (6.6%) patients were diagnosed with PHPT; 8/9 patients underwent parathyroidectomy and one patient was advised to follow-up. Among the rest of 128 non-PHPT patients, higher SCLs showed a trend of positive association with higher tumor grade and axillary lymph node involvement, and received immunotherapy, although without statistical significance. We found a higher prevalence of PHPT in treated BC patients compared to the general population. Higher SCLs show a trend of positive correlation with some more aggressive histopathologic tumor features and with immunotherapy. The results of this study suggest that assessment of SCLs should be routinely performed to rule out PHPT in treated BC patients with low BMD.Smjernice o koštanom zdravlju za bolesnice s rakom dojke (RD) preporučuju ispitivanje mineralne gustoće kostiju (bone mineral density, BMD). U bolesnica s niskom vrijednosti BMD-a i povišenom razinom kalcija u serumu (RKS) dodatno se procjenjuje primarni hiperparatireoidizam (PHPT). Cilj je bio utvrditi učestalost PHPT-a u liječenih bolesnica s RD i sniženom vrijednosti BMD-a te analizirati povezanost RKS s histopatološkim značajkama tumora i onkološkim liječenjem. Retrospektivna studija obuhvatila je postmenopauzalne bolesnice s RD koje su pregledane u Ambulanti za osteoporozu između 2013. i 2020. godine. Klinički podaci i podaci o BMD prikupljeni su iz medicinske dokumentacije. Bolesnice s biokemijskom sumnjom na PHPT podvrgnute su standardnim postupcima snimanja paratireoidnih žlijezda. U devet od 137 (6,6%) bolesnica dijagnosticiran je PHPT; 8/9 bolesnica podvrgnuto je paratireoidektomiji, a jednoj je bolesnici savjetovano praćenje. U ostalih 128 bolesnica bez PHPT-a više RKS pokazale su trend pozitivne povezanosti s višim gradusom tumora, zahvaćenošću aksilarnih limfnih čvorova i primljenom imunoterapijom, iako nije postignuta statistička značajnost. Utvrdili smo veću učestalost PHPT-a u liječenih bolesnica s RD u odnosu na opću populaciju. Više RKS pokazuju trend pozitivne korelacije s nekim agresivnijim histopatološkim značajkama tumora i imunoterapijom. Rezultati ove studije upućuju na to da bi se kod liječenih bolesnica s RD i s niskom vrijednosti BMD-a trebala rutinski provoditi procjena RKS kako bi se isključio PHPT

Scar quality after an open decompression of median nerve

Sindrom karpalnog kanala (SKT) je kronična kompresivna neuropatija nervusa medijanusa u ručnom zglobu te obuhvaća 90% svih perifernih kompresivnih neuropatija. Najčešće nastupa u srednjim godinama, češće u žena. Najvažniji predisponirajući faktori rizika su spol, dob te genetički i antropometrijski faktori. U najvećem broju slučajeva sindrom karpalnog kanala je idiopatska bolest čiji simptomi perzistiraju mjesecima pa čak i godinama. U ispravnom postavljanju dijagnoze najvažniji je EMNG nalaz koji pokazuje usporenu motoričku i osjetnu provodnost u području ručnog zgloba u ranoj fazi bolesti, za razliku od kasne faze u kojoj mišići pokazuju jasne znakove denervacije. Zbog toga, iako postoje mogućnosti konzervativnog oblika liječenja, većina rezistentnih bolesnika se na kraju odlučuje za kirurški tretman koji u više od 95% slučajeva dovodi do trajnog olakšanja simptoma. Danas se najčešće izvodi tzv. otvorena operacija koja se sastoji u presijecanju transverzalnog karpalnog ligamenta. Ovim radom pokušali smo dokazati kako kratki uzdužni rez rezultira funkcionalnim i estetski prihvatljivim ožiljkom. Analizirali smo preoperativne i postoperativne simptome te kvalitetu ožiljka kod 33 bolesnika operirana zbog sindroma karpalnog kanala. Dobiveni podaci ukazuju da se upotrebom kratke uzdužne incizije postiže dugoročno adekvatna dekompresija nervusa medijanusa uz prihvatljivu kvalitetu postoperacijskog ožiljka.Carpal Tunnel Syndrome (CTS) is a chronic compressive neuropathy of the median nerve in the wrist and encompasses 90% of all peripheral compressive neuropathies. Most commonly occurs in middle age, more often in women. The most important predisposing risk factors are sex, age and genetic and anthropometric factors. In most cases, carpal tunnel syndrome is an idiopathic illness whose symptoms persist for months and even years. In the correct diagnosis setting, the most important is the EMNG finding that shows slow motor and sensory conductance in the wrist area at an early stage of the disease, unlike the late phase in which the muscles show clear signs of denervation. Therefore, although there are opportunities for conservative treatment, most resistant patients are ultimately selected for surgical treatment that in more than 95% of cases leads to permanent relief of symptoms. Today, the most commonly performed is the so-called open operation consisting in the transection of the transverse carpal ligament. With this work we tried to prove how short longitudinal cut results in a functional and aesthetically acceptable scarring. We analyzed preoperative and postoperative symptoms and scarring quality in 33 patients operated due to carpal tunnel syndrome. The obtained data indicate that adequate long-term decompression of median nerve is achieved by using the short-long incision with acceptable postoperative scarring quality