Five-year experience in the treatment of syndactyly and polydactyly of the hand with respect to satisfaction of patient parents

Uvod: Ishodi kirurškog liječenja sindaktilije i polidaktilije šake u dječjoj dobi mogu se procjenjivati na temelju objektivnih metoda i subjektivnog dojma roditelja bolesnika. Materijali i metode: Proveli smo retrospektivnu studiju rezultata 5-godišnjeg liječenja 47-ero bolesnika sa sindaktilijom ili polidaktilijom šaka putem telefonske ankete. Ukupan odaziv na telefonsku anketu iznosio je 68%. Rezultati: Tridesetero ispitanih roditelja (94%) nije navelo nikakve funkcijske tegobe, dok je dvoje (6%) navelo kako njihova djeca imaju poteškoća s pisanjem. Osmero roditelja djece (25%) navelo je slabiju pokretljivost operiranih prstiju, od čega dvoje (6%) ima poteškoća u adaptaciji na svakodnevni život. Šestero roditelja (19%) nije zadovoljno s izgledom ožiljka, a njih dvoje (6%) je tražilo drugo mišljenje u drugim ustanovama. Rasprava i zaključak: Roditelji djece s palčanom polidaktilijom šake naveli su najlošije rezultate što se tiče poslijeoperacijske pokretljivosti prstiju. Taj je rezultat konzistentan s dostupnom literaturom. Zadovoljstvo bolesnika u velikoj je mjeri ovisilo o izgledu poslijeoperacijskog ožiljka.Outcomes of surgical treatment of hand syndactyly and polydactyly in childhood can be measured by objective methods or by subjective impression of the patient’s parents. We performed a 5-year retrospective study of the treatment of 47 patients with either syndactyly or polydactyly of the hands over a telephone questionnaire. Response rate to the questionnaire was 68%. Thirty (94%) parents did not report any kind of functional impairment, whereas two (6%) parents stated that their children had diffi culties while writing. Eight (25%) parents described stiff ness of the operated fi ngers, of which only two (6%) had diffi culties in adjustment to everyday life. Parents of six patients (19%) were not satisfi ed with the scar and two (6%) parents had sought second opinion in another hospital. Parents of the patients in whom we had performed correction of radial polydactyly reported worst results in terms of stiff - ness of the fi ngers, which is consistent with the available literature data. The satisfaction of patient’s parents largely depends on the surgical scar appearance

Post-mortem findings of inflammatory cells and the association of 4-hydroxynonenal with systemic vascular and oxidative stress in lethal COVID-19

A recent comparison of clinical and inflammatory parameters, together with biomarkers of oxidative stress, in patients who died from aggressive COVID-19 and survivors suggested that the lipid peroxidation product 4-hydroxynonenal (4-HNE) might be detrimental in lethal SARS-CoV-2 infection. The current study further explores the involvement of inflammatory cells, systemic vascular stress, and 4-HNE in lethal COVID-19 using specific immunohistochemical analyses of the inflammatory cells within the vital organs obtained by autopsy of nine patients who died from aggressive SAR-CoV-2 infection. Besides 4-HNE, myeloperoxidase (MPO) and mitochondrial superoxide dismutase (SOD2) were analyzed alongside standard leukocyte biomarkers (CDs). All the immunohistochemical slides were simultaneously prepared for each analyzed biomarker. The results revealed abundant 4-HNE in the vital organs, but the primary origin of 4-HNE was sepsis-like vascular stress, not an oxidative burst of the inflammatory cells. In particular, inflammatory cells were often negative for 4-HNE, while blood vessels were always very strongly immunopositive, as was edematous tissue even in the absence of inflammatory cells. The most affected organs were the lungs with diffuse alveolar damage and the brain with edema and reactive astrocytes, whereas despite acute tubular necrosis, 4-HNE was not abundant in the kidneys, which had prominent SOD2. Although SOD2 in most cases gave strong immunohistochemical positivity similar to 4-HNE, unlike 4-HNE, it was always limited to the cells, as was MPO. Due to their differential expressions in blood vessels, inflammatory cells, and the kidneys, we think that SOD2 could, together with 4-HNE, be a potential link between a malfunctioning immune system, oxidative stress, and vascular stress in lethal COVID-19

Preliminary findings on the association of the lipid peroxidation product 4-hydroxynonenal with the lethal outcome of aggressive COVID-19

Major findings of the pilot study involving 21 critically ill patients during the week after admission to the critical care unit specialized for COVID-19 are presented. Fourteen patients have recovered, while seven passed away. There were no differences between them in respect to clinical or laboratory parameters monitored. However, protein adducts of the lipid peroxidation product 4-hydroxynonenal (HNE) were higher in the plasma of the deceased patients, while total antioxidant capacity was below the detection limit for the majority of sera samples in both groups. Moreover, levels of the HNE-protein adducts were constant in the plasma of the deceased patients, while in survivors, they have shown prominent and dynamic variations, suggesting that survivors had active oxidative stress response mechanisms reacting to COVID-19 aggression, which were not efficient in patients who died. Immunohistochemistry revealed the abundant presence of HNE-protein adducts in the lungs of deceased patients indicating that HNE is associated with the lethal outcome. It seems that HNE was spreading from the blood vessels more than being a consequence of pneumonia. Due to the limitations of the relatively small number of patients involved in this study, further research on HNE and antioxidants is needed. This might allow a better understanding of COVID-19 and options for utilizing antioxidants by personalized, integrative biomedicine approach to prevent the onset of HNE-mediated vitious circle of lipid peroxidation in patients with aggressive inflammatory diseases

PREDVIĐANJE RUBOVA KARCINOMA BAZALNIH STANICA POMOĆU DERMOSKOPIJE

Introduction: Basal cell carcinoma (BCC) is a slow-growing epithelial tumor that rarely metastasizes, and has the rising incidence in the last decades. Complete surgical removal to reduce local recurrence is the therapy goal. Aim: To investigate the effi cacy of dermatoscopy in distinguishing superfi cial from other histopathologic BCC subtypes and in predicting the required surgical margins to reduce recurrence rate. Methods: We conducted a single-center, retrospective study in the period between January 1, 2011 and December 31, 2020. After BCC diagnosis was established, skin lesions were evaluated using dermatoscopy. After surgical excision, histopathologic analysis of the tumor and peritumoral tissue was performed by an experienced pathologist. Correlation between dermatoscopy and histopathology fi ndings were evaluated. Results: All tumors were up to 20 mm in largest diameter with head and neck being the most affected skin site (56%). There was an absolute correlation between dermatoscopy and histopathology in superfi cial BCC subtype (kappa coeffi cient 1.000; p<0.001), lower in nodular (kappa 0.847; p<0.001) and infi ltrative subtype (kappa value 0.846, p<0.001). A large majority of tumors were 1-2 mm from the inked margins (81%), belonging to pT1 category. Regarding the recurrence rate, there was no statistically signifi cant relationship with tumor size, margin or base status or tumor thickness; 8.8% of patients had recurrence in the median follow-up period of 120 months. There was a signifi cantly poorer survival period regarding recurrence in infi ltrative BCC subtype when compared to superfi cial (51 vs. 108 months; p<0.001) and nodular subtype (51 vs. 72 months, p<0.001). Conclusion: Dermatoscopic evaluation of the BCC margins could be helpful in preoperative assessment, with emphasis on inking of surgical specimen margins.Uvod: Bazocelularni karcinom kože je spororastući tumor koji vrlo rijetko metastazira, a incidencija kojega se povećava tijekom posljednjih nekoliko desetljeća. Liječenje je većinom kirurško s ciljem kompletnog odstranjenja i smanjenja mogućnosti nastanka lokalnih recidiva. Neki se podtipovi tumora mogu liječiti i konzervativno. Cilj: Analizirati uspješnost dermoskopije u identifi kaciji kirurških rubova sa svrhom smanjenja učestalosti nastanka recidiva te razlikovanje superfi cijalnog od ostalih podtipova. Metode: Klinički dio studije je proveden u Poliklinici Manola, a analiza patohistoloških preparata na Zavodu za patologiju Medicinskog fakulteta Sveučilišta u Zagrebu u razdoblju od 1. siječnja 2011. do 31. prosinca 2020. godine. Nakon postavljanja kliničke dijagnoze bazocelularnog karcinoma tumori su pregledani dermoskopski. Nakon kirurškog odstranjenja iskusni patolog je analizirao tumor i peritumorsko tkivo s naglaskom na korelaciju kliničkog i patohistološkog nalaza. Rezultati: Većina tumora bila je lokalizirana u području glave i vrata (56 %), a svi su bili manji od 20 mm u najvećem promjeru (pT1). Utvrđena je potpuna korelacija između dermoskopskog i patohistološkog nalaza superfi cijalnog podtipa (kappa koefi cijent 1,000, p<0,001), ali manja podudarna glede nodularnog (kappa 0,847, p<0,001) i infi ltrativnog podtipa (kappa 0,846, p<0,001). Većina tumora (81 %) se nalazila na 1-2 mm od bližeg resekcijskog ruba označenog bojom za tkiva. Tijekom razdoblja praćenja recidiv tumora je dijagnosticiran u 8,8 % pacijenata. Međutim, nije utvrđena statistički značajna povezanost između veličine odnosno debljine tumora i statusa rubova i baze materijala. Utvrđena je statistički značajna razlika između infi ltrativnog i superfi cijalnog bazocelularnog karcinoma u odnosu na razdoblje od dijagnoze do nastanka recidiva (51 u odnosu na 108 mjeseci, p<0,001) odnosno infi ltrativnog i nodularnog podtipa (51 napram 72 mjeseca, p<0,001). Zaključak: Dermoskopska evaluacija rubova i baze bazocelularnog karcinoma je uspješna u većini slučajeva osim infi ltrativnog podtipa. U patohistološkoj analizi je nužno označavanje resekcijskih rubova poradi procjene potpunosti ekscizije i predviđanja mogućnosti nastanka lokalnih recidiva