Učinak lokalne infiltracijske anestezije na liječenje poslijeoperacijske boli kod rinoplastike u dnevnoj kirurgiji

Use of local infiltration anaesthesia with 2% lidocaine in combination with epinephrine 1/100000 in rhinoplasty and 0.25% levobupivacaine in this research as an adjunct to general anaesthesia is compared analysing the need for postoperative analgesia in rhinoplasty patients. 30 patients received lidocaine combined with epinephrine (LA) and other 30 patients received levobupivacaine (LB). Comparison is done with Visual Analogue Scale in 30 min and 1, 3, 6 h postoperatively. Also 24 h need for analgesic treatment was recorded. In conclusion postoperative analgesia in LB group with general anaesthesia was significantly prolonged (P = 0.038).Preoperativnu lokalnu infiltracijsku anesteziju sa 2% lidokainom u kombinaciji sa epinefrinom 1/100000 i 0,25 % levobupivakainom kao dodatku općoj anesteziji uspoređivali smo mjerenjem potrebe za postoperativnom analgezijom u pacijenata koji su se podvrgli operativnom zahvatu korekcije nosa. 30 pacijenata je primilo lidokain u kombinaciji sa epinefrinom (LA), a drugih 30 pacijenata je primilo levobupivakain (LB). PremaVisualnoj analgnoj skali s (VAS) mjerena je razina boli nakon 30 min, 1, 3, 6 sati. Isto tako unutar 24 sata mjerena je potreba za analgetskom terapijom. Poslijeoperacijska analgezija je trajala značajno dulje u skupini pacijenata LB u kojoj je primijenjen levobupivakain u kombinaciji sa općom anestezijom (P = 0.038)

Autologous Tissue Grafts in Rhinoplasty

Grafts in rhinoplasty have a wide range of use in different indications. They can be utilized for structural support, augmentation, increasing projection, replacement of over resected structures, smoothing and fine tuning of the dorsum or the tip. Various tissues can be used for those purposes to give the appropriate amount of strength, volume or coverage. We present a series of case reports with the use of autologous tissues in both primary and secondary rhinoplasties performed using both an open and closed approach. The tissues that were used are septal cartilage, conchal cartilage, rib cartilage, temporal fascia, retroauricular soft tissue, bone and fat tissue. Cartilage has been used as full thickness structural grafts, sliced cartilage, diced cartilage or cartilage paste. Fascia and soft tissues have been used as overlay, or as a wrap for diced cartilage. The understanding of the physical properties of each of these tissues and familiarity with the spectrum of use in different indications using different approaches give us the possibility to achieve stabile, aesthetically balanced results without the stigmata of surgery

Does rotation thrombelastometry (ROTEM) improve early prediction of coagulopathy in breast tumor?

Background and purpose: Breast Cancer is the second most common cancer among women after skin carcinoma. Incindence in Croatia in 2012 was 2227 new cases per year with mortality 1033 women per year. One of the most pronaunced caracteristics of cancers in general are changes in coagulation factors. Except usual coagulation factors there is thrombelasometry which is dynamic method for evaluation of coagulation factors. We have been used thrombelastometry to see differences in coagulation factors for carcinomas and benign breast diseases. Materials and methods: We included 132 patients with benign and malignant breast diseases in Institute of Thumors, Clinical Hospital Center “Sisters of Mersy”, Zagreb, Croatia gathered in prospective study in 2012/2013. We compared differences in coagulation parameters with thrombelastometry and usual coagulation factors in earlier mentioned two groups of patients with Mann-Whitney U test what is graficly described with Box and Whiskers plots and correlatio coefficients are described in table with Spearman correlation coefficients. Results: A5,A10,A15,A20,A25 and A30, MCF and AUC intem are significatly higher in malignant breast disease patients. Significant trend of elevation of these values is present in both patients groups, but those are sigificantly higher in patient group with malignant tumors. While in patients group with malignant tumors almost every correlation coefficients between A5-A30, MCF and AUC intem and cogulation markers are significant, those correlations among patients with benign diseases are not significant. Those values suggests that A5-A30, MCF and AUC intem are significatly correlated with most common used coagulation markers only in patients with malignant diseases. Conclusions: There are differences in coagulation factors in patients with benign and malignant breast diseases. Trend of elevation of markers of coagulation values is present in both disease, but significantly higher values are in malignant tumor. Our results are based on small numbers and larger number of patients with precise data of coagulation parameters are still needed

Estilo parental, filhos adolescentes e transplante hepático

Los cambios biopsicosociales de la adolescencia sitúan a los adolescentes trasplantados de hígado en mayor riesgo de no adherencia al tratamiento y al empeoramiento de la evolución en comparación con otros grupos de edad. Nuestro objetivo es determinar si la influencia del modelo parental afecta a la tolerancia tras el trasplante hepático. Método: La escala de exigencia y responsabilidad se aplicó a 30 adolescentes trasplantados de hígado y adultos jóvenes (12-30 años). La correlación entre la frecuencia del modelo parental con la tolerancia, el rechazo clínico y el rechazo en la biopsia fue hecho siguiendo el test de Chi-cuadrado. Resultados: Los resultados indican que el 57% de los adolescentes calificaron sus padres como autoritarios o sensibles, el 43% de los adolescentes definieron a sus padres como no sensibles, subdivididos en varios grupos de: 30% negligentes, permisivos el 10% y autoritarios el 3%. En correlación, no se observó ninguna diferencia significativa en el modelo parental comparando los grupos adherentes y no adherentes (X2 = 0,52, p = 0,37) y entre los grupos con y sin rechazo clínico (X2 = 0,34, p = 0,42) y entre los grupos con y sin rechazo confirmado por biopsia (X2 = 0,81, p = 0,30). Conclusiones: El estilo de crianza no tenía ninguna influencia en la adherencia, el rechazo clínico y el rechazo de la biopsia en este grupo de pacientes jóvenes con trasplante de hígado, ya que la adherencia a los inmunosupresores y el rechazo pueden ser modificados por múltiples factores. Es necesario analizar una muestra mayor para confirmar estos datos.The biological, psychological and social developmental changes that occur during adolescence place the transplanted adolescent at an even higher risk of non-adherence and poor outcome than other age groups. Our aim is check whether parenting style influences the post-liver transplant outcome after liver transplantation. Participantsand Methods: Exigency and responsiveness scale was applied to 30 liver transplanted adolescents and young adults (12-30 years old). Chi square test was used to correlate frequency of parental style with adherence, clinical rejection and rejection in biopsy. Results: 57% parents were classified as authoritative or responsive.13/30 were non responsive, which were further sub classified as negligent 30%, permissive 10% and authoritarian 3%. There was no significant difference in parenting style comparing the compliant and noncompliant groups (X2 = 0.52, p = 0.37), as well as between groups with and without clinical rejection (X2=0,34, p=0,42) and between groups with and without biopsy proven rejection (X2=0,81, p=0,30). Conclusions: Parenting style had no influence in adherence, clinical or biopsy proven rejection in this group of young patients that underwent liver transplantation. Since compliance and rejection may be modified by multiple factors, a larger sample analyses would be necessary to confirm these data.As transformações biopsicossociais da adolescência colocam os adolescentes transplantados de fígado em maior risco de não aderência ao tratamento e piora da evolução quando comparados a outros grupos etários. Objetivo: Verificar se o estilo parental influencia na adesão ao tratamento do pós-transplante hepático. Método: A escala de exigência e responsividade foi aplicada para 30 adolescentes transplantados de fígado e adultos jovens (12-30 anos). A correlação da freqüência do estilo parental com a adesão, rejeição clínica e rejeição na biópsia foi feito pelo teste do Qui-quadrado. Resultados: os achados apontam que 57% adolescentes classificaram seus pais como autoritativos ou responsivos, 43% adolescentes apontaram os pais como não responsivos, subdivididos nos subgrupos: negligente 30%, permissivo 10% e autoritário 3%. Na correlação, não foi observada diferença significativa no estilo parental comparando os grupos aderentes e não aderentes (X2 = 0,52, p = 0,37), assim como entre os grupos com e sem rejeição clínica (X2 = 0,34, p = 0,42) e entre os grupos com e sem rejeição comprovada por biópsia (X2 = 0,81, p = 0,30). Conclusões: O estilo parental não teve influência na adesão, rejeição clínica e rejeição à biópsia neste grupo de pacientes jovens transplantados de fígado, uma vez que a aderência aos imunossupressores e a rejeição podem ser modificadas por múltiplos fatores. É necessário analisar amostra maior para confirmar estes dados.peerReviewe

Usporedba učinaka i lokalne infiltracijske analgezije u različitih kirurških zahvata u dnevnoj kirurgiji

Purpose of this study was assessing of local infiltration analgesia (LI A) with levobupivacaine on the trend of acute postoperative pain and outcome in individuals who underwent rhinoplasty procedure and abdominoplasty performed in general anaesthesia. The research was conducted on 60 patients, of which 30 patients underwent rhinoplasty procedure and the other 30 patients underwent abdominoplasty procedure in general anaesthesia with LI A in “Bagatin” Polyclinic in the time period between 01.01.2014. and 01.01.2017. Postoperative analgesics doses on the same day of surgery were noted in 85 % of participants who underwent an abdominoplasty procedure and in 45 % of participants underwent rhinoplasty procedure. Patients who underwent abdominoplasty were discharged from the facility within 48 hours, while all patients who underwent rhinoplasty procedure were discharged on the same day of the surgery. During the first postoperative day patients who underwent a rhinoplasty procedure did not require analgesics, while only 3 % of patients who underwent an abdominal liposuction procedure required an additional dose of analgesics. The research results had shown, when LI A was performed, the manifestation of acute postoperative pain and vomiting did not lead to prolonged stay in day surgery.Svrha studije je procjena djelovanja lokalne infiltracijske analgezije (LI A) s levobupivakainom na promjene akutne poslijeoperacijske boli i ishod za pacijente podvrgnute rinoplastici i abdominoplastici u općoj anesteziji. Istraživanje je provedeno na 60 pacijenata, od kojih je 30 pacijenta bilo podvrgnuto abdominoplastici i 30 pacijenata podvrgnuto rinoplastici sa LI A u općoj anesteziji u Poliklinici Bagatin u vremenskom periodu od 01.01.2014. i 01.01.2017. U 85 % bolesnika podvrgnutih abdominoplastici zabilježena je poslijeoperacijska primjena analgetika, te u 45 % bolesnika podvrgnutih rinoplastici. Pacijenti podvrgnuti abdominoplastici otpušteni su iz poliklinike unutar 48 sati nakon kirurškog zahvata, a svi pacijenti koji su podvrgnuti rinoplastici otpušteni su na isti dan kirurškog zahvata. Tijekom prvog poslijeoperacijskog dana bolesnici podvrgnuti rinoplastici nisu imali potreba za analgeticima, dok je u 3 % bolesnika podvrgnutih abdominoplastici bila potrebna dodatna doza analgetika. Rezultati su studije pokazali da uz primjenu LI A-e poslijeoperacijska bol i povraćanje nakon kirurškog zahvata nisu utjecali na duljinu boravka u ustanovi u kojoj je zahvat učinjen

Distraction Osteogenesis

Distrakcijska osteogeneza je sve popularniji postupak produženja kostiju ličnog skeleta. Uz intraoralne koriste se i ekstraoralni distraktori. Autori iznose pregled razvoja distraktora i njihovu primjenu u liječenju kostiju lica. Indikacija za korišenje distraktora se sve šire i distrakcija se koristi u liječenju malformacija, malformacijskih sindroma, postraumatskih defekata kosti, deformiteta i dr. Prednost im je relativno jednostavan i brz postupak, kratka hospitalizacija, nema potrebe za uzimanjem transplnatata kosti i najvažnije istovremeno produženje ne samo kosti nego i mekih tkiva.Distraction osteogenesis is increasingly used for bone lengthening of facial skeleton. Distractors may be intraoral and extraoral. The authors present development of distractors and their use for treatment of facial bones. Procedure may be used for treatment of malformations, syndroms, posttraumatic bone defects and deformities. The advantage of a distractor are a simple and fast procedure, short period of hospitalization, procedure does not require bone grafts and enables simultaneous bone lengthening and lengthening of soft tissues

Optimalna analgezija za kirurgiju dojke ubrzala je oporavak u dnevnoj kirurgiji

Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts. This included breast augmentation, breast augmentation and lifting operations, in a ratio of 2 to 1.According to statistics from the American Association of Plastic Surgeons (ASPS), in 2020 breast augmentation with implants was ranked fifth of all cosmetic surgeries performedand the second largest body surgery immediately after liposuction, with 193,073 procedures done. In addition to these procedures, breast augmentation (87,051) and breast reduction (33,574) procedures were also popular. Due to the increased interestin these procedures and their high daily percentage of operating programs, adequate analgesia and recovery of patients, who undergo these cosmetic breast corrections, areimportant. Today, it is no longer enough for an operation to go well and the patients to have good results. It is also important that the procedure itself, from induction of anesthesia to early and late recovery, allows for a quick return to daily activities and work.Estetska kirurgija dojke najčešći je operativni zahvat na tijelu u Poliklinici Bagatin. Prema statistici američkog udruženja plastičnih kirurga ( ASPS-u) 2020. povećanje grudi implantatima je bilo na 5-om mjestu svih estetskih operativnih zahvata i na 2-om mjestu operacija na tijelu odmah iza liposukcije i iznosio je 193,073. Uz navedene zahvate popularni su zahvati podizanje grudi (87,051) i smanjenja (redukcije) grudi (33,574). Zbog velike popularnosti ovih zahvata i velikog udjela istih u svakodnevnom operativnom programu bitna je adekvatna analgezija i oporavak pacijentica koje idu na estetske operacije korekcije grudi. Ovaj segment je bitan jer danas više nije dovoljno samo da operacija prođe dobro i da pacijenti imaju dobar rezultat nego je bitan i sam postupak od uvođenja u anesteziju do ranog i kasnog oporavka i brzog povratka svakodnevnim aktivnostima i poslu

Adult-onset acne: prevalence, impact, and management challenges

Acne is a multifactorial and inflammatory disease of pilosebaceous follicles, which affects most adolescents. Recent epidemiological data revealed a difference in adults affected by this disease. Women have a high prevalence and incidence when compared with men, especially after 25 years of age. In contrast to what was initially thought, most of these patients do not present endocrinopathy capable of leading to the development of the lesions. When present, polycystic ovarian syndrome is the main cause. However, in these cases, acne is rarely the only dermatological manifestationhirsutism and acanthosis nigricans are often present. The majority of the normoandrogenic acne patients present a history since adolescence, but in many cases the lesion distribution and intensity change with time. There is often a typical localization of the lesions in the lower third of the face and lateral region of the neck. Another interesting feature is related to the impact on quality of life (QoL), which is always intense. Often there are signs of depression, even when the lesions are mild. As most adult patients are women, in addition to the conventional options, there is also hormone treatment. Combined oral contraceptives and spironolactone are good options. Knowing more about the particularities in etiopathogenesis, impact on QoL, and specific treatment options is important to all dermatologists who face the challenge of treating acne in adults.Univ Fed Sao Paulo, Paulista Med Sch, Rua Eugenio Bettarello 55 Ap 134B, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Paulista Med Sch, Rua Eugenio Bettarello 55 Ap 134B, Sao Paulo, SP, BrazilWeb of Scienc

Utjecaj lokalne infiltracijske analgezije na poslijeoperacijsku bol u pacijenata s abdominoplastikom

The aim of this study was the influence of local infiltrating analgesia with levobupivacaine on acute postoperative pain in patients that underwent abdominoplasty in day surgery. Local infiltration anesthesia is an injection of local anesthetic solution in painful areas. General anesthesia and tumescent fluid solution were performed in all patients. The study included 55 patients within age range from 20 to 72 years old. Study was conducted from January 2016 to February 2019. Postoperative pain after abdominoplasty was evaluated. LIA were performed before closure of abdominal wall after resection of skin and subcutaneous fat in lower part of abdominal wall. Infiltration was performed after plication of rectus abdominis muscles with single shot of 40 ml 0.25 % Bupivacaine. Postoperative pain was reduced in the abdominal wall and in the wound area around umbilicus and in lower abdomen scar after waking from general anesthesia. Occurrence of acute postoperative was noticed in all participants. 85% of patients required an additional dose of analgesics and only in 3% of patients was required during the first postoperative day discharged during 48 hours. The research has shown that the appearance of acute postoperative pain did not lead to prolonged stay in the facility for day surgery.Cilj istraživanja je utjecaj lokalne infiltracijske analgezije s levobupivakainom na akutnu postoperacijsku bol u pacijenata podvrgnutih abdominoplastici u dnevnoj kirurgiji. Lokalna infiltracijska anestezija je injiciranje lokalnog anestetika u bolna područja na kojima operiramo. Opća anestezija učinjena je uz infiltraciju trbušnog potkožnog zida s tumescentnom otopinom. U studiju je uključeno 55 pacijenta u dobi od 20 do 72 godine. Studija se provodila od siječnja 2016. do veljače 2019. godine s evaluacijom poslijeoperacijske boli kod abdominoplastike. LIA se koristila prije zatvaranja trbušne stjenke nakon resekcije kožno-potkožnog tkiva u području donjeg dijela trbušne stjenke sa 40 ml 0,5 % Bupivakaina. Poslijeoperacijska bol u trbušnom zidu i u rani oko pupka i u području donjeg vodoravnog reza bila je manja. Dodatne analgetike poslije kirurškog zahvata dobilo je 85% pacijenata dok prvi poslijeoperacijski dan samo 3% pacijenata koji su otpušteni iz Poliklinike tijekom 48 sati. Istraživanje pokazuje da poslijeoperacijska bol poslije abdominoplastike neće produljiti boravak u poliklinici