Rhinoplasty revision with dorsal augmentation by using PRF and temporalis fascia: case report

Background: Platelet rich fibrin (PRF) provides better healing, hemostasis, less pronounced edema and lesser resorption of the autologous augmentation material. The aim of this case report is to present a patient undergoing the 2nd revision rhinoplasty, after unsatisfactory results regarding function and esthetics. Case report: A middle-aged women, who had previously undergone rhinoplasties on two occasions in an external institution, presented with nasal dorsum irregularities, lower nasion, rocker deformity, bilateral internal and external valve insufficiency and acute nasolabial angle. The functional problem was solved by using bilateral spreader grafts and lateral crural strut grafts shaped by previously harvested septal cartilage. The reinforced lateral crura were separated from the hinge area and placed in the previously dissected alar rim pockets. The ptotic tip was reinforced by using an ANSA banner graft. The desired tip width, rotation and tip defining point position was achieved by domal creation sutures, interdomal sutures and tip position suture. Since the patient had an extremely thin skin, no tip refinement graft was used. Dorsal irregularities were to be addressed by using minor hump removal, fine drilling of residual irregularities with a diamond burr and camouflage on lay graft composed of previously harvested temporalis fascia with platelet rich fibrin matrix placed between the fascia and skin-soft tissue envelope. The patient has undergone regular follow ups since, reporting an improved function as well as a satisfactory esthetic result. Physical examination has shown normal nasal patency, uninterrupted brow tip line with smooth contours of the dorsum and normal nasolabial angle. Discussion: By reviewing the literature, most authors recommend PRF application as an addition to the diced cartilage camouflage graft for dorsal irregularities, showing superiority compared to the temporalis fascia, in terms of better healing, lesser edema, lesser resorption and smoother contours. In our case we decided to use temporalis fascia and PRF only, since the patient had an extremely thin skin, numerous minor irregularities and a lack of septal cartilage left for harvesting. It has provided a satisfactory result both subjectively and objectively upon follow up examinations by the surgeon

Klinički značaj izraženosti gena BORIS i MYC u karcinomu pločastih stanica hipofarinksa [Clinical significance of BORIS and MYC expression in hypopharyngeal squamous cell carcinoma]

Hypopharyngeal squamous cell carcinoma belongs to malignant diseases with dismal prognosis. The most prominent risk factors for this type of cancer are known to cause global DNA hypomethylation and activate cancer-related genes. BORIS is often aberrantly activated in cancer and is involved in activation of MYC transcription. The expression of BORIS and MYC was investigated in retrospective study of 59 hypopharyngeal carcinoma samples. BORIS and MYC expression was analyzed regarding to conventional prognostic factors: tumor size, lymph node involvement and the degree of tumor differentiation. The influence of BORIS and MYC expression on five-year survival rate was analyzed. Two detected BORIS transcript variants, BORISd and BORISk, were expressed in 33.9% and 76.3% of tumor analyzed tumors. The expression of both BORIS transcript variants significantly influenced the five-year survival rate (BORISd, p=0,001; BORISk, p=0,011). BORIS protein was detected in 42.4% of tumor samples and its expression had no impact on patients survival rate. The expression of MYC, regardless of its subcellular localization had no influence on patients survival. Multivariate analysis by recursive partitioning profiled BORISd expression as most powerful prognostic factor in this type of cancer

Postauricular fascia: the hidden key to successful otoplasty

Introduction: Traditional otoplasty techniques involve cartilage cutting, scoring and reshaping it with sutures. Intrinsic postauricular fascia gained popularity in 2001 when Horlock et al. first described a medially based fascia flap which served as cover for Mustradé sutures. Due to the consequent decrease in the recurrence rate, the decrease in need for revision and the reduction in the number of complications, we can witness a significant increase in the utilization of postauricular fascia flaps in otoplasty, even as a stand-alone procedure for correction of protruding ears. Aim: To describe a novel modified partial laterally based perichondrioadipodermal flap in cartilage-spearing otoplasty and to review the existing modifications of intrinsic postauricular fascia flaps in literature. Surgical technique summery: Postauricular skin incision is performed as de-epitelialization. Incision and elevation of the distally based flap is set in the mid-third of the exposed fascia. The dissection and elevation of the flap is performed on the subperichondrial plane. Discussion: Many authors, over the years, contributed to the perfection of the otoplasty techniques to obtain the most natural appearance of the ear. In strive for perfection, and with goal to reduce known complications of previous techniques, the postauricular fascia flap was first introduced in 2001. Since then, modifications of medially and laterally based fascia flap have been published. Yet, each still has some minor drawbacks. In respect to published postulates, we modified the existing technique to serve us as a great addition to traditional techniques and as stand-alone procedure in correcting isolated upper helical protrusion. Conclusion: Modifications of intrinsic postauricular fascia flaps may present a great addition to traditional techniques, but with constant awareness to look each protruding ear per se

Single Incision Laparoscopic Cholecystectomy – A New Advantage of Gallbladder Surgery

In this study is demonstrated our experience in single incision laparoscopic cholecystectomy (SILS), compared to standard laparoscopic cholecystectomy. There were 48 single incision laparoscopic cholecystectomies (SILS) performed during one-year period (A group) and results have been compared with a group of 50 patients who underwent standard laparoscopic cholecystectomy (B group). Outcome measures included operative time, need for conversion, complications, additional analgesia for pain control after procedure, hospital stay and cosmetic outcome. The mean operative time was 46+/–3.5 min in A group, and 43+/–4 min in B patients group. Early postoperative complications were not detected. The mean hospitalization period was 2 days in both groups. Our experience suggests that SILS cholecystectomy can be performed with outcome similar to standard laparoscopic surgery while affording better cosmesis

Therapy of Umbilical Hernia during Laparoscopic Cholecystectomy

The aim of this study is to show our experience with umbilical hernia herniorrhaphy and laparoscopic cholecys- tectomy, both in the same act. During last 10 years we operated 89 patients with cholecystitis and pre-existing umbilical hernia. In 61 of them we performed standard laparoscopic cholecystectomy and additional sutures of abdominal wall, and in 28 patients we performed in the same act laparoscopic cholecystectomy and herniorrhaphy of umbilical hernia. We observed incidence of postoperative herniation, and compared patients recovery after herniorrhaphy combined with laparoscopic cholecystectomy in the same act, and patients after standard laparoscopic cholecystectomy and additional sutures of abdominal wall. Patients, who had in the same time umbilical hernia herniorrhaphy and laparoscopic chole- cystectomy, shown better postoperative recovery and lower incidence of postoperative umbilical hernias then patients with standard laparoscopic cholecystectomy and additional abdominal wall sutures

Sindrom toksičnog šoka nakon septorinoplastike

Sindrom toksičnog šoka rijetka je bolest uzrokovana bakterijskim toksinima, a karakteriziraju je nagli početak, vrućica, hipotenzija, osip i multiorgansko zatajenje. U literaturi se procjenjuje da je godišnja incidencija bolesti od 0,8 do 5,8 oboljelih na 100,000 ljudi s tendencijom porasta posljednjih godina. Najčešći uzročnici su bakterije Staphylococcus aureus i Streptococcus pyogenes (beta hemolitički streptokok grupe A; BHS-A). Bakterije proizvode egzotoksine koji se u organizmu oboljeloga ponašaju kao superantigeni, aktivirajući veliki broj limfocita T, što rezultira masivnom proizvodnjom proupalnih citokina. Citokini također djeluju tako da uzrokuju oštećenje tkiva i kapilarno curenje koje dovodi do multiorganskog zatajenja. Liječenje uključuje zbrinjavanje šoka, kirurški debridman (ukoliko je indicirano), uklanjanje stranih tijela, te antibiotsku terapiju. U ovom radu prikazujemo slučaj šesnaestogodišnje bolesnice koja je razvila sindrom toksičnog šoka nakon kirurškog zahvata. Kod bolesnice je zbog deformacije nosne pregrade i piramide učinjena septorinoplastika i parcijalna turbinektomija donjih nosnih školjki u općoj anesteziji. Tijekom operativnog zahvata postavljena je obostrana tamponada nosnih kavuma tamponom načinjenim od hidroksiliranog polivinil acetata (Merocel). Otpuštena je na kućnu njegu prvi postoperativni dan te se drugi postoperativni dan javila zbog povraćanja, hipotenzije, febriliteta, grlobolje, glavobolje i osipa. Postavljena je sumnja na sindrom toksičnog šoka, te je bolesnica detamponirana i liječena dvojnom antibiotskom, vazopresornom i imunoglobulinskom terapijom. U brisu ždrijela izoliran je BHS-A, dok su hemokulture ostale sterilne. Primijenjena terapija rezultira poboljšanjem općeg stanja, dok je kasniji tijek bolesti kompliciran pojavom smetnji srčanog provođenja koje su regredirale na simptomatsku terapiju. Sindrom toksičnog šoka je životno opasno stanje s visokim mortalitetom, a rano prepoznavanje simptoma i rani početak liječenja ključni su za povoljan ishod