45 research outputs found
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
KliniÄki znaÄaj izraženosti gena BORIS i MYC u karcinomu ploÄastih 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 MustradƩ 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 ā 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+/ā3.5 min in A group, and 43+/ā4 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 toksiÄnog Å”oka nakon septorinoplastike
Sindrom toksiÄnog Å”oka rijetka je bolest uzrokovana bakterijskim toksinima, a karakteriziraju je nagli poÄetak,
vruÄica, hipotenzija, osip i multiorgansko zatajenje. U literaturi se procjenjuje da je godiÅ”nja incidencija bolesti
od 0,8 do 5,8 oboljelih na 100,000 ljudi s tendencijom porasta posljednjih godina. NajÄeÅ”Äi uzroÄnici su
bakterije Staphylococcus aureus i Streptococcus pyogenes (beta hemolitiÄki streptokok grupe A; BHS-A).
Bakterije proizvode egzotoksine koji se u organizmu oboljeloga ponaÅ”aju kao superantigeni, aktivirajuÄi veliki
broj limfocita T, Å”to rezultira masivnom proizvodnjom proupalnih citokina. Citokini takoÄer djeluju tako da
uzrokuju oÅ”teÄenje tkiva i kapilarno curenje koje dovodi do multiorganskog zatajenja. LijeÄenje ukljuÄuje
zbrinjavanje Ŕoka, kirurŔki debridman (ukoliko je indicirano), uklanjanje stranih tijela, te antibiotsku terapiju.
U ovom radu prikazujemo sluÄaj Å”esnaestogodiÅ”nje bolesnice koja je razvila sindrom toksiÄnog Å”oka nakon
kirurÅ”kog zahvata. Kod bolesnice je zbog deformacije nosne pregrade i piramide uÄinjena septorinoplastika i
parcijalna turbinektomija donjih nosnih Å”koljki u opÄoj anesteziji. Tijekom operativnog zahvata postavljena je
obostrana tamponada nosnih kavuma tamponom naÄinjenim od hidroksiliranog polivinil acetata (Merocel).
OtpuÅ”tena je na kuÄnu njegu prvi postoperativni dan te se drugi postoperativni dan javila zbog povraÄanja,
hipotenzije, febriliteta, grlobolje, glavobolje i osipa. Postavljena je sumnja na sindrom toksiÄnog Å”oka, te je
bolesnica detamponirana i lijeÄena dvojnom antibiotskom, vazopresornom i imunoglobulinskom terapijom. U
brisu ždrijela izoliran je BHS-A, dok su hemokulture ostale sterilne. Primijenjena terapija rezultira
poboljÅ”anjem opÄeg stanja, dok je kasniji tijek bolesti kompliciran pojavom smetnji srÄanog provoÄenja koje
su regredirale na simptomatsku terapiju. Sindrom toksiÄnog Å”oka je životno opasno stanje s visokim
mortalitetom, a rano prepoznavanje simptoma i rani poÄetak lijeÄenja kljuÄni su za povoljan ishod