Dilemmas in the Diagnosis and Treatment of Odontogenic Tumors

Na temelju podjele odontogenih tumora koju je Svjetska zdravstvena organizacija prihvatila godine 1971., a zatim dopunila i izmijenila 1992., autori su procijenili stanje dijagnostike i liječenja te vrste tumora u nas, navodeći domaću stručnoznanstvenu literaturu, koja se bavila tom problematikom postupno prikazujući nove slučajeve dijagnosticiranih odontogenih tumora. U kontekstu promjena koje su se dogodile u zadnjoj podjeli tumora iz 1992. i podataka iz suvremene svjetske literature, prikazuje se nekoliko tipičnih i atipičnih patoloških promjena iz skupine odontogenih tumora koji su zadnjih godina u nas dijagnosticirani. U zaključku se zbog složenosti problematike upozorava na potrebu uvođenja kliničkog patologa koji bi se bavio isključivo područjem oralne patologije.A survey of the diagnosis and treatment of odontogenic tumors in Croatia, based on the World Health Organization classification of these tumors from 1971, supplemented and modified in 1992, is presented, along with the respective Croatian scientific and professional literature reporting on new cases of odontogenic tumors diagnosed over a certain period of time. Several typical and atypical pathologic changes from the group of odontogenic tumors diagnosed during the last few years are described in view of the latest 1992 modifications of tumor classification. The authors point to the complexity of the problem which obviously requires a clinical pathologist to be included in the team to exclusively work on oral pathology

Procjena genotoksičnih učinaka irinotekana i cisplatina na zdrave mišje stanice primjenom alkalnog komet testa

The purpose of cytostatic agents is to act exclusively upon tumor cells, and to inhibit growth or induce tumor cell death by impairing their cell cycle progression. However, the majority of these agents are not specific in their action, and subsequently produce toxic effects on healthy tissues causing significant adverse events in both patients and health professionals exposed to these drugs. Various cytogenetic and molecular biology assays play an important role in the assessment of genotoxic effects related to antineoplastic drugs. Within a short period after exposure to a potentially genotoxic agent, these assays are able to assess the level of cellular DNA damage and/or to monitor the dynamics of DNA repair. Sensitive techniques, such as alkaline comet assay, are of special importance in the detection of primary DNA damage occurring in individual cells regardless of the cell cycle phase. The aim of the study was to assess and compare DNA damage that irinotecan and cisplatin induce in peripheral leukocytes, and normal kidney, liver and brain cells of Swiss albino mice. The results show that both cytostatics produce statistically significant DNA damage in normal cells compared to the control group. Compared to irinotecan, cisplatin has a significantly more potent genotoxic effect on these cells, which may be attributed to various mechanisms of action of the studied drugs.Po svojoj namjeni citostatici bi trebali djelovati isključivo na tumorske stanice, te narušavanjem njihovog staničnog ciklusa spriječiti rast ili izazvati smrt tih stanica. Međutim, većina ovih lijekova je u svom djelovanju nespecifična, zbog čega se toksične posljedice odražavaju i na stanicama zdravih tkiva, a rezultat toga su značajne nuspojave u bolesnika i osoba koje su profesionalno izložene tim lijekovima. U procjeni genotoksičnih učinaka antineoplastičnih lijekova značajnu ulogu imaju različiti citogenetični i molekularno-biološki testovi. Pomoću njih u kratkom vremenskom razdoblju nakon izlaganja nekom potencijalno genotoksičnom agensu, možemo procijeniti razinu oštećenja stanične DNA i/ili pratiti dinamiku njenog popravka. Posebnu važnost imaju tehnike poput alkalnog komet testa koje omogućavaju osjetljivo otkrivanje primarnih oštećenja DNA u pojedinačnim stanicama, neovisno o fazi staničnog ciklusa. Cilj našeg istraživanja je bio ustanoviti i usporediti oštećenja DNA koja izazivaju irinotekan i cisplatina na leukocitima periferne krvi, na zdravim stanicama bubrega, jetre i mozga Swiss albino miševa. Sukladno rezultatima istraživanja oba citostatika dovode do statistički značajnih oštećenja DNA spomenutih zdravih stanica u odnosu na kontrolnu skupinu. Međusobno uspoređujući irinotekan i cisplatinu možemo zamijetiti da cisplatina ima statistički značajno jači genotoksični učinak od irinotekana na spomenute stanice, što pripisujemo različitim mehanizmima djelovanja promatranih citostatika

Interakcija inhalacijskih anestetika i citostatika

Inhaled anesthetics are often used for inducing or maintaining anesthesia in cancer patients as the length and complexity of the surgical procedure cannot be predicted for it depends on intraoperative surgical and pathohistological findings, and as often as not requires repeated operations for removal or reduction of the primary tumor, regional metastases, recurrence, pathological fractures, or surgery complications. These are easily volatile liquids that enter the body through inhalation, and then, by diffusion through the aleveolocapillary membrane, they are transferred into the blood stream to be transported to all other organs and the central nervous system. Most of the inhaled anesthetics are eliminated from the body through respiration; a portion of them, however, metabolizes in the liver via the cytochrome P450 oxidase family and is excreted via the kidneys, so the issue of their toxicity has always attracted a considerable interest from investigators. Cancer patients receiving cytostatic agents during the perioperative period increase in number every day. Aside from their planned surgery, cancer patients receiving cytostatics also undergo emergency surgery either for their disease complication or for another reason. It is important to understand the pharmacology of cytostatics, their interaction with anesthetics, pharmacokinetics and toxic reactions. Cytostatics and general anesthetics act immunosuppressively and thus compromise the patient’s immune status. In addition, cytostatics depress the myocardium and damage lung function, which can cause serious problems during anesthesia. Each anesthesia as well as each surgery produce stress on the body, and the anesthetics themselves alter the cell immunity so the patients receiving cytostatics during their perioperative period can experience serious general and organ-specific side effects. It would be worth knowing whether any of the most commonly used anesthetics today show an advantage in treating patients withcancer, especially patients receiving chemotherapy, and whether the inhaled anesthetics combined with cytostatics increase, enhance or even suppress the individual effect on various types of cells, above all on tumor cells that can become resistant to therapy for developing the so-called „multidrug resistance“.Inhalacijski anestetici često se primjenjuju za uvod u anesteziju ili za održavanje anestezije kod onkoloških bolesnika zbog toga što se kod uvoda u anesteziju dužina i opseg operacijskog zahvata često ne mogu predvidjeti i ovise o intraoperacijskom kirurškom i patohistološkom nalazu, a nerijetko su potrebne ponavljane operacije zbog uklanjanja ili redukcije primarnog tumora, regionalnih metastaza, recidiva bolesti, udaljenih metastaza, patoloških fraktura ili zbog komplikacija same operacije. To su lako hlapljive tekućine koje u organizam ulaze udisanjem, a zatim difuzijom kroz alveolokapilarnu membranu prelaze u krvotok, krvotokom se dopremaju do svih ostalih organa i do središnjeg živčanog sustava. Veći dio inhaliranih anestetika se eliminira iz organizma respiracijom, me|utim jedan dio metabolizira se u jetri putem obitelji citokrom oksidaza P450 i izlučuje putem bubrega te je pitanje njihove toksičnosti oduvijek izazivalo veliki interes istraživača. Svakodnevno se povećava broj onkoloških bolesnika koji u periperacijskom periodu primaju citostatike. Osim planiranih operacijskih zahvata onkološki bolesnici koji primaju citostatike podvrgavaju se i hitnim operacijskim zahvatima, bilo zbog komplikacija bolesti ili zbog nekog drugog razloga. Važno je razumjeti farmakologiju citostatika, interakciju s anesteticima, farmakokinetiku i toksične reakcije. Citostatici i opći anestetici djeluju imunosupresivno na bolesnika te kompromitiraju njegov imunološki status. Osim toga, citostatici deprimiraju miokard i oštećuju plućnu funkciju, što može izazvati ozbiljne probleme u anesteziji. Svaka anestezija i operacija predstavlja stres za organizam, a sami anestetici mijenjaju staničnu imunost, te bolesnici koji primaju citostatike u perioperacijskom periodu mogu imati ozbiljne opće i organ specifične nuspojave. Bilo bi dobro znati ima li neki od danas najčešće upotrebljavanih anestetika prednost u primjeni kod onkoloških bolesnika, osobito ako ti bolesnici primaju citostatike te da li inhalacijski anestetici i citostatici u kombinaciji povećavaju, potenciraju ili čak suprimiraju pojedinačni učinak na različite vrste stanica, osobito tumorskih stanica koje mogu postati rezistentne na terapiju zbog tzv. „multidrug resistance“

Interakcija inhalacijskih anestetika i citostatika

Inhaled anesthetics are often used for inducing or maintaining anesthesia in cancer patients as the length and complexity of the surgical procedure cannot be predicted for it depends on intraoperative surgical and pathohistological findings, and as often as not requires repeated operations for removal or reduction of the primary tumor, regional metastases, recurrence, pathological fractures, or surgery complications. These are easily volatile liquids that enter the body through inhalation, and then, by diffusion through the aleveolocapillary membrane, they are transferred into the blood stream to be transported to all other organs and the central nervous system. Most of the inhaled anesthetics are eliminated from the body through respiration; a portion of them, however, metabolizes in the liver via the cytochrome P450 oxidase family and is excreted via the kidneys, so the issue of their toxicity has always attracted a considerable interest from investigators. Cancer patients receiving cytostatic agents during the perioperative period increase in number every day. Aside from their planned surgery, cancer patients receiving cytostatics also undergo emergency surgery either for their disease complication or for another reason. It is important to understand the pharmacology of cytostatics, their interaction with anesthetics, pharmacokinetics and toxic reactions. Cytostatics and general anesthetics act immunosuppressively and thus compromise the patient’s immune status. In addition, cytostatics depress the myocardium and damage lung function, which can cause serious problems during anesthesia. Each anesthesia as well as each surgery produce stress on the body, and the anesthetics themselves alter the cell immunity so the patients receiving cytostatics during their perioperative period can experience serious general and organ-specific side effects. It would be worth knowing whether any of the most commonly used anesthetics today show an advantage in treating patients withcancer, especially patients receiving chemotherapy, and whether the inhaled anesthetics combined with cytostatics increase, enhance or even suppress the individual effect on various types of cells, above all on tumor cells that can become resistant to therapy for developing the so-called „multidrug resistance“.Inhalacijski anestetici često se primjenjuju za uvod u anesteziju ili za održavanje anestezije kod onkoloških bolesnika zbog toga što se kod uvoda u anesteziju dužina i opseg operacijskog zahvata često ne mogu predvidjeti i ovise o intraoperacijskom kirurškom i patohistološkom nalazu, a nerijetko su potrebne ponavljane operacije zbog uklanjanja ili redukcije primarnog tumora, regionalnih metastaza, recidiva bolesti, udaljenih metastaza, patoloških fraktura ili zbog komplikacija same operacije. To su lako hlapljive tekućine koje u organizam ulaze udisanjem, a zatim difuzijom kroz alveolokapilarnu membranu prelaze u krvotok, krvotokom se dopremaju do svih ostalih organa i do središnjeg živčanog sustava. Veći dio inhaliranih anestetika se eliminira iz organizma respiracijom, me|utim jedan dio metabolizira se u jetri putem obitelji citokrom oksidaza P450 i izlučuje putem bubrega te je pitanje njihove toksičnosti oduvijek izazivalo veliki interes istraživača. Svakodnevno se povećava broj onkoloških bolesnika koji u periperacijskom periodu primaju citostatike. Osim planiranih operacijskih zahvata onkološki bolesnici koji primaju citostatike podvrgavaju se i hitnim operacijskim zahvatima, bilo zbog komplikacija bolesti ili zbog nekog drugog razloga. Važno je razumjeti farmakologiju citostatika, interakciju s anesteticima, farmakokinetiku i toksične reakcije. Citostatici i opći anestetici djeluju imunosupresivno na bolesnika te kompromitiraju njegov imunološki status. Osim toga, citostatici deprimiraju miokard i oštećuju plućnu funkciju, što može izazvati ozbiljne probleme u anesteziji. Svaka anestezija i operacija predstavlja stres za organizam, a sami anestetici mijenjaju staničnu imunost, te bolesnici koji primaju citostatike u perioperacijskom periodu mogu imati ozbiljne opće i organ specifične nuspojave. Bilo bi dobro znati ima li neki od danas najčešće upotrebljavanih anestetika prednost u primjeni kod onkoloških bolesnika, osobito ako ti bolesnici primaju citostatike te da li inhalacijski anestetici i citostatici u kombinaciji povećavaju, potenciraju ili čak suprimiraju pojedinačni učinak na različite vrste stanica, osobito tumorskih stanica koje mogu postati rezistentne na terapiju zbog tzv. „multidrug resistance“

Pleomorfni adenom mekog nepca – prikaz slučaja

A case of a minor salivary gland tumor of the soft palate in a 64-year-old female patient is reported. Fine-needle aspiration cytology diagnosed pleomorphic adenoma. Transoral extirpation was done. Histological examination confirmed cytological diagnosis. There is no recurrence after 4 years of follow-up. Tumors of the salivary glands constitute about 3% of all tumors. Most of them arise in the major glands. Tumors localized in the minor glands are more often malignant. Pleomorphic adenoma constitutes 10% of minor salivary gland tumors. Diagnosis of intraoral tumors includes diagnostic imaging as well as fine-needle aspiration cytology. Preoperative work up influences surgical approach.Prikazana je bolesnica s tumorom male žlijezde slinovnice mekog nepca. Citološki se radilo o pleomorfnom adenomu. Učinjena je transoralna ekstirpacija. Patohistološka dijagnoza potvrdila je citološki nalaz. Na redovitim kontrolama bolesnica je više od 4 godine bez recidivnog tumora. Tumori žlijezda slinovnica čine oko 3% svih lokalizacija tumora. Češći su tumori velikih žlijezda slinovnica, tumori lokalizirani u malim žlijezdama slinovnicama češće su maligni. Pleomorfni adenomi čine 10% tumora malih žlijezda slinovnica. Dijagnostička obrada intraoralnih tumora uključuje metode vizualizacije tumora, kao i aspiracijsku citodijagnostiku. Rezultati učinjenih pretraga utječu na odluku o kirurškom pristupu

COMPUTER REPRESENTATION OF OSTEOSYNTHESIS STABILITY IN LOCKING PLATES USED FOR THE TREATMENT OF OSTEOPOROTIC PROXIMAL HUMERUS FRACTURES

Background: Proximal humerus fractures are represented as 4-5% of all fractures, with incidence notably growing with age. Since surgical internal fixation in treatment of proximal humeral fractures is used, fractures of osteoporotic bone and choice of plate for their osteosynthesis represent particular problem. The aim of the study was to test two locking plates: Philos plate with locking screws with determinated direction, and Arthrex plate with poliaxial locking screws, using the finite element method. Subjects and methods: This study used version 6.10 of Abaqus FEA software package for simulation and fine element analysis of Philos and Artrex plates attached to the osteotomy models of proximal humerus with fracture gap at 0°, 10° and 20° in four types of static load: abduction, adduction, axial compression and flexion. Simulation results of loads in abduction, adduction, axial loads and flexion, were described with the total bone displacement (U) and maximum bone displacement in the fracture gap (Uf ). Results: When examining the Philos plate in axial load on the bone with fracture gap angle from 0°, 10° and 20° no significant differences between the results for the displacements were observed. Therefore, results for other loads are related to total displacements of the bone only at the angle of 0°. Given that the results of the total bone displacement and maximum bone displacement in the fracture gap with Artrex plate were mostly higher, for comparison with the results of bone displacement in Philos plate it was taken that total bone displacement and maximum displacement in the fracture gap in Artrex plate represent 100% of the total displacement. Philos plate showed 60.71% for abduction, 76.07% for adduction, 102.24% for axial loads and 79.59% for flexion of total bone displacement in Artrex plate, and 60.48% for abduction, 76.07% for adduction, 96.05% for axial load and 79.96% for flexion of maximum displacement in the fracture gap in Artrex plate. Conclusions: Osteosynthesis for osteoporotic fractures of proximal humerus with Philos plate in computer simulation proved to be more stable than with Arthrex plate

THE RESULTS OF INTERNAL FIXATION OF PROXIMAL HUMERAL OSTEOPOROTIC FRACTURES WITH PHILOS LOCKING PLATE

Background: In the last fifty years since plate and screw osteosynthesis has been implemented in fracture treatment, osteosporotic bone fractures were observed as a special problem. Due to special histologic, anatomic, physical and biomehanic properties of osteoporotic changed bone the laws of biomechanics suggest that stable osteosynthesis for osteoporotic bone is necessary to increase the contact surface of metallic implants and bone and the stability of the screw-plate-bone compound. There are numerous surgical techniques and methods for treatment of osteoporotic proximal humeral fractures. Every surgical procedure has to establish anatomical reduction and stable fixation that will enable early mobilisation. Subjects and methods: The aim of this study was to present results of internal fixation of proximal humeral osteoporotic fractures with PHILOS locking plate. Between 2007 and 2012, a total of 67 patients older than 65 years with closed proximal humerus fractures underwent surgical treatment with PHILOS plate system (Synthes, Switzerland). 42 patients were operated with deltopectoral approach and 25 with deltoid split approach. After a mean follow up period of 14.68 (6-28) months functional and radiologic results were assessed. Results: We noted 9 postoperative complications related to surgical technique (1 intraarticular screw placement, 1 displacement in major tuberculum fragment, 1 displacement in major tuberculum fragment along with oblique placement of the plate, 2 cases of inadequate reduction, 1 case of humeral head avascular necrosis, varus humeral head fixation in 3 cases). None of the patients developed superficial or deep surgical infection. There was no nonunions. In the final evaluation, the Constant shoulder score was 91.75 (72-100). Conclusions: In this study PHILOS locking plate showed good applicability, respecting bone biologic properties because of negligible interference with blood supply of the humeral head. There was no requirement to shape the plate enabling stabilization at constant angles as clear benefit of this plate. All that enables early mobilisation, and no implant insufficiency resulting in satisfactory treatment results and high Constant shoulder scores