Rhinophyma: our thirty-year experience in treatment applying the combined techniques of decortication and electrocautery

Cilj: Rozacea je jedna od najčešćih kroničnih dermatoloških bolesti. Dijeli se u četiri podtipa, a podtip III naziva se rinofima i karakteriziran je povećanjem nosa. Etiologija bolesti još je uvijek nepoznata. Cilj je ovoga rada prikazati naše tridesetogodišnje iskustvo u liječenju rinofime kombiniranim kirurškim pristupom (dekortikacijom i elektrokauterizacijom). Materijal i metode: U istraživanju je sudjelovalo 55 bolesnika muškog spola, starije životne dobi, u periodu od 1980. do 2010. godine. Rezultati: Prednost tehnike koju smo koristili je u očuvanju izvornog oblika nosa i izvorne boje kože nosa. Značajno je istaknuti da nismo primijetili recidiv bolesti niti godinu dana nakon operacijskog zahvata. Zaključak: Osvrnuli smo se na sve do sada poznate kirurške metode rada u liječenju rinofime te ukazali na njihove prednosti i nedostatke. Osim kirurškog liječenja, navodimo i pokušaj liječenja medikamentima, od kojih je vrijedno izdvojiti liječenje novijim lijekom pod imenom Tamoxifen.Rosacea is one of the most common chronic dermatological diseases. It has four subtypes and the third one is referred to as rhinophyma. It is characterized by an increase in nose volume and its aetiology is still unknown. The aim of this paper is to present the results of our thirty-year experience in the treatment of rhinophyma applying the combined surgical techniques of decortication and electrocauterization. Materials and methods: The research embraced a pattern of 55 male patients and was carried out in the period from 1980 to 2010. Results: The advantage of these techniques consists in preserving the original nose shape and colour. It is important to point out that no recurrence was observed even after one year elapsed from the operation. Conclusion: The paper includes essential information on all surgical methods in the treatment of rhinophyma specifiying their advantages and disadvantages. Besides surgical treatment, rhinophyma can be treated with drugs of which Tamoxifen is particularly worth while mentioning

Rhinophyma: our thirty-year experience in treatment applying the combined techniques of decortication and electrocautery

Cilj: Rozacea je jedna od najčešćih kroničnih dermatoloških bolesti. Dijeli se u četiri podtipa, a podtip III naziva se rinofima i karakteriziran je povećanjem nosa. Etiologija bolesti još je uvijek nepoznata. Cilj je ovoga rada prikazati naše tridesetogodišnje iskustvo u liječenju rinofime kombiniranim kirurškim pristupom (dekortikacijom i elektrokauterizacijom). Materijal i metode: U istraživanju je sudjelovalo 55 bolesnika muškog spola, starije životne dobi, u periodu od 1980. do 2010. godine. Rezultati: Prednost tehnike koju smo koristili je u očuvanju izvornog oblika nosa i izvorne boje kože nosa. Značajno je istaknuti da nismo primijetili recidiv bolesti niti godinu dana nakon operacijskog zahvata. Zaključak: Osvrnuli smo se na sve do sada poznate kirurške metode rada u liječenju rinofime te ukazali na njihove prednosti i nedostatke. Osim kirurškog liječenja, navodimo i pokušaj liječenja medikamentima, od kojih je vrijedno izdvojiti liječenje novijim lijekom pod imenom Tamoxifen.Rosacea is one of the most common chronic dermatological diseases. It has four subtypes and the third one is referred to as rhinophyma. It is characterized by an increase in nose volume and its aetiology is still unknown. The aim of this paper is to present the results of our thirty-year experience in the treatment of rhinophyma applying the combined surgical techniques of decortication and electrocauterization. Materials and methods: The research embraced a pattern of 55 male patients and was carried out in the period from 1980 to 2010. Results: The advantage of these techniques consists in preserving the original nose shape and colour. It is important to point out that no recurrence was observed even after one year elapsed from the operation. Conclusion: The paper includes essential information on all surgical methods in the treatment of rhinophyma specifiying their advantages and disadvantages. Besides surgical treatment, rhinophyma can be treated with drugs of which Tamoxifen is particularly worth while mentioning

Rhinophyma: our thirty-year experience in treatment applying the combined techniques of decortication and electrocautery

Cilj: Rozacea je jedna od najčešćih kroničnih dermatoloških bolesti. Dijeli se u četiri podtipa, a podtip III naziva se rinofima i karakteriziran je povećanjem nosa. Etiologija bolesti još je uvijek nepoznata. Cilj je ovoga rada prikazati naše tridesetogodišnje iskustvo u liječenju rinofime kombiniranim kirurškim pristupom (dekortikacijom i elektrokauterizacijom). Materijal i metode: U istraživanju je sudjelovalo 55 bolesnika muškog spola, starije životne dobi, u periodu od 1980. do 2010. godine. Rezultati: Prednost tehnike koju smo koristili je u očuvanju izvornog oblika nosa i izvorne boje kože nosa. Značajno je istaknuti da nismo primijetili recidiv bolesti niti godinu dana nakon operacijskog zahvata. Zaključak: Osvrnuli smo se na sve do sada poznate kirurške metode rada u liječenju rinofime te ukazali na njihove prednosti i nedostatke. Osim kirurškog liječenja, navodimo i pokušaj liječenja medikamentima, od kojih je vrijedno izdvojiti liječenje novijim lijekom pod imenom Tamoxifen.Rosacea is one of the most common chronic dermatological diseases. It has four subtypes and the third one is referred to as rhinophyma. It is characterized by an increase in nose volume and its aetiology is still unknown. The aim of this paper is to present the results of our thirty-year experience in the treatment of rhinophyma applying the combined surgical techniques of decortication and electrocauterization. Materials and methods: The research embraced a pattern of 55 male patients and was carried out in the period from 1980 to 2010. Results: The advantage of these techniques consists in preserving the original nose shape and colour. It is important to point out that no recurrence was observed even after one year elapsed from the operation. Conclusion: The paper includes essential information on all surgical methods in the treatment of rhinophyma specifiying their advantages and disadvantages. Besides surgical treatment, rhinophyma can be treated with drugs of which Tamoxifen is particularly worth while mentioning

Myxoma of the Zygomatic Bone – A Case Report

Myxoma is a benign tumor composed of primitive connective tissue cells and mesenchymal mucousal stroma. Also referred to as, a gelationus or colloidal tumor. Although rare, it can be found in the atrium of the heart, and it is the most common heart tumor. It has also been described in other body sites, one of which is the bone. We report a case of a 57-yearold female patient, with recurrent headaches located in the area of the right half of the face. Radiological analysis (Multislice Computed Tomography of the paranasal sinuses and viscerocranium) was performed, and a formation of irregular contours, destroying the right zygomatic bone, was described, measuring 25x17x20 mm in its widest diameters. Its medial border was adjacent to the lateral wall of the right maxillary sinus and the cortical bone in this segment was thinned, but preserved. A probatory excision was performed in general anesthesia, and the histopathological fi nding showed, starlike tumor cells embedded in mucoid stroma and infi ltrating the bone. After pathohistological confi rmation of myxoma, the tumor was excised in total, using infraorbital surgical approach to the zygomatic bone. During the follow-up, the patient was symptom free, without headaches, and there were no signs of local tumor recurrence. Despite of the fact that myxoma behaves as a benign disease in its nature, it can cause destruction of the tissue in the vicinity of the tumor itself, and thus major health issues for the patient. A timely proper diagnosis and the right choice of a surgical treatment can help avoid more extensive surgery procedures, as shown in our case report

Post-otoplasty Ear Keloid

Uvod: Odstojeća uška predstavlja jedan od najčešćih estetskih deformiteta ušne školjke. Idealno vrijeme za liječenje je predškolska dob. Pristup svakom bolesniku je individualan i uključuje detaljan pregled i uzimanje anamnestičkih podataka. Kirurško liječenje uvijek čini kombinacija nekoliko kirurških pristupa (Mustard, Converse, Bear, Pitanguy, Šercer, Stenström...). Komplikacije zahvata su rijetke, a kao jedna od mogućih izdvaja se pojava keloida ili prekomjernog ožiljka. Prikaz slučaja: U desetogodišnje djevojčice zbog odstojećih uški učinjena je otoplastika po Bearu. Osam mjeseci poslije operacije pojavio se manji keloid u području poslijeoperacijskog ožiljka. Promjenu smo liječili flavonoidom u vidu gela. Dvije godine poslije operacijskog zahvata kod bolesnice je ustanovljen velik grozdasti keloid na obje uške. U liječenju smo koristili kiruršku eksciziju, intralezijske kortikosteroide i terapiju argon laserom. Rasprava: Keloid je česta kožna lezija koja se teško liječi i ima visoku učestalost recidiviranja. Do sada nije osmišljen jedinstven terapijski pristup keloidu. On uključuje primjenu okluzivnog zavoja, intralezijske injekcije kortikosteroida, kriokirurgiju, kiruršku eksciziju, radioterapiju, lasersku terapiju, terapiju interferonom, 5 % imiquimod kremom, 5- FU (fluorouracilom) i drugu manje poznatu terapiju usmjerenu na sintezu kolagena. Zaključak: U našem slučaju koristili smo se pristupom koji se sastojao od kirurške ekscizije keloida te poslijeoperacijske uporabe intralezijskih injekcija kortikosteroida i primjene argon lasera. S obzirom na to da se radi o dječjoj dobi, uočili smo nedostatak literature o primjeni intralezijskih kortikosteroida. Nadamo se da će naš rad pridonijeti spoznajama o mogućnostima liječenja keloida nakon otoplastike u dječjoj dobi.Aim: Prominent ear represents one of the most common aesthetic deformations of the auricle. The ideal time for its treatment is the pre-school age. The approach to each patient is individual and includes a detailed examination and thorough medical history. Surgical treatment always uses a combination of several techniques, including those after Mustard, Converse, Bear, Pitanguy, Šercer, Stenström et al. It is very rarely followed by some complications, one of them being keloid or excessive scar. Case: An otoplasty after Bear was carried out on the protruding ears of the ten year girl. Eight months after the operation, a minor keloid appeared in view of a post-operative scar which was treated by gel flavonoid. Two years after the operation a large grapelike keloid was found at both auricles. The treatment included excision, intralesional corticosteroids and argon laser therapy. Discussion: Keloids are skin lesions difficult to treat and are highly recidive. So far, no common therapy for keloid treatment has been established. It includes the application of occlusive bandage, intralesional corticosteroid injections, surgery, excision, radiotherapy, laser therapy, interferon therapy, therapy by 5% imiquimod cream, by 5 FU (fluorouracil) and other less utilised therapy aimed at collagen synthesis. Conclusion: The authors used the combined techniques of keloid excision followed by post-operative intralesional corticosteroid injections and the application of argon laser. Additionally, we observed a lack of resources dealing with intralesional corticosteroid applications in children. Therefore, our paper should encourage further research of keloid treatment, following otoplasty in childhood

Epidermal Growth Factor Receptor Protein Expression and Gene Amplification in Normal, Hyperplastic, and Cancerous Glottic Tissue: Immunohistochemical and Fluorescent in Situ Hybridization Study on Tissue Microarrays

Aim To evaluate the importance of epidermal growth factor receptor (EGFR) protein overexpression and gene amplification in carcinogenesis of glottic cancer. Method In order to evaluate EGFR expression at protein and gene level, immunohistochemical (IHC) analysis and fluorescent in situ hybridization (FISH) were performed on tissue microarrays of laryngeal tissue (145 samples) – 38 samples of normal mucosa, 46 samples of hyperplastic lesions, and 61 samples of cancerous lesions. Results Membranous (mEGFR) and cytoplasmic (cEGFR) EGFR expression was significantly different between the analyzed groups. The differences were most striking in the suprabasal-transforming zone. IHC evaluation showed that high and low mEGFR staining contributed to the differentiation of dysplastic lesions, simple hyperplasia, and cancerous tissue, as well as between different degrees of atypia in hyperplastic lesions (P < 0.050). EGFR gene amplification was not found in simple and abnormal hyperplastic lesions, but it was confirmed in 2/21 atypical hyperplasias, indicating that gene amplification can facilitate identification of malignant potential in hyperplastic lesions. In cancerous tissue, EGFR gene amplification was found in 8/50 samples. EGFR gene amplification was found in preinvasive cancer in one patient. In invasive carcinomas, gene amplification was not associated with stage or grade. Carcinomas with gene amplification showed significantly higher cEGFR expression (basal layer P = 0.003; suprabasal layer P = 0.002). Conclusions This study confirmed an increase in EGFR protein expression and gene amplification with the increase in biological aggressiveness of glottic lesions. A correlation between EGFR gene amplification and protein expression was established. Gene amplification proved to be an early event in glottic carcinogenesis, indicating its importance for glottic cancer prevention, early detection, and protocol selection

New surgical method for closing downward migrated tracheoesophageal puncture

Cilj: Traheoezofagealni govor pomoću govorne proteze čini zlatni standard u rehabilitaciji glasa laringektomiranih bolesnika. Jedna od mogućih komplikacija vezana uz korištenje govorne proteze je spuštanje traheoezofagealne fistule. Cilj ovog rada je prikazati novu metodu kirurškog pristupa zatvaranja spuštene traheoezofagealne fistule. Ispitanici i metode: U istraživanju je sudjelovalo 6 bolesnika s spuštenom traheoezofagealnom fistulom. U liječenju smo koristili novu kiruršku metodu zatvaranja spuštene traheoezofagealne fistule koja se bazira na prikazivanju fistule u punom opsegu od 360° i postavljanju dvostruke ligature kanala traheoezofagealne fistule. Rezultati: U naših bolesnika nije došlo do komplikacija povezanih s kirurškim liječenjem (infekcije, krvarenje), kao niti do ponovnog spuštanja govorne proteze. Svi pacijenti su nakon ponovno postavljanja govorne proteze imali dobro rehabilitiran glas i govor. Zaključci: Metoda koju smo koristili u zatvaranju spuštene traheoezofagealne fistule je jednostavna i učinkovita. Također, obzirom da ne zahtjeva posebne kirurške instrumente lako je primjenjiva i dostupna za korištenje u svakodnevnoj kirurškoj praksi.Aim: Tracheoesophageal speech with voice prosthesis is a gold standard in voice rehabilitation of laryngectomized patients. One of the possible complications associated with the use of voice prosthesis is downward migration of tracheoesophageal puncture. The aim of this paper is to present new surgical method for closing downward migrated tracheoesophageal puncture. Patients and methods: The study included 6 patients with downward migrated tracheoesophageal puncture. In treatment we have used new surgical method for closing downward migrated tracheoesophageal puncture which is based on displaying the tracheoesophageal puncture in full range of 360° and placing a double ligature on tracheoesophageal puncture. Results: There were no complications associated with surgical treatment (infection, bleeding) or with recurrence of downward migration of speech prosthesis. All patients had a well rehabilitated voice and speech after reinserting the speech prosthesis. Conslusions: The method that we have used for closing downward migrated tracheoesophageal puncture is simple and effective, and also doesn’t require special instruments and thus we believe it can be used in everyday ENT practice

Juvenile Angiofibroma of the Maxillary Sinus

Juvenile angiofibromas are benign fibro-vascular tumours of the nasopharynx that develop in prepubertal and adolescent males. Typical symptoms are longstanding unilateral nasal obstruction occasionally followed by epistaxes and frequent severe intraoperative haemorrhage of the discovered mass.We report the case of a 14-year-old boy histologically diagnosed with a juvenile angiofibroma in spite of the atypical localisation of the polyploid mass of the left maxillary sinus

Gene Amplification of Epidermal Growth Factor Receptor in Atypical Glottic Hyperplasia

The study searched for epidermal growth factor receptor (EGFR) gene amplification in hyperplastic glottis lesions. After classical pathohistological findings of hematoxylin-eosin (HE) slides and quantitative immunohistochemical (IHC) analysis, fluorescent in situ hybridization (FISH) was used on tissue microarrays of laryngeal hyperplastic tissue ranging from normal mucosa to abnormal and atypical hyperplastic lesions. FISH analysis of two atypical hyperplastic lesions discovered the amplification of EGFR gene while it was not found in simple and abnormal hyperplastic lesions. The results may indicate that EGFR gene amplifications could possibly correlate with the histopathologic picture. Tissue samples burdened with specific oncogen signatures like EGFR gene amplification could be detected in precancerous lesion. This might improve follow-up and treatment protocols of glottic lesions which are an everyday problem for ENT practitioners. Further research is mandatory to confirm our findings

Maculopapular Eruption Secondary to Itraconazole

Adverse cutaneous reactions to itraconazole are known to be quite rare. We report a case of maculopapular reaction caused by itraconazole. On the 7th day of itraconazole therapy for hand onychomycosis, in a 39-year-old woman pruritus occurred with a subsequent morbiliform, symmetric, maculopapular eruption on the upper torso, neck, trunk and pressure- bearing areas. Eruption progressed, becoming confluent and spreading to extremities. Due to increasing indications for the administration of itraconazole its increased usage as well as the possibility of allergic reactions should be expected even if these are a rare event