Sentinel node biopsy for skin melanoma

Background/Aim. Skin melanoma is one of the most malignant diseases with increasing incidence rate. Sentinel node biopsy (SNB) is very important for early detection of metastatic spread. The aim of the study was to analyze the first 40 patients with skin melanoma of 1 to 4 mm Breslow thickness when SNB was indicated. Methods. The patient characteristics, localization of the primary melanoma as well as histology grade were analyzed. SNB with intraoperative radiocolloid and methylene blue dye detection was performed. Results. Complication rate after SNB was analyzed and seroma was found in 5% of the patients. The therapeutic node dissection was performed in 10 patients with positive sentinel biopsy. The follow-up lasted two years. In five patients the false negative SNB was defined after the mean time of 11 months and the therapeutic dissection was performed. Conclusion. SNB in melanoma patients is a useful diagnostic procedure. It is advised for melanoma of 1 to 4 mm Breslow thickness

Breast reconstruction following amputation for cancer

Background/Aim. Today, breast reconstruction is a widely accepted method in the treatment of breast cancer after modified radical mastectomy. Reconstruction methods are associated with an acceptable number of complications and reconstruction favorably impacts quality of life. The aim of the study was to present our experience in breast reconstruction. Methods. We presented here a four-year experience with 84 patients with breast reconstruction after modified radical mastectomy. Results. Implant reconstructions were most common, 44 (52.3%), with primary reconstruction in 31(70.4%) and secondary in 13 (29.5%) women. Lattisimus dorsi flap (LDF) and implant were utilized in 32 (38%) of the patients, with primary reconstruction in 24 (75%) and secondary in 8 (25%) women. Transversal rectus abdominis myocutaneous (TRAM) flap was rarely used - just in 8 (9.5%) patients and only for secondary breast reconstruction. Postoperatively, some early complications such as hematoma, seroma, infections and partial flap necrosis were observed in 10 (11.9%) patients. Late complications, such as implant rejection, hypertrophic scarring and hernias at the flap elevation site, were noted in 10 (11.9%) cases. Implant loss occurred in 5 (5.9%) cases. All the complications were successfully managed, and patients rated their reconstruction as follows: excellent, 49 (59%) cases; very good, 20 (24%), and good, 14 (16.8%). In one case, disease progression was observed 6 months after the primary breast reconstruction. Conclusion. Breast reconstruction is an acceptable method in the treatment of breast cancer in patients in the need for or with already performed mastectomy. The choice of reconstruction approach depends on the breast volume, patient's wish and experience of surgical team. Our results suggest the advantage of breast reconstruction with LDF with implant, since the technique is safe, complications relatively rare and easily manageable, and the results are excellent or very good in each woman

Unusual case of successful hand replantation with bad functional outcome: A case report

Introduction. Traumatic hand amputation is a very severe and rare injury. Replantation and revascularization surgery requires the existence of specialized centres and well-educated teams of microsurgeons. In places where there are no such specialized centres for this kind of surgery, traumatic hand amputation is a major concern and quite a challenge, and a successfully performed replantation is a great accomplishment. Case Outline. We report a case of a successfully survived replanted hand in a 35-year-old male patient with unfortunately bad end result of the treatment. The patient with the amputated left hand (disarticulation) had a surgery 4 hours after injury. The urgent surgical procedure required a debridement, the excision of the first row of the carpal bones, external fixation of the wrist, vascular anastomoses, nerve repair, tenorrhaphy, skin sutures and decompression skin incisions. The successful operation did not have a successful post-operative course due to the patient’s psychiatric problems and lack of rehabilitation at the psychiatric institution where the treatment was continued. Conclusion. Successful surgical performance can unfortunately be ruined due to inadequate further treatment course or the wrong selection for such a demanding surgery. The survival of the amputated hand can be achieved surgically, but achieving refunctioning does not always depend on surgery. It also depends on the very patient, his motivation, rehabilitation, as well as on the proper selection for such a demanding and complex surgical procedure

METHODS FOR EXPERIMENTAL ANASTOMOSES PROTECTION ON THE COLUMN

The paper presents the results of an experimental research on small animals (rats) whose purpose is to check upon efficiency of the protection methods for suppressing dehiscence of the column anastomoses.The research is carried out on 90 experimental animals divided into three groups of 30. In the control group (group K) the segment resection of the left side of the column is done with termino-terminal anastomosis by a one-layer extension suture. In the II animal group the anastomosis protection is done by intraluminal application of latex prosthesis (group L) and in the III group the fibrin adhesive or bio adhesive application is done (group F). The complete dehiscence of anastomosis as the cause of mortality in the group K is registered in 3 (10%) cases while in the group L in 2 (6,6%) animals. In the group F there is no dehiscence with the energence of diffuse peritonitis. By applying the protection methods in performing on the column better results are achieved and they are manifested in a smaller number of dehiscences. The local application of the fibrin adhesive provides for the best results since the good mechanical protection is achieved while at the same time the healing time of the column anastomoses is shortened

Collet Sicard syndrome as atypical presentation of neck fibrosarcoma: a case report

We report a 57 years old female patient with neck fibrosarcoma. Her main complaints consisted of hoarseness, difficulty swallowing, pain in the left side of her neck and left shoulder region, which all indicated the Collet Sicard syndrome, so the working diagnosis was glomus tumor Diagnostic MSCT was used, and the characteristics of the radiologic finding did not indicate any of the paraganglioma types, although the tumor was localized in the area of the carotid bifurcation, demonstrating the signs of extension into the jugular foramen. The patient has been treated surgically in general anesthesia and pathologic diagnosis was fibrosarcoma

POSTOPERATIVE QUALITY OF LIFE AFTER TENSION AND TENSIONLESS SOLVING OF INGUINAL HERNIAS

The aim of the paper is to evaluate the postoperative quality of life of the patients after two different types of operation of the inguinal hernia. At the Surgical Clinic of the Clinic Center, Niš, in the period of two years (2000 and 2001) there were 173 patients operated, 95 of them by the classic tension methods (Bassini, Halstedt, Shouldice) while 78 by the tension less methods (Lichtenstein). In the group of patients operated by the tension less technique a lower degree of postoperative pains was recorded (fewer analgetics, smaller values at the descriptive pain scale) as well as an earlier return to physical and working activity comparing to the group of patients operated by the classic methods. Such results are explained by smaller tissue trauma and by the lack of tissue tension with the Lichtenstein method which makes it the chosen method in solving inguinal hernias

Expression of regulatory proteins and proliferative activity in relation to phenotypic characteristics of upper urothelial carcinoma

Background/Aim. Deregulation of the normal cell cycle is common in upper urothelial carcinoma (UUC). The aim of this study was to investigate the expression of regulatory proteins of the cell cycle (p53, p16, cyclin D1, HER-2) and proliferative Ki-67 activity in UUC, and to determine their interaction and influence on the phenotypic characteristics of UUC. Methods. In 44 patients with UUC, histopathological and immunohistochemical analyses (p53, p16, cyclin D1, HER-2, and Ki-67) of tumors were done. Results. Overexpression/ altered expression of p53, p16, cyclin D1 or HER-2 was detected in 20%, 57%, 64%, and 57% of tumors, respectively. Eleven (25%) UUC had a high proliferative Ki-67 index. Forty patients (91%) had at least one marker altered, while four (9%) tumors had a wild-type status. Analysis of relationship between expressions of molecular markers showed that only high expression of p53 was significantly associated with altered p16 activity (p < 0.05). High Ki-67 index was associated with the high stage (p < 0.005), solid growth (p < 0.01), high grade (p < 0.05), and multifocality p < 0.05) of UUC, while high expression of p53 was associated with the solid growth (p < 0.05). In regression models that included all molecular markers and phenotypic characteristics, only Ki-67 correlated with the growth (p < 0.0001), stage (p < 0.01), grade (p < 0.05) and multifocality (p < 0.05) of UUC; Ki-67 and HER-2 expression correlated with the lymphovascular invasion (p < 0.05). Conclusions. This investigation showed that only negative regulatory proteins of the cell cycle, p53 and p16, were significantly associated in UUC, while proliferative marker Ki-67 was in relation to the key phenotypic characteristics of UUC in the best way

Experimental closure of gunshot wounds by fibrin glue with antibiotics in pigs

Background/Aim. Gunshot wounds caused by the automatic rifle M70AB2 (AK-47) 7.62 mm, after the primary surgical management, were closed with delayed primary suture during the next four to seven days. This period coincides with the fibroblastic phase of wound healing. Fibrin glue is used as a local hemostatic and as a matrix for the local dosed release of antibiotics. Antibiotics addition to fibrin glue resulted in continuous diffusion into the surrounding next 4 to 7 days. The aim of this study was to create the preconditions for gunshot wounds closing without complications by the application of fibrin glue with antibiotics 24 h after primary surgical treatment. Methods. A total of 14 pigs were wounded in the gluteofemoral region by the bullet M67, initial velocity of 720 m/s. All wounded animals were surgically treated according to the principles of the warsurgery doctrine. Seven wounds were closed with primary delayed suture four days after the primary surgical treatment (traditional approach). Fibrin glue with antibiotics was introduced in seven wounds during the primary surgical treatment and primary delayed suture was done after 24 h. The macroscopic appearance and the clinical assessment of the wound were done during the primary surgical treatment and during its revision after 24 h, as well as histopathological findings at the days 4 and 7 after wounding. Results. Gunshot wounds caused by the automatic rifle M70AB2 (AK-47) 7.62 mm, and treated with fibrin glue with antibiotics after primary surgical management, were closed with primary delayed suture after 24 h. In further wound evolution there were no complications. Conclusion. Uncomplicated soft-tissue wounds caused by an automatic M70AB2 rifle may be closed primarily with delayed suture without the risk of developing complications if on revision, 24 h after primary surgery, there were no present necrotic tissues, hematoma, and any signs of infection when fibrin glue with antibiotics (ceftriaxone and clindamycin) was applied. The use of this method should be limited to individual and strictly controlled cases in civil practice for now

PROTECTIVE POSSIBILITIES OF THE AUTOTRANSPLANTATION OF THE INJURED SPLEEN

The spleen autotransplantation is a conserving method that is indicated in the most serious injuries of the spleen followed by the jarring of the parenchyma or total devascularization of the organ when it is impossible to apply any other conserving procedure.After multiple devascularizing injuries of the spleen of the fifth degree were induced, 20 dogs were subjected to autotransplantation of the organ while the same number of the animals was primary splenectomized. Two months and a half after the conserving operation, that is, splenectomy, all the animals (from both the groups) were exposed to an intravenous inoculation of the sublethal doses of pneumococci for the sake of perceiving immunological efficiency of the conserved tissue and compa-ring the mortality rate from the pneumococci sepsis between the two examined groups.The positive hemoculture and the logarithmic increase of the number of diplococcus in the blood samples are registered in all 40 animals. A higher mortality rate and a highly significant increase of the bacteria in blood are registered in the group of splenectomized animals with respect to the auto transplanted group.The obtained results point to the immunoprotective advantage of the conserving actions with respect to the classical splenectomic procedure