False aneurysm of deep femoral artery branch following blunt trauma

Background: Pseudoaneurysms of the deep femoral artery (DFA) as a result of blunt trauma are very rare, therefore they are often not suspected. Surgery remains the treatment of choice and should be carried out electively for asymptomatic aneurysms. The stent-graft placement is another way of treatment but long-term durability of DFA stentgrafting is still unknown. Case Report: We present a case of a 20-year-old male patient with a pseudoaneurysm of DFA as a result of blunt trauma which was successfully treated with a stengraft. Conclusions: A pseudoaneurysm should be suspected in any patient presenting with an enlarging haematoma following blunt trauma. The use of stent-grafts seems to be a safe and efficient way of treatment of post traumatic DFA pseudoaneurysms and should be considered as one of treatment options

Application of probit method for the elastographic evaluation of venous obliterating material after sclerotherapy procedure

Purpose: Status after sclerotherapy constitutes a good clinical model for venous thrombosis with known age. The aim of this study was to compare elastographic parameters of material obliterating the great saphenous vein at 7-21 days after polidocanol sclerotherapy. Material and methods: The study included 60 patients subjected to sclerotherapy due to venous insufficiency (45 women and 15 men, mean age 51.2 ± 14.7 years, range 27-77 years). Elastographic parameters of obliterating material: total area of vessel cross-section (mm2), relative areas (%) covered by tissues with highest, intermediate, and lowest elasticity, were determined 7 ± 1, 14 ± 2, and 21 ± 2 days post-sclerotherapy, respectively. Mean time to partial and complete organisation of the obliterating material was estimated during probit regression analysis. Results: The relative area of vessel cross-section covered by tissues with the lowest elasticity underwent a statistically significant enlargement, either between the first and the second (Z = 6.725, p 21 days, respectively. Conclusions: Ultrasound elastography may accurately reflect the age of venous thrombosis in polidocanol sclerotherapy model. Mixed, fibro-elastic structure of a 14-day-old obliterating material visualised by elastography probably corresponds with chronic thrombus

Kwestionariusz BREAST-Q: narzędzie do oceny jakości życia pacjentek po rekonstrukcji piersi płatem DIEP/SIEA

Leczenie raka piersi stanowi ważne zagadnienie dla onkologów i chirurgów plastycznych. Dokonuje się znaczący postęp dotyczący wiedzy i sposobów terapii tego nowotworu. Leczenie niejednokrotnie wymaga rekonstrukcji amputowanej piersi. Współczesne metody są coraz doskonalsze i coraz bardziej dopasowane do potrzeb pacjentki. Jednocześnie obserwowany jest stały wzrost zainteresowania oceną jakości życia po wykonywanych procedurach medycznych. Taki trend obserwowany jest szczególnie w chirurgii plastycznej, gdzie prosta ocena ilości powikłań nie jest wystarczająca. Aby skutecznie pomagać, istnieje potrzeba skrupulatnej oceny leczenia dokonanej przez pacjentki. Celem pracy jest omówienie i przedstawienie zastosowania kwestionariusza BREAST-Q. Pozwala on na ocenę zadowolenia chorej ze zrekonstruowanej piersi, satysfakcji z całego procesu leczenia rekonstrukcyjnego i opieki medycznej. W pracy przedstawiono wyniki badania jakości życia kwestionariuszem BREAST-Q u 20 pacjentek po wtórnej rekonstrukcji piersi płatem DIEP bez usuwania żebra podczas uzyskiwania dostępu do naczyń dawczych. Ocena jakości życia pacjentek służy chirurgowi zajmującemu się rekonstrukcją do analizy swojej pracy. Pozwala na głębsze zrozumienie potrzeb i lepsze doradzanie kolejnym pacjentkom podczas konsultacji przedoperacyjnych. Uzyskane wyniki mogą być też przydatne dla płatnika przy podejmowaniu decyzji odnośnie do poziomu refundacji poszczególnych procedur

Properties and clinical application of human amniotic epithelial cells (HAEC)

In the contemporary medicine, undifferentiated progenitor cells of various origin and various degree of plasticity have become highly promising. Their most abundant, renewable and uncontroversial sources are placental tissues and umbilical blood. The only epithelial cells in this group come from the amnion which is used as a whole as an allogenic biological dressing. They have a range of unusual properties, such as the relative lack of histocompatibility antigens, plasticity (enabling their differentiation into a number of epithelial and mesenchymal cells) and the lack of neoplastic capacity. Amniotic epithelial cells are the only epithelial cells of the placenta. It is believed that they retain their progenitor (pluripotent) properties even in term pregnancies. This probably results from the fact that they omit the differentiation that accompanies gastrulation. Such features are typical of all placental cells which differ from amniotic epithelial cells only in their non-epithelial origin. In culture conditions, amniotic epithelial cells are characterized by a considerable plasticity: they can be stimulated to differentiate into adipocytes, chondrocytes, osteocytes, myocytes, cardiomyocytes, neurocytes, pancreatic cells and hepatocytes. To date, however, the attempts to direct their development towards the epidermis have not been successful. Obtaining multilayer epidermis in amniotic epithelial culture would be of considerable importance for tissue engineering of biological dressings. Amniotic membranes have been used for this purpose for many years, but because of their complex structure and metabolic requirements, they do not heal but dry up when applied to the wound. Some reports, however, indicate that the epithelium isolated from the amnion could be able to heal thus being suitable for allogenic grafts.Współczesna medycyna coraz większe nadzieje pokłada w niezróżnicowanych komórkach progenitorowych różnego pochodzenia i o różnym stopniu plastyczności. Ich najbardziej zasobnym, odnawialnym i niekontrowersyjnym źródłem wydają się tkanki łożyska i krew pępowinowa. Jedyne w tej grupie komórki nabłonkowe pochodzą z owodni, wykorzystywanej często w całości jako allogeniczny opatrunek biologiczny. Mają one szereg niezwykłych cech, takich jak względny brak ekspresji antygenów zgodności tkankowej, plastyczność (umożliwiająca różnicowanie w cały szereg komórek nabłonkowych i mezenchymalnych) oraz brak zdolności do nowotworzenia. Komórki nabłonka owodni są jedynymi nabłonkowymi komórkami łożyska. Uważa się, że nawet w donoszonej ciąży zachowują właściwości progenitorowe (pluripotencjalne). Wynika to prawdopodobnie z faktu, iż pomijają różnicowanie towarzyszące gastrulacji. Cechy te przejawiają zresztą wszystkie komórki łożyska, różniące się od komórek nabłonka owodni jedynie nienabłonkowym pochodzeniem. W hodowli komórki nabłonka owodni charakteryzują się dużą plastycznością: ulegają stymulacji do różnicowania w kierunku adypocytów, chondrocytów, osteocytów, miocytów, kardiomiocytów, neurocytów, komórek trzustki i hepatocytów. Dotychczas nie udało się jednak skierować ich rozwoju w kierunku naskórka. Uzyskanie nabłonka wielowarstwowego w hodowli komórek nabłonka owodni miałoby ogromne znaczenie dla inżynierii tkankowej opatrunków biologicznych. Błony owodniowe wykorzystywane są w tym celu od wielu lat, jednak wskutek złożonej struktury i wymagań metabolicznych nie ulegają wgajaniu – wysychają po położeniu na powierzchni rany. Niektóre badania wskazują natomiast, że nabłonek izolowany z owodni mógłby się wgajać, nadawałby się zatem do allogenicznych przeszczepów

Simple Clinical Tests in Severe Carpal Tunnel Syndrome

Patients with severe carpal tunnel syndrome may be characterised by an atypical clinical picture. They assess complaints as becoming less bothersome than in the past. It seems that this may influence the diagnostic value of some clinical tests used in physical examinations. The aim of the study was the selection of the most reliable clinical tests in a group of patients with severe carpal tunnel syndrome. Material and methods. The material comprised 38 cases of severe form of the disease in a group of 37 prospective patients. The methods consisted in the evaluation of the rate of positive results of selected clinical tests, and in the comparison of their statistical correlation with selected parameters of median nerve conduction. Results. The study results indicated that high incidence of two-point discrimination disorders showed a correlation with the sensory conduction parameters, including the median-ulnar sensory latency difference. The Durkan's and Phalen's tests were positive in almost all patients with advanced carpal tunnel. The Katz hand diagram revealed significantly enhanced sensitivity in the “probable” pattern. Conclusions. We speculate that the two-point discrimination, evaluated with the use of a simple paper clip, enables the selection of a group of patients with severe form of the syndrome for further differentiation. The tool used for facilitating the differential diagnosis is the Katz hand diagram. The Durkan's and Phalen's tests have an equally high value. However, they show no correlation with the conduction parameters, as measured by EMG

BREAST-Q questionnaire: tool for evaluation of quality of life following breast reconstruction with DIEP/SIEA flap

Breast cancer management is important for both oncologists and plastic surgeons. We can observe a considerable progress in knowledge and treatment modalities in this type of cancer. Treatment often requires reconstruction of the removed breast. Modern methods are becoming better and more suited to patient’s needs. At the same time, we observe a steadily increasing interest in quality of life after medical procedures. This tendency is particularly visible in plastic surgery, where simple analysis of complication rate is insufficient. In order to effectively help, a scrupulous evaluation of the outcomes by the patient herself is necessary. The aim of the study is to discuss and present the use of BREAST-Q questionnaire. It allows to assess patient’s satisfaction with the breast treatment as a whole and medical care. In this article, we present BREAST-Q questionnaire scores in 20 patients following secondary breast reconstruction with DIEP flap without rib removal when accessing internal mammary vessels. The assessment of quality of life is necessary for the reconstructive surgeon to evaluate his own work. It enables deeper understanding of needs and better advice for future patients during preoperative consultation. The results can also be useful for payers in order to decide about reimbursement of specific procedures

Incomplete excision of basal cell carcinoma (BCC) in the head and neck region: to wait, or not to wait?

Introduction : Recurrence rates for incompletely excised basal cell carcinoma (BCC) vary widely in the literature. Clinical observation is a commonly accepted method of follow up, however such management of these lesions still remains controversial. Aim : To evaluate the rate and factors associated with the recurrence of BCC of the head and neck region after incomplete excision. Material and methods : Medical records of 135 patients with 156 incompletely excised BCCs of the head and neck region were analyzed retrospectively. The primary outcome was the rate of recurrence. Additionally, a correlation of recurrence to clinical and morphological factors was analyzed. Results : Recurrence occurred in 72 (46%) lesions. The mean interval to recurrence was 20 months. In each category of factors, the highest relative risk of recurrence was correlated to: location on the scalp – 2.27, diameter over 2 cm – 1.21, nodular clinical form – 1.29, morpheaform histopathological type – 1.67, recurrent lesion – 1.88, irradicality of excision in the lateral margin – 1.24 and closure of the skin defect with the split-thickness skin graft – 1.42 relative risk. Conclusions : Observation is an acceptable management option as less than a half of incompletely excised BCCs recurred and needed further treatment. As 85% of recurrences occur within 3 years after operation, clinical observation should be particularly careful during this period, however long-term recurrence should not be underestimated

Distal Hand Migration of Polyacrylamide Gel after Breast Augmentation: A Case Report and Review of the Literature

Breast augmentation is one of the most popular cosmetic surgery procedures in the world and it requires a comprehensive study of the methods performed. As less-invasive techniques are sought, tissue fillers have found its purpose in these procedures. However, it has been revealed that some of them may be associated with serious complications. One of them is the Aquafilling/Los Deline gel. A case report of a female patient who developed unprecedented sequelae after Aquafilling injection—distant migration of the gel in the hand—was presented in this study. The patient underwent total gel removal from the left forearm, arm, and both breasts as well as wound debridement and irrigation. We discovered a canal connecting the left breast to the left forearm, created by a polyacrylamide hydrogel dislocation. It was thoroughly revised using an endoscope. Despite the advantages of tissue fillers such as simplicity of use and less invasiveness, certain complications can occur after injection. Although a few of them have been banned due to these sequelae, new ones continue to appear. Every new product should be examined very carefully before it is introduced to the market

Dried human skin fibroblasts as a new substratum for functional culture of hepatic cells

The primary hepatocytes culture is still one of the main challenges in toxicology studies in the drug discovery process, development of in vitro models to study liver function, and cell-based therapies. Isolated hepatocytes display a rapid decline in viability and liver-specific functions including albumin production, conversion of ammonia to urea, and activity of the drug metabolizing enzymes. A number of methods have been developed in order to maintain hepatocytes in their highly differentiated state in vitro. Optimization of culture conditions includes a variety of media formulations and supplements, growth surface coating with the components of extracellular matrix or with synthetic polymers, three-dimensional growth scaffolds and decellularized tissues, and coculture with other cell types required for the normal cell-cell interactions. Here we propose a new substratum for hepatic cells made by drying confluent human skin fibroblasts' culture. This growth surface coating, prepared using maximally simplified procedure, combines the advantages of the use of extracellular matrices and growth factors/cytokines secreted by the feeder layer cells. In comparison to the hepatoma cells grown on a regular tissue culture plastic, cells cultured on the dried fibroblasts were able to synthesize albumin in larger quantities and to form greater number of apical vacuoles. Unlike the coculture with the living feeder layer cells, the number of cells grown on the new substratum was not reduced after fourteen days of culture. This fact could make the dried fibroblasts coating an ideal candidate for the substrate for non-dividing human hepatocytes