Incidence of lymph node metastases after piecemeal laser-surgical and en bloc cold steel resection of auricular VX2 carcinoma. A comparative study.

The CO2 laser surgery has become a widely used clinical treatment in otorhinolaryngology. In advanced neoplastic disease of the head and neck it is often difficult and even impossible to expose well the whole tumor through the surgical laryngoscope. In such cases the tumor is usually divided with the CO2 laser in several parts, which are excised separately. This approach seems opposed to the basic principles of oncologic surgery, where the tumor should not be touched in order to avoid local recurrences or metastatic spread. The proponents of the piecemeal resections refer back to few morphological and clinical studies, which show no evidence of increased incidence of metastases after the piecemeal resection. On this background the aim of the present study was to compare the piecemeal laser surgical complete (R0) resection with cold steel complete (R0) en bloc resection of tumors in an animal model. For both surgical approaches the incidence of local recurrences, regional and distant metastases had to be compared. After randomization to the both study arms in 143 male New Zealand White rabbits a VX2 squamous cell carcinoma was induced on the auricle. On day 8 a complete resection of the tumour was performed: for the first group - with cold steel resection en bloc; for the second group the cancer was transected by the CO2 laser following which it was removed in two pieces - piecemeal laser-surgical resection. On the 42nd postoperative day all animals were sacrificed and subjected to evaluation of the tumoral spread. Compared on the incidence of LN metastases the two therapeutic groups showed significant differences. Twenty-five percent of the animals with en bloc cold steel had metastases to regional lymph nodes, whereas forty-seven percent of the laser piecemeal group had metastatic nodal involvement. The incidence of distant metastases was similar for both study groups - 12.3% for the en block resection group and 7.7% for the piecemeal laser resection group. In this experimental setting the piecemeal laser surgical resection achieved better local results, but lead to more metastases (mainly lymphatic ones), than the cold steal en bloc resection. However, it is unlikely that tumor cells disseminated from the resection line itself caused this difference, as the vessels here were occluded by the laser. Mechanisms, which could explain the observed difference include dissemination through the walls of the intratumoral or peritumoral lymphatics. Piecemeal laser resection may decompress intratumoral pressure and release intra and peritumoral lymphatics, causing a flood of tumor emboli. Changes in the permeability and the lymph/blood flow caused by the local laser heat could have similar effect. Additionally mechanical trauma to the tumor mass itself or explosion-like tumor cell spread into the lymphatic network due to the applied laser energy could also precipitate metastases

Surgical approach to giant rhinophyma

Introduction: Giant rhinophyma is a rare condition, representing end-stage rosacea – phymatous rosacea of the nose. This extreme growth of the nasal skin is an embarrassing cosmetic condition.Case report: We present a clinical case of a 76-year old male patient with excessive growth of the nose over years. Apart of the cosmetic condition the patient complained of impaired nasal breathing, which needed stenting of the nostrils and impairment when eating. His facial skin showed typical signs of rosacea. The therapeutic approach chosen included surgical resection with electrocautery and disposable razor blades. The histologic examination of the specimen confirmed the clinical diagnosis. The result achieved was very good both functionally and cosmetically.Conclusion: It is quite debatable why a person with inital rosacea and later progressive rhinophyma seeks no medical advice/treatment or gets no correct medical treatment and follow-up and ends with a debiliating rhinophyma.----------------------------------Въведение: Гигантската ринофима е рядко болестно състояние. Това е краен етап в еволюцията на розацеята – фиматозна розацея на носа. Екстремното разрастване на кожата на носа представлява сериозен естетически деформитет.Клиничен случай: Представяме клиничен случай на 76-годишен пациент с постепенно нарастване на носа в хода на години до ексцесивни размери. Освен самия козметичен дефект, оплакванията на пациента включват затруднено до невъз можност носно дишане, за което той е бил принуден да използва своеобразни стентове и смущения дори на храненето. По лицето му се установяват типични за розацея кожни промени. Терапевтичният подход е хирургически – резекция чрез електроскалпел и послойно изтъняване със самобръсначки. Хистологичното изследване потвърждава клиничната диагноза. Пациентът оценява късния постоперативен резултат като много добър, както във функционално, така и в естетично отношение.Заключение: Открит остава въпросът защо пациент, при който първоначално се развива розацея, която с времето еволюира до ринофима със значителни размери, не търси лекарска помощ или не получава адекватна такава, за да се достигне обезобразяваща гигантска ринофима

DIGITAL ONCOLOGY PATIENT RECORD - HETEROGENEOUS FILE BASED APPROACH

Introduction: Oncology patients need extensive follow-up and meticulous documentation. The aim of this study was to introduce a simple, platform independent file based system for documentation of diagnostic and therapeutic procedures in oncology patients and test its function.Material and methods: A file-name based system of the type M1<separator>M2<separator>M3.F2 was introduced, where M1 is a unique identifier for the patient, M2 is the date of the clinical intervention/event, M3 is an identifier for the author of the medical record and F2 is the specific software generated file-name extension.Results: This system is in use at 5 institutions, where a total of 11 persons on 14 different workstations inputted 16591 entries (files) for 2370. The merge process was tested on 2 operating systems - when copied together all files sort up as expected by patient, and for each patient in a chronological order, providing a digital cumulative patient record, which contains heterogeneous file formats.Conclusion: The file based approach for storing heterogeneous digital patient related information is an reliable system, which can handle open-source, proprietary, general and custom file formats and seems to be easily scalable. Further development of software for automatic checks of the integrity and searching and indexing of the files is expected to produce a more user-friendly environmen

DIAGNOSTIC VALUE OF HYDRONEPHROSIS ULTRASOUND EVALUATION

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Incidence of lymph node metastases after piecemeal laser-surgical and en bloc cold steel resection of auricular VX2 carcinoma. A comparative study.

The CO2 laser surgery has become a widely used clinical treatment in otorhinolaryngology. In advanced neoplastic disease of the head and neck it is often difficult and even impossible to expose well the whole tumor through the surgical laryngoscope. In such cases the tumor is usually divided with the CO2 laser in several parts, which are excised separately. This approach seems opposed to the basic principles of oncologic surgery, where the tumor should not be touched in order to avoid local recurrences or metastatic spread. The proponents of the piecemeal resections refer back to few morphological and clinical studies, which show no evidence of increased incidence of metastases after the piecemeal resection. On this background the aim of the present study was to compare the piecemeal laser surgical complete (R0) resection with cold steel complete (R0) en bloc resection of tumors in an animal model. For both surgical approaches the incidence of local recurrences, regional and distant metastases had to be compared. After randomization to the both study arms in 143 male New Zealand White rabbits a VX2 squamous cell carcinoma was induced on the auricle. On day 8 a complete resection of the tumour was performed: for the first group - with cold steel resection en bloc; for the second group the cancer was transected by the CO2 laser following which it was removed in two pieces - piecemeal laser-surgical resection. On the 42nd postoperative day all animals were sacrificed and subjected to evaluation of the tumoral spread. Compared on the incidence of LN metastases the two therapeutic groups showed significant differences. Twenty-five percent of the animals with en bloc cold steel had metastases to regional lymph nodes, whereas forty-seven percent of the laser piecemeal group had metastatic nodal involvement. The incidence of distant metastases was similar for both study groups - 12.3% for the en block resection group and 7.7% for the piecemeal laser resection group. In this experimental setting the piecemeal laser surgical resection achieved better local results, but lead to more metastases (mainly lymphatic ones), than the cold steal en bloc resection. However, it is unlikely that tumor cells disseminated from the resection line itself caused this difference, as the vessels here were occluded by the laser. Mechanisms, which could explain the observed difference include dissemination through the walls of the intratumoral or peritumoral lymphatics. Piecemeal laser resection may decompress intratumoral pressure and release intra and peritumoral lymphatics, causing a flood of tumor emboli. Changes in the permeability and the lymph/blood flow caused by the local laser heat could have similar effect. Additionally mechanical trauma to the tumor mass itself or explosion-like tumor cell spread into the lymphatic network due to the applied laser energy could also precipitate metastases

Modeling of Biochemical Nitrate Reduction in Constant Electric Field

Experiments on the bioelectrochemical stimulation of enzyme reduction of nitrate to nitrite in a potentiostatic regime at different catode potentials were carried out. It was established that the stimulation effect of the constant electric field on nitrate reduction is also relevant for cell-free enzyme preparation, i.e. the effect is related to the constitutive enzymes nitrate-reductase and nitrite-reductase, contained in the cell membranes. Mathematical modeling of these experimental data as well as data for the same process accomplished by living immobilized cells was carried out. The purpose of the modeling was to select the most suitable kinetic model and then estimate the kinetic parameters and their dependence on the cathode potential. The mathematical models were based on the Michaelis-Menten kinetics taking into account inhibition by nitrate and nitrite. This modeling helped to conclude that the stimulation consists of two effects: enhanced maximum rate of nitrate enzyme reduction and faster nitrite reduction to eliminate nitrite inhibition on the overall process. It was found that the maximum reaction rates of nitrate and nitrite reduction depend on the cathode potential with maxima at + 0.01 V vs. the saturated hydrogen electrode

Mathematical Modeling for Studying Microbial Processes – Some Examples

Mathematical modeling may have different purposes in chemical and biochemical engineering sciences. One of them is to confirm or to reject kinetic models for certain processes, or to evaluate the importance of some transport phenomena on the net chemical or biochemical reaction rate. In the present paper different microbial processes are considered and modeled for evaluation of kinetic constants for batch and continuous processes accomplished by free and immobilized microbial cells. The practical examples are from the field of wastewater treatment and biosynthesis of products, like enzymes, lactic acid, gluconic acid, etc. By the aid of mathematical modeling the kinetics and the type of inhibition are specified for microbial wastewater denitrification and biodegradation of halogenated hydrocarbons. The importance of free and immobilized cells and their separate contribution to the overall microbial process is also evaluated for some fermentation processes: gluconic acid production, dichloroethane biodegradation, lactic acid fermentation and monochloroacetic acid biodegradation

Evaluation of complications of functional endoscopic sinus surgery

Aim: The objective of this study is to evaluate the complications after functional endoscopic sinus surgery (FESS) in the Department of Otorhinolaryngology at the St. Marina University Hospital, Varna.Materials and Methods: The records of all patients subjected to FESS were evaluated retrospectively. The complications were classified as major (severe hemorrhage, leakage of cerebral spinal fliud, visual disturbances) and minor (mild hemorrhage, periorbital hematoma and cellulitis, subcutaneous emphysema, epiphora).Results: The records of all patients subjected to FESS in the time period March 2006 to January 2016 were retrieved from the digital patient record system of a single institution, St Marina University Hospital, in Varna, Bulgaria and evaluated retrospectively. A total of 65 patients aged 11-77 (2 children, mean age 13 +/- 2.8 years and 63 adults, mean age 46.5 +/- 13.9 years, 41 men and 24 women), who were subjected to FESS, were evaluated. Ten cases were classified as minor complications (15.3%). They included subcutaneous emphysema (n=1, 1.5%) and minimal postoperative bleeding (n=9, 13.8%). Four cases were classified as major complications (6.1%). They included severe hemorrhage, requiring transfusion, nasal packing or rehospitalization (n=3, 4.6%), and visual disturbances (n=1, 1.5%).Conclusion: FESS may be considered a relatively safe method with low rate of the complications, but as with any surgical intervention, it carries risks. According to other published reports the average rate of minor and major FESS complications is about 9% and about 0.9%, respectively

Endoscopic imaging of the human laryngeal complex in an experimental setting - methodology and clinical significance

AIM: The human laryngeal complex has been an endoscopic sight since the late 19th century, however despite the technological advances little has changed in the standard observational methodology, with optical distortion of the image being a major setback in all endoscopic studies. The aim of this study is to evaluate different endoscopes and image correction algorithms in the endoscopic imaging of the laryngeal complex.METHODS AND MATERIALS: Conventional rigid 00, 300, 700 and 900 endoscopes and a flexible otorhinolaryngoscope with two-dimensional imaging capabilities, a digital camera and a direct laryngoscope were used together with an intubation mannequin to obtain endoscopic images of the laryngeal complex. Images of a custom made lens distortion grid were taken to compare the different optical systems and used as a benchmark for image correction. Both sets of images were superimposed in order to digitally correct for angle and lens distortion and to show the true size and proportions of the human laryngeal complex, so far seen only during an intubation or autopsy.RESULTS: After comparing the fiber optic and rigid endoscope obtained images, the rigid endoscopes proved to have better imaging qualities and therefore a better potential for future in depth study of laryngeal anatomy. The rigid 700 endoscope, compared to other rigid systems, allowed for an atraumatic perpendicular to the glottis view of the laryngeal complex, best suited for the study, despite the higher image distortion.CONCLUSION: Based on the collected data the 700 rigid otorhinolaryngoscope together with a standard software correction is an affordable, atraumatic and reliable method for anatomical and proportionate measuring of the human laryngeal complex in a model study