Ultrasound Assessment of Regional Lymph Nodes in Melanoma Staging

Background: Melanoma can early metastasize to regional lymph nodes. The sentinel lymph node (SLN) is the first lymph node draining directly from the site of primary melanoma, and the pathohistological status of the SLN is the most significant prognostic factor for overall survival prevalence and prognosis in patients with melanoma. Ultrasound is a very useful for the imaging of regional lymph node metastases, combined with Doppler and cytopuncture. Objective: The aim of this study was to investigate the role of ultrasound assessment of regional lymph nodes in melanoma staging. Patients and methods: The study included all patients with primary melanoma detected in the period between 2003 and 2012, in whom diagnostic processing has not proven distant metastases or physical examination did not find enlarged lymph nodes. In total, 202 surgically treated patients were included in the study, of which 101 patients underwent ultrasound examination of regional lymph nodes using a linear probe of at least 12 MHz, while ultrasound of regional lymph nodes was not performed for 101 patients. Results: The results of this study emphasize the importance of ultrasound in the diagnostics and treatment of patients with melanoma. Based on the observation of the occasional positive ultrasound and fine needle aspiration cytology (FNAC) in regional lymph nodes, our results indicate that a proportion of patients can avoid sentinel lymph node biopsy (SLNB). In case of a positive ultrasound findings (complemented with FNAC of suspicious nodes), direct dissection of regional lymph nodes is recommended. However, negative ultrasound findings do not exclude the presence of micrometastases due to poor sensitivity of this method and is not a contraindication for SLNB. Conclusion : Therefore, there is a need for further studies on metastatic melanoma, especially those in the sentinel lymph nodes and in its early stage

Ultrasound Assessment of Regional Lymph Nodes in Melanoma Staging

Background: Melanoma can early metastasize to regional lymph nodes. The sentinel lymph node (SLN) is the first lymph node draining directly from the site of primary melanoma, and the pathohistological status of the SLN is the most significant prognostic factor for overall survival prevalence and prognosis in patients with melanoma. Ultrasound is a very useful for the imaging of regional lymph node metastases, combined with Doppler and cytopuncture. Objective: The aim of this study was to investigate the role of ultrasound assessment of regional lymph nodes in melanoma staging. Patients and methods: The study included all patients with primary melanoma detected in the period between 2003 and 2012, in whom diagnostic processing has not proven distant metastases or physical examination did not find enlarged lymph nodes. In total, 202 surgically treated patients were included in the study, of which 101 patients underwent ultrasound examination of regional lymph nodes using a linear probe of at least 12 MHz, while ultrasound of regional lymph nodes was not performed for 101 patients. Results: The results of this study emphasize the importance of ultrasound in the diagnostics and treatment of patients with melanoma. Based on the observation of the occasional positive ultrasound and fine needle aspiration cytology (FNAC) in regional lymph nodes, our results indicate that a proportion of patients can avoid sentinel lymph node biopsy (SLNB). In case of a positive ultrasound findings (complemented with FNAC of suspicious nodes), direct dissection of regional lymph nodes is recommended. However, negative ultrasound findings do not exclude the presence of micrometastases due to poor sensitivity of this method and is not a contraindication for SLNB. Conclusion : Therefore, there is a need for further studies on metastatic melanoma, especially those in the sentinel lymph nodes and in its early stage

Učinkovitost osteosinteze s košarastom pločicom kod multifragmentnih prijeloma ivernog vrška - Procjena ekstenzije koljena u kasnom poslijeoperacijskom razdoblju

The aim of the study was to assess functional status of the knee extensor system in the late postoperative period (at least two years of the operation and implant removal) in patients submitted to basket plate osteosynthesis for transverse or comminuted fracture of the apex of patella. The study included 71 patients with comminuted patellar apex fracture who had undergone basket plate osteosynthesis. The status of the knee extensor system was evaluated by a modified Cincinnati test. Excellent results were recorded in 59.2%, good in 30.6% and satisfactory in 10.2% of study patients. There were no poor results. In addition to ensuring osteosynthesis stability and the potential of early weight bearing, basket plate osteosynthesis meets the requirements of modern traumatology and the authors are inclined to consider it the method of choice to treat comminuted or transverse fractures of the apex of patella.Cilj ove prospektivne studije bila je procjena funkcijskog statusa ekstenzornog sustava koljena u kasnom poslijeoperacijskom razdoblju (najmanje dvije godine nakon operacije i uklanjanja usatka) u bolesnika podvrgnutih osteosintezi s košarastom pločicom zbog poprečnog ili multifragmentnog prijeloma ivernog vrška. Procjena je obuhvatila 71 bolesnika s multifragmentnim prijelomom patelarnog vrška u kasnom poslijeoperacijskom razdoblju nakon osteosinteze s košarastom pločicom. Status ekstenzornog sustava koljena procjenjivan je modificiranim testom Cincinnati. Izvrsni rezultati su zabilježeni u 59,2%, dobri u 30,6% i zadovoljavajući u 10,2% bolesnika. Loši rezultati dosad nisu zabilježeni. Uz osiguranje stabilnosti osteosinteze i mogućnost ranog opterećenja, osteosinteza s košarastom pločicom ispunjava zahtjeve suvremene traumatologije, te prema našem mišljenju predstavlja metodu izbora u zbrinjavanju multifragmentnog ili poprečnog prijeloma ivernog vrška

Učinkovitost osteosinteze s košarastom pločicom kod multifragmentnih prijeloma ivernog vrška - Procjena ekstenzije koljena u kasnom poslijeoperacijskom razdoblju

The aim of the study was to assess functional status of the knee extensor system in the late postoperative period (at least two years of the operation and implant removal) in patients submitted to basket plate osteosynthesis for transverse or comminuted fracture of the apex of patella. The study included 71 patients with comminuted patellar apex fracture who had undergone basket plate osteosynthesis. The status of the knee extensor system was evaluated by a modified Cincinnati test. Excellent results were recorded in 59.2%, good in 30.6% and satisfactory in 10.2% of study patients. There were no poor results. In addition to ensuring osteosynthesis stability and the potential of early weight bearing, basket plate osteosynthesis meets the requirements of modern traumatology and the authors are inclined to consider it the method of choice to treat comminuted or transverse fractures of the apex of patella.Cilj ove prospektivne studije bila je procjena funkcijskog statusa ekstenzornog sustava koljena u kasnom poslijeoperacijskom razdoblju (najmanje dvije godine nakon operacije i uklanjanja usatka) u bolesnika podvrgnutih osteosintezi s košarastom pločicom zbog poprečnog ili multifragmentnog prijeloma ivernog vrška. Procjena je obuhvatila 71 bolesnika s multifragmentnim prijelomom patelarnog vrška u kasnom poslijeoperacijskom razdoblju nakon osteosinteze s košarastom pločicom. Status ekstenzornog sustava koljena procjenjivan je modificiranim testom Cincinnati. Izvrsni rezultati su zabilježeni u 59,2%, dobri u 30,6% i zadovoljavajući u 10,2% bolesnika. Loši rezultati dosad nisu zabilježeni. Uz osiguranje stabilnosti osteosinteze i mogućnost ranog opterećenja, osteosinteza s košarastom pločicom ispunjava zahtjeve suvremene traumatologije, te prema našem mišljenju predstavlja metodu izbora u zbrinjavanju multifragmentnog ili poprečnog prijeloma ivernog vrška

Senile Lentigo – Cosmetic or Medical Issue of the Elderly Population

Senile lentigo or age spots are hyperpigmented macules of skin that occur in irregular shapes, appearing most commonly in the sun- exposed areas of the skin such as on the face and back of the hands. Senile lentigo is a common component of photoaged skin and is seen most commonly after the age of 50. There are many disscusions on whether senile lentigo represents a melanoma precursor, namely lentigo maligna melanoma and, if there is a need for a regular follow up in cases of multiple lesions. Clinical opservations sometimes report that in the location of the newly diagnosed melanoma, such lesion preexsisted. On contrary, some authors believe that senile lentigo represents a precursor of seborrheic keratosis, which does not require a serious medical treatment. However, the opservation of the possible association of senile lentigo with the melanoma development makes us cautious in the assessment of this lesion. Histologically, there are elongated rete ridges with increased melanin at the tips, and the number of melanocytes is not increased. The dermatoscopic features are also distinctive. If the lesion becomes inflammed it may evolve into benign lichenoid keratosis. Cryotherapy and laser treatment are common therapeutic approaches. Sun protection creams may be useful in early lesions

Our Experience of Melanoma Thickness as a Predictor of Outcome of Sentinel Node Biopsy

All follow up protocols for patients with malignant melanoma (MM) are oriented to early detection of metastases. As most of the relapses happened in regional lymph nodes, special attention is given to this region, using different diagnostic tools. Sentinel lymph node biopsy (SLNB) is generally accepted method in determining status of lymph nodes in MM patients, in their staging. This method provides valuable prognostic information, facilitates early therapeutical lymphadenectomy and so provides good base for identification of those patients who are candidates for different adjuvant modalities of treatment. (In 2001 American Joint Committee on Cancer introduced new staging system for melanoma patients which presents good frame for prognosis and therapeutical approach. Inclusion of new criteria will allow better and more individualized prognosis and treatment.) The most important predictor of SLNB outcome is thickness of tumor according to Breslow, while there is no sufficient data to show correlation with other factors.We retrospectively studded 431 patients, out of which SLNB was performed on 188. Forty patients or 21.3% had positive lymph nodes. Our results showed strong correlation of tumor thickness and Clark level of invasion with SLNB outcome. Metastatic lymph nodes were founded in all acral-lentiginous melanoma patients, followed by nodular melanoma – 55.6% and superficial spreading melanoma – 14.1%. Results showed statistically significant predilection of positive SLNB in male patients and no correlation of positive SLNB with histological type of tumor. On the contrary, it showed significant correlation with development of metastases. Thus our results are similar to other comparable studies

Ozljede glavnog žučovoda tijekom otvorene i laparoskopske kolecistektomije u Kliničkoj bolnici "Sestre milosrdnice" od 1995. do 2001. godine

Bile duct injury is one of the most severe complications of cholecystectomy. Several multi-center studies have demonstrated these injuries to be more commonly associated with laparoscopic cholecystectomy than with open cholecystectomy. During a 7-year period, from January 1995 till December 2001, 4528 patients underwent cholecystectomy at the University Department of Surgery, Sestre milosrdnice University Hospital in Zagreb, Croatia. Laparoscopic cholecystectomy was performed in 2657 (58%) of these patients. Bile duct injury was recorded in 15 (0.33%) patients, three (0.16%) of them submitted to open cholecystectomy. Of the latter, partial transsection of the common bile duct occurred in two patients and complete transsection in one patient. In the series of patients with laparoscopic cholecystectomy, bile duct injury occurred in 12 (0.45%) patients, with complete transsection of the common bile duct observed in five, partial transsection in three, and bile duct injury with a metal clip in three patients. Common bile duct stricture without apparent intraoperative injury developed in one patient during the late postoperative period. All these 15 patients with iatrogenic bile duct injury that occurred during either open or laparoscopic cholecystectomy were surgically managed. Roux-en-Y choledochojejunostomy was performed in nine patients, whereas the remaining six patients underwent common bile duct reconstruction by creating a terminoterminal anastomosis and T-tube insertion. Stricture of the anastomosis in the late postoperative period developed in five of these patients, who underwent secondary reconstruction of biliary continuity by Roux-en-Y choledochojejunostomy.Ozljeda glavnog žučovoda jedna je od najtežih komplikacija kolecistektomije. Nekoliko je multicentričnih studija pokazalo kako su ove ozljede češće kod laparoskopske negoli kod otvorene kolecistektomije. Tijekom sedmogodišnjeg razdoblja, od siječnja 1995. do prosinca 2001. godine, na Klinici za kirurgiju Kliničke bolnice "Sestre milosrdnice" u Zagrebu izvedena je kolecistektomija u 4528 bolesnika. Laparoskopska kolecistektomija učinjena je u 2657 (58%) bolesnika. Ozljeda glavnog žučovoda zabilježena je u 15 (0,33%) bolesnika. Ozljeda glavnog žučovoda nastala je u troje (0,16%) operiranih bolesnika metodom otvorene kolecistektomije. Djelomično presijecanje glavnog žučovoda nastupilo je kod dvoje bolesnika, a potpuno presijecanje kod jednog bolesnika. U skupini bolesnika kod kojih je učinjena laparoskopska kolecistektomija do ozljeda glavnog žučovoda došlo je u 12 (0,45%) operiranih: potpuno presijecanje glavnog žučovoda u petero, djelomično presijecanje u troje, ozljeda metalnom kopčom također u troje te suženje glavnog žučovoda bez intraoperacijski vidljive ozljede u jednog bolesnika i to u kasnom poslijeoperacijskom razdoblju. Svi bolesnici s jatrogenom ozljedom glavnog žučovoda koja je nastala nakon otvorene ili laparoskopske kolecistektomije liječeni su kirurški. Koledokojejuno-anastomoza po Rouxu izvedena je u devetoro bolesnika a kod šestoro bolesnika napravljena je rekonstrukcija glavnog žučovoda pomoću terminoterminalne anastomoze i uvođenjem T cjevčice. Suženje anastomoze nastupilo je u kasnom poslijeoperacijskom razdoblju u petoro bolesnika. Zato je kod njih izvedena sekundarna rekonstrukcija žučnog kontinuiteta pomoću koledokojejuno-anastomoze po Roux-u

Magnetska rezonanca u procjeni razmjera ozljede kod distorzije skočnog zgloba

The aim of the study was to evaluate the status of all soft tissue and osseous structures by magnetic resonance imaging (MRI) in patients with acute ankle injury. During a two-year period (2001-2003), 50 patients with acute ankle injury (osseous injury excluded by conventional radiography) underwent MRI evaluation within 7 days of injury infliction. The following injuries were confirmed: joint effusion, joint capsule extension, lateral collateral ligament injury, fibular malleolus infraction, flexor hallucis longus tendon injury, brevis and longus peroneus tendon injury, infraction of talus and injury of tibiofibular syndesmosis. Study results pointed to a great variety of capsule-ligament andosseous structure injuries as well as to the existence of injuries undetectable by clinical examinationi and conventional radiography, where MRI proved highly useful in identifying selected patients sustaining ankle injury.Cilj studije bio je procijeniti stanje svih mekih tkiva i koštanih struktura u bolesnika s akutnom ozljedom gležnja pomoću prikaza magnetskom rezonancom (MRI). Tijekom dvogodišnjeg razdoblja (2001. - 2003.) procjena pomoću MRI provedena je u 50 bolesnika s akutnom ozljedom skočnog zgloba (u kojih je koštana ozljeda isključena konvencionalnom radiografijom) unutar 7 dana od nastupa ozljede. MRI je potvrdila slijedeće ozljede: zglobni izljev, ekstenziju zglobne kapsule, ozljedu lateralno kolateralnih ligamenata, infrakciju fibularnog maleolusa, ozljedu tetive dugog palčanog fleksora, ozljedu tetive kratkog i dugog peroneusa, infrakciju talusa i ozljedu tibiofibularne sindesmoze. Dobiveni rezultati pokazali su raznovrsne ozljede kapsulno-ligamentnih i koštanih struktura, kao i postojanje ozljeda nevidljivih na kliničkom pregledu i konvencionalnoj radiografiji, za koje je MRI vrlo korisna dijagnostička metoda u odabranih bolesnika s ozljedom skočnog zgloba

Magnetska rezonanca u procjeni razmjera ozljede kod distorzije skočnog zgloba

The aim of the study was to evaluate the status of all soft tissue and osseous structures by magnetic resonance imaging (MRI) in patients with acute ankle injury. During a two-year period (2001-2003), 50 patients with acute ankle injury (osseous injury excluded by conventional radiography) underwent MRI evaluation within 7 days of injury infliction. The following injuries were confirmed: joint effusion, joint capsule extension, lateral collateral ligament injury, fibular malleolus infraction, flexor hallucis longus tendon injury, brevis and longus peroneus tendon injury, infraction of talus and injury of tibiofibular syndesmosis. Study results pointed to a great variety of capsule-ligament andosseous structure injuries as well as to the existence of injuries undetectable by clinical examinationi and conventional radiography, where MRI proved highly useful in identifying selected patients sustaining ankle injury.Cilj studije bio je procijeniti stanje svih mekih tkiva i koštanih struktura u bolesnika s akutnom ozljedom gležnja pomoću prikaza magnetskom rezonancom (MRI). Tijekom dvogodišnjeg razdoblja (2001. - 2003.) procjena pomoću MRI provedena je u 50 bolesnika s akutnom ozljedom skočnog zgloba (u kojih je koštana ozljeda isključena konvencionalnom radiografijom) unutar 7 dana od nastupa ozljede. MRI je potvrdila slijedeće ozljede: zglobni izljev, ekstenziju zglobne kapsule, ozljedu lateralno kolateralnih ligamenata, infrakciju fibularnog maleolusa, ozljedu tetive dugog palčanog fleksora, ozljedu tetive kratkog i dugog peroneusa, infrakciju talusa i ozljedu tibiofibularne sindesmoze. Dobiveni rezultati pokazali su raznovrsne ozljede kapsulno-ligamentnih i koštanih struktura, kao i postojanje ozljeda nevidljivih na kliničkom pregledu i konvencionalnoj radiografiji, za koje je MRI vrlo korisna dijagnostička metoda u odabranih bolesnika s ozljedom skočnog zgloba

Ozljede glavnog žučovoda tijekom otvorene i laparoskopske kolecistektomije u Kliničkoj bolnici "Sestre milosrdnice" od 1995. do 2001. godine

Bile duct injury is one of the most severe complications of cholecystectomy. Several multi-center studies have demonstrated these injuries to be more commonly associated with laparoscopic cholecystectomy than with open cholecystectomy. During a 7-year period, from January 1995 till December 2001, 4528 patients underwent cholecystectomy at the University Department of Surgery, Sestre milosrdnice University Hospital in Zagreb, Croatia. Laparoscopic cholecystectomy was performed in 2657 (58%) of these patients. Bile duct injury was recorded in 15 (0.33%) patients, three (0.16%) of them submitted to open cholecystectomy. Of the latter, partial transsection of the common bile duct occurred in two patients and complete transsection in one patient. In the series of patients with laparoscopic cholecystectomy, bile duct injury occurred in 12 (0.45%) patients, with complete transsection of the common bile duct observed in five, partial transsection in three, and bile duct injury with a metal clip in three patients. Common bile duct stricture without apparent intraoperative injury developed in one patient during the late postoperative period. All these 15 patients with iatrogenic bile duct injury that occurred during either open or laparoscopic cholecystectomy were surgically managed. Roux-en-Y choledochojejunostomy was performed in nine patients, whereas the remaining six patients underwent common bile duct reconstruction by creating a terminoterminal anastomosis and T-tube insertion. Stricture of the anastomosis in the late postoperative period developed in five of these patients, who underwent secondary reconstruction of biliary continuity by Roux-en-Y choledochojejunostomy.Ozljeda glavnog žučovoda jedna je od najtežih komplikacija kolecistektomije. Nekoliko je multicentričnih studija pokazalo kako su ove ozljede češće kod laparoskopske negoli kod otvorene kolecistektomije. Tijekom sedmogodišnjeg razdoblja, od siječnja 1995. do prosinca 2001. godine, na Klinici za kirurgiju Kliničke bolnice "Sestre milosrdnice" u Zagrebu izvedena je kolecistektomija u 4528 bolesnika. Laparoskopska kolecistektomija učinjena je u 2657 (58%) bolesnika. Ozljeda glavnog žučovoda zabilježena je u 15 (0,33%) bolesnika. Ozljeda glavnog žučovoda nastala je u troje (0,16%) operiranih bolesnika metodom otvorene kolecistektomije. Djelomično presijecanje glavnog žučovoda nastupilo je kod dvoje bolesnika, a potpuno presijecanje kod jednog bolesnika. U skupini bolesnika kod kojih je učinjena laparoskopska kolecistektomija do ozljeda glavnog žučovoda došlo je u 12 (0,45%) operiranih: potpuno presijecanje glavnog žučovoda u petero, djelomično presijecanje u troje, ozljeda metalnom kopčom također u troje te suženje glavnog žučovoda bez intraoperacijski vidljive ozljede u jednog bolesnika i to u kasnom poslijeoperacijskom razdoblju. Svi bolesnici s jatrogenom ozljedom glavnog žučovoda koja je nastala nakon otvorene ili laparoskopske kolecistektomije liječeni su kirurški. Koledokojejuno-anastomoza po Rouxu izvedena je u devetoro bolesnika a kod šestoro bolesnika napravljena je rekonstrukcija glavnog žučovoda pomoću terminoterminalne anastomoze i uvođenjem T cjevčice. Suženje anastomoze nastupilo je u kasnom poslijeoperacijskom razdoblju u petoro bolesnika. Zato je kod njih izvedena sekundarna rekonstrukcija žučnog kontinuiteta pomoću koledokojejuno-anastomoze po Roux-u