RESUMEN
Results of this clinical study on surgical treatment of pressure ulcers at Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital showed that there was no difference between the 2011-2016 and 2003-2008 periods, indicating continuation of good surgical treatment planning and appropriate postoperative care. Despite the smaller number of hospitalized patients in the 2011-2016 period (31 patients and 42 reconstructive procedures), the number of reconstructive procedure was similar to the recent 2003-2008 period (47 patients and 57 reconstructive procedures). The best results of reconstruction of sacral region pressure ulcer were achieved with fasciocutaneous and musculocutaneous flaps. Whenever possible, depending on the extent of the defect, musculocutaneous flaps should be preferred for reconstruction. It is especially suitable for pressure ulcer recurrence. For ischial region reconstruction, good results can be obtained by mobilizing the semimembranosus and/or semitendinosus in defect gap. For trochanteric region, the tensor fascia lata flap is a good choice. For maximal functional and reconstructive results, a multidisciplinary approach in pressure ulcer treatment has the leading role in the modern concept of wound healing. Surgical treatment should always include radical debridement, ostectomy and well planned defect reconstruction. Conservative treatment should be support to surgical treatment with a focus on patient health care and high hygiene measures. In recent years (2011-2016), the usage of better conservative treatment led to reduction of patient hospital stay and surgical treatment of pressure ulcer. Further 'wound care' nurses training in Croatia can lead the trend towards advanced practice nursing in pressure ulcer prevention and conservative treatment.
Asunto(s)
Desbridamiento/métodos , Procedimientos de Cirugía Plástica , Úlcera por Presión , Cuidados de la Piel , Cirugía Plástica , Adulto , Croacia/epidemiología , Desbridamiento/estadística & datos numéricos , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Úlcera por Presión/epidemiología , Úlcera por Presión/cirugía , Mejoramiento de la Calidad , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Procedimientos de Cirugía Plástica/tendencias , Recurrencia , Cuidados de la Piel/métodos , Cuidados de la Piel/normas , Cuidados de la Piel/tendencias , Cirugía Plástica/métodos , Cirugía Plástica/tendencias , Cicatrización de HeridasRESUMEN
PURPOSE: Radiofrequency ablation (RFA) is a promising minimal invasive modality to treat small breast cancer (BCA). In most studies cancers were surgically excised shortly after RFA. We present six patients inoperable when diagnosed with BCA, and performed RFA instead of surgery. MATERIALS AND METHODS: Ultrasound-guided bipolar RFA was performed under local anesthesia in six women aged 63 - 85 years. They had core-biopsy proven T 1 - 2N0 M0, grade I or II, 1.0 - 2.7 cm sized invasive ductal cancers, with positive estrogen receptor status. Four tumors measured > 2 cm, and three 1.0 - 1.2 cm in diameter. Patients were at high-risk for general anesthesia and surgery because of severely impaired cardiac function, advanced age, or associated diseases (acute myeloid leukaemia (AML), diabetes, hypertension, depression) and/or refused surgery. RESULTS: Six tumors in five patients were completely ablated, without recurrence during follow-up (range: 9 - 49 months). One superficially located cancer was partially ablated; the patient died two months later from myocardial infarction. The Patient with AML and BCA had an infection of the treated breast after 4 months and postponed mastectomy to an AML remission status. There were no signs of malignancy in histopathology; the patient finally died of leukemia 42 months after RFA. The remaining four patients are well, without complications. CONCLUSION: Ultrasound-guided percutaneous RFA under local anesthesia is an effective alternative to surgery for BCA < 3 cm in patients with a high-risk for surgery.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Carcinoma Ductal/diagnóstico por imagen , Ablación por Catéter/métodos , Ultrasonografía Intervencional/métodos , Ultrasonografía Mamaria , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Carcinoma Ductal/mortalidad , Carcinoma Ductal/patología , Causas de Muerte , Comorbilidad , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Proyectos PilotoRESUMEN
A new technique for 'waterproofing' during the second stage of a two-stage hypospadias repair is described. It is simpler and involves less tissue dissection than other waterproofing techniques. The senior author has used it over a period of 6 years as standard practice. The technique has been used in a total of 24 cases, in which the fistula rate was 8% (two cases).
Asunto(s)
Hipospadias/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Preescolar , Circuncisión Masculina/estadística & datos numéricos , Fístula Cutánea/etiología , Humanos , Masculino , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos Masculinos/efectos adversosRESUMEN
Twenty-six hands in 26 adults with osteoarthrosis of the thumb trapeziometacarpal joint were randomised to undergo either trapeziectomy alone (control) or with the interposition of porcine dermal collagen xenograft (Permacol). The study was terminated prematurely because of apparent reactions to the implants in six of 13 patients. The collagen interposition group required more frequent review on clinical grounds and were discharged later after surgery. Three of the implants have been removed and histology revealed foreign body reactions in all. There was no difference in thumb movement or power after surgery between the two groups. However, improved grip strength was observed and improved function were reported only in the control group. Permacol patients reported greater pain and were less satisfied with their operations than control patients. We conclude that interposition of Permacol is detrimental to the results of trapeziectomy.
Asunto(s)
Materiales Biocompatibles/efectos adversos , Colágeno/efectos adversos , Osteoartritis/terapia , Prótesis e Implantes/efectos adversos , Pulgar , Anciano , Materiales Biocompatibles/uso terapéutico , Colágeno/uso terapéutico , Femenino , Tejido de Granulación/patología , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
The work of the War Hospital in Tomislavgrad during the war in Bosnia and Herzegovina from 1992 to 1995 is described. The War Hospital in Tomislavgrad was one of the first medical institutions organized in Bosnia and Herzegovina, with the intention of providing surgical treatment and care to soldiers, local civilians, and refugees who found shelter in this part of the country. It was located on the main communication route connecting Bosnia and Herzegovina and the south part of Croatia. During the 4-year period, 23,191 examinations, of which 8,341 were first-time examinations, and 1,547 surgical operations were performed. The hospital provided a high level of surgical and anesthesiology service in an area where none existed before the war. All patients were treated regardless of their nationality or religion, thus mitigating the consequences of the war.
Asunto(s)
Hospitales Militares/organización & administración , Guerra , Bosnia y Herzegovina , Áreas de Influencia de Salud , Equipos y Suministros de Hospitales , Humanos , Objetivos Organizacionales , Personal de Hospital/provisión & distribución , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Transporte de Pacientes/organización & administración , Triaje/organización & administraciónRESUMEN
In the Department of Plastic Surgery of "Dubrava" University Hospital from 1993 to 1999 four patients were treated for radiation induced sarcoma. All of the patients were formerly operated for breast cancer and irradiated postoperatively. The mean time span between radiotherapy and development of sarcoma was 4.75 years. Four patients were treated with wide excision and immediate reconstruction with local flaps. One of the patients had fibrosarcoma, two patients had lymphangiosarcoma, and one patient had osteosarcoma. Two patients died within two years. Radiation induced sarcomas are therapy resistant, and the review of literature did not show large controlled investigations which would offer the most optimal treatment. Most frequently a rapid progression of the disease is seen.
Asunto(s)
Neoplasias de la Mama/radioterapia , Neoplasias Inducidas por Radiación , Neoplasias Primarias Secundarias/etiología , Sarcoma/etiología , Neoplasias Torácicas/etiología , Anciano , Femenino , Fibrosarcoma/etiología , Fibrosarcoma/terapia , Humanos , Linfangiosarcoma/etiología , Linfangiosarcoma/terapia , Persona de Mediana Edad , Neoplasias Primarias Secundarias/terapia , Osteosarcoma/etiología , Osteosarcoma/terapia , Sarcoma/terapia , Neoplasias Torácicas/terapiaRESUMEN
In a prospective study on 35 wounded persons we examined the effects of ozone on how well split-thickness skin grafts took in war wounds. Each of the 35 wounded persons hat at least two similar gunshot wounds, one on the lower leg or forearm and the other on the upper leg or upper arm. During the first 10 days all wounds were treated with 10% NaCl water solution dressings until the moment when healthy granulations were observed. Thereafter, the defects were covered with split-thickness skin grafts according to Thiersch. For technical reasons we treated grafts on the lower leg and forearm with ozone following the usual scheme. Grafts on the upper leg or upper arm were treated in the conventional way and they served as a control group. The results obtained in the group followed up are presented by percentage of graft takes after 10 days and accordingly compared with the results obtained in the control group. There was a higher percentage of takes in ozone-treated split-thickness skin grafts. More than 74.3% of the split-thickness skin grafts treated with ozone had a take of more than 75% of the covered surface as apposed to only 40% of the grafts treated with the conventional method. The results in these two groups were compared with a chi square matched pair test. Difference in take of the skin grafts in these two groups was statistically significant at P < 0.01.
Asunto(s)
Traumatismos del Brazo/cirugía , Traumatismos de la Pierna/cirugía , Ozono/administración & dosificación , Trasplante de Piel , Guerra , Cicatrización de Heridas/efectos de los fármacos , Heridas por Arma de Fuego/cirugía , Adulto , Croacia , Fijadores Externos , Supervivencia de Injerto/efectos de los fármacos , Humanos , Masculino , Estudios Prospectivos , Infección de Heridas/cirugíaRESUMEN
The effects of reconstituted basement membrane (Matrigel) on in vivo survival and growth of several murine tumors were studied. Survival of tumor cells was enhanced in all experiments which resulted in increased incidence and/or in increased tumor mass. While basement membrane enhanced the in vivo growth of B16F6 melanoma cells, survival of these mice was prolonged. Basement membrane increased the incidence but reduced the growth of Ehrlich ascites tumor. Walker-256 hypercalcemic breast carcinosarcoma growth was enhanced and glandular-like structures were observed when grown on Matrigel. The results indicate that the enhanced survival of tumor cells in the presence of basement membrane is not unequivocally linked with increased malignancy.