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Popović M, Dedić Plavetić N, Vrbanec D, Marušić Z, Mijatović D, Kulić A. Interleukin 17 in early invasive breast cancer. Front Oncol 2023; 13:1171254. [PMID: 37427128 PMCID: PMC10328740 DOI: 10.3389/fonc.2023.1171254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Interleukin 17 (IL-17) has a key role in inflammatory responses. Increased serum concentrations of IL-17 have been reported in patients with different types of cancer. Some studies suggest antitumor activity of IL-17 while others speak in favor of its association with poorer prognosis. The lack of data on IL-17 behavior in vivo hinders the efforts to clarify the exact role of IL-17 in breast cancer patients and precludes the usage of IL-17 as potential therapeutic target. Methods The study included 118 patients with early invasive breast cancer. The serum concentration of IL-17A was measured before surgery and during adjuvant treatment and compared with healthy controls. The correlation of serum IL-17A concentration and different clinical and pathological parameters, including IL-17A expression in the corresponding tumor tissue samples, was analyzed. Results Significantly higher serum concentrations of IL-17A were found in women with early breast cancer before surgery, but also during adjuvant treatment in comparison to healthy controls. No significant correlation to tumor tissue IL-17A expression was observed. There was a significant postoperative decrease of serum IL-17A concentrations even in patients with relatively lower preoperative values. A significant negative correlation was found between serum IL-17A concentrations and the tumor estrogen receptor expression. Conclusion The results suggest that the immune response in early breast cancer is mediated by IL-17A, particularly in triple-negative breast cancer. IL-17A-mediated inflammatory response subsides postoperatively, but IL-17A concentrations remain elevated compared to the values in healthy controls, even after the removal of the tumor.
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Affiliation(s)
- Marina Popović
- Department of Oncology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Natalija Dedić Plavetić
- Department of Oncology, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Damir Vrbanec
- School of Medicine, Juraj Dobrila University of Pula, Pula, Croatia
| | - Zlatko Marušić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Davor Mijatović
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Surgery, Division of Plastic, Reconstructive and Breast Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Kulić
- Department of Oncology, Division of Experimental Oncology and Pathophysiology, University Hospital Centre Zagreb, Zagreb, Croatia
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Vrbanović Mijatović V, Gatin L, Tonković D, Bandić Pavlović D, Smuđ Orehovec S, Miklić Bublić M, Mijatović D. THE EFFECT OF REGIONAL VS. GENERAL ANESTHESIA ON THE IMMUNE RESPONSE IN BREAST CANCER SURGERY: A NARRATIVE REVIEW OF THE LITERATURE. Acta Clin Croat 2022; 61:115-120. [PMID: 36824636 PMCID: PMC9942466 DOI: 10.20471/acc.2022.61.s2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
For breast cancer patients, surgery remains the cornerstone in treatment. Perioperative and postoperative period is associated with impaired immune function that can have profound implications for cancer patients in terms of tumor recurrence and metastases. The three main factors include surgery and related neuroendocrine stress response, anesthetic drugs, including opioid analgesics and postoperative pain. The most investigated immune cells are natural killer (NK) cells that are affected by both anesthesia and surgery. It has been demonstrated that ketamine, thiopental, volatile anesthetics, fentanyl and morphine, but not propofol, remifentanil or tramadol reduce the number of circulating NK cells and depress their toxicity. The level of NK cells' cytotoxicity is inversely proportional to the stage and spread of cancer. Regional anesthesia and its potential beneficial effects on the perioperative immune response and long-term outcome after surgery has been investigated as an alternative to general anesthesia in patients undergoing breast cancer surgery. In this paper, we present a review of literature aimed to assess the impact of regional anesthesia techniques on the immune response in patients undergoing breast cancer surgery and how it compares to general anesthesia.
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Affiliation(s)
- Vilena Vrbanović Mijatović
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Anesthesiology, Reanimatology and Surgical Intensive Care Medicine
| | - Lucija Gatin
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Dinko Tonković
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Anesthesiology, Reanimatology and Surgical Intensive Care Medicine
| | - Daniela Bandić Pavlović
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Anesthesiology, Reanimatology and Surgical Intensive Care Medicine
| | - Sanda Smuđ Orehovec
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Surgery
| | - Martina Miklić Bublić
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Zagreb, Zagreb, Croatia
| | - Davor Mijatović
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia,University of Zagreb, School of Medicine, Department of Surgery
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Sermaxhaj F, Dedić Plavetić N, Gozalan U, Kulić A, Radmilović Varga L, Popović M, Sović S, Mijatović D, Sermaxhaj B, Sopjani M. The role of interleukin‑7 serum level as biological marker in breast cancer: a cross‑sectional, observational, and analytical study. World J Surg Oncol 2022; 20:225. [PMID: 35794603 PMCID: PMC9258073 DOI: 10.1186/s12957-022-02646-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background The important role that the immune system plays in malignant diseases is well known. The action of interleukin-7 (IL-7) as a cytokine has been observed in many cellular processes, both in normal cells of the immune system and in some cancer cells. The aim of this study has been to explore whether there is any elevation of interleukin-7 serum levels in early invasive breast cancer (EIBC) patients in comparison with healthy controls. In addition, the correlation between the IL-7 serum level and the histopathological characteristics of the tumor has been evaluated. Methods This cross-sectional, observational, and analytical study included 213 consecutive patients with EIBC (113 from Croatia and 100 from Kosovo) and 62 healthy participants as the control group (30 from Croatia and 32 from Kosovo). Blood samples have been taken from patients confirmed with breast cancer (BC) by biopsy, prior to surgical intervention and other oncological treatments, as well as from healthy participants. A serum IL-7 level has been measured, using the “Sandwich” ELISA Immunoenzyme test. In addition, after the surgical intervention, histopathological specimen examinations and immunohistochemistry have been performed and analyzed. The differences in the distribution of the numerical variables have been analyzed with the Mann–Whitney U test and Kruskal–Wallis ANOVA test. Correlations have been tested with Pearson coefficients. A P-value < 0.05 has been accepted as statistically significant. Results The serum level of IL-7 in EIBC patients was significantly higher than in control cases (P 0.001). Patients with invasive lobular carcinoma (ILC) seem to have a lower IL-7 serum level compared to other histological subtypes, and the difference has been significant (P = 0.043). There has been no correlation between IL-7 serum level and histopathological characteristics of the tumor, with neither age nor menopausal status of the patients. Conclusions Noting the significant increase in the IL-7 serum level in the EIBC patients as compared to the healthy control group, the use of IL-7 as a potential diagnostic indicator for BC, as well as in the follow-up of the patients after treatment, can be assumed. The lack of correlation with tumor size, lymph node metastasis, and all other histopathological characteristics of the tumor questions its use as a prognostic indicator.
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Dujmović A, Jurišić N, Orehovec SS, Vrbanović Mijatović V, Mijatović D. PSEUDOCYST FORMATION AFTER ABDOMINOPLASTY: A CASE REPORT. Acta Clin Croat 2022; 60:548-551. [PMID: 35282498 PMCID: PMC8907945 DOI: 10.20471/acc.2021.60.03.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/28/2021] [Indexed: 11/25/2022] Open
Abstract
Abdominoplasty is one of the most popular aesthetic body contouring procedures. Seroma formation is the most common early complication after abdominoplasty. Usually, it resolves with punctions and seroma evacuation. Chronic seroma and pseudocyst formation is a rare complication and it demands surgical intervention. Based on our experience from the described case, the pseudocyst needs to be radically extirpated and a combination of quilting sutures, fibrin glue, three weeks of suction drainage, and compressive garments should be used to prevent recurrence.
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Dujmović A, Begić Z, Tarle M, Tomašković I, Vrbanović Mijatović V, Mijatović D. The Acceptance of Cosmetic Surgery Scale (Acss) and Its Correlations with Psychological Characteristics among the Croatian Population. Psychiatr Danub 2021; 33:255-259. [PMID: 35150493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND This study aimed to examine the results of Acceptance of Cosmetic Surgery Scale among the Croatian population and its correlations with other scales and demographic data. SUBJECT AND METHODS The sample consisted of 420 people who voluntarily filled out an online questionnaire. They completed demographic questions and four scales: Acceptance of Cosmetic Surgery Scale (ACSS), Rosenberg Self-Esteem Scale (RSES), Satisfaction With Life Scale (SWLS), and Body Appreciation Scale-2 (BAS-2). RESULTS ACSS scale showed five statistically significant differences between genders and a higher overall score in women, but no significant differences were recorded in three ACSS subscales and the overall ACSS score. In contrast to men, women respondents recorded a significant negative correlation between ACSS subscales score (Social, Consider) and BAS-2 and Satisfaction with life score, while a positive correlation was recorded with BMI. CONCLUSION The ACSS score among the Croatian population was higher than the results among the Italian and Serbian population, and similar to the original American study, which tells us that the Croatian population accepts and considers cosmetic surgery a lot. Furthermore, our results are important for practitioners and patients because they revealed correlations between ACSS scores and the self-thinking scale.
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Affiliation(s)
- Anto Dujmović
- Department of Plastic and Reconstructive Surgery, University Clinical Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia,
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Smuđ Orehovec S, Dujmović A, Mijatović D, Mance M, Šarčević B. Immunohistochemical Expression of Matrix Metalloproteinase-1 and Cyclooxygenase-2 in Cutaneous Squamous Cell and Basal Cell Carcinoma. Acta Dermatovenerol Croat 2021; 291:8-20. [PMID: 34477058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The most common nonmelanoma skin cancers (NMSC) are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The incidence of NMSC is 18-20 times higher than the incidence of melanoma. The Cyclooxygenase-2 (COX-2) and Matrix Metalloproteinase-1 (MMP-1) enzymes have both been linked to the development of these diseases but their exact significance is unknown. We conducted a retrospective analysis on 148 adult patients with cutaneous BCC and SCC. Cases were divided according to the sub-types of BCC and the degree of SCC differentiation. Immunohistochemical staining for COX-2 and MMP-1 was performed and analyzed to determine if the expression of these biomarkers were associated with BCC subtypes and the degree of SCC. differentiation. We did not find a significant association of the level of differentiation of SCC with the immunohistochemical expression for MMP-1 or COX-2. There was a significant association between BCC subtypes and immunohistochemical expression for MMP-1; positive expression of this enzyme reduces the odds for the infiltrative subtypes by 90%. A marginally significant association between BCC subtypes and immunohistochemical expression for COX-2 was also found. This enzyme was highly expressed in non-infiltrative basal cell carcinoma types (94%) compared with infiltrative types (71%). In conclusion, we did not find a significant predictor for SCC expression levels for either of two biomarkers, while the expression of MMP-1 in BCC was significantly inversely associated with the infiltrative type (moderate sensitivity and high specificity). Further research with larger sample sizes is needed to precisely determine the role these enzymes have in these diseases.
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Affiliation(s)
- Sanda Smuđ Orehovec
- Sanda Smuđ Orehovec, MD, Division of Plastic and Reconstructive Surgery and Breast Surgery , Department of Surgery, Clinical Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia;
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Radmilović Varga L, Dedić Plavetić N, Podolski P, Mijatović D, Kulić A, Vrbanec D. PROGNOSTIC VALUE OF TOPOISOMERASE 2-ALPHA AND B-MYB IN EARLY BREAST CANCER TREATED WITH ADJUVANT CHEMOTHERAPY. Acta Clin Croat 2021; 60:16-24. [PMID: 34588717 PMCID: PMC8305358 DOI: 10.20471/acc.2021.60.01.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/12/2021] [Indexed: 11/24/2022] Open
Abstract
Breast cancer is the most common malignancy in females. Despite its well-established prognostic factors, our prognostic ability at an individual patient level remains limited. In this study, the immunohistochemical expression of B-Myb and DNA topoisomerase 2-alpha (Topo2a) was analyzed in primary tumors to identify patients with a higher risk of disease recurrence after adjuvant chemotherapy for early invasive breast cancer. We analyzed a cohort of 215 early invasive breast cancer patients having undergone surgery from 2002 to 2003 at the Zagreb University Hospital Centre, including 153 patients treated with adjuvant chemotherapy. All of them were followed-up prospectively for at least ten years according to routine institutional practice. Statistically significant correlations were found between B-Myb and Topo2a expression levels and particular well-established prognostic factors. B-Myb expression was lower in estrogen receptor (ER)-positive tumors (p=0.0773), whereas larger tumors and those with positive lymphovascular invasion displayed a statistically significantly higher B-Myb expression (p=0.0409 and p=0.0196). Higher tumor grade indicated higher Topo2a values (p=0.0102 and p=0.0069). The subgroup with the expression of both proteins above the median value had an almost statistically significantly (p=0.0613) inferior prognosis compared to the rest of the cohort. Study results showed the B-Myb and Topo2a expression to have a prognostic value in breast cancer patients after adjuvant chemotherapy, which should be additionally explored in future studies in a larger patient cohort.
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Affiliation(s)
| | - Natalija Dedić Plavetić
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
| | - Paula Podolski
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
| | - Davor Mijatović
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
| | - Ana Kulić
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
| | - Damir Vrbanec
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
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Dujmović A, Jurišić N, Mance M, Bulić K, Vrbanović Mijatović V, Mijatović D. Tattoo Pigment within Regional Lymph Nodes Mimicking Cutaneous Melanoma Metastasis. Acta Dermatovenerol Croat 2020; 28:47-48. [PMID: 32650854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dear Editor, The diagnosis of malignant melanoma accounts for 1-2% of all cancer diagnoses, around 4% of all malignant skin diseases, and 80% of all skin cancer deaths (1). The prognosis depends on several factors including tumor size, Clark level, Breslow thickness, location, ulceration, and presence of metastases. Detection of lymph node metastasis is initially accomplished by clinical examination and by operative evaluation for occult metastasis using sentinel lymph node biopsy (SLNB) when indicated (2). Lymph nodes (LN) with melanoma metastasis may appear normal in early stages, but eventually they become dark, firm, and enlarged (3). In 2017, a 32-year-old female patient was referred to our ward by a dermatologist following a biopsy excision of a nevus under her right breast that tested positive for a cutaneous melanoma grade T2aNx with a Breslow thickness of 1.9 mm, with no sign of ulceration and no history of previous illnesses or chronic diseases. Based on the American Joint Committee on Cancer (AJCC) guidelines, wide excision with a sentinel lymph node (SLN) biopsy was indicated (4). The patient was injected with 0.4 mL CiTc 99m Nanocoll in all four quadrants around the primary scar. A 2 cm wide elliptical excision was performed circumferentially around the scar and to the depth of the muscular fascia of the thorax. With the aid of a gamma probe, a single radioisotope positive lymph node was located in the ipsilateral axilla, but 5 dark pigmented lymph nodes situated behind the SLN were visualized during manual dissection and thought to be consistent with metastatic disease (Figure 1). Due to this new finding, an excisional biopsy of all pigmented nodes was performed. Histology of the excised skin did not demonstrate any further cancerous cells. The size of the SLN was 15 mm, and immunohistochemistry for Melan A was negative for metastatic melanoma. Histological analysis of the darkly pigmented nodes was negative for metastatic melanoma as the pigment was demonstrated to originate from the dermal tattoo on the patient's back that had been removed by dermabrasion 3 years before melanoma development (Figure 2, Figure 3). Dermal tattooing results in initial sloughing of the overlying epidermis, variable dermal inflammation, and gradual assimilation of pigment into macrophages. Much of the pigment is rapidly carried into regional draining LN, which was shown in 2010 on a SKH-1a mouse model, and causes lymphadenopathy which is thought to be a result of local inflammation (6). Importantly, even after removal of the offending cutaneous tattoo the tattoo pigment can persist in draining or distant nodes visible to the naked eye (7). In such cases, LN can mimic metastatic malignant melanoma and may prompt the surgeon to proceed with radical lymph node dissection which may not be necessary. Despite clear guidelines for melanoma treatment in the general population, there are several questions that need to be addressed: firstly, how should a physician approach a patient with unknown history of tattoo removal, a diagnosis of melanoma, and intraoperative darkly pigmented lymph nodes? Secondly, due to the lack of scientific data and treatment protocol, if the SLN is normally colored while other regional nodes are darkly pigmented, what should the treatment plan entail?
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Mance M, Smuđ-Orehovec S, Vrbanović-Mijatović V, Mijatović D. Primary Alveolar Rhabdomyosarcoma of the Breast in a 17-Year-Old Girl. JCO Oncol Pract 2019; 16:93-95. [PMID: 31770055 DOI: 10.1200/jop.19.00476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Smuđ-Orehovec S, Mance M, Halužan D, Vrbanović-Mijatović V, Mijatović D. Defect Reconstruction of an Infected Diabetic Foot Using Split- and Full-thickness Skin Grafts With Adjuvant Negative Pressure Wound Therapy: A Case Report and Review of the Literature. Wounds 2018; 30:E108-E115. [PMID: 30457564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Any alteration or impairment to normal wound healing can result in the development of chronic wounds, which may lead to serious complications such as infection and loss of body fluid and proteins. Primary closure alone may not be sufficient to fulfill the criteria of successful defect reconstruction. Therefore, additional procedures such as skin grafting must be considered as an option. CASE REPORT The case of a 43-year-old woman with diabetes who was admitted to the University Hospital Rebro (Zagreb, Croatia) due to an infected, nonhealing wound on her left foot. Skin grafts combined with negative pressure wound therapy (NPWT) before and after graft application improved wound healing in this patient. CONCLUSIONS In this patient, the combination of skin grafts with NPWT before and after graft application reduced the comorbidities and complications often seen in the diabetic patient population. Herein, the authors utilized a quicker, cost-efficient, and safer technique of wound closure compared with traditional nonsurgical methods.
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Affiliation(s)
- Sanda Smuđ-Orehovec
- University Hospital Rebro, Department of Plastic, Reconstructive and Aesthetic Surgery, Zagreb, Croatia
| | - Marko Mance
- University Hospital Rebro, Department of Plastic, Reconstructive and Aesthetic Surgery, Zagreb, Croatia
| | - Damir Halužan
- University Hospital Rebro, Department of Vascular Surgery, Zagreb, Croatia
| | | | - Davor Mijatović
- University Hospital Rebro, Department of Plastic, Reconstructive and Aesthetic Surgery, Zagreb, Croatia
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Augustin G, Čižmešija Z, Žedelj J, Petrović I, Ivković V, Antabak A, Mijatović D, Škegro M. LAPAROSCOPIC APPENDECTOMY DOES NOT INCREASE THE RATE OF NEGATIVE APPENDECTOMY along with a lower rate of perforated appendicitis - RESULTS IN 1899 PATIENTS at Zagreb UHC. Acta Clin Croat 2018; 57:503-509. [PMID: 31168184 PMCID: PMC6536279 DOI: 10.20471/acc.2018.57.03.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
SUMMARY – Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs. open (p=0.24); negative appendectomy (adults) – lap vs. open (p=0.15); negative-negative appendectomy (children) – lap vs. open (p=0.36); negative-negative appendectomy (adults) – lap vs. open (p=0.21); negative-positive appendectomy (children) – lap vs. open (p=0.53); negative-positive appendectomy (adults) – lap vs. open (p=0.56); and laparoscopy group negative appendectomy in children vs. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.
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Affiliation(s)
| | - Zrinka Čižmešija
- 1Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb (cand. med.), Zagreb, Croatia; 3Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Jurica Žedelj
- 1Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb (cand. med.), Zagreb, Croatia; 3Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Igor Petrović
- 1Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb (cand. med.), Zagreb, Croatia; 3Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Vanja Ivković
- 1Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb (cand. med.), Zagreb, Croatia; 3Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Anko Antabak
- 1Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb (cand. med.), Zagreb, Croatia; 3Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Davor Mijatović
- 1Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb (cand. med.), Zagreb, Croatia; 3Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Mate Škegro
- 1Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb (cand. med.), Zagreb, Croatia; 3Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
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Dujmović A, Marčinko D, Bulić K, Kisić H, Duduković M, Mijatović D. Quality of Life and Depression Among Female Patients Undergoing Surgical Treatment for Breast Cancer: A Prospective Study. Psychiatr Danub 2018; 29:345-350. [PMID: 28949315 DOI: 10.24869/psyd.2017.345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Breast carcinoma is the most common malignant disease in women in the majority of developed countries. The development of depression as well as the quality of life (QoL) in these patients depends not only on the result of oncologic treatment, but on the cosmetic outcome as well. The primary aim of this prospective study was to investigate the changes in QoL and depressive symptoms among patients undergoing surgical treatment for breast cancer. SUBJECTS AND METHODS We conducted a prospective study that included 100 female patients (mean age 60.26 years) who underwent surgical and oncological treatment for breast carcinoma at the University Hospital Center Zagreb, Croatia. The patients were photographed before and after treatment and were required to fill out a standardized quality of life questionairres QLQ - C30 and QLQ - BR23, Beck Depression Inventory (BDI) and a questionnaire on breast asymmetry. RESULTS Our results show that patients had significantly higher QoL levels compared with their pre-surgical results. Statistical trend of a lower degree of depression was also observed. A worse cosmetic outcome (i.e., postoperative assymetry) was associated with a lower QoL, but there was no association with depression. Depression was significantly related to the level of pain and lower financial status. CONCLUSION QoL improved after surgical treatment of breast cancer and was dependant on postoperative asymmetry, whereas the findings for depressive symptoms remained less clear. Future research should investigate more factors that may contribute to the QoL and degree of depression in this patient population.
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Affiliation(s)
- Anto Dujmović
- Department of Plastic, Reconstructive and Cosmetic Surgery, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia,
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Mijatović D, Orehovec SS, Đapić T, Vrbanović Mijatović V, Mance M. Management of a Complex Lower Limb Open Fracture in a Teenage Patient: A Case Report. Ostomy Wound Manage 2018; 64:47-52. [PMID: 29847311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The challenges of managing Gustilo IIIB tibial fractures (ie, high energy trauma with a contaminated wound >10 cm in length, severe comminution ["crumbling"] or segmental fractures, and periosteal stripping) in children are unique in part because no clear guidelines exist and the injuries may cause short-term and long-term complications. Repeated wound debridement and secondary reconstruction are required in approximately 20% of these cases in both adults and children. A 13-year-old girl presented with severe polytrauma including an open Gustilo type IIIB fracture of the left lower leg. The patient declined limb amputation; a multidisciplinary team (plastic, pediatric, orthopedic-trauma surgeons, pediatrician, psychiatrist, clinical pharmacologist, anesthesiologist, physiotherapist, nurses) was assembled in order to give the patient the best chance of a successful outcome. Multiple limb salvage and reconstructive procedures including wound debridements, necrectomies, long-term negative pressure wound therapy, soft tissue reconstructions, external bone fixation, bone osteosynthesis, multiple skin grafts, and free-flap reconstruction were provided over a period of 6 months with great success. The patient is doing well 3 years after initial injury and is walking without complications. A multidisciplinary approach and structured treatment plan are important to minimize complications, avoid unnecessary delays in treatment, decrease morbidity, and provide the patient with the best result possible. Studies examining optimal treatment strategies for children and adolescents with these complicated fractures are needed.
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Herceg D, Buzina DS, Ceović R, Dotlić S, Ilić I, Orehovec SS, Herceg GH, Mijatović D, Separović R, Silovski T, Vrbanec D. [CROATIAN SOCIETY FOR MEDICAL ONCOLOGY CLINICAL GUIDELINES FOR DIAGNOSIS, TREATMENT AND FOLLOW-UP OF PATIENTS WITH MELANOMA]. Lijec Vjesn 2016; 138:22-29. [PMID: 27290810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Melanoma in the Western world has an increasing incidence. One of the most important factor for the increase in incidence is sporadic, uncontrolled exposure to the sun. The basis for the treatment of primary melanoma is surgical treatment. Treatment of metastatic disease of melanoma in recent years experienced significant changes. BRAF and MEK inhibitors, immunotherapy with programmed cell-death immune checkpoint inhibitors (anti-PD-1-antibodies) are new options for the treatment of metastatic disease. A mulitidisiplinary team of Croatian Society for Medical Oncology provides recommendations for diagnosis, treatment and follow-up of melanoma primarily driven to the discovery of new drugs and therapeutic options, that change the prognosis of patients with metastatic melanoma.
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Herceg D, Jakopović M, Plavetić ND, Samaržija M, Čučević B, Mijatović D, Nikolić I, Trivanović D, Šeparović R, Vrbanec D. [CANCER PATIENTS FOLLOW-UP – CROATIAN SOCIETY FOR MEDICAL ONCOLOGY CLINICAL GUIDELINES Part V: melanoma, sarcomas, central nerve system tumors, lung cancer]. Lijec Vjesn 2016; 139:17-23. [PMID: 30148587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Treatment of oncological patients must be based upon multidisciplinary approach, and takes place in specialized oncological centers. By the end of a specific oncological treatment further follow-up is being managed mostly by the oncologists, but the role of the general practitioners becomes more important every day and therefore should be precisely defined. Nowadays, most of the existing follow-up guidelines are not being based on prospective studies, yet on the expert’s opinion of a precise oncological center or specialists. The aim of the Croatian Society of Medical Oncology (CSMO) with these recommendations is to standardize and rationalize the diagnostic procedures’ algorithm in follow–up of oncological patients after primary treatment, in patients with melanoma, sarcomas, central nerve system tumors and lung cancer.
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Mijatović D, Smud S, Dujmović A. [Our experience in vulvar reconstruction after radical and hemivulvectomy]. Lijec Vjesn 2012; 134:192-194. [PMID: 22930940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Bogdanić B, Augustin G, Kekez T, Mijatović D, Hlupić L, Vanek M. Perforated ascending colon cancer presenting as colocutaneous fistula with abscess to the anterior abdominal wall at the site of a cholecystectomy scar treated with biologic mesh. Coll Antropol 2012; 36:335-338. [PMID: 22816243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Ascending colon cancer as a colocutaneous fistula to the abdominal wall at the site of a previous postoperative scar is extremely rare. A 69 year old male presented with five day history of pain and foul smelling discharge from right subcostal scar from elective cholecystectomy performed 8 years ago. Last three days, he had fever up to 39 degrees C, with mild pain in right upper abdominal quadrant without vomiting, diarrhea, bloody stools or weight loss. Computed tomography, with peroral contrast, revealed extralumination into abdominal wall with several fistulas reaching the skin. Emergency median laparotomy found infiltrating tumor of ascending colon into abdominal wall. A right hemicolectomy and complete thickness abdominal wall excision (7 x 10 cm) was performed. The abdominal wall defect was too extensive for primary closure and two 20 x 20 cm moist gauzes were placed to cover the defect and were fixed with stitches to the skin. On second postoperative day, due to contamination, porcine dermal collagen implant was placed intraperitoneally. Such emergency presentations and therapeutic options are discussed.
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Affiliation(s)
- Branko Bogdanić
- University of Zagreb, Zagreb University Hospital Center, Department of Surgery, Zagreb, Croatia
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Mijatović D, Dujmović A, Smud S. [Quality of life after breast reconstruction]. Lijec Vjesn 2012; 134:116-117. [PMID: 22768687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Veir Z, Dujmović A, Duduković M, Mijatović D, Cvjeticanin B, Veir M. Endoscopically assisted latissimus dorsi flap harvesting and breast reconstruction in young female with Poland syndrome. Coll Antropol 2011; 35:1303-1305. [PMID: 22397277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We will describe a second phase of breast reconstruction on a young girl suffering from Poland syndrome. She has the breast, pectoralis major and minor muscle aplasia on the right side. She has no other deformities. The best result is achieved by combining latissimus dorsi flap and a silicone implant, and even better aesthetic result is accomplished with endoscopically assisted latissimus dorsi harvesting. Purpose of this operation is to correct the chest asymmetry and to accomplish good aesthetic result.
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Affiliation(s)
- Zoran Veir
- University of Zagreb, Zagreb University Hospital Center, Department of Plastic and Reconstructive Surgery and Breast Surgery, Zagreb, Croatia.
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Veir Z, Duduković M, Miklić P, Mijatović D, Cvjeticanin B, Veir M, Dujmović A. Reconstruction of a soft tissue defect of the back after myelomeningocele closure with modified V-Y plasty. Coll Antropol 2011; 35:1295-1298. [PMID: 22397275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Myelomeningocele is a congenital defect in vertebral arches with cystic dilatation of meninges and structural or functional abnormality of spinal cord or cauda equina. It is a form of spinal dysraphisam with overlying skin defect (spina bifida aperta). That condition is related to other clinical complications such as infection that can produce furthermore complications. To prevent rate of complications surgical treatment in first 24 h is strongly suggested. In this case report we describe a patient (infant) with congenital myelomeningocele who's defect was treated surgically by the neurosurgeon. In operative procedure plastic surgeon was involved to cover the skin defect remaining after neurosurgical closure of spinal canal. Bilateral advancement local skin flaps were used in soft tissue defect closure. Review of the literature that refers to advancement local skin flaps was carried out.
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Affiliation(s)
- Zoran Veir
- University of Zagreb, Zagreb University Hospital Center, Department of Plastic and Reconstructive Surgery and Breast Surgery, Zagreb, Croatia.
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Veir Z, Smud S, Bogdanić B, Cvjeticanin B, Bagatin D, Dujmović A, Duduković M, Ivrlac R, Bulić K, Mijatović D. Combined vacuum-assisted closure treatment with laparoscopic mobilization of an omental flap and meshed skin grafts for reconstruction of infected sternotomy wounds: two cases. Coll Antropol 2009; 33:1427-1430. [PMID: 20102106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In cardiac surgery, poststernotomy wounds are life threatening complications, with mortality up to 50%. We described two patients, who underwent coronary artery bypass grafting and postoperatively developed a deep sternal wound infection. Reconstruction was combined with vacuum-assisted closure treatment, laparoscopic mobilization of an omental flap and split thickens skin grafts. The omental flap is a well-vascularized local flap with a large surface area and has excellent immunologic and angiogenic properties. Both patients recovered completely. In our opinion, vacuum-assisted closure treatment and laparoscopic mobilization of great omentum is suitable option for treating deep sternal wounds.
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Affiliation(s)
- Zoran Veir
- Department of Plastic Surgery, University Hospital Center Zagreb, Zagreb, Croatia.
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Bogdanić B, Smud S, Bagatin D, Nola M, Mijatović D, Majerović M. Giant basal cell carcinoma of the back: a case report and review of the literature. Coll Antropol 2009; 33:315-318. [PMID: 19408644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Basal cell carcinoma (BCC) is the most common cutaneous malignancy and the most common human malignancy in general. Out of all basal cell carcinomas, giant basal cell carcinoma represents less than 1%. Only 10% of all basal cell carcinomas are located on the trunk and majority is located on the head and neck. We describe a patient with a exophytic giant basal cell carcinoma of the back size 8.5 x 8 x 6 cm, infiltrating skin 1.5 cm. Two years after the lesion has occurred, diagnosis was made by pathohistological analysis. The patent was treated surgically, by excision. Review of the literature that refers to giant basal cell carcinoma was carried out.
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Affiliation(s)
- Branko Bogdanić
- Department of Surgery, University Hospital Center "Zagreb", Zagreb, Croatia.
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Mijatović D, Bulić K, Dzepina I, Unusić J. The supply of blood in the skin territory above the lower part of the serratus anterior muscle. Coll Antropol 2006; 30:543-7. [PMID: 17058521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
At present, the putative clinical use of the musculocutaneous and ostomusculocutaneous serratus anterior flaps has been compromised by the risk of partial or total necrosis of the skin overlying the lower part of the serratus anterior muscle. Therefore, the aim of this study was to delineate a skin area vascularized by perforant musculocutaneous branches of arteries stemming from the lower segment of the anterior serrated muscle. Black ink was injected in thoracodorsal artery branches for the serratus anterior muscle in 50 human cadavers before the autopsies (the study was approved by the Institutional Review Board). The surface area of the labeled skin was determined and its borders delineated by means of transparent millimeter grid. Planimetry data were subsequently analyzed with the aid of PC computer program. The results show that the calculated mean surface area (143.79 +/- 2.68 x 2.077; range 138.22-149.36 cm2) of the skin vascularized by perforant musculocuaneous branches stemming from the lower segment of the anterior serrated muscle, can serve as a reliable guide for taking serratus anterior flap in any patient. Therefore, appropriately sized musculocutaneous or osteomusculocutaneous serratus anterior flap can be safely and efficiently used in plastic and reconstructive surgery.
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Affiliation(s)
- Davor Mijatović
- Department of Plastic Surgery, University Hospital Center Zagreb, Zagreb, Croatia.
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Mijatović D, Bulić K, Nikolić V. Quantification model for muscular forces and momentums in human lower extremities. Coll Antropol 2006; 30:593-9. [PMID: 17058530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The possibility of calculating muscular forces and momentums and their influence on skeleton was evaluated in this study by means of computerized tomography performed on a living person. Through this, the surface and corrected surface for each muscle cross section area were obtained, the distance from muscular centroide to the neutral bone axis was measured, and muscular force and muscular momentum on the bone were determined. Muscular momentum on the bone was obtained by multiplication of the muscular force and the distance between muscular centroide and neutral bone axis. The use of computerized tomography, as a method for creating a model for quantification of muscular forces and momentum, was proven to be reliable according to exactness in evaluation of all human lower extremity structures which is the basis for muscular biomechanical characteristic calculations.
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Affiliation(s)
- Davor Mijatović
- Department of Plastic Surgery, University Hospital Zagreb, Zagreb, Croatia.
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Mijatović D, Bulić K, Unusić J. [Secondary breast bilateral reconstruction with myocutaneous pedicled latissimus dorsi flap after primary bilateral skin sparing mastectomy reconstruction with consecutive severe capsular contraction]. Lijec Vjesn 2006; 128:210-3. [PMID: 17087135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We present a patient who was operated due to bilateral breast carcinoma with immediate bilateral breast reconstruction with silicone implants after skin sparing mastectomy in a neighbouring country to Croatia. One year following the operation a severe bilateral capsular contracture was manifested. Due to a large umbilical hernia and lower laparotomy scar it was not possible to reconstruct the breasts with any abdominal free or pedicled flap. We performed bilateral secondary breast reconstruction with latissimus dorsi myocutaneous flap and silicone implants in two stages with good postoperative result.
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Affiliation(s)
- Davor Mijatović
- Zavod za plasticnu kirurgiju, Klinika za kirurgiju KBC-a Zagreb.
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Mijatović D, Bulić K, Unusić J. [Surgical treatment of primary lymphedema of penis and scrotum]. Lijec Vjesn 2006; 128:192-3. [PMID: 16910424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Cavcić J, Turcić J, Opacić M, Martinac P, Mijatović D, Alfirević I. Primary malignant melanoma of the rectum: a case report. Acta Med Croatica 1998; 51:239-41. [PMID: 9473806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of the study was to describe the diagnostic procedure, indications for operation and operative result in a patient with primary malignant melanoma of the rectum. In the patient, hospitalized at the Department of Surgery, School of Medicine in Zagreb, a malignant melanoma of the rectum was diagnosed by rectoscopy and histology. Tumor staging was determined by endorectal ultrasonography. Operation was indicated for malignant disease with partial obstruction of the rectum. Since the tumor was locally inoperable, with liver metastases a palliative operative procedure (sigmoidal colostoma) was performed. The operative finding confirmed the tumor stage obtained by ultrasonography. The patient died 5 months after the operation due to widespread dissemination of the malignant disease. Thereby, the accuracy of preoperative tumor staging by ultrasonography was confirmed. We believe that, in view of its accuracy, endorectal ultrasonography can be used for tumor staging in patients with primary melanoma of the rectum. Therefore, expensive diagnostic imaging methods like CT and MRI are no longer necessary.
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Affiliation(s)
- J Cavcić
- University Department of Surgery, University Hospital Centre, Zagreb, Croatia
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