Prognostic factors of local recurrence and survival after curative rectal cancer surgery: a single institution experience

The aim of our study is to evaluate the importance of prognostic factors, both tumor-related and therapy related, and their impact on local recurrence rate of rectal carcinoma. It is also important to evaluate impact of chemoradiotherapy (CRT) on local recurrence rate and survival. We used the data of 514 patients with rectal carcinoma treated at Clinic of surgery at University Hospital Centre in Osijek, during the period from 2000 to 2007. Routine follow-up was carried out until March of 2012 or death. Median life expectancy for all patients who underwent surgery was 98 months. 47% of patients with resection without residual tumor (R0) did not develop local recurrence after median of observation of 90 months. 5-year survival rate for patients with R0 resection was 76.4%. The patients who had preoperative serum levels of carcinoembryonic antigen (CEA) within the normal range (< 5 microg/mL) had a significantly better prognosis with 5-year survival of 75.8%, than patients with elevated levels who had 5-year survival of 46.5%. Tumor stage had great influence on survival and was defined by UICC TNM (International Union against Cancer, Tumor Node Metastases) classification, 7th edition. 5-year survival rate was (93.5% for stage I, 87.4% for stage II, 58.2% for stage III, 8.1% for stage IV). Patients with low grade differentiation tumors had 5-year survival rate of 73.5%, and those with high-grade had 38.2%. We have found that preoperative CRT significantly reduces the rate of local recurrence (5.3% vs. 14.1%), but patients who were treated with preoperative CRT did not appear to benefit significantly in terms of their long-term prognosis, because there was no difference in overall survival between the patients who received preoperative radiochemotherapy and those who did not receive it (66.2% vs. 67.8%). It was found that the R-classification, anatomical extent of tumor described by the TNM classification of the UICC, tumor grade, and preoperative CEA serum level were prognostic factors that influenced survival.

Vasculometry of upper and lower extremities in correlation with development of pathologic conditions like the diabetic foot

We assume that the vascular apparatus of the lower limb did not evolutionary adapt to leg mass and volume. The lower limb is greater in length and volume that the upper limb, and therefore the arteries should have a bigger diameter and cross-sectional area. During pathoanatomic autopsies at the Department of Pathology of University Hospital Center Osijek we have taken segments of 1 cm of length from the subclavian, femoral, radial and tibial artery. Our sample contained segments from 51 bodies, 24 female and 27 male. We have measured leg and arm length and circumference. From these data the idealized limbs volume was calculated by geometric approximations to a cone fragment. The relation between idealized leg and arm volume and arterial cross-sectional area were calculated. For statistical analysis, Student's t-test was used. At the Department of Radiology of the University Hospital Center Osijek we measured the diameter of subclavian and femoral artery in systole and diastole in 41 patients (21 female and 20 male) by Color Doppler ultrasound, and the circumference and length of upper and lower limb was measured. There is a slightly difference between the diameter and cross-sectional area of subclavian and femoral artery. Leg length was for 48.5% bigger than arm length and the difference in volume between upper and lower limb is significantly different. The foot has four to five times greater volume than the arm, and is vascularised by an arterial tree of similar diameter. This fact proves our hypothesis that the blood supply to the lower limbs compared to the mass of tissue is smaller.

Numerical analysis of standard and modified osteosynthesis in long bone fractures treatment

The fundamental problem in osteoporotic fracture treatment is significant decrease in bone mass and bone tissue density resulting in decreased firmness and elasticity of osteoporotic bone. Application of standard implants and standard surgical techniques in osteoporotic bone fracture treatment makes it almost impossible to achieve stable osteosynthesis sufficient for early mobility, verticalization and load. Taking into account the form and the size of the contact surface as well as distribution of forces between the osteosynthetic materials and the bone tissue numerical analysis showed advantages of modified osteosynthesis with bone cement filling in the screw bed. The applied numerical model consisted of three sub-models: 3D model from solid elements, 3D cross section of the contact between the plate and the bone and the part of 3D cross section of the screw head and body. We have reached the conclusion that modified osteosynthesis with bone cement resulted in weaker strain in the part of the plate above the fracture fissure, more even strain on the screws, plate and bone, more even strain distribution along all the screws' bodies, significantly greater strain in the part of the screw head opposite to the fracture fissure, firm connection of the screw head and neck and the plate hole with the whole plate and more even bone strain around the screw.

Advantages of modified osteosynthesis in treatment of osteoporotic long bones fractures--experimental model

In surgery of fractured long bones, a patient suffering from osteoporosis represents constant challenge to a surgeon and applied material and instruments that need to destroy as little as possible of an already damaged bone. One potential way of increasing the contact surface between the implants and osteoporotic bone is injection of bone cement (methyl-metacrilat, Palakos) into a prepared screw bed. This method of osteosynthesis was therefore subjected to experimental research to prove that application of modified osteosynthesis using bone cement in treatment of fractures in osteoporotic patients has advantage over the standard method of osteosynthesis because this modified method enables significantly greater firmness and stability of the osteosynthesis, which is the essential precondition of a successful fracture healing. The research was carried out on six macerated cadaveric preparations of a shin bone from the osteological collection from Institute for Anatomy, School of Medicine, University "J. J. Strossmayer". All samples of long bones were artificially broken in the middle part of the diaphysis and then standard osteosynthesis and modified osteosynthesis with screws filled with bone cement were performed on the samples. Results show that under identical static action of the moment of torsion in the modified osteosynthesis torsion angle deviation is lower than in the standard osteosynthesis. In modified osteosynthesis with bone cement the first results for angle of torsion deviation greater than 0.2 degrees were noticed after 120 minutes, while in the standard method of osteosynthesis they were noticed already in the first minute.

Human leptospirosis in eastern Croatia, 1969-2003: epidemiological, clinical, and serological features

This survey presents epidemiological, serological and clinical features of 270 patients (85% males, 18% children) treated for leptospirosis from 1969 to 2003 at the Clinic for Infective Diseases, University Hospital Osijek, Osijek, eastern Croatia. 75% of the admissions were between July and October. The route of transmission was mostly by indirect contact with domestic animals, less frequently by direct contact with urine or tissue of infected animals. Clinical presentation included signs and symptoms with expected and common frequency, with the exception of jaundice (62%) and aseptic meningitis (60%), which occurred with higher incidence than previously reported. Acute renal failure ensued in 53% of patients, 7% of whom required haemodialysis. No deaths were observed. Therapy consisted of antimicrobials (penicillin and doxycycline) and symptomatic measures. Diagnosis was confirmed by microscopic agglutination test (MAT). There were in total 18 serological types of Leptospira detected, and types L. sejroe, L.pomona, L. australis and L. icterohaemorrhagiae prevailed. During the last 10 y some new types were observed. Leptospirosis was not rare in the region of eastern Croatia, and its course could be life-threatening if not recognized and adequately treated.

Effect of intraocular silicone oil on ocular tissue

The aim of this study was to find out to which extent the instilled silicone oil affects the changes of lens, cornea, and the ocular pressure with regard to its time kept in the operated eye with a lens. The study was carried out on the sample of 40 patients, divided in three groups. The first group of patients with the silicone oil kept in the eye during 3 months, the second one during 3-6 months, and the third one during 6-9 months. Statistically important changes were observed in the progression of the lens opacification with the patients, progressively with the time of keeping the silicone oil in the eye. The followed cornea opacifications and increased ocular pressure were not statistically significantly linked with the length of keeping the silicone oil in the eye, so that it can be concluded that the silicone oil is the best substitute for the vitreous body but it should be removed from the eye, most frequently, in the period of 3-6 months from the date of its instillation, and after 3 weeks at the earliest.

Intracranial infection as a common complication following war missile skull base injury

The purpose of this paper is to stress the importance of clinical observation, the appropriate antimicrobial therapy, and early surgery in the management of intracranial infection following war missile penetrating skull base injury. There were 21 skull base missile injuries treated surgically in a 4-year period. Careful removal of devitalised brain tissue with dural closure was performed with all patients to prevent the development of intracranial infection. Subsequent clinical and radiological surveillance was performed to detect evidence of infection and abscess formation if fragments were left in place. Broad range antibiotic coverage, and the antioedematous agents were applied in the early postoperative period. Infection about the brain was seen in four cases. We recorded three cases of brain abscess formation, while one patient developed bacterial meningitis. The incidence of infectious complications was relatively high in our series. After the organisms causing infection were known, treatment was modified to be as specific as possible. It was not necessary to reoperate on intracranially retained foreign bodies and fragments since they did not increase the infection rate. However, repeated surgery is necessary for a brain abscess.