Search

Involvement of proliferation and apoptosis in the human limb development was analyzed electronmicroscopically and immunohistochemically in histological sections of 8 human embryos, 4(th) -10(th) week old, using apoptotic (caspase-3, AIF, BAX), anti-apoptotic (Bcl-2) and proliferation (Ki-67) markers, and TUNEL method. The data were analyzed by Mann-Whitney test, Kruskal-Wallis and Dunn's post hoc test. Initially, developing human limbs consisted of mesenchymal core and surface ectoderm with apical ectodermal ridge (AER). During progression of development, strong proliferation activity gradually decreased in the mesenchyme (from 78% to 68%) and in the epithelium (from 62% to 42%), while in the differentiating finger cartilages proliferation was constantly low (26-7%). Apoptotic caspase-3 and AIF-positive cells characterized mesenchyme and AER at earliest stages, while during digit separation they appeared in interdigital mesenchyme as well. Strong Bcl-2 expression was observed in AER, subridge mesenchyme and phalanges, while BAX expression charaterized limb areas undergoing apoptosis. Ultrastructurally, proliferating cells showed mitotic figures, while apoptotic cells were characterized by nuclear fragmentation. Macrophages were observed around the apoptotic cells. We suggest that intense proliferation enables growth and elongation of human limb primordia, and differential growth of digits. Both caspase-3 and AIF-dependant pathways of cell death control the extent of AER and numer of cells in the subridge mesenchyme at earliest developmental stages, as well as process of digit separation at later stages of limb development. Spatio-temporal co-expresson of Bcl-2 and BAX indicates their role in suppression of apoptosis and selective stimulation of growth during human limb morphogenesis.

Proximal humerus fractures are represented as 4-5% of all fractures, with incidence notably growing with age. Since surgical internal fixation in treatment of proximal humeral fractures is used, fractures of osteoporotic bone and choice of plate for their osteosynthesis represent particular problem. The aim of the study was to test two locking plates: Philos plate with locking screws with determinated direction, and Arthrex plate with poliaxial locking screws, using the finite element method.This study used version 6.10 of Abaqus FEA software package for simulation and fine element analysis of Philos and Artrex plates attached to the osteotomy models of proximal humerus with fracture gap at 0°, 10° and 20° in four types of static load: abduction, adduction, axial compression and flexion. Simulation results of loads in abduction, adduction, axial loads and flexion, were described with the total bone displacement (U) and maximum bone displacement in the fracture gap (Uf).When examining the Philos plate in axial load on the bone with fracture gap angle from 0°, 10° and 20° no significant differences between the results for the displacements were observed. Therefore, results for other loads are related to total displacements of the bone only at the angle of 0°. Given that the results of the total bone displacement and maximum bone displacement in the fracture gap with Artrex plate were mostly higher, for comparison with the results of bone displacement in Philos plate it was taken that total bone displacement and maximum displacement in the fracture gap in Artrex plate represent 100% of the total displacement. Philos plate showed 60.71% for abduction, 76.07% for adduction, 102.24% for axial loads and 79.59% for flexion of total bone displacement in Artrex plate, and 60.48% for abduction, 76.07% for adduction, 96.05% for axial load and 79.96% for flexion of maximum displacement in the fracture gap in Artrex plate.Osteosynthesis for osteoporotic fractures of proximal humerus with Philos plate in computer simulation proved to be more stable than with Arthrex plate.

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by intestinal hamartomatous polyps in association with mucocutaneous pigmentations. Here we present a case of a 30-year-old woman who was hospitalized and underwent diagnostic procedures because of crampy adbdominal pain. Physical examination on admission revealed pigmented spots around lips and on the oral mucosa. Multiple polyps were found in stomach, small and large intestine, with signs of initial ileo-ileal intussusception. After endoscopic removal of achievable polyps, we applied gastroscope through laparotomy and enterotomy and removed total number of 34 polyps from small bowell. The polyps were found to be mostly hamartomatous at histological examination. This procedure can provide removal of the most polyps, which are potentially premalignant, also with less complicationes than after multiple intestinal resectiones.

BACKGROUND: There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach. METHODS: We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used. RESULTS: During our study period, 280 patients aged 30- 36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group. CONCLUSION: The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves.

Although Lichtenstein's procedure is the standard procedure in surgical hernia treatment, and the role of laparoscopic hernia repair is constantly increasing, preperitoneal approach for femoral hernia repair should be equally considered.After the horizontal incision of transversal fascia, preperitoneal space is visualized. The hernial sac is opened and its content is placed in the abdominal cavity, or if there is a need, resection is performed. Once the peritoneum is sutured, the iliopubic tract and Cooper's ligament are bridged with two or three sutures in the medial portion of the femoral ring.From 1998 to 2008, 94 patients were treated for femoral hernia using the preperitoneal approach. Out of 94 participants, 86 were female. Intestinal obstruction was present in 48 cases. Resection of the small intestine or omentum was performed in 40 patients. There was no perioperative mortality. We observed early postoperative complications in 4 patients. Following the procedure, there was no recurrence of the femoral hernia.We found that preperitoneal repair is the method of choice in surgical treatment of femoral hernia. The surgical technique is simple and feasible, while fully acknowledging the functional anatomy of the inguinofemoral region and the etiology of the condition.

An inguinal hernia is a usual medical problem. The golden standard for its treatment is Lichtenstein's repair. But, there are still some dilemmas about inguinal hernia repair technique, including the role of laparoscopy. The aim of this study is to analyze patient's quality of life after Lichtenstein's or laparoscopic inguinal hernia repair.Retrospective analysis of medical documentation of 216 operated patients during the year 2006 at the Department of digestive surgery, University hospital Split, Croatia using tension free mesh repair procedures: Lichtenstein or laparoscopy (TAPP). Among the other data, the analysis includes use of antibiotic prophylaxis and thrombosis prophylaxis. The quality of life analysis was performed using the Short form 36 questionnaire (SF-36).We operated 212 (98.15%) males and 4 (1.85%) females. The average age of operated patients was 60.15 +/- 13.98 years. The antibiotic prophylaxis was prescribed to 22 (10.19%) patients with some of risk factors for wound infection. We did not register any secondary wound infection. Thrombosis prophylaxis was prescribed to all patients and there were no complications. The quality of life analysis showed no statistically significant differences between Lichtenstein and laparoscopic procedure with slightly better results for laparoscopic procedure in some of the SF-36's domains.There are no differences in quality of life between the patients operated with Lichtenstein or laparoscopic procedure. Despite that, we believe that laparoscopy has its place for inguinal hernia repair especially for recurrent and bilateral hernias.

Retrospective clinical study of patients with rectal tumors treated by transanal endoscopic microsurgery (TEM) using Ultracision.From 1997-2006 54 patients were treated by excision of the rectal tumors situated in the middle and distal portion, using the harmonic scalpel. We treated 25 male (range 40-76 years) and 29 female (range 46-80 years) patients. Tumors were benign or well or moderately differentiated carcinomas in stage T1N0M0 or T2N0M0. Excision was done by Ultracision (UltraCision, Ethicon Endo-Surgery) to all patients. Preoperative examinations were: colonoscopy, biopsy, tumor markers, CT, transanal ultrasound, pelvic NMR, gynecological exam in females. The tumors were excised by harmonic scalpel after submucosal infiltration of adrenalin (1: 200 000) and 2% lidocaine.There was no morbidity or mortality in this group of patients. Histopathology was: Adenoma tubovillosum in alteratio maligna 20, adenocarcinoma (T1N0M0) 6, (T2N0M0) 8, adenocarcinoma with lymphatic vessels and perineural spaces invasion 1, adenoma villosum 12 and adenoma tubulare 7. After surgical treatment 8 patients underwent adjuvant radiotherapy. There was no local recurrence during this period.TEM is a method of choice in the treatment of rectal benign tumors and malignant tumors in stage T1N0M0, grade 1 and 2. Harmonic scalpel provides a safer, easier, and more precise surgical section through clean, bloodless and better visualized operative field.

Laparoscopic cholecystectomy is the gold standard in choledocholithiasis treatment. Currently there is no generally accepted algorithm for choledocholithiasis treatment. A few years ago suspected or diagnosed choledocholithiasis was indication for open operation if bilious stones could not be removed with therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Today, advancements in laparoscopic equipment and operation technique render the possibility for laparoscopic treatment of choledocholithiasis. There are many different ways in which to treat choledocholithiasis, depending on the time of diagnosis. Due to the considerable variability in choledocholithiasis treatment, which depends in turn on many objective and subjective factors, we propose a unique diagnostic algorithm for the treatment of choledocholithiasis.From January 1st until December 31st 2005, at the University Department of Surgery -Split, 131 laparoscopic cholecystectomies were performed. Thirty-three patients with suspected choledocholithiasis were treated by laparoscopic intraoperative cholangiography. After positive cholangiography, thirteen laparoscopic transcystic extractions were performed. The patients were treated in the supine position. The surgeon was positioned between the legs of the patient, the assistants on opposite sides of the patient, and the scrub nurse on the right side of the surgeon. Transcystic stone extraction was performed using a flexible choledochoscope, which was connected to the left laparoscopic monitor using Picture-in-picture system and by Nitinol tipless Dormia basket.The total number of operated patients includes 18 women and 15 men. The mean age of patients was 60.16 +/- 15.36. The mean length of operation was 86 +/- 21.79. Mean hospitalization length of patients with laparoscopic cholecystectomy was 2.45 +/- 1.14 days; while mean hospitalization length of patients with stone extraction was slightly longer 2.90 +/- 1.18, (p = 0.564).Today several different possibilities approaches exist for the treatment of choledocholithiasis and it doesn't have to be treated unconditionally using endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy before, during or after laparoscopic cholecystectomy, or by the open operation.

The use of ultrasonically activated scalpel for tissue cutting and coagulation is a potential replacement for electrosurgery, which can be related to different complications. Its working principle is to transform the electric power into the mechanical longitudinal movement of the working part of the instrument, by a piezoelectric transducer situated in the hand piece. Between October 2000 and June 2004, six patients with abdominal cysts were treated by laparoscopy, using the harmonic scalpel. The average age was 40.8 (ranging from 15–60) years. Laparoscopic abdominal cyst fenestration was performed in five patients, and laparoscopic cholecystectomy and abdominal cyst fenestration were done in one patient during the same operation. The average duration of the operation was 40 (ranging from 25–70) minutes and hospital stay was 2.8 (ranging from 1–5) days. Laparoscopic abdominal cyst fenestration using the harmonic scalpel is a safe and successful operation, with good results including all the advantages of the minimally invasive surgery.