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Mezenhimske matične stanice (MMS) su multipotentne progenitorske stanice podrijetlom od odraslih tkiva, koje imaju sposobnost diferencijacije u različita tkiva mezodermalnog podrijetla, uključujući kost, hrskavicu i masno tkivo. Danas se za istraživačke i terapijske svrhe MMS najčešće izoliraju iz koštane srži (KS-MMS), no problemi vezani uz njihovu primjenu uključuju morbiditet donorskog mjesta, malen broj izoliranih stanica za terapijske svrhe i slabljenje diferencijacijskog potencijala s povećanjem dobi davatelja. Sve navedeno razlog je potrazi za alternativnim i mlađim donorskim izvorima MMS. U ovoj se disertaciji prvi put predstavlja i opisuje izolacija MMS iz nepčanih tonzila. Izvršena je komparativna i kvantitativna analiza adherentnih stanica iz tog tkiva, nazvana tonzilarnim MMS (T-MMS). T-MMS su uspoređene s KS-MMS, dobro istraženim i karakteriziranim tipom MMS. Analiza površinskih biljega pokazala je da T-MMS nemaju CD14, CD31, CD34 i CD45, a da izražavaju CD29, CD44, CD90 i CD105 biljege, što je karakterističan fenotip KS-MMS. Poput KS-MMS, i T-MMS je bilo moguće diferencirati u adipocite, osteocite i hondrocite. Diferencijacijski potencijal T-MMS je analiziran histološkim i histokemijskim pretragama, te RT-PCR analizom ekspresije gena znakovitih za pojedina mezenhimska tkiva. Populacija stanica izoliranih iz tonzila na površini ne izražava MHC molekule II. razreda, što može omogućiti terapijsku primjenu alogenih T-MMS. S obzirom na jednostavan kirurški pristup i izostanak etičkih dvojba oko tonzilektomije, ljudske nepčane tonzile mogle bi se iskoristiti kao prikladan alternativni izvor mladih i brzo proliferirajućih progenitorskih stanica za bazična istraživanja i terapijske primjene., Mesenchymal stem cells (MSCs) are adult multipotent progenitor cells that have the ability to differentiate into lineages of mesenchymal tissues including cartilage, bone and fat. They were originally isolated from bone marrow (BM-MSCs), but current challenges of clinical application of BM-MSCs include donor-site morbidity, and low cell yields associated with age-related decrease in cell number and differentiation potential, underscoring the need to identify alternative sources of MSCs. In the present work, the presence of MSCs in tonsillar tissue is reported for the first time. We performed comparative and quantitative analyses of BM-MSCs with a subpopulation of adherent cells isolated from this lymphoid tissue, termed tonsil-derived MSCs (T-MSCs). Surface epitope analysis revealed that T-MSCs were negative for CD14, CD31, CD34 and CD45 expression and positive for CD29, CD44, CD90 and CD105 expression, a characteristic phenotype of BM-MSCs. Similar to BM-MSCs, T-MSCs could be induced to undergo adipogenic, osteogenic and chondrogenic differentiation. Differentiation potential of T-MSCs was analyzed histologically, histochemically and by RT-PCR for the expression of lineage related marker genes. T-MSCs did not express class II MHC antigens, suggesting a potential role as a human allogeneic cell source for cell-based therapies. Thus, human palatine tonsil-derived MSCs, which are easily accessible without ethical concerns, represent an attractive alternative source for adult progenitor cells or MSCs for basic research and future clinical applications.

Endoscopic CO2 laser surgery (ELS) is a widely accepted treatment modality for early laryngeal cancer. Commonly reported advantages of ELS are good oncologic results with low incidence of complications. Although less common if compared with open procedures, complications following ELS can be very serious, even with lethal outcome. They can range from intraoperative endotracheal tube fire accidents to early and late postoperative sequels that require intensive medical treatment, blood transfusion, or revision surgery. We present our institutional experience, discuss the possible complications of ELS for laryngeal cancer, and outline the concepts of their treatment, with comprehensive literature review. Complications are more frequent following the treatment of supraglottic as compared to glottic cancer. If compared with open surgery, ELS for laryngeal cancer is associated with a lower incidence of complications. Every surgeon performing ELS should comply with particular strategies to avoid complications in the first place, and have a clear concept of their management if they occur.

Ispitali smo postoje li razlike u intraoperacijskim i ranim postoperacijskim koncentracijama paratiroidnog hormona između prve skupine bolesnika kod kojih je izvršena tiroidektomija s pomoću ultrazvučnog rezača te druge skupine bolesnika operiranih standardnom tehnikom s pomoću elektrokoagulacije i ligatura kao hemostatskih metoda. U svih bolesnika s totalnom tiroidektomijom uzeta je krv u četiri mjerne točke: neposredno nakon indukcije u anesteziju, 10 minuta nakon odstranjenja prvog režnja štitnjače, 10 minuta nakon potpunog odstranjenja štitnjače i 24 sata nakon operacije. Iz uzoraka krvi određena je koncentracija paratiroidnog hormona s pomoću imunoradiometrijskog testa. Usporedba koncentracija paratiroidnog hormona između prve i druge skupine nije pokazala statistički značajnu razliku ni za jednu od četiri mjerne točke. Usporedba koncentracija paratiroidnog hormona unutar istih skupina u odnosu na prijeoperacijske vrijednosti (prvu mjernu točku) pokazala je da su u obje skupine koncentracije paratiroidnog hormona u sve tri postincizijske mjerne točke bile značajno niže od koncentracija izmjerenih prije početka operacije (p

In head and neck squamous cell carcinoma distant metastases are rare and metastases to the heart are extremely rare. In this report we present a patient with a sublingual and laryngeal carcinoma with metastases to lung and heart. Cardiac metastases present with non-specific symptoms that depends on the size and location of the metastases. The ideal tools for diagnosing cardiac metastases are echocardiography and cardiac MRI. CT scan could be used as a screening method of distant metastases in head and neck cancer. The treatment of cardiac metastases is generally ineffective.

sindrom Hermansky-Pudlak je rijedak autosomno recesovni poremećaj karakteriziran sklonošću krvarenju uslijed poremećene funkcije trombocita, okulokutanim albinizmom te poremećajem lizosomske funkcije s posljedičnim zahvaćanjem više organskih sustava. Poremećaj funkcije trombocita uzrokovan je nedostatkom gustih zrnaca u trombocitimakoja sudjeluju u drugoj fazi agregacije. Nakupljanje pigmenta lipofuscina u lizosomima može uzrokovati plućnu fibrozu, granulomatozni kolitis, bubrežnu insuficijenciju i kardiomiopatiju. Prikazujemo bolesnika u dobi od t dogina koje se u dobi od 2 godine prezentirao slikom profuznog krvarenja desne tonzile tijekom akutne streptokokne infekcije. Inicijalne laboratorijske pretrabe bile su uredne. Dječak ima okulokutani albinizam i od ranog je djetinjtva bio sklon stvaranju hematoma i krvarenju nakon minimalnih ozljeda. Laboratorijska obrada je pokazala mikrocitnu blagu anemiju te blago povišen kolesterol i triglideride, smanjenu agregaciju trombocita s adrenalinom, ADP i kolagenom te nedostatak gustih zrnaca u trombocitima pregledom elektronskim mikroskopom. Oftalmološkom obradom utvrđena je teška ambliopija, horizontalni nistagmus i blijeda papila n. optici. Ovo je prvi bolesnik s Hermansky-Pudlak sindromom u jugoistočnom dijelu Europe i prvi koji se prezentirao krvarenjem iz tonzile. Bolesnici zahtijevaju multidisciplinarni pristup, doživotno praćenje, a dugoročna prognoza ovisi o razvoju plućnih komplikacija.

We present our experience with primary CO2 laser surgery for planocellular supraglottic carcinoma. During a ten-year period, we performed 64 curative supraglottic laryngectomies. Twenty-nine patients presented with T1 and 35 with T2 carcinoma. There were 46 patients without regional and/or distant metastases (N0 neck), and 18 patients with N+ neck. Thirty-three (52%) patients were treated with surgery alone, and in 31 (48%) patients surgical procedure was combined with radiotherapy. Estimated overall 5-year survival for all patients was 89%. Local and regional tumor control as well as survival rate were comparable with the results of other therapeutic options, i.e. radiotherapy or open supraglottic laryngectomy. Functional results outline the advantages of endoscopic laser surgery for laryngeal carcinoma. Transoral endoscopic CO2 laser surgery is efficacious treatment for T1 and T2 supraglottic carcinoma, and can be combined with neck dissection and postoperative irradiation.

Ultrazvučni rezač rabi mehaničke vibracije za istodobnu koagulaciju i rezanje. Cilj rada je prikazati naše iskustvo sa 161 bolesnikom operiranim s pomoću ovog instrumenta. Ultrazvučni rezač je korišten u razdoblju od 5 mjeseci za 123 operacije štitnjače, 13 parotidektomija te 25 tonzilektomija. U kontrolnoj skupini bolesnika učinjeno je 106 tiroidektomija, 9 parotidektomija te 30 tonzilektomija uz upotrebu elektrokoagulacije i ligatura kao primarnih hemostatskih postupaka. Upotrebom ultrazvučnog rezača trajanje operacija na štitnoj i parotidnoj žlijezdi skraćeno je za 20– 30% u usporedbi s konvencionalnim zahvatima. Kožna incizija kod zahvata na štitnjači u prosjeku je bila kraća 1, 5 cm. Prosječno trajanje tonzilektomije izvedene s pomoću ultrazvučnog rezača bilo je 5, 5 minuta kraće u odnosu na kontrolnu skupinu. Intenzitet boli, kao i postoperativne komplikacije, bile su komparabilne u obje skupine. Upotreba ultrazvučnog rezača skraćuje operativno vrijeme i smanjuje intraoperativni gubitak krvi te omogućuje manji kožni rez u kirurgiji štitnjače.

One of the main objectives of our 3-dimensional (3D) computer-assisted functional endoscopic sinus surgery was to design a computer-assisted 3D approach to the presurgical planning, intraoperative guidance, and postoperative analysis of the anatomic regions of the nose and paranasal sinuses. Such an extremely powerful approach should allow better insight into the operating field, thereby significantly increasing the safety of the procedure. The last step to implementing the technology in the operating room was to connect the computer workstations and video equipment to remote locations by using a high-speed, wide-bandwidth computer network. During patient preparation, the surgeon in the operating room consulted remote experienced and skillful surgeons by viewing CT images and 3D models on computer workstations. The surgeon and consultants used software for CT image previews and 3D model manipulations on top of collaboration tools to define the pathosis, produce an optimal path to the pathosis, and decide how to perform the real surgical procedure. With tele-flythrough or tele-virtual endoscopy rendered through the use of 3D models, both surgeons can preview all the characteristics of the region (ie, anatomy, pathosis) and so predict and determine the next steps of the operation. This ensures greater safety thanks to the operation guidance and reduces the possibility of intraoperative error. The duration of the teleconsultation is thus shortened, which may prove the greatest benefit of tele-3D computer-assisted surgery. If this method were used, clinical institutions would spend less money for telesurgical consultation.

One of the main objectives of our project named 3D C-FESS and Tele-3D-C-FESS (supported by an unrestricted grant provided by the Croatian Ministry of Science, No. 3-01-543/96) was to design a computer assisted 3D-approach in presurgical planning, intraoperative guidance and postoperative analysis of anatomical regions of the nose and paranasal sinuses. The idea was born in the early ‘ 90s, and our first operation of this kind was done in May 1994. Such an extremely powerful approach should allow a better insight into the operating field including significantly greater safety of the procedure itself. Using our own approach in computer assisted functional endoscopic sinus surgery, we were able to "look inside" the patient, during the real surgical procedure. Telesurgery, as a specific part of telemedicine, consists of two or more operating rooms connected with a computer network. Through this network two encoded live video signals from endo-camera and operating room camera are transferred to other remote locations involved in the telesurgery/consultation procedure. Our telesurgery approach allows surgeons not only to see and to transfer video signals, but also to transfer 3D computer models and surgical instrument movements with image/3D-model manipulations, all together, in real time during the surgery. We use JPEG and MPEG2 encoders and decoders, ATM communication equipment, graphic workstations, 3D digitizers and standard endoscopic surgical instruments. The new video encoders using MPEG2 standards and ATM computer networks using inverse multiplexing, greatly improve the safety of surgical procedures, especially in endoscopic surgery. The best results are obtained using ATM-OC3 technologies, with the most acceptable price-performance using inverse multiplexing method across 4-8 E1 lines.

The main goal of our dynamic 3D computer-assisted reconstruction of a metallic retrobulbar foreign body following orbital injury with ethmoid bone involvement was to use 3Dinformation obtained from standard computed tomography data (CT) to explore and evaluate the nasal cavity, ethmoidal sinuses, retrobulbar region, and the foreign body itself by simulated dynamic computed visualization of the human head. A foreign body, 10x30 mm in size, partially protruded into the posterior ethmoidal cells and partially into the orbit, causing dislocation and compression of the medial rectus muscle and inferior rectus muscle. The other muscles and the optic nerve were intact. Various steps were taken in developing diagnostic and surgical activities. Thin CT sections of the nasal cavity, orbit and paranasal sinuses were performed on a conventional CT device at a regional medical center, CT scans were transmitted via computer network to different locations, and special views very similar to those seen on standard endoscopy were created. Special software for 3D modeling, specially designed and modified for 3D C-FESS purposes, was used, as well as a 3D-digitizer connected to the computer and multimedia navigation through the computer during 3D C-FESS. Our approach provides the visualization of very delicate anatomical structures within the orbit in unconventional (non-standard) sections and angles of viewing, which cannot be obtained by standard endoscopy or 2D-CT scanning. Finally, virtual endoscopy (VE) or a 'computed journey' through the anatomical spaces of the paranasal sinuses and orbit substantially improves the 3D C-FESS procedure by simulating the surgical procedure prior to real surgery.

The main goal of our dynamic 3D computer-assisted reconstruction of a metallic retrobulbar foreign body following orbital injury with ethmoid bone involvement was to use 3D-information obtained from standard computed tomography (CT) data to explore and evaluate the nasal cavity, ethmoidal sinuses, retrobulbar region, and the foreign body itself by simulated dynamic computed visualization of the human head. A foreign body, 10 x 30 mm in size, partially protruded into the posterior ethmoidal cells and partially into the orbit, causing dislocation and compression of the medial rectus muscle and inferior rectus muscle. The other muscles and the optic nerve were intact. Various steps were taken to further the ultimate diagnosis and surgery. Thin CT sections of the nasal cavity, orbit and paranasal sinuses were made on a conventional CT device at a regional medical center, CT scans were transmitted via a computer network to different locations, and special views very similar to those seen on standard endoscopy were created. Special software for 3D modeling, specially designed and modified for 3D C-FESS purposes, was used, as well as a 3D-digitizer connected to the computer and multimedia navigation through the computer during 3D C-FESS. Our approach achieves the visualization of very delicate anatomical structures within the orbit in unconventional (non-standard) sections and angles of viewing, which cannot be obtained by standard endoscopy or 2D CT scanning. Finally, virtual endoscopy (VE) or a 'computed journey' through the anatomical spaces of the paranasal sinuses and orbit substantially improves the 3D C-FESS procedure by simulating the surgical procedure prior to real surgery.

The value of acute phase proteins in the assessment of clinical activity of ulcerative colitis

Više od pola stpljeća veza nos-pluća bila je zanemarivana sve do 80-tih godina 20. stoljeća kada je primjećeno da se nakon uspješnog liječenja upale sinusa astma poboljšava. Zadnjih godina pitanje patologije gornjig dišnih putova u području astmologije postaje vrlo aktualno. Infektivna komponenta sinusitisa čest je pokretač asmatskog napada i aktivno sudjeluje u razvoju astme

Cilj istraživanja: Točna etiologija sinonazalne polipoze još je uvijek nepoznata. Ova studija istražuje ulogu metabolita arahidonske kiseline u pojavi rekurentne polipoze. Materijali i metode: Tkivna produkcija prostaglandina E2 (PGE2), 6-keto-prostaglandina F1-alfa (PGI2), tromboksana A2 (TxA2) i leukotriena C4 (LTC4) u uzorcima nosne sluznice određivana je s pomoću metode radioimunoeseja u 51 bolesnika sa sinonazalnom polipozom (SNp) i u 14 dobrovoljaca na zdravoj nosnoj sluznici. Rezultati: Skupina bolesnika sa SNp bez dokazanog recidiva u poslijeoperativnom razdoblju (Skupina 1) pokazala je manje PGE2 koncentracije od skupina bolesnika s recidivom SNp (Skupina 2 i Skupina 3). Razlike u koncentracijama PGI2 u navedenim skupinama bile su bez statističke značajke. U usporedbi s ostalim skupinama, skupina bolesnika koji su više puta operirani zbog SNp (Skupina 3) imala je veću prosječnu koncentraciju TxA2. LTC4 koncentracije bile su najveće u skupinama bolesnika s recidivom SNp (Skupina 2 i Skupina 3). Kad je incidencija rekurencije polipoze (unutar 18 mjeseci nakon operacije) uspoređena sa stupnjem koncentracije LTC4 u vrijeme kirurškog zahvata, stupanj recidiviranja bio je značajno viši u bolesnika s povišenim LTC4 stupnjem nego u onih s normalnim LTC4 stupnjevima. Zaključak: LTC4 može imati prognostičku vrijednost. Moguće značenje metabolita arahidonske kiseline je veliko i upućuje na moguće terapijske smjernice.

Foreign bodies of paranasal sinuses are quite an infrequent finding. They are usually detected after various types of head trauma. They most commonly occur as a consequence of improper handling firearms or explosives. In the countries at war, e.g. during the Patriotic War in Croatia, adults and children were almost equally exposed to these injuries. This is also the main characteristic of all war injuries. High-quality CT diagnosis provides extremely valuable information on anatomical relationships between paranasal sinuses and the surrounding structures, thus significantly improving the safety of functional endoscopic sinus surgery (FESS). However, in spite of its numerous advantages, such a 2D-CT head display has some shortcomings. This is one of the reasons for developing a new approach, as we have called “computer assisted FESS in third dimension” (3D C-FESS), in pre- and intraoperative head imaging, as well as in posoperative analysis. Our first patient, operated per viam 3D C-FESS, was a 12-year-old child, who was inflicted a gunshot wound in the region of the left eye (May 1994).