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Abstract: Background. In spite of preservation of the accessory nerve there is still considerable proportion of patients with partial nerve damage during modified radical neck dissection (MRND). Methods. The nerve was identified during the surgery and its branches for the trapezius muscle mapped with nerve monitor. Results. The accessory nerve was mapped during 74 hemineck dissections and three patterns were identified. In type 1 nerve exits at the posterior end of the sternocleidomastoid muscle (SCm) and then it enters the level V (66 %). In type 2 the nerve for trapezius muscle branches off before entering the SCm (22 %). In type 3 the nerve exits at the posterior part of the SCm and it joins to the cervical plexus (12 %). The nerve than exits this junction more medially as a single trapezius branch. Conclusions. The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.
Keywords: spinal accessory nerve, nerve mapping, neck dissection, anatomy, shoulder disability
Published in DiRROS: 11.04.2024; Views: 197; Downloads: 48
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Abstract: The present study investigated the influence of SCUBA dives with compressed air at depths of 10 and 20 m on ECG-derived HRV parameters in apparently healthy individuals. We hypothesized that cardiac sympathetic activity (measured by HRV parameters) adapts proportionally to diving depth, and that both time- and frequency-domain parameters are sensitive enough to track changes in cardiac ANS function during diving activities and subsequently during the recovery period. Eleven healthy middle-aged recreational divers (nine men and two women, age 43 ± 8, all nonsmokers) volunteered to participate in the present study. The participants (all open-circuit divers) were equipped with dry suits and ECG Holter devices and were later randomly assigned to dive pairs and depths (10 m vs. 20 m), and each participant served as his or her own control. No interaction effects (diving depth x time epoch) were found for the most commonly used HRV markers. More precisely, in response to two different diving protocols, a significant post hoc effect of time was observed for HR and SDNN, as these parameters transiently decreased during the dives and returned to baseline after ascent (p < 0.001). The ULF, VLF (p < 0.003), TP, and LF parameters decreased significantly during the dives, while HF significantly increased (p < 0.003). SCUBA diving apparently challenges the cardiac ANS, even in healthy individuals. The observed changes reveal possible underwater methods of influencing the parasympathetic activity of the heart depending on the depth of the dive. These results identify autonomic nervous system markers to track the cardiovascular risk related to diving and point to the possibility of tracking cardiovascular system benefits during underwater activities in selected patients
Keywords: autonomic nervous system, diving, parasympathicus, cardiovascular risk
Published in DiRROS: 09.04.2024; Views: 73; Downloads: 29
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Abstract: Background. Carotid endarterectomy (CF.A) is widely used in the management of high-rade carotid stenosis: It is a surgical procedure requiring general anaesthesia and is suitable only for lesions located at or close to the carotid bifurcation. It may develop complications, such as stroke, death, cranial nerve palsies, wound haematoma and cardiac complications. The risk of complications is increased in patients with recurrent carotid artery stenosis following CEA, in subjects undergoing radiotherapy to the neck, and in patients with cardiopulmonary disease. The drawbacks of CEA have led physicians to search for alternative treatment options. Carotid angioplasty and stenting (CAS) is less invasive than CEA. The method is particularly suitable for the treatment of recurrent stenosis after previous CEA and distalinternal artery stenosis, which is inaccessible for CEA. CAS does not cause cranial nerve palsies. Moreover, it does not require general anaesthesiaand causes lower morbidity and mortality in patients with severe cardiopulmonary disease. The complications of CAS include stroke due to distalimmobilisation of a plaque or thrombus dislodged during the procedure, abrupt vessel occlusion due to thrombosis, dissection or vasospasm, and restenosis due to intmal hyperplasia. CAS is a relatively new procedure; therefore, it is essential to establish its efficacy and safety before it is introduced widely into clinical practice. Patients and methods. In Slovenia, we have also started with carotid angioplasty by the study: Slovenian Carotid Angioplasty Study (SCAS). We performed CAS in 17 patients (12 males and 5 females) aged from 69 to 82 years. All patients were symptomatic with stenosisgreater than 70 %. 10 patients suffered transient ischemic attacks, 4 patients minor strokes and 3 patients amaurosis fugax. (Abstract truncated at 2000 characters)
Published in DiRROS: 31.01.2024; Views: 142; Downloads: 30
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Abstract: Background. We wanted to determine the diagnostic accuracy, sensitivity and specificity of computed tomographic angiography (CTA) of intracranial vessels,and to establish the advantages and disadvantages of CTA compared to digital subtraction angiography (DSA) as the gold standard in patients with acute subarachnoid haemorrhage (SAH). Patients and methods. We prospectively studied 52 patients with acute SAH. Confirmation of the haemorrhage by a conventional computed tomography (CT) scan was immediately followed by intracranial CTA. DSA was performed after the CTA examination and so did not influence the interpretation of CTA images. The sensitivity, specificity and diagnostic accuracy of CTA were determined by comparing the results with the data from DSA and with the surgical findings. Cases where the CTA and DSA results did not match were analysed, and the advantages and disadvantages of intracranial CTA were determined. Results. The diagnostic accuracy of CTA was 95%, its sensitivity was 93%, and its specificity was 98%. False-negative results were obtained in three patients who harboured small aneurysms, two in the region of the cavernous sinus and one at the division of pericallosal and callosomarginal arteries. In one patient with a false-positive result, DSA showed an infundibular widening of the posterior communicating artery. In all seven patients who underwent operations on the basis of CTA results, the surgical findings confirmed the presence of aneurysms as well as the intracranial vessel anatomy demonstrated by CTA. Conclusions. Intracranial CTAis a fast and minimally invasive method with a high diagnostic accuracy, sensitivity and specificity, which has an important place in the detection andpreoperative evaluation of intracranial aneurysms in patients with acute SAH.
Published in DiRROS: 22.01.2024; Views: 128; Downloads: 32
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Abstract: Kožni tumorji spadajo med najpogostejše novotvorbe pri človeku. Delimo jih v tri skupine: benigni, predmaligni in maligni kožni tumorji. Zlasti na obrazu starejših ljudi se pojavijo značilne kožne spremembe, ki so posledica kronološke starosti bolnika in škodljivih zunanjih dejavnikov, zlasti solarno-klimatskih učinkov. Med malignimi tumorji sta najpomembnejša bazalno in spinalno celični karcinom, ki nezdravljena povzročata hudo lokalno uničenjetkiva. Hitra in pravilna diagnoza ter čimprejšnja kirurška odstranitevs histološko preiskavo omogoča učnkovito zdravljenje z dobrim estetskim rezultatom. Rano po eksciziji tumorja neposredno zašijemo s posameznimi ali tekočim intradermalnim šivom. Majhne kožne vrzeli pokrijemo s prostimi presadki kože različne debeline ali lokalnimi transpozicijskimi in rotacijskimi naključnimi kožnimi režnji. Pri velikih tkivnih vrzelih pa je potrebna rekonstrukcija z vezanimi režnji ali prostim prenosom tkiv.
Published in DiRROS: 28.11.2023; Views: 186; Downloads: 47
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