Tomislav Meštrović

Reconstruction of skin defects after radical excision of anorectal giant condyloma acuminatum: 6 cases.

The authors report six cases of giant condyloma accuminatum and evaluate the use of mesh‐skin grafts in covering the skin defect after radical local excision of perianal giant condyloma acuminatum. Medical records of six patients suffering from the giant condylomata acuminata and treated surgically at the Department of Surgery, Clinical Hospital Center Zagreb, were examined. Use of mesh‐skin grafts in covering the skin defect after radical local excision of GCA was compared to other methods of treating the skin defect after radical excision of perianal lesions such as secondary wound healing. Four patients were treated by radical local excision and two patients were treated by abdominoperineal resection. There were partial graft failures (satisfactory result) in all patients and complete healing took about 3 to 4 weeks from time of grafting. A mesh‐skin graft was used to cover the skin defect. There were no recurrences, wound infections, wound bleeding, hypertrophic scars, or mesh‐like skin appearance of the recipient site. Therefore a good cosmetic and functional result was achieved. Use of mesh‐grafts in covering the wounds after radical excision of anorectal giant condylomata acuminata compares favorably to healing by secondary intention in terms of wound healing time, and gives good functional and cosmetic results.

Thoracoabdominal and coronary arterial aneurysms in a young man with a history of Kawasaki disease

We report a case of a large symptomatic thoracoabdominal aortic aneurysm in a 22-year-old man with a history of Kawasaki disease in childhood. According to multislice computed tomography scan findings, the aneurysm was classified as Crawford type III. Coronary angiography revealed a giant aneurysm of the left coronary artery and aneurysm of the circumflex artery. Functional tests for myocardial perfusion and function revealed no significant ischemic territories. Because of symptoms of imminent rupture, aneurysm resection and aortic reconstruction with a 26-mm zero porosity Dacron graft was performed and was successful. Cardiovascular consequences of Kawasaki disease are discussed with attention to the late sequelae. Indications for surgical treatment and importance of follow-up into adulthood are emphasized.

Radiation measurements around X-ray cabinet systems.

Security personnel who operate X-ray units for the control of hand luggage and personal items at airports are generally not under dosimetric surveillance. A significant increase in the number of inspected items per passenger, due to rigorous air traffic security measures, raises a question of extended exposure of these workers to scattered X-ray radiation. A new approach to investigating directions of breaches of scattered X-ray radiation in the area near to an X-ray cabinet system, which is based on using active electronic dosemeters is presented. Influence of the increase in the number of inspected items in time on the dose rate is described. Time-dependent dose rates have showed a very good correlation with passengers undergoing security control prior to boarding an airplane. Measurements confirmed that an increase in the dose rate, coinciding with rush hours, was caused by scattered radiation passing through incompletely closed lead curtains. It is found that the doses at the entrance to the inspection tunnel are 50% higher than those at the exit, which is a consequence of inherent operational characteristics of X-ray cabinet systems.

Total Occupational Exposure During Characterisation, Conditioning, and Securing of Radioactive Sealed Sources: A New Dosimetric Concept Using Active Electronic Dosimeters

Total Occupational Exposure During Characterisation, Conditioning, and Securing of Radioactive Sealed Sources: A New Dosimetric Concept Using Active Electronic Dosimeters Radiation dosimetry in protection against ionising radiation involves research of all possible pathways through which natural or man-made radioactive materials can contaminate a habitat and actually harm its biota. It also takes into account natural and artificial (man-made) electromagnetic ionizing radiation (γ and x radiation). This article presents a dosimetric study assessing exposure to man-made ionising radiation of local environment and total occupational exposure of two professional workers involved in characterisation, conditioning, and securing of unused radioactive sealed sources. The purpose of the study was to validate a new active electronic dosimeter (AED) of type ALARA OD and to develop a new monitoring method by tracing the external occupational exposure over real time. This method is used to continuously measure and record external radiation doses and, which is a novelty, establish dose rates receiving pattern as a function of real time. Occupational whole body dosimetric results obtained with AED were compared with results obtained with passive dosimetry (film badge and thermoluminiscence). Air, dust, and silicon sand samples were analysed by gamma-spectrometry to estimate internal exposure of the two workers to 222Rn due to inhalation or ingestion of dust and sand in indoor air. In order to establish total occupational exposure, control radon measurement was performed in the immediate environment and the external Hazard index (Hex) was calculated. Ukupna profesionalna izloženost tijekom karakterizacije, kondicioniranja i osiguravanja zatvorenih radioaktivnih izvora: novi dozimetrijski koncept uporabom aktivnih elektronskih dozimetara Dozimetrijski koncept zaštite od ionizirajućeg zračenja podrazumijeva istraživanje svih mogućih putova kojima radioaktivni materijal nastao u prirodi ili kao posljedica ljudskog djelovanja može ući u okoliš i utjecati na biotu ili onečistiti habitat oštećujući biotu. Taj koncept također uzima u obzir prirodno i umjetno (stvoreno ljudskim djelovanjem) elektromagnetsko ionizirajuće zračenje (γ i X-zračenje). U ovom radu predstavljena je dozimetrijska istraživačka studija kojom se istražuje i procjenjuje ukupna profesionalna izloženost dvaju radnika te izloženost lokalnog habitata ionizirajućem zračenju. Studija je obuhvatila karakterizaciju, kondicioniranje i osiguravanje nekorištenih, uskladištenih zatvorenih radioaktivnih izvora u cilju potvrđivanja i validacije novog aktivnog elektronskog dozimetra (AED) tipa ALARA OD te razvoj nove metodologije praćenja vanjske profesionalne izloženosti u vremenu. Kontinuirano mjerenje i snimanje primljenih vanjskih doza te kao novitet, brzine doze kao funkcije vremena, daju novu i jedinstvenu snimku profesionalnih doza i uzoraka primanja brzine doze na danome radnome mjestu. Rezultati mjerenja profesionalne doze za cijelo tijelo dobiveni uporabom AED-ova uspoređeni su s dozimetrijskim rezultatima [Hp(10)] dobivenim uporabom pasivnih dozimetara (filmskih i termoluminiscentnih dozimetara). Provedene su gamaspektrometrijske analize zraka, prašine i silikatnog pijeska te su dobiveni podaci iskorišteni za procjenu moguće unutarnje izloženosti radnika 220Rn inhalacijom zraka ili ingestijom prašine i pijeska. Radi određivanja ukupne profesionalne izloženosti bilo kojeg radnika uključenog u ovaj projekt, provedena su kontrolna mjerenja radona i izračunan je Hazard index (Hex).

Endovascular Treatment of a Late False Aneurysm Complicating Open Suprarenal Mycotic Aneurysm Repair With a Cryopreserved Aortic Homograft

We report a patient who was initially treated for a suprarenal mycotic aortic aneurysm. The aneurysm repair was performed using a cryopreserved arterial homograft and debranching of visceral arteries. Five years later, the patient was referred due to a large symptomatic false aneurysm at the distal homograft anastomosis. Endovascular repair was indicated and performed using a bifurcated Medtronic composite stent graft. The procedure was uneventful, while control angiography showed complete exclusion of the false aneurysm. Within 6 months of follow-up, the endograft showed favorable position and maintained patency with no signs of endoleaks. We discuss the role of the cryopreserved homografts for in situ repair of mycotic aortic aneurysms and comment on possible late complications after placing those grafts.