Sparnauskas, Tomas

Introduction Liquefied petroleum gas is colorless, odorless hydrocarbon mixture. Rapid evaporation cause cold injury, as the resulting drop in temperature can lead to frostbite [1]. Frostbite represents a cold induced injury in which tissue temperatures fall low enough to allow ice crystal formation within superficial deep layers [2]. For frostbite injuries, initiating reperfusion directed therapy early is associated with superior tissue protection compared with conventional conservative care, defined as noninvasive management without active restoration of microvascular flow [3]. Case Presentation This case describes a 34 y.o. man who sustained a right hand injury while refueling a car with LPG. Immediately after the incident, his hand became numb and cold. Examination showed diffuse redness, swelling, and hypoesthesia. He was admitted to the ICU for thrombolysis. After treatment swelling stabilized and a single serous blister appeared dorsally, the dorsal hand and medial side of the fifth finger were paler, but all fingers remained warm. Further management included LMWH aspirin ibuprofen and wound care with paraffin mesh and sterile dressings. Early antithrombotic therapy and local wound care preserved perfusion, halted injury progression and resulted in complete hand viability. At discharge swelling and sensory deficits had resolved, skin integrity was restored and no ischemic changes were present. Discussion When exposed to cold, the body responds by alternating vasoconstriction and vasodilation to protect the extremities from cold induced damage [4]. However this protective response can also lead to severe injury, including progressive thrombosis and tissue ischemia [5]. Early thrombolytic therapy has been shown to reduce amputation rates in severe frostbite [6]. In our case, early assessment and prompt medical reperfusion therapy stabilized perfusion and improved tissue recovery. Conclusions This unique case highlights the potential severity of LPG induced frostbite and the importance of early recognition of frostbite as a thrombotic injury. Prompt vascular assessment and monitoring of tissue perfusion guided targeted treatment. Early thrombolytic and antithrombotic therapy improved perfusion halted injury progression and resulted in complete preservation of hand viability with full functional recovery.

Introduction Bilateral partial hand amputations severely reduce function. Losing multiple fingers, especially thumbs, which provide about 40 % of hand function [1] limits grasp and independence. Crush injuries often cannot be fully reconstructed [2]. Partial hand prostheses fill a gap when reconstructive surgery is not possible [3]. Modern 3D scanning and printing allow rapid individualised prostheses. Case Presentation A 62 y music performer’s hands were crushed by a press, causing traumatic amputations of all fingers except the right thumb and index, part of the left thumb. Emergency surgery involved debridement, osteosynthesis of the remaining digits, attempted replantation. Nonviable fingers were amputated. Over the next year the right index developed chronic osteomyelitis with a comminuted fracture. After failed conservative care, sequestrectomy and Masquelet technique with a polymethylmethacrylate (PMMA) spacer reinforced the bone. Prostheses were considered only when no other treatments remained. Once the wounds healed, palms were laser scanned with a HandySCAN 700 to capture residual anatomy. Anonymised 3D scans were transferred into Fuse CAD to create digital models of a mechanical left hand prosthesis with custom sockets, finger segments. Discussion Digital fabrication provided precise, patient specific prosthesis. Reports show that custom 3D printed devices improve grasp and fit [4]. A mechanical design was chosen because body powered prostheses are lighter and more durable than myoelectric prostheses [5]. The HandySCAN 700 captures up to 480000 measurements s⁻¹ using laser triangulation enabling accurate custom prosthetic design [6]. Although many body powered partial hand devices can be coupled to preserved joints, digits this case used a self contained mechanical prosthesis without residual finger actuation. Masquelet technique reinforced the index finger. Its PMMA spacer fills bone cavities and provides structural support [7]. Conclusions Digital 3D scanning and CAD based fabrication produced a custom mechanical partial hand prosthesis that should restore functional grasp and improve the patient’s independence. Precisely matched to the residual palm this printed lightweight body powered device provided a stable, comfortable interface and may offer a feasible option when multiple digits are amputated and not reconstructable.

Bazinių (pamatinių) ląstelių karcinoma (BLK) – labiausiai tarp baltaodžių paplitusi piktybinė nemelanominio odos vėžio forma, kilusi iš epiderminių ląstelių. Europoje maždaug 85 proc. visų ligos atvejų nustatoma veido ir kaklo srityse, o ši lokalizacija siejama su ypatinga funkcine ir estetine svarba, dėl to tai kelia nemažai iššūkių gydytojams [19]. Gydant BLK labai svarbu pašalinti visą naviką, kad liga neatsikartotų ar toliau nebeplistų, kartu siekiama maksimaliai išsaugoti sveikus audinius ir užtikrinti geriausią funkcinį bei estetinį rezultatą. Šiuo metu daugelyje išsivysčiusių pasaulio šalių auksiniu didelės rizikos BLK gydymo standartu laikoma Mohso mikrografinė chirurgija (MMC). Šiame straipsnyje pateikiame šios technikos ir kitų gydymo būdų palyginamąją analizę.

Background & Objectives: Even though claudins, as a protein component of intercellular tight junctions, are native in human tissues, some studies hypothesize about claudin-4 being a marker for invasive skin melanoma phenotype. Objective of the study is to determine specific features of claudin-4 expression in skin melanoma. Methods: An immunohistochemical reaction with monoclonal claudin 4 (CLDN4) antibody was performed for selected cases of compound nevi (n=15) and metastatic skin melanoma (n= 15), scanning these samples with „Pannoramic Viewer (3D Histech)". Each digitalized histological view was analysed in digital microimaging software „Slideviewer". 100 consecutive melanocytic neoplastic cells were ranked according to their membranous reaction intensity scale from 0 (no reaction) to 4 points (high intensity reaction) in one 20x microscopic magnification field (approx. 0.785 mm) for each sample (Cohen’s kappa coefficient>0.9). Statistical analysis was applied (p<0.05). Results: High intensity claudin-4 expression was greater in metastatic skin melanoma (median=26, interquartile range=34) compared to benign nevi, where no cases exhibited a high reaction (p<0.001). Similarly, moderate expression was observed exclusively in melanoma (median=37, interquartile range=40), while benign nevi demonstrated no moderate staining (p<0.001). Mild expression also followed this pattern, with corresponding melanoma cases (median=22, interquartile range=23) compared to the absence of mild staining in benign nevi (p<0.00l). Conclusion: Study of claudin-4 immunohistochemical expression in melanocytic lesions suggest that benign nevi consistently lack any intensity of claudin-4 expression and may serve as an appropriate negative control group for evaluating benign and malignant melanocytic neoplastic lesions. Metastatic skin melanomas exhibit predominantly moderate to high intensity of claudin-4 expression, suggesting the potential diagnostic role of this immunohistochemical marker in clinic pathology practice testing for malignant melanocytic lesions.