A Battery in the Stenotic Esophagus of a Child with a Congenital Tracheoesophageal Fistula

A case of a three-year-old male child who was admitted to our hospital with the suspicion that he had swallowed a battery approximately one hour before admittance. The parents believed that it was a button-shaped lithium battery approximately 12 mm in diameter. A chest X-ray was taken immediately, and a battery was identified in the esophagus at the fifth thoracic vertebra. By reviewing the child’s medical history, we found that the child had had surgery the day after birth due to congenital atresia of the esophagus and a tracheoesophageal fistula type III b. An esophagoscopy was performed one hour after admittance, and the battery was found to be partially past the scar from the first surgery. Because of that, the battery was pushed further toward the stomach, out of fear that retrieving the battery through the scarred section of the child’s esophagus could damage the stenotic wall. Upon the next X-ray of the abdomen, the battery was observed in the stomach. The child was monitored, and X-rays were taken over the next several days. The battery was evacuated in stool eight days after it had been ingested

Cytotoxicity investigation of a new hydroxyapatite scaffold with improved structural design

Introduction Biodegradable porous scaffolds are found to be very promising bone substitutes, acting as a temporary physical support to guide new tissue regeneration, until the entire scaffold is totally degraded and replaced by the new tissue. Objective The aim of this study was to investigate cytotoxicity of a synthesized calcium hydroxyapatite-based scaffold, named ALBO-OS, with high porosity and optimal topology. Methods The ALBO-OS scaffold was synthesized by the method of polymer foam template. The analysis of pore geometry and scaffold wallstopography was made by scanning electron microscope (SEM). The biological investigations assumed the examinations of ALBO-OS cytotoxicity to mouse L929 fibroblasts, using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromidefor (MU) and lactate dehydrogenase (LDH) tests and inverse phase microscopy. Results The SEM analysis showed high porosity with fair pore distribution and interesting morphology from the biological standpoint. The biological investigations showed that the material is not cytotoxic to L929 cells. Comparison of ALBO-OS with Bio-Oss, as the global gold standard as a bone substitute, showed similar results in MTT test, while LDH test showed significantly higher rate of cell multiplication with ALBO-OS. Conclusion The scaffold design from the aspect of pore size, distribution, and topology seems to be very convenient for cell adhesion and occupation, which makes it a promising material as a bone substitute. The results of biological assays proved that ALBO-OS is not cytotoxic for L929 fibroblasts. In comparison with Bio-Oss, similar or even better results were obtained

Kirurško liječenje recidivirajućeg metastatskog karcinoma doštitne žlijezde

We present the case of a 48-year-old male patient who underwent surgery for a recurrent metastatic parathyroid gland carcinoma in the patient’s right paratracheal space of the neck. The patient had undergone surgery for lower right parathyroid gland carcinoma 28 months earlier. Results: The metastases were resected en bloc with an ipsilateral central neck dissection and with the removal of the enlarged lower left parathyroid gland. After exploration of the remnant parathyroid glands we noticed that lower left parathyroid gland was macroscopically enlarged so we decided to remove it to prevent possible hypercalcemia in future and to also prevent possible recurrence of cancer or development of a new primary, considering the identical embryological origin of the lower parathyroid glands and possibility of synchronous, multiple tumors, which generally follow the same embryological origin if they occur. The patient was also treated with radiation therapy after the surgery. Conclusion: With the present surgical approach to recurrent metastatic parathyroid gland carcinoma, we aimed to prevent the recurrence of cancer or development of new primary and prevent or delay hypercalcemia in the future with all severe adverse metabolic states associated with high serum calcium levels.Prikaz slučaja 48 godišnjeg muškog bolesnika koji je operiran zbog recidvirajućeg metastatskog karcinoma doštitne žlijezde u paratrahealnom prostoru vrata desno. 28 mjeseci prije bolesnik je operiran poradi karcinoma donje desne doštitne žlijezde. Rezultati: Metastaze su odstranjene zajedno s ipsilateralnom centralnom disekcijom desne strane vrata kao i povećana donja lijeva doštitna žlijezda. Naime, nakon eksploracije preostalih doštitnih žlijezda, primjetili smo da je donja lijeva doštitna žlijezda makroskopski povećana, pa smo je odlučili odstraniti zbog te činjenice te da preveniramo razvoj moguće hiperkalcemije u budućnosti, a također i da preveniramo mogući recidiv karcinoma ili razvoj novog primarnog karcinoma uzimajući u obzir istu embriološku osnovu nastanka donjih doštitnih žlijezda i mogućnost razvoja istodobnih, sinhronih karcinoma doštitnih žlijezda koji, ukoliko se pojave, uglavnom prate istu embriološku osnovu. Bolesnik je liječen i radioterapijom nakon operacije. Zaključak: Prikazanim kirurškim pristupom liječenju recidivirajućeg metastatskog karcinoma doštitne žlijezde cilj nam je bio da spriječimo ponovni recidiv karcinoma ili nastanak novog primarnog karcinoma i da spriječimo ili odgodimo razvoj moguće hiperkalcemije u budućnosti sa svim teškim štetnim metaboličkim stanjima povezanima s visokim razinama kalcija u serumu

Decontamination of Mycotoxin-Contaminated Feedstuffs and Compound Feed

Mycotoxins are known worldwide as fungus-produced toxins that adulterate a wide heterogeneity of raw feed ingredients and final products. Consumption of mycotoxins-contaminated feed causes a plethora of harmful responses from acute toxicity to many persistent health disorders with lethal outcomes; such as mycotoxicosis when ingested by animals. Therefore, the main task for feed producers is to minimize the concentration of mycotoxin by applying different strategies aimed at minimizing the risk of mycotoxin effects on animals and human health. Once mycotoxins enter the production chain it is hard to eliminate or inactivate them. This paper examines the most recent findings on different processes and strategies for the reduction of toxicity of mycotoxins in animals. The review gives detailed information about the decontamination approaches to mitigate mycotoxin contamination of feedstuffs and compound feed, which could be implemented in practice

Pristup liječenju tumorskog tromba folikularnog karcinoma štitnjače u unutarnjoj jugularnoj i brahiocefaličnoj veni

Thyroid gland carcinoma causing tumor thrombus in the great veins of the neck and mediastinum is a rare condition with poor prognosis. Invasion of the internal jugular vein by thyroid gland carcinoma has been occasionally reported, but tumor thrombi extending to the great veins of the mediastinum are reported extremely rarely. We present a treatment approach in a case of follicular thyroid carcinoma intravascular tumor thrombus in the left internal jugular and left brachiocephalic vein.Karcinom štitnjače koji uzrokuje tumorske trombe u velikim venama vrata i medijastinuma je rijedak i ima lošu prognozu. Invazija unutarnje jugularne vene karcinomom štitnjače se povremeno opisuje u člancima, ali tumorski trombi koji zahvaćaju velike vene medijastinuma su iznimno rijetko opisani. Prikazujemo pristup liječenjuintravaskularnog tumorskog tromba folikularnog karcinoma štitnjače u lijevoj unutranjoj jugularnoj i lijevoj brahiocefaličnoj veni

Does Life along the Sea Carry Greater Risk of Thyroid Cancer?

Aim of this study was to determine whether there are any differences between coastal and inland Dalmatia in incidence rates and clinical characteristics of thyroid cancer. Data on 651 persons who suffer from and have undergone surgery for thyroid cancer have been analysed. All patients lived in Dalmatia between 1997 and 2006. Data were collected via surveys, insight into medical histories and results of histopathological analysis. In Dalmatia, in the overall sample, there are no statistically significant differences in incidence between coastal and inland areas (c 2=3.03; df=1; p=0.082). Somewhat higher overall incidence has been recorded in the inland (8.5%000) than in the coastal Dalmatia (7.3%000). In the overall sample, in Dalmatia, women make up 81.4% of patients and papillary cancer accounts for 80.0% of all thyroid cancers. The ratio of papillary to folicullar cancer is 7.8:1 in coastal and 4.2:1 in inland Dalmatia. Papillary and medullary types are more common in the coastal area and follicular and anaplastic cancer types in the inland area and the differences are statistically significant (p>0.033). Epidemiological characteristics of thyroid cancer in coastal Dalmatia are in accordance with the characteristics of this cancer as described in iodine-sufficient areas: the most common type is papillary cancer, and the ratio of papillary to follicular is 7.8:1. Sex-wise, the coastal area records a higher ratio of male patients (1:3.8) than the inland area (1:7.1). There are no statistically significant differences in thyroid cancer incidence rates between coastal and inland Dalmatia. Epidemiological characteristics of thyroid cancer in inland Dalmatia are in some ways more similar to those of continental Croatia. This result could be the consequence of previous iodine insufficiency in inland Dalmatia

EPIDEMIOLOGICAL CHARACTERISTICS OF THYROID CANCER IN DALMATIA, CROATIA

Cilj istraživanja ove retrospektivne epidemiološke studije bio je utvrditi epidemiološke osobitosti karcinoma štitnjače u Dalmaciji i usporediti ih s epidemiološkim osobitostima karcinoma štitnjače u Hrvatskoj. Korišteni su podaci Hrvatskog registra za rak objavljeni u Hrvatskom zdravstveno-statističkom ljetopisu i godišnjim biltenima, te podaci o 651 bolesniku od raka štitnjače operiranom u bolnicama Dalmacije u razdoblju 1997.-2006. godina. Stope incidencije u Dalmaciji uspoređene su sa stopama u Hrvatskoj. Nađeno je da je prosječna, dobno standardizirana stopa incidencije karcinoma štitnjače posljednjih deset godina u cijeloj Hrvatskoj 8,1, a u Dalmaciji 9,32 na 100.000 stanovnika. Razlika je statistički značajna (p<0,05). Stope incidencije (dobno standardizirana na europsko i svjetsko stanovništvo, gruba, na temelju istraživanja) pokazuju trend porasta i značajno su više na području Dalmacije u odnosu na cijelu Hrvatsku. Spolna struktura oboljelih pokazuje da žene u odnosu na muškarce četiri puta češće obolijevaju. U Dalmaciji, u ukupnom uzorku, žene čine 81,4% oboljelih, a papilarni karcinom čini 80,03% oboljelih od karcinoma štitnjače. Medijan životne dobi novooboljelih na području Dalmacije je 50 godina. Zaključeno je da su stope incidencije karcinoma štitnjače značajno više u Dalmaciji u odnosu na Hrvatsku. Po navedenim karakteristikama Dalmacija se ne razlikuje od ostalih priobalnih ili otočnih područja svijeta s visokim stopama incidencije, a odnos papilarni: folikularni karcinom u istraživanom uzorku je 6,4:1.The causes of angioedema (AE), a self-limited, localized swelling of subcutaneous tissue or mucosa unaccompanied by urticaria, are diverse. The commonly applied label of “allergic” is frequently wrong and standard anti-allergic therapy can be ineffective. Types of AE could be categorized according to mediators which mediate vascular leakage: bradykinin AE (hereditary, acquired, angiotensin-converting enzyme inhibitor (ACEi)-related), histamine AE (allergic etiology), and various mediators mediated AE (pseudoallergic reaction to non-steroidal anti-inflammatory drugs). Idiopathic AE is a poorly understood syndrome. The growing relevance of AE without urticaria has been highlighted; angioedema is the most common cause of hospital admission among all acute allergic diseases. The diagnosis of AE is based on the presence of family history (hereditary), absence of family history with the onset during or after the fourth decade of life (acquired C1Inh deficiency), and treatment with ACEi (ACEi-related angioedema). About 0.1%-0.7% of patients taking ACEi develop angioedema as a well-documented but still frequently unrecognized side effect of drugs. Laboratory diagnosis is enabled by measuring serum levels of C1Inh antigen or C1Inh function. Type 1 (hereditary angioedema (HAE) was diagnosed when both antigenic and functional levels of C1Inh were below 50% of normal, and type 2 when functional levels of C1Inh were low, along with antigenic levels normal or higher. ACEi-related AE is diagnosed when AE recurs during therapy and disappears upon withdrawal. Symptoms may appear several years after therapy introduction. Severe acute attacks should be treated with C1Inh concentrate and icatibant, a selective and specific antagonist of bradykinin B2 receptors. Prophylaxis with attenuated androgens (danazol, stanazolol, oxandrolone) is effective in preventing symptom development

The value of contact endoscopy in the screening of precancerous lesions of laryngeal epithelium in smokers

Kontaktna endoskopija je neinvazivna dijagnostička metoda koja pruža uvid u mikroskopsku sliku epitela sluznice larinksa, a stanice se analiziraju in vivo, čime je uklonjena mogućnost oštećenja i deformiranja stanica pri izradi preparata. U radu smo metodom kontaktne endoskopije analizirali epitel sluznice glasnica kod bolesnika koji još nemaju kliničkih simptoma bolesti. Početne promjene larinksa su makroskopski nevidljive, a rano prepoznavanje ovih promjena omogućava bolju prognozu i jednostavnije liječenje. Ovaj rad pokazuje znatno veću učestalost početnih patoloških promjena larinksa u pušača u odnosu na nepušače. Ova pretraga je pogodna i kod bolesnika s kroničnim laringitisom ili izraženijom leukoplakijom, u procjeni mjesta biopsije za patohistološku pretragu, jer se time dobiva pouzdanija dijagnoza uz manje oštećenje sluznice larinksa. Pretragu bi bilo poželjno provesti i u pušača kod kojih je došlo do promjene glasa, jer se neinvazivnom metodom dobiva mikroskopski uvid u početne patološke promjene epitela sluznice glasnica.Contact endoscopy as a noninvasive diagnostic method provides an insight into the microscopic picture of laryngeal mucosa epithelium. The cells are analyzed in vivo, thus obviating the possible cell damage and distortion on preparation. In the present study, vocal cord mucosa epithelium was analyzed by contact endoscopy in subjects still free from clinical symptoms of disease. Initial laryngeal lesions are macroscopically invisible, and early detection of these changes is associated with better prognosis and easier management. The present study also demonstrated a considerably higher prevalence of initial pathologic lesions of the larynx in smokers versus nonsmokers. This method is also suitable for patients with chronic laryngitis or pronounced leukoplakia to identify the best site of biopsy for histopathologic analysis, as it offers a more reliable diagnosis with less damage to laryngeal mucosa. This noninvasive method should preferably be also used in smokers with voice alteration because it provides a microscopic insight into initial pathologic lesions of the vocal cord mucosa epithelium

The value of contact endoscopy in the screening of precancerous lesions of laryngeal epithelium in smokers

Kontaktna endoskopija je neinvazivna dijagnostička metoda koja pruža uvid u mikroskopsku sliku epitela sluznice larinksa, a stanice se analiziraju in vivo, čime je uklonjena mogućnost oštećenja i deformiranja stanica pri izradi preparata. U radu smo metodom kontaktne endoskopije analizirali epitel sluznice glasnica kod bolesnika koji još nemaju kliničkih simptoma bolesti. Početne promjene larinksa su makroskopski nevidljive, a rano prepoznavanje ovih promjena omogućava bolju prognozu i jednostavnije liječenje. Ovaj rad pokazuje znatno veću učestalost početnih patoloških promjena larinksa u pušača u odnosu na nepušače. Ova pretraga je pogodna i kod bolesnika s kroničnim laringitisom ili izraženijom leukoplakijom, u procjeni mjesta biopsije za patohistološku pretragu, jer se time dobiva pouzdanija dijagnoza uz manje oštećenje sluznice larinksa. Pretragu bi bilo poželjno provesti i u pušača kod kojih je došlo do promjene glasa, jer se neinvazivnom metodom dobiva mikroskopski uvid u početne patološke promjene epitela sluznice glasnica.Contact endoscopy as a noninvasive diagnostic method provides an insight into the microscopic picture of laryngeal mucosa epithelium. The cells are analyzed in vivo, thus obviating the possible cell damage and distortion on preparation. In the present study, vocal cord mucosa epithelium was analyzed by contact endoscopy in subjects still free from clinical symptoms of disease. Initial laryngeal lesions are macroscopically invisible, and early detection of these changes is associated with better prognosis and easier management. The present study also demonstrated a considerably higher prevalence of initial pathologic lesions of the larynx in smokers versus nonsmokers. This method is also suitable for patients with chronic laryngitis or pronounced leukoplakia to identify the best site of biopsy for histopathologic analysis, as it offers a more reliable diagnosis with less damage to laryngeal mucosa. This noninvasive method should preferably be also used in smokers with voice alteration because it provides a microscopic insight into initial pathologic lesions of the vocal cord mucosa epithelium

Glomus tumor of the lingual base: a case report

Glomus tumori su pretežito benigni neuroendokrini tumori nastali od ekstraadrenalnih paraganglija autonomnog živčanoga sustava. Iako su vrlo rijetki, problemi vezani za njihovu pravodobnu dijagnozu i liječenje, čine ih zanimljivim i zahtjevnim. U radu je prikazan bolesnik u dobi od 24 godine s glomus tumorom baze jezika. Tumor je dokazan radiološkim metodama (kompjutorizirana tomografija i angiografija). Terapija je bila isključivo kirurška. Do sada je u literaturi opisan samo jedan slučaj paraganglioma orofarinksa.Glomus tumors generally are benign neuroendocrine tumors originating from extra-adrenal paraganglia of the autonomic nervous system. Although very rare, the problems associated with timely diagnosis and treatment of glomus tumors make them rather intriguing and demanding. A case is presented of a 24-yearold man with glomus tumor of the lingual base. The tumor was verified by radiological methods (computerized tomography and angiography) and treated exclusively by surgical approach. To our knowledge, a single case of oropharyngeal paraganglioma has been reported in literature