Sialendoskopija v času pred, med in po pandemiji covida-19

Sialendoskopske tehnike predstavljajo novo paradigmo, ki je bistveno spremenila zdravljenje zastojne bolezni žlez slinavk. Epidemija covida-19 predstavlja nov izziv za zdravstveni sistem sleherne države in postavlja na preizkušnjo številne, predvsem elektivne kirurške metode zdravljenja. Kirurški posegi v področju glave in vratu in še posebej v ustni votlini predstavljajo hudo tveganje za prenos covida-19. Pri izvajanju sialendoskopije oziroma sialendoskopsko asistirane operacije sta kirurška ter anesteziološka ekipa izpostavljeni slini in refleksom občutljivega anatomskega področja ust oziroma zgornjih dihal in prebavil. Ostaja vprašanje, kolikšno je tveganje glede na fazo operacije, vrsto anestezije, uporabljeno osebno varovalno opremo ter trenutno epidemiološko situacijo covida-19. V času pandemije covida-19 smo na Kliniki za otorinolaringologijo in cervikofacialno kirurgijo Ljubljana izvajali le nujne, kasneje pa tudi elektivne sialendoskopske in sialendoskopsko asistirane posege. Menimo, da je v času obvladljive epidemiološke situacije sialendoskopska kirurgija ob upoštevanju indikacij in zaščitnih ukrepov lahko varna za bolnika in izvajalca

The New Setup in the Belgrade Low-Level and Cosmic-Ray Laboratory

The Belgrade underground laboratory consists of two interconnected spaces, a ground level laboratory and a shallow underground one, at 25 m.w.e.. The laboratory hosts a low-background gamma spectroscopy system and cosmic-ray muon detectors. With recently adopted digital data acquisition system it is possible to study simultaneously independent operation of two detector systems, as well as processes induced by cosmic-ray muons in germanium spectrometers. Characteristics and potentials of present experimental setup, together with some preliminary results for the flux of fast neutrons and stopped muons are reported.Comment: 12 pages, 16 figure

MANAGEMENT OF CERVICAL LYMPH NODES IN PATIENTS WITH LARYNGEAL CARCINOMA – PATTERNS OF FAILURE

The purpose of our study was to show the patterns of regional failure when a neck dissection is chosen as part of a laryngeal cancer operation, focusing our interest on selective neck dissections. From January 1, 1987 through December 31, 1991, we performed 374 neck dissections on 207 previously untreated patients with laryngeal squamous cell carcinoma. Selective neck dissections represented the majority of all dissections performed (87%). The overall regional recurrence rate was 4.84% and the average duration of follow-up 58 months after operation. The regional in-field recurrence rate after selective neck dissections in postoperatively irradiated N2b and N1 cases was 12.5% and 8.3%, respectively. It seems that a more comprehensive neck dissection would not benefit these patients, because the majority of regional recurrences developed in the dissected field. Selective neck dissections with postoperative radiotherapy represent appropriate therapeutic and not only diagnostic procedures in the treatment of patients with laryngeal carcinoma, even in N2b cases.</p

Sialendoscopy-Based Analysis of Submandibular Duct Papillae with a Proposal for Classification

Identifying a submandibular (Wharton&rsquo;s) duct punctum often hinders sialendoscopy; however, there is a paucity of evidence on whether the appearance of Wharton&rsquo;s duct papilla impacts the sialendoscopic procedure. A classification of Wharton&rsquo;s duct papillae based on the macroscopic appearance, size of dilatation probes, and sialendoscopic approach was proposed herein. The classification describing four main types of papillae, A, B, C, and D, was prospectively evaluated on 351 Wharton&rsquo;s duct papillae in 315 patients. For each papillae type, the demographic/clinical data, intraoperative complications, and time required for sialendoscope introduction were analyzed. Estuary-like papilla (type A) was commonly seen after spontaneous stone extrusion, had no intraoperative complications noted, and had the shortest time required for the sialendoscope introduction. Normal papilla (type B) was the most frequently observed papilla (48.1%), reflecting diverse underlying pathology, while difficult papilla (type C) was often associated with unfavorable anatomical variations of the mandible or floor of the mouth. Substantially closed papilla (type D) had the highest rate of intraoperative complications, namely, perforation with a false passage, and required the longest time for the sialendoscope introduction. In seven patients (2.0%), the entrance into the duct was feasible only through the fistula, while the sialendoscope introduction failed in eight patients (2.3%). In conclusion, the appearance of Wharton&rsquo;s duct papillae may be influenced by the underlying pathology. Based on the proposed classification, papilla typology affects the duration of sialendoscope introduction and may influence the frequency of intraoperative complications

Sialendoscopy in Management of Juvenile Recurrent Parotitis—A Single Centre Experience

Juvenile recurrent parotitis is a rare inflammatory disease of the parotid gland that shares diverse therapeutic management between institutions. Sialendoscopy has been demonstrated as an efficient diagnostics and therapeutic method with minimal complications; however, due to the rarity of the disease and limited data, there is a lack of universal guidelines on its optimal management. Herein, we retrospectively analysed patients with juvenile recurrent parotitis who had the sialendoscopy performed at our tertiary centre. Descriptive data were retrieved along with the number of swelling episodes one year before and after the sialendoscopy intervention. In the last decade, twenty-nine sialendoscopic procedures were performed at our clinics on twenty-one patients diagnosed with juvenile recurrent parotitis. Most of them underwent the procedure under general anaesthesia (86%). In the year before and after the sialendoscopic procedure, the patients had 3.9 ± 2.7 and 0.2 ± 0.4 episodes of swelling per year, respectively. The difference proved to be statistically significant (p < 0.0001). The complete resolution was noted in sixteen patients (76%); however, the procedure was not repeated on the same side of any patient. Solely one patient had a relapse of the disease reported more than twelve months after the sialendoscopy, nonetheless, one of his exacerbation episodes was already reported in the first year after the sialendoscopy. The mean follow-up period of patients was 48.6 months (range, 13–116 months). All things considered, this study emphasises sialendoscopy as an effective minimally invasive diagnostic and therapeutic tool for the management of juvenile recurrent parotitis

Kirugija glave in vratu med pandemijo covida-19

Kirurgija glave in vratu med pandemijo covida-19 je za zdravstveni sistem velik izziv. Pred kirurškimi posegi je potrebna ustrezna priprava in poznavanje vseh možnosti zdravljenja, da bolnik in zdravstveni delavci ne tvegajo okužbe. Treba je odložiti vse posege, katerih odložitev ne ogroža bolnikovega zdravja. Operacijske posege glede na nujnost delimo v tri skupine – v prvo skupino sodijo urgentni, neodložljivi posegi, v drugo skupino posegi, ki jih lahko odložimo za največ štiri tedne, in v tretjo skupino posegi, katerih odložitev za šest do osem tednov ne vpliva na izid zdravljenja. Pred predvideno operacijo je treba ugotoviti status okužbe bolnika z virusom SARS-CoV-2, razen ob urgentnih posegih, ki jih opravimo ne glede na status okužbe bolnika. Kirurški posegi glave in vratu se med seboj razlikujejo glede na možnost prenosa okužbe z virusom SARS-CoV-2 s pozitivnega bolnika na zdravstvenega delavca; pri tem upoštevamo predvsem verjetnost tvorbe aerosola med posegom. Med posege največjega tveganja sodijo endoskopske preiskave zgornjih dihal in prebavil ter žlez slinavk in operacije v tem področju, ki prekinejo sluznice. Te so: traheotomija, laringektomija, faringektomija, operacija raka ustne votline, transoralna laserska mikrokirurgija, transoralna robotska kirurgija. V skrbi za zdravje zdravstvenega osebja in bolnikov je med kirurškimi posegi nujna dosledna uporaba osebne varovalne opreme ne glede na okuženost bolnika