The estimation of value of selective neck dissection in the treatment of patients with carcinomas pharyngeal and oral localisation

Skoro se navršilo sto godina od kada je zaslugom George Crile-a opisana sistematska ekscizija cervikalnih limfonodusa u cilju hirurškog lečenja bolesnika sa karcinomima glave i vrata. George Crile je 1906. godine opisao operaciju koju je nazvao "radikalna disekcija vrata", zasnovanu na sopstvenom iskustvu i studiji impozantne serije 4500 bolesnika s karcinomima glave i vrata koji su umrli zbog primarnog tumora ili regionalnih metastaza u vratu i samo 1% zbog udaljenih metastaza. Radikalna disekcija vrata vremenom postaje gotovo standardna procedura za bolesnike kojima je bio potreban hirurški tretman metastatskih depozita u kombinaciji sa uklanjanjem primarnog tumora. U međuvremenu, svima koji su bili angažovani u lečenju bolesnika s karcinomom glave i vrata postalo je jasno da je radikalna disekcija vrata adekvatna u tretiranju velikih palpabilnih limfonodusa, ali i preterano agresivna kako na pacijentima s malim palpabilnim limfonodusima, i naročito na onima bez palpabilnih limfonodusa ili sa visokim rizikom metastaziranja. Modifikovana radikalna disekcija (MRDV) uklanja "en bloc" iste limfonoduse i limfatike kao i radikalna disekcija, ali očuvanjem jedne ili više nelimfatičkih struktura koje se rutinski uklanjaju radikalnom disekcijom, smanjuje postoperativni morbiditet. Još dalje se otišlo selektivnim disekcijama (SDV) koje preferiraju američki hirurzi glave i vrata. Operacije uključuju selektivno uklanjanje pojedinih grupa limfonodusa sa rizikom metastaze i očuvanje svih nelimfatičkih struktura i preostalih grupa nodusa u slučajevima nodus negativnog vrata. Zagovara se njena primena i u slučajevima nodus pozitivnog vrata. Ovde vladaju velike kontroverze posebno kada je u pitanju grupa bolesnika sa evidentnim metastatskim depozitima u vratu...There has recently been one hundred years since George Crile demonstrated systematic cervical lymph nodes excision for treatment of patients with head and neck carcinoma. In 1906, George Crile has described surgical operation he called “radical neck dissection”, based on his previous experience and a study of impressive group of 4.500 patients with head and neck carcinoma. Over time, radical neck dissection has became almost standard procedure for patients who required surgical treatment of metastatic deposits combined with primary tumor removal. In the meantime, everyone involved in treatment of patients with head and neck carcinoma began to understand that the radical neck dissection was adequate for treating large palpable lymph nodes, but that it was excessively aggressive in both patients with small palpable lymph nodes, and especially those without palpable lymph nodes or with high risk of metastases. Modified radical neck dissection (MRND) removes “en block” the same lymph nodes and vessels as radical dissection, but by preserving one or more non-lymphatic structures that are being radically removed by radical dissection it decreases postoperative morbidity. Selective neck dissections, which are being preferred by American head and neck surgeons, went even further. Operations include selective removal of individual groups of lymph nodes with risk of metastases and preservation of all non-lymphatic structures and remaining groups of lymph nodes in cases of node-negative neck. It use in cases of node-positive neck is being advocated as well. There are large controversies in this area, especially in patients with evident metastatic neck deposits. The research was performed at Clinic for Otolaryngology and Maxillofacial Surgery of Clinical Center of Serbia in Belgrade. The study included 608 patients treated over a ten year period, from January 1, 1992 to December 31, 2001, who have been followed up for at least 5 years after administered treatment..

Rendgen-kefalometrijska analiza pozicije kondila nakon bimaksilarne osteotomije mandibularnog prognatizma

Background/Aim. Postoperative condylar position is a substantial concern in surgical correction of mandibular prognathism. Orthognathic surgery may change condylar position and this is considered a contributing factor for early skeletal relapse and the induction of temporomandibular disorders. The purpose of this study was to evaluate changes in condylar position, and to correlate angular skeletal measurements following bimaxillary surgery. Methods. On profile teleradiographs of 21 patients with mandibular angular and linear parametres, the changes in condylar position, were measured during preoperative orthodontic treatment and 6 months after the surgical treatment. Results. A statistically significant difference in values between the groups was found. The most distal point on the head of condyle point (DI) moved backward for 1.38 mm (p = 0.02), and the point of center of collum mandibulae point (DC) moved backward for 1.52 mm (p = 0.007). The amount of upward movement of the point DI was 1.62 mm (p = 0.04). Conclusion. In the patients with mandibular prognathism, the condyles tend to migrate upward and forward six months after bimaxillary surgery.Uvod/Cilj. Postoperativna pozicija kondila je značajna za hiruršku korekciju mandibularnog prognatizma. Ortognatska hirurgija može da promeni poziciju kondila, a to može biti jedan od faktora koji doprinosi ranom skeletnom recidivu i pojavi temporomandibularnih disfunkcija. Zbog toga je cilj ove studije bio da proceni promene pozicije kondila kao i da ne korelišu promene pozicije kondila sa angularnim skeletnim promenama nakon bimaksilarne hirurgije. Metode. Na telerendgenskim snimcima 21 bolesnika sa mandibularnim prognatizmom mereni su angularni i linearni parametri koji opisuju promene u položaju kondila, pre ortodontske pripreme i šest meseci nakon hirurške korekcije. Rezultati. Ustanovljena je statistička značajnost razlika u vrednosti parametara između grupa. Tačka DI - najdistalnija tačka na glavi kondila, pomerila se unazad 1,38 mm (p = 0,02), a tačka DC - tačka koja označava centar collum mandibulae, pomerila se, takođe, unazad za 1,52 mm (p = 0,007). Vrednost pomeranja tačke DI naviše bila je 1,62 mm (p = 0,04). Zaključak. Kod bolesnika sa mandibularnim prognatizmom, kondili su težili da migriraju unapred i naviše šest meseci nakon bimaksilarne operacije

Kvalitet života laringektomisanih bolesnika u Srbiji

Introduction/Objective Total laryngectomy is a very mutilating operation and it leads to drastic changes in life quality. The purpose of this study was to examine factors of importance to the laryngectomized patients' quality of life and to evaluate characteristics of esophageal voice and speech. Methods The study was conducted at the Clinic of Otorhinolaryngology and Maxillofacial Surgery, at the Clinical Center of Serbia (Belgrade, Serbia), during the period between March 2012-2015. The study included 223 patients diagnosed with laryngeal cancer, who underwent total laryngectomy. The total of 168 laryngectomized patients were provided with phoniatric rehabilitation. Results The quality of life was significantly better for those laryngectomized patients who did undergo phoniatric rehabilitation. By means of intensive phoniatric rehabilitation the esophageal voice and speech was established in 86.3% of laryngectomized patients registered by objective acoustic analysis. Rehabilitated laryngectomy patients had a significantly lower presence of voice handicap sense (VHI: 19.57 ± 7.35) and expressed significantly lower symptoms of depression and anxiety (PHQ-9: 3.8 ± 4.2; GAD-7: 3.4 ± 4.2). Cronbach's alpha coefficient was above 0.7 EORTC QLQ-C30 on three levels of Likert scales: the scale of physical and emotional functioning and fatigue; as well as EORTC QLQ-H&N43 questionnaire: the symptoms of head and neck pain, speech, swallowing and eating problems and body image. Conclusion Significantly improving the quality of life of laryngectomized patients was achieved by a multidisciplinary rehabilitation. Phoniatric rehabilitation carried out in a planned and systematic way is the most efficient rehabilitation of laryngectomized patients.Uvod/Cilj Totalna laringektomija, kao veoma mutilantna operacija, dovodi do drastičnih promena u kvalitetu života. Cilj ove studije je da istraži faktore od značaja za kvalitet života laringektomisanih bolesnika i da proceni karakteristike ezofagusnog glasa i govora. Metode Istraživanje je sprovedeno u Klinici za otorinolaringologiju i maksilofacijalnu hirurgiju Kliničkog centra Srbije u Beogradu, u periodu od marta 2012. do marta 2015. godine. Ispitivanjem je bilo obuhvaćeno 223 bolesnika kojima je zbog verifikovanog karcinoma larinksa učinjena totalna laringektomija i sprovedena fonijatrijska rehabilitacija kod 168 laringektomisanih bolesnika. Rezultati Kvalitet života laringektomisanih bolesnika kod kojih je sprovedena fonijatrijska rehabilitacija je značajno bolji od onih koji nisu imali fonijatrijsku rehabilitaciju. Intenzivnom fonijatrijskom rehabilitacijom je uspostavljen ezofagusni glas i govor kod 86,3% laringektomisanih bolesnika, koji je registrovan objektivnom akustičkom analizom. Rehabilitovani laringektomisani bolesnici imaju značajno niže prisustvo hendikepa zbog glasa (VHI: 19,57 ± 7,35) i značajno niže izražene simptome depresije i anksioznosti (PHQ-9: 3,8 ± 4,2; GAD-7: 3,4 ± 4,2). Kronbahov α koeficijent je bio iznad 0,7 na tri skale upitnika EORTC QLQ-C30: fizičko funkcionisanje, emocionalno funkcionisanje i umor, kao i kod pet skala QLQ-H&N43 upitnika: bol u glavi/vratu, problemi sa gutanjem, problemi sa govorom, problemi pri jelu i slika o sebi. Zaključak Značajno poboljšanje kvaliteta života laringektomisanih bolesnika postiže se multidisciplinarnom rehabilitacijom. Fonijatrijska rehabilitacija, koja se sprovodi planski i sistematično, predstavlja najekonomičniji način rehabilitacije laringektomisanih bolesnika

Small Cell Neuroendocrine Tumor of the Larynx – A Small Case Series

Neuroendocrine tumors are the most common nonsquamous types of laryngeal neoplasms. They are classified as typical carcinoids, atypical carcinoids, small-cell neuroendocrine carcinomas, and paragangliomas. The aim of the paper is to present four patients with small-cell neuroendocrine tumor arising in larynx. There were one woman and three men whose ages were 47–77 years; all of them had metastases when first seen. The clinical presentation and management of such type of tumor are discussed. Small-cell neuroendocrine carcinomas are very aggressive neoplasms. Patients could benefit from surgery, but radiotherapy and chemotherapy remain the treatment of choice. Examination of a large series is required to define the most useful diagnostic methods and the most successful treatment modalities

Chemistry knowledge structure - views of chemistry teachers

Modern society is characterized by rapid development in all spheres of human life. The development of education system should contribute to the development of societies and respond to all innovations placed by the industry. School has to adapt to the changeable demands of society and work on the development of positive students' attitudes towards science. In addition, schools should help students to develop effective strategies for science and chemistry learning. The chemistry teachers are expected to find the easiest and the most effective way in which students could acquire new knowledge and skills. It is important that students have an opportunity to develop understanding of chemistry instead of using the rote learning. In addition, it is necessary that students understand the practical application of the studied content and in this way functional knowledge can be acquired. Thinking about connections between concepts in chemistry and other disciplines could improve students' knowledge and lead to increasing their motivation and finally to the formation of the functional knowledge. The aim of this presentation is to show the structure of knowledge that chemistry teachers in Serbia expect their students to have when they finish primary or secondary school. In the questionnaire, a total of 120 teachers from primary and secondary schools in Serbia were asked to: 1) display the conceptual maps; 2) identify the most important chemical concepts; 3) point to the links between chemical concepts which they expect their students to learn. The results showed that teachers in primary and secondary schools use a very similar combination of concepts and identify them as key concepts for students' education in chemistry

Management of orbital complications of acute rhinosinusitis in pediatric patients : a 15-Year single-center experience

BACKGROUND: The major clinical dilemma managing acute rhinosinusitis (ARS) in pediatric population is distinguishing uncomplicated rhinosinusitis from a complicated bacterial ARS and orbital complications, the latter requiring antimicrobials and surgical intervention. However, factors associated with severe orbital complications and the optimum management strategy remains controversial. The objectives of this study were to characterize the clinical outcomes of children with orbital complications of ARS and to identify risk factors associated with disease severity. METHODS: This retrospective cohort analysis evaluated the clinical outcomes of 61 children admitted for orbital complications between January 1, 2002 and December 31, 2017. Descriptive statistics were performed to examine the demographics and clinical findings. We compared groups using Mann-Whitney U test for continuous variables and χ for categorical variables. RESULTS: Although two-thirds of children had received prehospital antibiotics, half of the cohort presented with post-septal orbital complications. While 83% of isolates obtained from the same patients were susceptible to the prehospital antibiotics given, the majority of those who received prehospital antibiotics nevertheless required surgical intervention. We observed significant association between the age of presentation and disease severity. Children >5 years of age presented with more severe orbital complications despite prehospital antibiotics and were more likely to require surgical intervention (P 5 years with ARS due to worse orbital complications despite prehospital antibiotics.PostprintPeer reviewe

Vaspitni deo nastave hemije

Različiti obrazovni sistemi kroz ciljeve ističu razvoj odgovornih, moralnih i obrazovanih ličnosti, spremnih da aktivno deluju u svim oblastima značajnim za ljudski razvoj. Strateški dokumenti usvojeni u Srbiji definisali su različite uloge nastavnika među kojima je i vaspitna uloga. Od nastavnika se očekuje briga o fizičkom, kognitivnom i socio-emocionalnom razvoju učenika. Postavlja se pitanje u kojoj meri nastava hemije ima vaspitne efekte kao što su: formiranje prirodnonaučnog pogleda na svet, razmišljanje o socijalnoj relevantnosti znanja iz hemije i doprinosu tih znanja opštoj pismenosti mladih, briga o ličnom i društvenom zdravlju i bezbednosti, briga o kvalitetu životne sredine, razumevanje etičkih normi u nauci, razvoj moralnih vrednosti. U okviru istraživanja ispitani su stavovi 237 nastavnika hemije o njihovim vaspitnim ulogama u nastavnom procesu. Rezultati pokazuju da vaspitni segment nastave hemije može doprineti: uspešnosti učenika u učenju, izgrađivanju odgovornog odnosa prema životnoj sredini, podizanju brige o telesnom zdravlju i razvoju moralnih vrednosti.Book of Abstract

The estimation of value of selective neck dissection in the treatment of patients with carcinomas pharyngeal and oral localisation

Skoro se navršilo sto godina od kada je zaslugom George Crile-a opisana sistematska ekscizija cervikalnih limfonodusa u cilju hirurškog lečenja bolesnika sa karcinomima glave i vrata. George Crile je 1906. godine opisao operaciju koju je nazvao "radikalna disekcija vrata", zasnovanu na sopstvenom iskustvu i studiji impozantne serije 4500 bolesnika s karcinomima glave i vrata koji su umrli zbog primarnog tumora ili regionalnih metastaza u vratu i samo 1% zbog udaljenih metastaza. Radikalna disekcija vrata vremenom postaje gotovo standardna procedura za bolesnike kojima je bio potreban hirurški tretman metastatskih depozita u kombinaciji sa uklanjanjem primarnog tumora. U međuvremenu, svima koji su bili angažovani u lečenju bolesnika s karcinomom glave i vrata postalo je jasno da je radikalna disekcija vrata adekvatna u tretiranju velikih palpabilnih limfonodusa, ali i preterano agresivna kako na pacijentima s malim palpabilnim limfonodusima, i naročito na onima bez palpabilnih limfonodusa ili sa visokim rizikom metastaziranja. Modifikovana radikalna disekcija (MRDV) uklanja "en bloc" iste limfonoduse i limfatike kao i radikalna disekcija, ali očuvanjem jedne ili više nelimfatičkih struktura koje se rutinski uklanjaju radikalnom disekcijom, smanjuje postoperativni morbiditet. Još dalje se otišlo selektivnim disekcijama (SDV) koje preferiraju američki hirurzi glave i vrata. Operacije uključuju selektivno uklanjanje pojedinih grupa limfonodusa sa rizikom metastaze i očuvanje svih nelimfatičkih struktura i preostalih grupa nodusa u slučajevima nodus negativnog vrata. Zagovara se njena primena i u slučajevima nodus pozitivnog vrata. Ovde vladaju velike kontroverze posebno kada je u pitanju grupa bolesnika sa evidentnim metastatskim depozitima u vratu...There has recently been one hundred years since George Crile demonstrated systematic cervical lymph nodes excision for treatment of patients with head and neck carcinoma. In 1906, George Crile has described surgical operation he called “radical neck dissection”, based on his previous experience and a study of impressive group of 4.500 patients with head and neck carcinoma. Over time, radical neck dissection has became almost standard procedure for patients who required surgical treatment of metastatic deposits combined with primary tumor removal. In the meantime, everyone involved in treatment of patients with head and neck carcinoma began to understand that the radical neck dissection was adequate for treating large palpable lymph nodes, but that it was excessively aggressive in both patients with small palpable lymph nodes, and especially those without palpable lymph nodes or with high risk of metastases. Modified radical neck dissection (MRND) removes “en block” the same lymph nodes and vessels as radical dissection, but by preserving one or more non-lymphatic structures that are being radically removed by radical dissection it decreases postoperative morbidity. Selective neck dissections, which are being preferred by American head and neck surgeons, went even further. Operations include selective removal of individual groups of lymph nodes with risk of metastases and preservation of all non-lymphatic structures and remaining groups of lymph nodes in cases of node-negative neck. It use in cases of node-positive neck is being advocated as well. There are large controversies in this area, especially in patients with evident metastatic neck deposits. The research was performed at Clinic for Otolaryngology and Maxillofacial Surgery of Clinical Center of Serbia in Belgrade. The study included 608 patients treated over a ten year period, from January 1, 1992 to December 31, 2001, who have been followed up for at least 5 years after administered treatment..

Quality of life of laryngectomized patients in Serbia

Introduction/Objective. Total laryngectomy is a very mutilating operation and it leads to drastic changes in life quality. The purpose of this study was to examine factors of importance to the laryngectomized patients’ quality of life and to evaluate characteristics of esophageal voice and speech. Methods. The study was conducted at the Clinic of Otorhinolaryngology and Maxillofacial Surgery, at the Clinical Center of Serbia (Belgrade, Serbia), during the period between March 2012–2015. The study included 223 patients diagnosed with laryngeal cancer, who underwent total laryngectomy. The total of 168 laryngectomized patients were provided with phoniatric rehabilitation. Results. The quality of life was significantly better for those laryngectomized patients who did undergo phoniatric rehabilitation. By means of intensive phoniatric rehabilitation the esophageal voice and speech was established in 86.3% of laryngectomized patients registered by objective acoustic analysis. Rehabilitated laryngectomy patients had a significantly lower presence of voice handicap sense (VHI: 19.57 Ѓ} 7.35) and expressed significantly lower symptoms of depression and anxiety (PHQ-9: 3.8 Ѓ} 4.2; GAD-7: 3.4 Ѓ} 4.2). Cronbach’s alpha coefficient was above 0.7 EORTC QLQ-C30 on three levels of Likert scales: the scale of physical and emotional functioning and fatigue; as well as EORTC QLQ-H&N43 questionnaire: the symptoms of head and neck pain, speech, swallowing and eating problems and body image. Conclusion. Significantly improving the quality of life of laryngectomized patients was achieved by a multidisciplinary rehabilitation. Phoniatric rehabilitation carried out in a planned and systematic way is the most efficient rehabilitation of laryngectomized patients