The role of a family doctor concerning laryngeal cancer

Obiteljski liječnik, kao osoba prvog kontakta na relaciji liječnik bolesnik, ima izuzetnu ulogu ne samo u prevenciji raka grla, već i u njegovom ranom otkrivanju blago vremenim opažanjem onih simptoma koji će bolesnika na vrijeme dovesti do postavljanja prave dijagnoze i pravovremene terapije. Bolesnik sa rakom grla je specifičan ne samo zbog toga što ima malignu bolest, već i zbog toga što rak grla dovodi do gubitka, ili bar smanjenja, funkcija organa tako važnog u svakodnevnom životu čovjeka, a to je glas i govor. Bolesnik sa karcinomom grla postaje problem i sam sebi zbog teškoća u komunikaciji sa okolinom, ali i problem svojoj radnoj i obiteljskoj sredini koja ga takvog teže prihvaća. Gdje je tu mjesto obiteljskom liječniku?Family doctor as a person of the first contact between doctor and patient has an exceptional task not only in prevention but also in the early discovery of laryngeal cancer. Observation of symptoms will help make the right diagnosis timely and prescribe medical treatment for the patient. Such a patient is specific not only because of his malignant disease, but because laryngeal cancer affects the function of the speech organs, causing partial or complete loss of voice and speech. In everyday live a patient with laringeal cancer has difficulties in communication with other people. He becomes a burden to himself and to his family and working environment that accept him with difficulty. Where is there the place of the family doctor

Develpment of endoscopy at the ward for ear, nose and throat disease of the Bjelovar general hospital

U radu je dan pregled razvoja endoskopije u djelatnosti za bolesti uha, nosa i grla Opće bolnice Bjelovar, od osnutka do današnjih dana. Prikazan je slijed nabavke endoskopskih instrumentarija, te mogućnosti endoskopskih pretraga koje se na odjelu rade. Zatim se govori o broju i vrsti endoskopskih zahvata koji su obavljeni u posljednjih šest godina. ORL odjel u Bjelovaru raspolaže suvremenim instrumentarijem za ezofagoskopiju, traheobronhoskopiju, s krutim i fleksibilnim instrumentima, a u posljednje dvije godine i instrumentarijem za funkcionalnu endoskopsku sinusnu kirurgiju. Godišnje se napravi u prosjeku 33 ezofagoskopije, 7 traheobronhoskopija s rigidnim traheobronhoskopom, a zadnje dvije godine 85 bolesnika operirano je prema načelima funkcionalne endoskopske sinusne kirurgije.The development of endoscopy at the Ward for ear, nose and throat diseases of the General Hospital in Bjelovar was reviewed from its foundation to these days. The sequence of endoscopic instruments\u27 acquisitions and possibilities of endoscopic examinations preformed at the wadr are presented. The Otolaryngological ward in Bjelovar has at its disposal modern instruments for oesophagoscopy, tracheobronchoscopy, solid and flexibile instruments and since two years ago, the instruments for functional endoscopic sinus surgery. Annually an average of 33 oesophagoscopies and 7 tracheobronchoscopies with rigid tracheobronchoscope are done and up to now 85 patients have been operated on according to the principles of functional endoscopic sinus surgery

Reconstruction of ala nasi defect in patients with facial and trigeminal nerve paralysis caused by trigeminal trophic syndrome

Nosno krilo predstavlja važan izražajni detalj ljudskog lica čija rekonstrukcija predstavlja pravi izazov za kirurga. U radu se željelo prikazati mogućnosti rekonstrukcije potpunog defekta nosnog krila kod bolesnika s paralizom ličnog i trigeminalnog živca u sastavu trigeminalnog trofičkog sindroma. Pri rekonstrukciji se koristio otočasti transpozicijski režanj kože zdrave strane čela na subkutanoj peteljci koji posjeduje vlastitu vaskularizaciju i inervaciju, čije preživljenje ne ovisi o primajućoj regiji. Ovaj režanj pokazao se izuzetno pogodnim prilikom rekonstrukcije defekata nosnog krila u bolesnika s paralizom ličnog i trigeminalnog živca, jer donosi zdravo tkivo u neurološki mrtvu regiju.Ala nasi represents a significant expressive detail of human face, whose reconstruction represents a real challenge for a surgeon. The intention of the paper was to present the options for reconstruction of total ala nasi defect in patients with facial and trigeminal nerve paralysis in the pattern of the trigeminal trophic syndrome. During the reconstruction, the insular transposition flap was used from the healthy side of the forehead on the subcutaneous stalk, which possesses its own vascularization and innervation, and whose survival does not depend on the recipient area. This flap proved itself extremely suitable during the reconstruction of the ala nasi defects in patients with facial and trigeminal nerve paralysis, because it brings healthy tissue in the neurologically dead area

Current state of benign goitre surgery in the regions of Bilogora and Podravina and Slavonia and Baranja

Endemska gušavost podravskog područja, koju su ovjekovječili naivni slikari Hlebinske škole, predstavljala je do pred 20 godina veliki socijalno-medicinski problem. Sada, zahvaljujući uvođenju jodirane soli u ljudsku ishranu, endemska gušavost, a s tim u vezi i kretenizam, gotovo potpuno nestaju. Ipak, još uvijek ima sporadičnih pojava jednostavnih parenhimatoznih struma (Struma thyroidea simplex), ali glavnu masu čine nodozne strume. Anketa provedena na 11 kirurških odjela bilogorsko-podravske i slavonsko-baranjske regije pokazala je da samo 5 od njih liječe strume. U 3 medicinska centra (MC) one se liječe na odjelima za uho, nos i grlo (ORL), a u 4 MC strume se liječe i na kirurgiji i na ORL. Iz 1 MC upućuju se sve strume na liječenje u Zagreb, a iz 2 MC se šalju u Osijek. U jednom od njih dio struma ostaje na liječenju u ORL. U zadnjih 5 godina u kirurškim odjelima ovih regija liječeno je 457 benignih struma, od čega samo u Osijeku 385, a ostale 72 strume u druga 4 MC. Prema patohistološkom nalazu bilo je: Struma nodosa nontoxica 262, Struma nodosa toxica 14, Struma cystica 37, Struma parenchimatosa hyperthyreotica 59, adenoma toxicum 57, adenoma nontoxicum 7, thyreoditis ac. 2, thyreoiditis subac. 9, thyreoiditis ehr. 3, Struma parenchimatosa simplex 9. Operirano je 428 bolesnika, i to: suptotalne resekcije 134, klinaste resekcije 69, enukleacije 50, lobektomije 154, tiroidektomije 21. Medikalno je liječeno 29 bolesnika. Komplikacije su bile slijedeće: pareze n. rekurensa 4, hematoma 4, seroma 1, naknadni nalaz karcinoma 1, reoperacije 2. U svih bolesnika rana je drenirana na 24 — 48 sati, bilo gumenom laticom, bilo Redon-vakuum drenažom. Za vrijeme operacije rutinski se nisu prikazivali rekurentni živci. Starenjem stanovništva dolazi do porasta broja nodoznih struma, dok se broj parenhimatoznih struma stalno smanjuje. Zapaža se smanjenje broja struma liječnih u kirurškim odjelima, pa otuda mladi kirurzi nemaju mogućnosti da nauče operirati strume. U budućnosti bi trebalo formirati multidisciplinarne centre za bolesti štitnjače ili, još bolje, odjel za endokrinu kirurgiju. Na taj način bi se opet štitnjača našla u domeni kirurgije ne isključujući suradnju specijaliste za ORL.Endemic goitre in the region of Podravina, depicted by naive painters of Hlebine school, was a considerable social and medical problem twenty years ago. Today, thanks to iodinated salt, endemic goitre and cretenism have almost completely disappeared. There are still some sporadic cases of simple goitre, but toxic nodular goitre has the highest incidence. Goitre is treated at only five out of eleven hospitals in these regions. In three hospitals it is treated at the Ear, Nose and Throat Department (ENT) and in four hospitals both at the ENT Department and at the Department of Surgery. One hospital refers all its patients to Zagreb, while two of them refer patients to Osijek. During past five years 457 patients with goitre were treated at those five hospitals: 385 in Osijek and the remaining 72 in other four hospitals. According to pathohistological findings there were 262 non toxic nodular goitres, 14 toxic nodular goitres, 37 cystic goitres, 59 diffuse toxic goitres, 57 toxic adenomas, 7 non-toxic adenomas, 2 acute thyroiditides, 9 subacute thyrioditides, 3 chronic thyroiditides and 9 diffuse hyperplastic goitres. In 428 patients the following operations were performed: 134 subtotal resections, 69 wedge resections, 50 enucleations, 154 lobectomies and 21 thyroidectomies. Only 29 patients were treated conservatively. We had the following complications: 4 recurrent laryngeal nerve paralyses, 4 haematomas, 2 reoperations and one carcinoma of the thyroid. In all patients the wound has been drained for 24 — 48 hours. Recurrent laryngeal nerves were not identified during operation. With population growing older, there is an increased incidence of nodular goitres and a decreased incidence of diffuse goitres. The number of patients treated at surgical departments is also decreasing; hence, younger surgeons have less opportunity to learn proper techniques for goitre operations. In future, multidisciplinary centres for treating thyroid diseases or departments for endocrine surgery should be formed. In that way, thyroid diseases could be properly treated at surgical departments, with the help of the ENT specialists