The Lymph Node Roundness Index in the Evaluation of Lymph Nodes of the Neck

The study assessed the validity of the lymph node »roundness index« (RI) in the evaluation of enlarged lymph nodes of the neck. A total of 107 subjects were included in the prospective study, and 135 enlarged lymph nodes were examined. All the subjects were examined clinically and sonographically, the lymph node roundness index was determined, and soon after the nodes was surgically removed and pathohistologically diagnosed. On the basis of pathohistological diagnosis the study subjects were divided into two groups. The fi rst group consisted of patients with benign lymph nodes, and the second one comprised patients with malignant nodes. The second group was further divided into two sub-groups: those with primary malignant nodes and those with secondary lymph nodes (metastases). The study showed that the lymph node RI statistically differs between the groups. In benign lymphadenopathy the RI was 1.66±0.26, in primary malignant lymphadenopathy it was 1.31±0.25 and in secondary malignant lymphadenopathy 1.13±0.11. The analysis demonstrated that 82.9% of subjects randomly chosen from the group with primary malignant lymphadenopathy and 94.6% from the group with the secondary malignant lymphadenopathy have a smaller RI compared to randomly chosen subjects from the group with benign lymphadenopathy. Sensitivity of the method for primary malignant lymphadenopathy was 66.7% and specifi city was 92.9%. For secondary malignant lymphadenopathy the sensitivity was 95.5% and specifi city 92.9%. Based on this result we can conclude that the lymph node RI is a valid, simple, cost-effective and non-aggressive method which may »increase the suspicion« for a benign or malignant lymphadenopathy. RI≤1.5 is indicative of malignant lymphadenopathy and RI≥1.5 of benign lymphadenopathy

Ultrasound-guided fine needle aspiration cytology of neck nodes

Uvod: Ultrazvučno vođena citopunkcija u dijagnostici čvora na vratu je studija dijagnostičke točnosti u koju su uključeni pacijenti koji su se klinički prezentirali sa čvorom na vratu. Studija je provedena kako bi se stekla objektivna procjena vlastitih iskustava u primjeni ove metode. Ispitanici i postupci: Istraživanjem je obuhvaćeno ukupno 180 pacijenata, starosti 6-89 godina, podjednako muškog (96) i ženskog spola (84). U svih je bolesnika učinjen ultrazvuk vrata, a potom ultrazvukom vođena citopunkcija. Rezultati citološke analize uspoređeni su s referentnim („zlatnim“) standardom, patohistološkim nalazom. Ovisno o citološkoj dijagnozi, bolesnici su retrogradno podijeljeni u dvije velike skupine: prvu skupinu činilo je 98 bolesnika kod kojih je citološki dijagnosticirana dobroćudna tvorba; drugu skupinu činili su bolesnici sa zloćudnom izraslinom na vratu, a podijeljena je u dvije podskupine: bolesnici s primarnim zloćudnim promjenama, koju je činilo 25 bolesnika i bolesnici sa sekundarnim (metastatskim) zloćudnim promjenama vrata koju je činilo 57 bolesnika. Rezultati: Epidemiološkom analizom ustvrdili smo značajno stariju životnu dob za skupine bolesnika s primarnim i sekundarnim zloćudnim promjenama u odnosu na bolesnike s dobroćudnim promjenama. U skupinama sa zloćudnim promjenama, primarnim i sekundarnim, muškarci su bili češće zastupljeni (1,5:1 u korist muškaraca), dok je zastupljenost u skupini s dobroćudnim promjenama bila podjednaka. U skupinama bolesnika sa zloćudnim promjenama, primarnim i sekundarnim, sve dijagnoze postavljene citopunkcijom potvrđene su patohistološkom obradom. U skupini bolesnika kojima je citopunkcijom utvrđena dobroćudna promjena u 14 (14,2%) slučajeva je dijagnoza, nakon patohistološke obrade, promijenjena u zloćudnu, dok je značajno više bolesnika ostalo s istom dijagnozom (84 ili 85,8%). Limfocitna hiperplazija je najučestalija dijagnoza utvrđena citopunkcijom, kod koje je, po učinjenom patohistološkom nalazu, dijagnoza promijenjena u zloćudnu. Analizirajući valjanost citopunkcije vođene UZV, ukupno gledano, utvrđena je osjetljivost od 92%, specifičnost 85,7% i točnost od 83,9%, dok je za skupinu bolesnika sa sekundarnim zloćudnim promjenama (metastazama) utvrđena osjetljivost od 90%, specifičnost 73,8% i točnost od 85,5%. Rezultati su usporedivi, približno slični onima iz većih kliničkih ispitivanja. Zaključak: Naši rezultati ukazuju kako je UZV vođena citopunkcija, uz sva svoja ograničenja, korisna metoda u dijagnostici čvora na vratu, te može u velikom broju slučajeva isključiti potrebu za ekscizionom biopsijom i patohistološkom obradom, a u slučajevima kada ne isključuje potrebu za drugim dijagnostičkim postupcima svakako usmjeruje daljnju medicinsku obradu. Navedeni rezultati daju nam za pravo potvrditi ispravnost algoritma u kojem se, nakon klinički ustvrđenog čvora na vratu, obavlja citološka punkcija pod kontrolom UZV, a citološka dijagnoza će usmjeriti daljnji dijagnostičko-terapijski postupak.Introduction: Ultrasound-guided fine needle aspiration cytology in the diagnosis of neck nodes is a study of diagnostic accuracy which includes patients who have clinically presented themselves having neck nodes. The study has been conducted in order to gain on objective evaluation of personal experiences in using this form of procedure. Patients and methods: This research was done on a total of 180 patients, aged 6-89, about equally male and female (respectively 98 and 84). Neck ultrasonography was done on all patients and, after that, ultrasound-guided fine needle aspiration cytology. The results of fine needle aspiration cytology were compared with the referential („golden“) standard, histopathological report. Dependent of fine needle aspiration cytology diagnosis, the patients were retrospectively divided into two large groups. The first group consisted of 98 patients whose cytologic diagnosis showed benign nodes; the second group was made up of patients with malignant nodes and they were further separated into two subgroups: patients with primary malignant nodes, made up a group of 25 patients, and those with secondary malignant nodes (metastasis) on the neck, made up a group of 57 patients. Results: Epidemiological analysis determined a much older age in patient groups of primary and secondary malignant nodes in relation to those patients having benign nodes. In the group of patients having malignant nodes, both primary and secondary, men were more frequently present, (1.5:1 in favour of men), while their presence in the group with benign nodes was equal to that of women. In groups of patients with malignant nodes, both primary and secondary, all diagnoses made by fine needle aspiration were confirmed by histopathologic diagnosis. In other groups suffering benign nodes determined by a fine needle aspiration, in 14 (14.2%) cases diagnosis was changed into malignant after histopathologic reports, but for the majority of patients the diagnosis remained unchanged. Reactive lymph node hyperplasia is the most frequent diagnosis determined by fine needle aspiration cytology, after which, having done the histopathologic diagnosis, it was changed into malignant. While analysing ultrasound-guided fine needle aspiration cytology on the whole, sensitivity of 92%, specificity 85.7% and accuracy 83.9% were determined with the group of patients with secondary malignant nodes (metastasis) 90% sensivity, 73.8% specificity and 85.5% accuracy were determined. Conclusion: Our results show that ultrasound-guided fine needle aspiration cytology is, with all its restrictions, a useful method in neck node diagnosis, and in many cases it can eliminate the need for excision biopsy and histopathological diagnosis. In cases when the need for other diagnostic proceedings is not excluded, it certainly sets the guidelines for further proceedings. The above mentioned results give us the right to confirm the exactness of the algorithm in which ultrasound-guided fine needle aspiration cytology is done after clinically affirmed neck nodes under ultrasound control, and the cytology is supposed to direct further diagnostic-therapeutical procedure

NON-MELANOMA SKIN CARCINOMAS OF THE HEAD AND NECK

Background: The aim of this study was to evaluate the incidence and clinical features of non-melanoma tumors of the head and neck, as well as the validity of surgical therapy in their treatment. Subjects and methods: The study included 530 patients who were operated in the Otorhinolaryngology department of the Livno County Hospital. Results: In 295 cases (65.1%), it was basal cell carcinoma of the skin and was followed by squamous cell carcinoma of the skin, in 119 cases (29.9%) while the remaining 5% of cases referred to other non-melanoma skin carcinomas. Statistically significant, the most common non-melanoma skin carcinoma was basal cell carcinoma (hi-kvadrat =625,67; df=4; p<0,01). The most co mmon localization was the skin of the nose (24,2%), which proved to be statistically significant (hi-kvadrat =290,824; df=5; p=0,00). All patient underwent classic surgery, and in 358 cases (89.5%) the tumor was completely removed, while in 40 cases (10.5%) the tumor was partially removed which proved to be statisticaly significant (hi-kvadrat =254,08; df=1; p=0,00). Conclusions: The results of the study fully confirm the assertion that classical surgery is the method of choice in the treatment of non-melanoma skin cancers and in the vast majority it is proven to be sufficient

NON-MELANOMA SKIN CARCINOMAS OF THE HEAD AND NECK

Background: The aim of this study was to evaluate the incidence and clinical features of non-melanoma tumors of the head and neck, as well as the validity of surgical therapy in their treatment. Subjects and methods: The study included 530 patients who were operated in the Otorhinolaryngology department of the Livno County Hospital. Results: In 295 cases (65.1%), it was basal cell carcinoma of the skin and was followed by squamous cell carcinoma of the skin, in 119 cases (29.9%) while the remaining 5% of cases referred to other non-melanoma skin carcinomas. Statistically significant, the most common non-melanoma skin carcinoma was basal cell carcinoma (hi-kvadrat =625,67; df=4; p<0,01). The most co mmon localization was the skin of the nose (24,2%), which proved to be statistically significant (hi-kvadrat =290,824; df=5; p=0,00). All patient underwent classic surgery, and in 358 cases (89.5%) the tumor was completely removed, while in 40 cases (10.5%) the tumor was partially removed which proved to be statisticaly significant (hi-kvadrat =254,08; df=1; p=0,00). Conclusions: The results of the study fully confirm the assertion that classical surgery is the method of choice in the treatment of non-melanoma skin cancers and in the vast majority it is proven to be sufficient

THE INFLUENCE OF RELIGIOSITY AND PERSONALITY DIMENSIONS ON THE ATTITUDES ABOUT ABORTION

Background: A major public health problem is illegal abortion and its consequences and reliable data on abortions is globally unavailable. The Catholic Church advocates the protection of the human right for life that begins with conception. Religion was proven as an important predictor in forming abortion attitudes. Low points on openness and experience scales correlate with soc ial prejudices and conservative orientation. The Aim: To determine the impact of religiosity and personality dimension on abortion attitudes using Questionnaire of Religion, Abortion Attitudes Questionnaire and Big Five Questionnaire. Subjects and Methods: An in - depth study was conducted on a sample of 310 citizens of Herzeg - Bosnian County in Bosnia and Herzegovina. The instruments used in the research were: a short questionnaire with socio - demographic features, a questionnair e of religiosity, an abortion questionnaire and a Big Five questionnaire. Results: Citizens of Herzeg - Bosnian County, 89.1% of them, believe that abortion terminates life. For legal prohibition of abor- tion 73.1% of the respondents’ advocate, and Catholics are the most rigorous. Catholics mostly do not agree with the attitude t hat only a pregnant woman can decide on abortion in comparison to Islamic religion ( Ȥ2(4)=16.36; p<0.01). Only 13% of citizens are against the interference of the Church in the matter of abortion. The most insecurity can be seen in the attitude about the fat her\u27s participation in the abortion decision. Almost half of citizens who oppose abortion would still leave it as an option for women. Conclusion: Citizens of Herzeg - Bosnian County support the legal prohibition of abortion and see it as a termination of life. Orthodox respondents are the least opposed to abortion and they also see themselves the least as believers. In Catholic and Isl amic religions, religious identity and condemnation of abortion are expressed. Younger and mature people and male gender are importa nt predictors of abortion condemnation. The influence of personality dimension on abortion attitudes was also not found in this research

THE LENGTH OF BREASTFEEDING: THE ROLE OF PRENATAL EDUCATION AND LISTENING TO CLASSICAL MUSIC

Introduction: The use of music in midwifery is a new research field and further studies and clear evidence are needed to make it a valuable element of midwifery care. The aim of the study was to prove the influence of education of pregnant women and listening to classical music on the frequency and length of breastfeeding at discharge from the maternity hospital and 6 weeks after delivery. ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ Subjects and methods: A prospective randomized controlled study was conducted in 2019. The sample consisted of pregnant women from the area of Hercegbosna County, 198 of them (N=198). Results: No significant difference was found in the frequency of exclusive breastfeeding and feeding with supplementation between the experimental and control groups at discharge (88.9% vs 92.2%). A significantly larger number of subjects in the experimental group were exclusively breastfed compared to the control group after 6 weeks (χ²=4.541; df=1; p-0.033). Conclusion: The results indicate that investments in the development of the competencies of pregnant women and the creation of conditions in maternity hospitals can significantly affect the duration of exclusive breastfeeding

ANAPHYLAXIS DURING PREGNANCY

Anaphylaxis occuring during pregnancy has a potential to cause devastating damage to the unborn baby and the mother. However, majority of adverse outcomes of anaphylaxis during pregnancy frequently affect the neonates rather than the mothers. The negative neurologic outcomes of the fetus are mostly due to delayed caesarean delivery or inadequate doses of adrenaline during anaphylaxis. Most of the current knowledge on this clinical scenario is based on case reports and very few review articles. This is a mini review of the causes, diagnosis and management of anaphylaxis occuring during pregnancy

ANAPHYLAXIS DURING PREGNANCY

Anaphylaxis occuring during pregnancy has a potential to cause devastating damage to the unborn baby and the mother. However, majority of adverse outcomes of anaphylaxis during pregnancy frequently affect the neonates rather than the mothers. The negative neurologic outcomes of the fetus are mostly due to delayed caesarean delivery or inadequate doses of adrenaline during anaphylaxis. Most of the current knowledge on this clinical scenario is based on case reports and very few review articles. This is a mini review of the causes, diagnosis and management of anaphylaxis occuring during pregnancy

THE LENGTH OF BREASTFEEDING: THE ROLE OF PRENATAL EDUCATION AND LISTENING TO CLASSICAL MUSIC

Introduction: The use of music in midwifery is a new research field and further studies and clear evidence are needed to make it a valuable element of midwifery care. The aim of the study was to prove the influence of education of pregnant women and listening to classical music on the frequency and length of breastfeeding at discharge from the maternity hospital and 6 weeks after delivery. ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ Subjects and methods: A prospective randomized controlled study was conducted in 2019. The sample consisted of pregnant women from the area of Hercegbosna County, 198 of them (N=198). Results: No significant difference was found in the frequency of exclusive breastfeeding and feeding with supplementation between the experimental and control groups at discharge (88.9% vs 92.2%). A significantly larger number of subjects in the experimental group were exclusively breastfed compared to the control group after 6 weeks (χ²=4.541; df=1; p-0.033). Conclusion: The results indicate that investments in the development of the competencies of pregnant women and the creation of conditions in maternity hospitals can significantly affect the duration of exclusive breastfeeding

War Surgical Care – Experience from Franciscan Hospital »dr. fra Mato Nikoli}« in Nova Bila during Conflict in Central Bosnia (1993–1994)

This report presents experience in treatment of war injuries in Franciscan hospital »dr. fra Mato Nikoli}« in Nova Bila, during the war in Central Bosnia from 1993 to 1994, in conditions of encirclement and typhoid fever outbreak. Descriptive- retrospective analysis of organization, implementation and outcomes of surgical care for patients treated from January 1, 1993 till August 20, 1994. In this period, the hospital took care of 2500 wounded persons, 2286 (91.4%) of them male and 214 (8.6%) female, their the average age being 31.5 ± 12.8. There were 1412 gunshot injuries (56.5%), 1022 explosive injuries (40.9%), and 66 blunt injuries (2.6%). There were 1250 injuries to extremities (50.0%), 349 injuries to head and neck (14%), 233 chest injuries (9.3%) and 193 injuries to abdomen (7.7%). There were also 475 multiple injuries (19%). Surgical operations were performed in 1498 patients (60%), with surgical mortality rate of 4.5%. Total hospital mortality rate was 11.4 percent (n=286). Despite extremely difficult conditions of work and lack of doctors, we achieved a low hospital mortality rate. The hospital continued to work after the war. Today, it is a modern health institution in La{va Valley, Central Bosnia