Prisutnost bakterije helicobacter pylori u želucu i sluznici grkljana kod bolesnika s karcinomom grkljana

Helicobacter (H.) pylori is the cause of one of the most common chronic bacterial infections in humans. Risk factors for the development of laryngeal cancer are cigarette smoke, alcohol, and human papillomavirus. Several papers report on H. pylori isolated in tooth plaque, saliva, middle ear and sinuses. Many articles describe the presence of H. pylori in laryngeal cancer cases, however, without noting the possible source of infection, i.e. stomach or oral cavity. The aim of this study was to determine which patients and to what extent simultaneously developed H. pylori colonization in the stomach and the larynx. Prospective examinations were performed in 51 patients with laryngeal squamous cell carcinoma. The study group included patients with laryngeal squamous cell carcinoma histopathologically confirmed by two independent pathologists. The patients underwent fiber esophagogastroduodenoscopy with tumor tissue biopsy. Laryngeal and gastric biopsies were examined by histologic staining technique for histopathologic detection of H. pylori and with DNA analyses using the standardized fluorescent ABI Helicobacter plus-minus PCR assay. Laryngeal carcinoma patients showed positive H. pylori test results simultaneously in the laryngeal and stomach areas, implying H. pylori transmission from the stomach to the laryngeal area. In addition, H. pylori positive test results along with negative H. pylori results in the stomach region were also recorded, suggesting a possible bacteria migration from the oral cavity. In conclusion, H. pylori was found in the area of laryngeal carcinoma, and its migration appeared likely to occur both upwards (from the stomach to the mouth) and downwards (from the oral cavity to the stomach).Helicobacter (H.) pylori uzročnik je jedne od najčešćih kroničnih bakterijskih infekcija u ljudskoj populaciji, prisutne u svim zemljama u svijetu. Incidencija infekcije bakterijom H. pylori teško se može izravno utvrditi, jer akutna infekcija ima vrlo malo karakterističnih simptoma ili ih uopće nema. Planocelularni karcinom je najčešći karcinom grkljana koji čini 95% svih karcinoma grkljana. U čimbenike rizika za razvoj karcinoma grkljana ubrajaju se cigaretni dim i alkohol te infekcija humanim papilomavirusima. H. pylori je dokazan kao jedan od uzročnika karcinoma grkljana, ali nigdje nije jasno opisan rezervoar te bakterije s obzirom na to da je u nekoliko članaka dokazano nepostojanje bakterije H. pylori u zdravoj sluznici grkljana. Svrha našega rada bila je ispitati istodobnu prisutnost bakterije H. pylori u karcinomu grkljana i želucu. Kod 51 bolesnika s karcinomom grkljana učinjena je ezofagogastroskopija s uzimanjem uzoraka sluznice iz antruma i korpusa želuca te iz područja karcinoma grkljana za analizu na H. pylori pomoću lančane reakcije polimeraze i patohistološkom metodom. U tkivu karcinoma grkljana dobiveni su pozitivni rezultati testova na H. pylori istodobno s pozitivnim testom na H. pylori u području želuca, što upućuje na migraciju bakterije iz želuca u područje grkljana. U određenom broju ispitanika dobiveni su pozitivni rezultati testova na H. pylori u području karcinoma grkljana s negativnim testom na H. pylori u sluznici želuca, što upućuje na moguću migraciju bakterije iz usne šupljine. Iz nalaza se može zaključiti da je H. pylori prisutan u području karcinoma grkljana te da je njegov prijenos moguć i uzlaznim i silaznim putem iz usne šupljine i želuca

Kontroverze sindroma vratne vrtoglavice

Otkada su po prvi put spomenute i opisane, pa sve do danas, vratne vrtoglavice imaju svoje zagovornike i oponente, a vjerojatno će i ubuduće ostati polemička tema, sve dok se ne riješi pitanje pouzdanih dijagnostičkih testova i konsenzusom uspostave valjani kliničko-dijagnostički kriteriji. Premda postoje različite teorije o mehanizmu koji povezuje vrtoglavice s vratnim simptomima, još uvijek nemamo jasne i općeprihvaćene patofiziološke potpore ovom fenomenu. Suvremenom vestibularnom dijagnostikom se kod više od 90% ovakvih bolesnika dobije neki drugi uzrok poremećaja ravnoteže. Brojna klinička zapažanja, anatomsko-fiziološke i epidemiološke studije sugeriraju povezanost bola u vratu i općenito vratnih simptoma s vrtoglavicom, pa bi ovu činjenicu trebalo s punim uvažavanjem uzeti u obzir pri diferencijalno-dijagnostičkom razmatranju. Konačnu dijagnozu vratne vrtoglavice trebalo bi postaviti bolesnicima s bolom i otežanom pokretljivošću u vratu, kojima smo isključili sve ostale moguće uzroke vrtoglavice i kojima je usto liječenje dovelo do značajnog poboljšanja, kako vratnih, tako i simptoma poremećaja ravnoteže. Nju potkrjepljuje i kratko vrijeme proteklo od ozljede vrata do pojave simptoma vrtoglavice, pozitivan nalaz testa torzije vratne kralježnice i patološki nalaz MR-a gornjega dijela vratne kralježnice. Liječenje vratne vrtoglavice ne bi smjelo biti uskraćeno niti jednom bolesniku jer rasprava o postojanju ili nepostojanju vratnih vrtoglavica i mehanizmu njihova nastanka ima samo akademski, a gotovo nikakav praktični značaj. Pritom treba istaknuti da se kod većine bolesnika dobri rezultati postižu liječenjem metodama fizikalne terapije, posebice manualne, dok farmakoterapija i vestibularna rehabilitacija ne dovode do značajnijega poboljšanja

Connection between knowledge of oral hygiene and dental status of the elderly in Požeško-slavonska County

Timely visits to the dentist are extremely important for the preservation of dental health. Given the biological predisposition of teeth decay with age, it is important to act preventively in order to minimize the adverse effects of age on dental health. Aim: The aim of this study is to establish the correlation between the various factors related to oral health and dental status in older age and to examine the differences in dental status between retirement home residents and those living at home. Materials and methods: The data were collected through a survey consisting of 39 questions. The sample consisted of 110 participants located in the Požega HPP and the Home for the Elderly and Infirm in Požega, 42.7% of which were men and 57.3% women. The study used the selection criterion of persons over the age of 65. The average age in the sample was 77.35 years (SD = 7.18) ranging from 65 to 97 years of age. The data were collected in the period from January 2018 to July 2018. The participants were divided into two groups, those living in the Požega Nursing Home and those living in their own household but were hospitalized once in the Požega County Hospital. Results: The obtained results showed that participants have different dental problems that were partially related to their knowledge of oral hygiene. This paper emphasizes the importance of additional training and education for the elderly population in order to preserve and improve the quality of their dental health. Conclusion: The results of this study suggest that participants, in average, were less concerned about their dental health, which was confirmed by the small number of healthy teeth. There was a partial correlation between the knowledge about oral hygiene and the dental status of elderly people in Požega-Slavonia County, i.e. their knowledge was related only to some aspects of their dental status. According to the results obtained, it is important to organize training for the elderly about the importance of timely interventions when dental health is in question, as well as to further educate them about the harmful factors when it comes to the preservation of their dental health

Connection between knowledge of oral hygiene and dental status of the elderly in Požeško-slavonska County

Timely visits to the dentist are extremely important for the preservation of dental health. Given the biological predisposition of teeth decay with age, it is important to act preventively in order to minimize the adverse effects of age on dental health. Aim: The aim of this study is to establish the correlation between the various factors related to oral health and dental status in older age and to examine the differences in dental status between retirement home residents and those living at home. Materials and methods: The data were collected through a survey consisting of 39 questions. The sample consisted of 110 participants located in the Požega HPP and the Home for the Elderly and Infirm in Požega, 42.7% of which were men and 57.3% women. The study used the selection criterion of persons over the age of 65. The average age in the sample was 77.35 years (SD = 7.18) ranging from 65 to 97 years of age. The data were collected in the period from January 2018 to July 2018. The participants were divided into two groups, those living in the Požega Nursing Home and those living in their own household but were hospitalized once in the Požega County Hospital. Results: The obtained results showed that participants have different dental problems that were partially related to their knowledge of oral hygiene. This paper emphasizes the importance of additional training and education for the elderly population in order to preserve and improve the quality of their dental health. Conclusion: The results of this study suggest that participants, in average, were less concerned about their dental health, which was confirmed by the small number of healthy teeth. There was a partial correlation between the knowledge about oral hygiene and the dental status of elderly people in Požega-Slavonia County, i.e. their knowledge was related only to some aspects of their dental status. According to the results obtained, it is important to organize training for the elderly about the importance of timely interventions when dental health is in question, as well as to further educate them about the harmful factors when it comes to the preservation of their dental health

Kontroverze sindroma vratne vrtoglavice

Otkada su po prvi put spomenute i opisane, pa sve do danas, vratne vrtoglavice imaju svoje zagovornike i oponente, a vjerojatno će i ubuduće ostati polemička tema, sve dok se ne riješi pitanje pouzdanih dijagnostičkih testova i konsenzusom uspostave valjani kliničko-dijagnostički kriteriji. Premda postoje različite teorije o mehanizmu koji povezuje vrtoglavice s vratnim simptomima, još uvijek nemamo jasne i općeprihvaćene patofiziološke potpore ovom fenomenu. Suvremenom vestibularnom dijagnostikom se kod više od 90% ovakvih bolesnika dobije neki drugi uzrok poremećaja ravnoteže. Brojna klinička zapažanja, anatomsko-fiziološke i epidemiološke studije sugeriraju povezanost bola u vratu i općenito vratnih simptoma s vrtoglavicom, pa bi ovu činjenicu trebalo s punim uvažavanjem uzeti u obzir pri diferencijalno-dijagnostičkom razmatranju. Konačnu dijagnozu vratne vrtoglavice trebalo bi postaviti bolesnicima s bolom i otežanom pokretljivošću u vratu, kojima smo isključili sve ostale moguće uzroke vrtoglavice i kojima je usto liječenje dovelo do značajnog poboljšanja, kako vratnih, tako i simptoma poremećaja ravnoteže. Nju potkrjepljuje i kratko vrijeme proteklo od ozljede vrata do pojave simptoma vrtoglavice, pozitivan nalaz testa torzije vratne kralježnice i patološki nalaz MR-a gornjega dijela vratne kralježnice. Liječenje vratne vrtoglavice ne bi smjelo biti uskraćeno niti jednom bolesniku jer rasprava o postojanju ili nepostojanju vratnih vrtoglavica i mehanizmu njihova nastanka ima samo akademski, a gotovo nikakav praktični značaj. Pritom treba istaknuti da se kod većine bolesnika dobri rezultati postižu liječenjem metodama fizikalne terapije, posebice manualne, dok farmakoterapija i vestibularna rehabilitacija ne dovode do značajnijega poboljšanja

Uloga vestibularnih evociranih miogenih potencijala kao pokazatelja stanja oporavka kod boelsnika s dobroćudnom paroksizmalnom položajnom vrtoglavicom

Ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP) are newer diagnostic methods, which allow an insight into the otolith senses. Our aim was to determine changes in certain parameters of the VEMP wave complex after successfully performed repositioning procedure, as an indicator of the state of recovery in patients with benign paroxysmal positional vertigo (BPPV). This may confirm the theory of otolith returning into the area of otolithic senses. The study included 48 patients with unilateral posterior semicircular canal BPPV. On their first arrival, otoneurological examinations, oVEMP and cVEMP tests were performed. The same were included in follow up check-ups scheduled at seven days and six months after successful implementation of Epley maneuvers. The initial measurement revealed a significantly reduced amplitude of oVEMP on the affected side. On the 7-day measurement, the amplitude increase was observed on the affected side, with significant reduction in the amplitude ratio (p=0.693), which reached statistical significance on the last measurement at 6 months (p=0.006). These findings confirmed the hypothesis of the return of otoconia into the utricular area.Okularni vestibularni evocirani mišićni potencijali (oVEMP) i cervikalni VEMP (cVEMP) su novije dijagnostičke metode koje omogućuju uvid u stanje otolitičkih osjetila. Cilj je bio utvrditi postoje li promjene u određenim parametrima VEMP valnog kompleksa nakon uspješno provedenog Epleyjeva repozicijskog postupka, koje bi bile pokazatelji stanja oporavka bolesnika s dobroćudnom paroksizmalnom položajnom vrtoglavicom (BPPV). To bi potvrdilo teoriju o povratku otolita u područje otolitičkih osjetila. Sekundarni cilj istraživanja bio je utvrditi značenje pojedinih parametara VEMP ­kompleksa kao prediktora mogućih recidiva bolesti. Ispitivanje je uključilo 48 bolesnika s jednostranim BPPV stražnjega polukružnog kanalića. Pri prvom pregledu u sklopu cjelokupne otoneurološke obrade učinjene su im pretrage oVEMP i cVEMP. Ovo je ponovljeno i na pregledima kojima su bolesnici pristupili sedam dana i šest mjeseci nakon uspješno provedenog Epleyjeva postupka. Pri prvom mjerenju uočeno je značajno smanjenje amplitude oVEMP zahvaćene strane, izraženo kroz povećani omjer amplituda. U drugom mjerenju uočen je porast amplitude zahvaćene strane, dok je omjer amplituda posljedično smanjen (p=0,693), a statistički značajno smanjen pri završnom pregledu nakon 6 mjeseci (p=0,006). Značajno povećanje amplitude oVEMP zahvaćene strane nakon uspješnog repozicijskog postupka potvrđuje hipotezu o povratku otolita u području makule utrikulusa

Application of contemporary ARIA guidelines in treating allergic rhinitis in children

Cilj Cilj je ovoga rada prikazati primjenu suvremenih dijagnostičkih i terapijskih postupaka u zbrinjavanju alergijskoga rinitisa (AR), prema smjernicama ARIA, a od strane otorinolaringologa i pedijatra u Općoj bolnici Vukovar. Bolesnici i metode U otorinolaringološku ambulantu bilo je upućeno 92 djece od strane pedijatra, pod sumnjom da je riječ o AR, sa simptomima kao što su ovi: nosna opstrukcija, pojačana sekrecija, kihanje i svrbež nosa. Pacijenti su dalje bili podvrgnuti sljedećim pretragama: SPT, obrisak nosa na eozinofile, ECP, ukupni IgE, specifični IgE, objektivni ORL pregled, uključujući i endoskopiju nosa. Ove su pretrage učinjene prije, i nakon liječenja u trajanju od mjesec dana. Analizirali smo uspjeh liječenja u odnosu na izgled sluznice i stupanj nazočnosti simptoma bolesti. Rezultati Na samom početku liječenja prosječna vrijednost ukupnih IgE bila je 58,59 KIU/1, ECP 12,6 KIU/1, što je ukazivalo na visoki stupanj prosječne senzibiliziranosti, kao i visok stupanj opće alergijske reakcije organizma. Veliki je broj djece bio senzibiliziran na grinje (N=74, 80,34%), slično kao i na ambroziju (N=32, 34,78%) i pelud trava (N=42, 45,67%). Rezultati liječenja pokazali su značajno poboljšanje svih parametara sluznice, kao i smanjenje simptoma. Zaključak Korištenjem suvremenih dijagnostičkih i terapeutskih postupaka i u svijetu prihvaćenih smjernica ARIA u liječenju AR-a, otorinolaringolozi i pedijatri Opće bolnice Vukovar ostvarili su značajne rezultate u smanjenju simptoma te poboljšanju objektivnoga nalaza i kvalitete života vezane uz zdravlje oboljele djece.Idea The aim of the study was to present the results of contemporary, world-wide accepted diagnostic and therapeutic doctrines in treating AR used by pediatricians and ENT specialists in General Hospital Vukovar, Croatia. Method 92 children were referred by their pediatricians as AR suspects, with symptoms like nasal obstruction, hypersecretion, sneezing and itching to ENT outpatient unit. These patients were further submitted to the following tests: SPT, Eo nasal mucosal test, total and specific IgE, ECP, ENT exam, nasal endoscopy. These exams were performed both before and after the ARIA-guidelines treatment which had lasted for one month. We analyzed the effectiveness of this treatment regarding the nasal mucosa status and the symptoms. Results At the very start of the treatment the average RIST was 58,59, ECP 12,6, proving high average sensibilisation and high allergic activity. A large number of children were sensitive to house dust mite (N=74, 80,34%), as well as to ambrosia (N=32, 34,78%) and to grass pollen (N=42, 45,67%). Results of the therapy have shown the improvement regarding almost all symptoms and objective parameters. Conclusion By using modem diagnostic and therapeutic procedures, ENT specialists and pediatricians have obtained a noticeable relief of symptoms as well as the improvement of quality of life in children treated in Vukovar

Application of contemporary ARIA guidelines in treating allergic rhinitis in children

Cilj Cilj je ovoga rada prikazati primjenu suvremenih dijagnostičkih i terapijskih postupaka u zbrinjavanju alergijskoga rinitisa (AR), prema smjernicama ARIA, a od strane otorinolaringologa i pedijatra u Općoj bolnici Vukovar. Bolesnici i metode U otorinolaringološku ambulantu bilo je upućeno 92 djece od strane pedijatra, pod sumnjom da je riječ o AR, sa simptomima kao što su ovi: nosna opstrukcija, pojačana sekrecija, kihanje i svrbež nosa. Pacijenti su dalje bili podvrgnuti sljedećim pretragama: SPT, obrisak nosa na eozinofile, ECP, ukupni IgE, specifični IgE, objektivni ORL pregled, uključujući i endoskopiju nosa. Ove su pretrage učinjene prije, i nakon liječenja u trajanju od mjesec dana. Analizirali smo uspjeh liječenja u odnosu na izgled sluznice i stupanj nazočnosti simptoma bolesti. Rezultati Na samom početku liječenja prosječna vrijednost ukupnih IgE bila je 58,59 KIU/1, ECP 12,6 KIU/1, što je ukazivalo na visoki stupanj prosječne senzibiliziranosti, kao i visok stupanj opće alergijske reakcije organizma. Veliki je broj djece bio senzibiliziran na grinje (N=74, 80,34%), slično kao i na ambroziju (N=32, 34,78%) i pelud trava (N=42, 45,67%). Rezultati liječenja pokazali su značajno poboljšanje svih parametara sluznice, kao i smanjenje simptoma. Zaključak Korištenjem suvremenih dijagnostičkih i terapeutskih postupaka i u svijetu prihvaćenih smjernica ARIA u liječenju AR-a, otorinolaringolozi i pedijatri Opće bolnice Vukovar ostvarili su značajne rezultate u smanjenju simptoma te poboljšanju objektivnoga nalaza i kvalitete života vezane uz zdravlje oboljele djece.Idea The aim of the study was to present the results of contemporary, world-wide accepted diagnostic and therapeutic doctrines in treating AR used by pediatricians and ENT specialists in General Hospital Vukovar, Croatia. Method 92 children were referred by their pediatricians as AR suspects, with symptoms like nasal obstruction, hypersecretion, sneezing and itching to ENT outpatient unit. These patients were further submitted to the following tests: SPT, Eo nasal mucosal test, total and specific IgE, ECP, ENT exam, nasal endoscopy. These exams were performed both before and after the ARIA-guidelines treatment which had lasted for one month. We analyzed the effectiveness of this treatment regarding the nasal mucosa status and the symptoms. Results At the very start of the treatment the average RIST was 58,59, ECP 12,6, proving high average sensibilisation and high allergic activity. A large number of children were sensitive to house dust mite (N=74, 80,34%), as well as to ambrosia (N=32, 34,78%) and to grass pollen (N=42, 45,67%). Results of the therapy have shown the improvement regarding almost all symptoms and objective parameters. Conclusion By using modem diagnostic and therapeutic procedures, ENT specialists and pediatricians have obtained a noticeable relief of symptoms as well as the improvement of quality of life in children treated in Vukovar