Opetovani lipomatozni tumor hipofarinksa: prikaz slučaja i pregled literature

Liposarcoma is one of the most common soft-tissue sarcomas in adults, but head and neck are rarely involved, especially regions of the larynx and hypopharynx. According to Enzinger and Weiss, liposarcoma can be divided into 5 subtypes: well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated. We present an unusual case of well-differentiated liposarcoma of the hypopharynx in a patient with previous three procedures of endoscopic removal of hypopharyngeal tumor classified as benign lipoma. Well-differentiated liposarcoma is a tumor of low-grade malignancy, which frequently recurs locally, but does not metastasize. Wide tumor resection with free margins is mandatory. Immunohistochemistry is a useful diagnostic tool. We also discuss recently published literature on this unusual presentation of well-differentiated liposarcoma.Liposarkom je jedan od najčešćih mekotkivnih sarkoma u odrasloj dobi. Usprkos tome, zahvaćenost glave i vrata je rijetka, osobito u regijama larinksa i hipofarinksa. Prema Enzingeru i Weissu, liposarkom se može podijeliti u 5 podtipova: dobro diferenciran, miksoidni (miješani), tumor kružnih stanica, pleomorfni i nediferencirani. Mi predstavljamo neobičan slučaj bolesnika s dobro diferenciranim liposarkomom u hipofarinksu, koji je prije bio tri puta endoskopski operiran, a svaki je put odstranjeni tumor bio dijagnosticiran kao benigni lipom. Dobro diferencirani liposarkom je tumor niskog malignog potencijala, koji često nakon toga opetovano raste, ali ne daje metastaze. Široka resekcija tumora sa slobodnim rubovima je metoda prvoga izbora. Imunohistokemijska analiza je od osobitog dijagnostičkog značenja. Također, u radu se raspravlja o podacima iz novije literature glede neobičnih prikaza dobro diferenciranih liposarkoma hipofarinksa

Čimbenici rizika za infekciju kirurškog mjesta u operacijama karcinoma grkljana

Surgical site infection (SSI) is a significant factor of morbidity and mortality in patients surgically treated for laryngeal carcinoma. The aim of this prospective study in 277 patients was to determine the incidence of SSI in patients surgically treated for laryngeal squamous cell carcinoma and to identify risk factors for development of SSI. Patients with previous chemotherapy and/or radiotherapy were excluded. All patients had tracheostomy postoperatively and received antibiotic prophylaxis with cephalosporin, aminoglycoside and metronidazole. The overall incidence of SSIs in our cohort was 6.5% (18 patients): 4 (22.22%) patients with superficial infections, 11 (61.11%) with deep infections and 3 (16.66%) with organ-space infections. The remaining infections included pneumonia (1 case) and Clostridium difficile colitis (2 cases). The median hospital stay in patients having developed SSIs was longer than in those without SSIs (33.5 vs. 16 days, p<0.001). By using univariate analysis American Society of Anesthesiologists score ≥3, duration of surgery longer than 120 minutes and National Nosocomial Infections Surveillance risk index ≥1 were found to be significantly associated with the occurrence of SSI. Age, sex, body mass index, history of smoking, underlying diabetes and preoperative length of stay were found not to be associated with SSI. The most frequently isolated microorganism was Klebsiella spp.Infekcije kirurškog mjesta (IK M) predstavljaju značajan čimbenik za obolijevanje i smrtnost u bolesnika operiranih zbog karcinoma grkljana. Cilj ove prospektivne studije koja je obuhvatila 227 bolesnika bio je odrediti incidenciju IK M te utvrditi čimbenike rizika za njezin nastanak. Studija je isključila bolesnike s prethodnom radio- i/ili kemoterapijom. Svi su bolesnici imali poslijeoperacijsku traheostomu, a primali su antibiotičku profilaksu koja je sadržavala cefalosporin, aminoglikozid i metronidazol. Uočeno je da je srednja incidencija IK M 6,5% (18 bolesnika), uz 4 (22,22%) slučaja s površinskom incizijskom infekcijom, 11 (66,22%) s dubokom incizijskom infekcijom i 3 (16,66%) s infekcijom organa ili prostora. Ostale infekcije su bile upala pluća (1 bolesnik) i kolitis prouzročen bakterijom Clostridium difficile (2 bolesnika). Srednje trajanje bolničkog liječenja u bolesnika kod kojih se razvila IK M bilo je dulje od onih bez IK M (33,5 dana prema 16 dana; p<0,001). Koristeći univarijatnu analizu nađeno je da su ASA skor ≥3 Američke udruge anesteziologa, kirurška intervencija dulja od 120 minuta i NNI S (Nacionalno praćenje nozokomijalnih infekcija) indeks rizika ≥1 značajno udruženi s pojavom IK M. Godine, spol, tjelesna masa, pušenje, dijabetes, duljina prijeoperacijskog boravka u bolnici nisu povezani s IK M. Najčešće izolirani mikroorganizam je bila Klebsiella spp

Učinci dugotrajnog, niskodoziranog liječenja klaritromicinom na koncentracije Th1 citokina u nosnome sekretu u bolesnika s nosnom polipozom

Aim: Inflammatory processes in nasal mucosa are reflected in various local mediators, found both in mucosal tissue and nasal discharge. In this prospective study, we assessed the effects of long-term low-dose oral administration of clarithromycin (CAM) on Th1 cytokines in nasal secretions and on clinical parameters of severity of nasal polyposis. Methods: A total of forty nasal polyp patients (22 nonallergic and 18 allergic) received 500 mg/day single oral dose of CAM for eight weeks. We measured the levels of proinflammatory Th1 cytokines TNF-α, TNF-β, IL-1β, IL-2, IL-12, and IFN-γ in the nasal fluid samples, before and after treatment by CAM, using flow cytometric method. Before and after therapy, we scored each of the 40 patients according to nasal symptom score and endoscopic score. Results: Following treatment, we found significantly reduced levels of TNF-α (p=0.006) in nasal secretions of nonallergic patients, and of IL-1β (p=0.008) in nasal fluid of allergic patients. Our results suggest an association between the reduction of nasal polyp size and reduction of TNF-α levels in nasal fluid of nonatopic patients and an association between the reduction of nasal polyp size and reduction of IL-12 levels in nasal discharge of atopic patients. Macrolide therapy decreased the size of polyps in 10/22 nonatopic and in 9/18 atopic patients. After macrolide therapy, we found 67.83% nonallergic subjects and 55.55% allergic subjects with improved nasal symptomatology. Conclusion: Long-term low-dose treatment with CAM is effective in the management of nasal polyposis, because of its antiinflammatory and immunomodulatory actions.Cilj: Upalni procesi u nosnoj sluznici očituju se u različitim lokalnim medijatorima, u tkivu sluznice i u nosnom sekretu. U ovoj prospektivnoj studiji procijenili smo učinke dugotrajne, niskodozirane terapije klaritromicinom (CAM) na Th1 citokine u nosnome sekretu, kao i na kliničke parametre očitovanja nosne polipoze. Metode: Četrdesetero (22 nealergičnih i 18 alergičnih) bolesnika s nosnom polipozom dobivalo je po jednu dnevnu dozu od 500 mg CAM-a tijekom osam tjedana. Mjerili smo koncentracije proupalnih Th1 citokina TNF-α, TNF-β, IL-1β, IL-2, IL-12 i IFN-γ u uzorcima nosnoga sekreta, prije i nakon terapije CAM-om, primjenom protočne citometrije. Prije i nakon liječenja klinički smo klasificirali svakoga od četrdesetero bolesnika prema nosnome simptom rezultatu i endoskopskom rezultatu. Rezultati: Nakon liječenja detektirali smo značajno niže koncentracije TNF-α (p = 0,006) u nosnome sekretu nealergičnih bolesnika i IL-1β (p = 0,008) u nosnome sekretu alergičnih bolesnika. Naši rezultati sugeriraju povezanost između smanjenja veličine nosnih polipa i snižavanja koncentracije TNF-α u nosnom sekretu u neatopičnih bolesnika, kao i povezanost između smanjenja veličine nosnih polipa i snižavanja koncentracije IL-12 u nosnome sekretu u atopičnih ispitanika. Terapija makrolidnim antibiotikom smanjila je veličinu polipa u 10/22 nealergičnih i u 9/18 alergičnih bolesnika. Nakon makrolidne terapije našli smo 67,83 % nealergičnih i 55,55 % alergičnih ispitanika s poboljšanim nosnim simptomima. Zaključak: Zbog protuupalnih i imunomodulacijskih djelovanja, dugotrajna niskodozirana primjena CAM-a korisna je u liječenju nosne polipoze

Discussion at the Round Table “Croatia as a Welfare State”

U posljednjem broju „Revije za socijalnu politiku“ objavili smo referate priređene za Okrugli stol „Hrvatska kao socijalna država - zadanosti i usmjerenja“ koji je u organizaciji Centra za industrijsku demokraciju Saveza samostalnih sindikata Hrvatske održan 28. i 29. studenoga 1996. U ovom broju objavljujemo raspravu na Okruglom stolu te izlaganje akademika Eugena Pusića. Naime, od svih uvodnih izlaganja izdvojili smo upravo izlaganje akademika Pusića stoga što ono sadrži neka aktualna razmišljanja o socijalnoj državi koja nisu u potpunosti sadržana u njegovom već objavljenom prilogu u našem časopisu. Osim toga, na izlaganje akademika Pusića nadovezali su se neki sudionici u samoj raspravi

Eozinofilna upala u alergijskom rinitisu i nosnoj polipozi

On histopathological examination, nasal polyps and nasal mucosa in allergic rhinitis show different forms of pseudostratified respiratory epithelium, whereas the dominant characteristic of lamina propria is an eosinophilic infiltration. The aim of this study was to compare interleukin (IL)-5 and eosinophilic cationic protein (ECP) levels in the nasal fluid of 42 patients: 12 with allergic rhinitis and nasal septal deviation, 17 non-atopic patients with nasal polyposis, and 13 atopic nasal polyp patients were enrolled in this cross-sectional study. Nasal secretion samples were collected a few days before surgery. The levels of IL-5 were measured using fl ow cytometry and the ECP using a commercial ELISA kit. In addition, we counted eosinophils in hematoxylin-and-eosin-stained sections of all nasal polyp and all nasal mucosa samples taken from the inferior nasal turbinates during septoplasty. A significantly higher concentration of IL-5 was found in the nasal fluid of atopic patients with nasal polyposis than in non-atopic nasal polyp patients (p=0.025) and patients with allergic rhinitis (p=0.05). ECP was higher in atopic nasal polyp patients than in patients with allergic rhinitis (p<0.0001) and than in non-atopic nasal polyp patients (p<0.0001). Polyp eosinophils were higher in atopic’ than in non-atopic patients (p<0.0001) and higher than in the mucosa of patients with allergic rhinitis (p<0.0001). These however had signifi cantly more mucosal eosinophils than was found in the polyps of non-atopic patients’ (p=0.025). ECP levels in nasal fl uid and eosinophil counts in tissue specimens correlated well in all three groups of patients. Our study has shown that atopic nasal polyp patients have a higher level of eosinophilic inflammation than non-atopic patients with nasal polyps and patients with allergic rhinitis.Na histopatološkim pregledima nosni polipi, kao i nosna sluznica u alergijskom rinitisu pokazuju različite oblike pseudoslojevitog respiracijskog epitela, dok je osnovna karakteristika lamine proprije infiltracija eozinofilima. Cilj ove studije bio je usporediti koncentracije interleukina 5 (IL-5) i eozinofilnoga kationskog proteina (ECP) u nosnome sekretu pacijenata s alergijskim rinitisom, neatopičnih i atopičnih pacijenata s nosnom polipozom, kao i usporediti broj eozinofi la u tkivu nosnih polipa/nosne sluznice ovih pacijenata. Četrdeset dvoje (n=42) pacijenata, 12-ero s alergijskim rinitisom i devijacijom nosnog septuma, 17-ero neatopičnih pacijenata s nosnom polipozom i 13-ero atopičnih pacijenata s nosnom polipozom bilo je uključeno u ovu presječnu studiju. Uzorci nosnog sekreta bili su skupljeni iz nosnih šupljina svih ispitanika nekoliko dana prije kirurškog liječenja. Koncentracije IL-5 mjerene su metodom protočne citometrije, dok su koncentracije ECP mjerene komercijalnim ELISA-kitom. Eozinofi li su brojeni u svim uzorcima tkiva nosnih polipa, kao i u svim uzorcima tkiva sluznice uzetih s donje nosne školjke tijekom septoplastike. Značajno više koncentracije IL-5 izmjerene su u nosnom sekretu atopičnih pacijenata s nosnom polipozom u usporedbi s neatopičnim pacijentima s nosnom polipozom (p=0,025) i pacijentima s alergijskim rinitisom (p=0,05). Naši su rezultati pokazali više koncentracije ECP u atopičnih pacijenata s nosnom polipozom nego u pacijenata s alergijskim rinitisom (p<0,0001) i u usporedbi s nealergičnim pacijentima s nosnom polipozom (p<0,0001). Veći broj eozinofi la izbrojen je u tkivu polipa atopičnih pacijenata nego u tkivu polipa neatopičnih pacijenata (p<0,0001), kao i u sluznici pacijenata s alergijskim rinitisom (p<0,0001). U nosnoj sluznici pacijenata s alergijskim rinitisom našli smo značajno veći broj eozinofila nego u polipima neatopičnih pacijenata s nosnim polipima (p=0,025). Konačno, našli smo pozitivnu korelaciju između nivoa ECP u nosnom sekretu i broja eozinofila u uzorcima tkiva u sve tri skupine ispitanika. Zaključili smo da atopični pacijenti s nosnom polipozom imaju viši stupanj eozinofilne upale u usporedbi s neatopičnim pacijentima s nosnim polipima i s pacijentima s alergijskim rinitisom

Large Doubly Septated Concha Bullosa: An Unusual Anatomic Variation

Partial or total pneumatization of the middle turbinate is called concha bullosa. It’s one of the most common anatomic variations of the lateral nasal wall. The exact reason of such pneumatization is not known. It can originate from the frontal recess, middle meatus, sinus lateralis or, less frequently, from the posterior ethmoid cells. Concha bullosa remains usually asymptomatic. However, an extensively pneumatized middle turbinate may constitute space-occupying mass, and thus, it may cause nasal obstruction. We report an extremely rare case of a patient with a large, doubly septated concha bullosa with four different sources of aeration

Early postoperative complications in children with secretory otitis media after tympanostomy tube insertion in the Military Medical Academy during 2000-2009

Background/Aim. Secretory otitis media (SOM) is a chronic, nonpurulent inflammation of the middle ear, characterized by a long-term presence of liquids of different density in the middle ear for at least three consecutive months, different degrees of hearing loss and the absence of perforation of the eardrum. The aim of this study was to estimate the early postoperative complications after insertion of tympanostomy tube (TT) in children with secretory otitis media (SOM) in an 18-month period after TT insertion. Methods. This retrospective study included children with SOM (n = 478), aged from 2.5 to 16 years, operated from 2000 to 2009. During these ten years 365 children had TT in both ears, 131 children had TT in one ear and 55 children were operated two or more times. Totally 843 ears were operated on. Date were obtained by regular fallow up in Out-patient clinic concerning symptoms reported by children and parents, otomicroscopy findings and hearing measurements (audiometry and tympanometry). Results. Transient otorrhea was the most common early postoperative complication (16.5%), then obstruction (9.5%), premature extrusion of TT (3.9%), chronic otorrhea (3.1%), granulation tissue (1.1%) and medial displacement (0.5%). According to our experience gold and silicone TT were shown less successful than others. The incidence of premature extrusion of TT was significantly higher with gold TT, comparing to others (6/33, 18%; p &lt; 0.001). We also found significantly more frequent medial displacement with silicone TT than with other ones (2/4, 50%; p &lt; 0.001). Conclusion. There are many early postoperative complications of TT insertion, but they depend on the meticulous surgery techniques, regular postoperative examinations and the type of TT. The type of TT should be determined according to own experience

The relation between nonspecific hyperreactivity of the airways and atopic constitution in asthmatics

Background/Aim. Hyperreactivity of the airways caused by inflammation in asthmatics is the most important pathophysiological change. It represents a suitable ground that in the presence of risk factors and the drivers of asthma, asthmatic attack occurs. Atopic constitution is one of the most important risk factors for the development and expression of asthma. The aim of our study was to investigate the relationship between nonspecific airway hyperreactivity and atopic constituton in asthmatics. Methods. This retrospective analysis was conducted considering the results of nonspecific bronchoprovocative test with histamine, skin tests to inhalant allergens and total IgE levels in the serum of asthmatic patients with controlled bronchial asthma. The sample consisted of 162 asthmatics examined during one-year period. Results. The examinees were male asthmatic patients, aged between 18 and 30 years. We found that the examinees with a pronounced non-specific hyperreactivity had more significant skin reaction to inhaled allergens and higher levels of total IgE in serum. Conclusion. The results of our study show that the intensity of airway hyperresponsiveness to histamine in asthmatics is directly related to atopic constitution

Impulse oscillometry in evaluation bronchial hyperresponsivness in patients with persistent allergic rhinitis

Background/Aim. Impulse oscillometry (IOS) is a method for estimating lung function which is used for early detection of bronchial hyperresponsiveness (BHR) and asthma. The aim of the study was to determine the prevalence of BHR, the correlation between spirometry and IOS and sensitivity and specificity of IOS in proving BHR in patients with persistent allergic rhinitis. Methods. The study included 81 patients with allergic rhinitis. From all of them, medical history was taken, allergy testing was done, as well as measurements of parameters of lung function by the IOS and spirometry before and after nonspecific bronchial provocation test with histamin via Aerosol provocative system. Changes of the IOS parameters to fall in FEV1 of 20% were measured and compared with changes in the spirometry parameters. After bronchial challenge test subjects were divided into two groups: the group with BHR (group 1) and that without BHR (group 2). Results. The mean age of participants was 25.7 ± 5.7 years, and 50.5% were men. Out of the total number of subjects with allergy rhinitis, 56 (58.9%) had a positive BPT. After bronchoprovocation an average increase in the group 1 was 88.15% for Rrs5, 111.98% for Fres, and for AX 819.69%. The high degree of correlation between the IOS and spirometry was proven in the group 2, while the whole group 1 had a weak correlation between parameters of these two methods. High sensitivity and low specificity for Rrs5 and Fres compared to FEV1 in diagnosing BHR was proven. Conclusion. The study demonstrated a high prevalence of BHR in the study group of patients with persistent allergic rhinitis, poor correlation in relation to the spirometric measurements in the group with BHR and a high sensitivity and low specificity of IOS for the detection of early changes in the airways

„OMEGA SHAPE“ ANOMALY OF THE TYMPANIC SEGMENT OF THE FACIAL NERVE – A CASE REPORT

Dehiscence of the bony canal of the facial nerve is relatively common in the human adult. The highest incidence occurs in the tympanic segment, near the region of the oval window. However, extreme dehiscence and protrusion of the facial nerve are rare. We present a case of a 34-year-old man suffering intermittent left-sided middle ear discharge for several years. During the operation, we found the trunk of the facial nerve which looked like Greek alphabet letter “omega”. It protruded from the fallopian canal within the middle ear space between the first and second genu. The mucosa which covered the whole protruded facial nerve seemed healthy. The medial part of the cavum tympani was not affected. In this report, we described an extreme protrudion of the facial nerve inside the space of the cavum tympani. The dehiscence of the Fallopian canal was not associated with inflammation and bone resoption