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..

Uloga pojmova u nastavi prirodnih nauka

The present paper poses essential questions: What knowledge should students attain and what methods should be applied? The authors started up from cognitivistic view of cognition related to: (a) organizing knowledge of science in the form of generalized ideas or major concepts that can be reduced to a large number of information items, and (b) manner of building up students’ knowledge into meaningful units as matrices of interrelated concepts. Attention is directed to difficulties emerging in developing cognitive structures related to complex contents of science and methods of concept learning in the teaching process. The results of investigations show that students’ mastery of concepts is poor, and the reasons are to be found in the abstract character of contents themselves, lack of ability to interrelate contents within one discipline and between cognate ones, and the absence of establishing relationships between scientific concepts in cognitive structure. An efficient method of presenting scientific concepts was given and explained at three levels, such as macro, micro and symbolic. A model was suggested as a possible method for netting concepts in chemistry at primary school level. Practical recommendations were given to teachers how to assess students’ cognitive structure and how to apply appropriate methods.U radu se postavljaju suštinska pitanja: koja znanja učenici treba da stiču i kojim metodama. Pošlo se od kognitivističkog modela saznavanja koje se odnosi na: (a) organizovanje znanja iz prirodnih nauka u obliku generalizovanih ideja ili glavnih pojmova koji se mogu redukovati na veliki broj informacija i (b) način izgrađivanja znanja učenika u smisaone celine kao matrice međusobno povezanih pojmova. Ukazano je na teškoće u stvaranju kognitivnih struktura koje se odnose na složene sadržaje prirodnih nauka i na načine učenja pojmova u nastavi. Prikazani su i rezultati istraživanja koji pokazuju slabu ovladanost pojmovima, a razlozi proizlaze iz apstraktnosti samih sadržaja, nepovezivanja sadržaja unutar jedne i između srodnih disciplina, kao i neuspostavljanja odnosa među naučnim pojmovima u kognitivnoj strukturi učenika. Naveden je i objašnjen efikasan metod predstavljanja pojmova iz prirodnih nauka na tri nivoa: makro, mikro i simboličkom. Predložen je model kao mogući način umrežavanja pojmova iz hemije na osnovnoškolskom nivou. Date su praktične preporuke nastavnicima za procenu kognitivne strukture učenika i za korišćenje odgovarajućih metoda

Cooperation of the pre-service chemistry and geography teachers on an interdisciplinary lesson planning

The aim of this research was to examine the effects of a new platform for raising the pre-service chemistry and geography teachers’ awareness of cooperation possibilities associated with the planning relevant interdisciplinary lesson. The research featured the participation of 16 students of the Faculty of Chemistry and 28 students of the Faculty of Geography of Belgrade University. Two workshops were conducted within the research. During the first workshop the participants worked in small groups on the tasks which served to strengthen their awareness on the relevant science education. The second workshop comprised the jointly planning the interdisciplinary lessons in groups with members of the pre-service teachers of both subjects. The participants’ lesson plans contain goals that can be classified as those relevant for the individual and those relevant for society. Half of the lesson plans contained formulations of goals that can be assessed as relevant for certain professions. The activities planned for the attainment of the stated goals support an interdisciplinary approach, encompass the concepts envisaged by the chemistry and geography curricula, and the activities specific to these two subjects

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..

The algorithm for the assessment of functional work capacity of railway workers with chronic obstructive pulmonary disease (COPD)

The assessment of functional work capacity based on the biological function of the body and a specific job demands and job characteristics, determine whether a person is capable to do the job or group of jobs. Evaluation of work capacity (EWC) railway workers is conducted according to the program of Regulations for the former and periodic examinations of employees in workplaces with high risk published in the Official Gazette of RS no. 120/ 07 and 655. Regulations on health conditions to be met by railway workers, who are directly involved in railway transport. One of the most common chronic diseases during EWC is chronic obstructive pulmonary disease (COPD). The definition of contraindications for use of railway employees with COPD given by Ordinance 655 is in very general terms, trying to make it easier and improve the quality of assessment of work capacity, we have developed an algorithm for the assessment of work ability among these workers. When doubt the existence of COPD should first prove that the disease exists, according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines, and for occupational medicine we considered important to clarify and standardize the assessment criteria for EWC, which resulting in a diagnostic algorithm for EWC. It is also important to know which type of job will worker to do. Application of a diagnostic algorithm in EWC will allow optimal assessment of disease severity in railway and other workers suffering of COPD working at the workplace with an increased risk efficacy treatment evaluation; assess compensation of functional defects and determine schedule of periodical examination

Thyroglobulin specific IgE and a possible link to suspected penicillin induced allergic skin manifestations - cross sectional study.

Porcine thyroglobulin was important in the discovery of alpha-Gal allergy. Here, the linkage of porcine thyroglobulin-specific IgE with IgE positivity to routinely assessed allergens and to the incoming diagnosis within a population of suspected atopic individuals is explored. IgE, IgA, total IgG and IgG subclasses to porcine thyroglobulin, IgE to bovine, human thyroglobulin and meat extract were measured with ELISA. The following correlations were observed in IgE binding to porcine and bovine thyroglobulin (r = 0.910, p = 1x10 <sup>-17</sup> ), porcine and human thyroglobulin (r = 0.635, p = 4x10 <sup>-6</sup> ), human and bovine thyroglobulin (r = 0.746, p = 6x10 <sup>-9</sup> ) and porcine thyroglobulin and meat extract (r = 0.482, p = 0.0009). Only one out of ten samples which showed binding to porcine thyroglobulin in ELISA tested positive with ImmunoCAP alpha-Gal, implying different epitope/s. Increased IgE binding was detected towards a more electronegative fraction of porcine thyroglobulin separated according to charge and the binding could be partially inhibited by galactose. Anti-thyroglobulin IgE was found in 29.7% of the population, in subjects who were significantly younger, p < 0.0001 and it occurred more frequently in patients referred for testing penicillin specific IgE (OR 2.48, p = 0.0059) and were negative. IgE specific to porcine, bovine and possibly human thyroglobulin may be implicated in post-infectious skin manifestation misinterpreted as penicillin allergy