Endoskopska kirurgija prednje lubanjske jame: velika mukokela

Prikaz slučaja: 72-godišnja bolesnica obrađivana je po neurologu zbog dugotrajnih glavobolja i dvoslika na lijevom oku. Radiološkom obradom dijagnosticira se tumorska tvorba veličine 7-8 cm koja destriuira lubanjsku osnovicu, širi se u prednju lubanjsku jamu, te komprimira lijevu orbitu i etmoidne stanice. Endoskopskim endonazalnim pristupom učinjena je prednja i stražnja etmoidektomija, te evakuiran obilan mukozan sekret. Zaključak: Prvi postoperacijski dan bolesnica je subjektivno dobro, bez glavobolje i dvoslika, te je otpuštena na kućnu njegu

Endoskopska kirurgija prednje lubanjske jame: velika mukokela

Prikaz slučaja: 72-godišnja bolesnica obrađivana je po neurologu zbog dugotrajnih glavobolja i dvoslika na lijevom oku. Radiološkom obradom dijagnosticira se tumorska tvorba veličine 7-8 cm koja destriuira lubanjsku osnovicu, širi se u prednju lubanjsku jamu, te komprimira lijevu orbitu i etmoidne stanice. Endoskopskim endonazalnim pristupom učinjena je prednja i stražnja etmoidektomija, te evakuiran obilan mukozan sekret. Zaključak: Prvi postoperacijski dan bolesnica je subjektivno dobro, bez glavobolje i dvoslika, te je otpuštena na kućnu njegu

Obostrana koštana atrezija hoana: radi li se uistinu o urgentnoj kirurškoj potrebi ili... ?

Uvod: Obostrana atrezija hoana očituje se odmah po rođenju kao respiratorni distres, cijanozom, intermitentnim apnejama, jer novorođenče ne zna disati na usta. Ovu anomaliju najčešće se može vidjeti u sklopu CHARGE sindroma koji obuhvaća i poremećaje okularne kolobome, srčane malformacije, poremećaja rasta, anomalije središnjeg živčanog sustava, genitalne anomalije i anomalije uha. Prenatalnom dijagnostikom može se posumnjati na postojanje CHARGE sindroma detekcijom specifičnih velikih anomalija ultrazvučnim pregledom. Kirurško zbrinjavanje u ranom postporođajnom razdoblju potiče se kako bi se spriječila prolongirana endotrahealna intubacija i omogućilo oralno hranjenje. Prikaz slučaja: Muško nedonošće, tjelesne mase svega 1571 g, rođeno u 34. tjednu trudnoće, primarno reanimirano i zbog respiratorne insuficijencije, odmah po porodu intubirano, radi osiguranja dišnoga puta. Nekoliko sati nakon poroda i smještanja u pedijatrijsku jedinicu intenzivnog liječenja i neonatalne skrbi zbog nemogućnosti toalete dišnog puta učinjena transnazalna fiberendoskopija, potom i slikovna radiološka CT obrada kojom se potvrdila dijagnoza obostrane koštane atrezije hoana. Peti porođajni dan u općoj anesteziji nedonošće je podvrgnuto rekanalizaciji endoskopskim pristupom diodnim laserom. Nakon perforacije koštanih atrezija, postavljeni su kateteri br. 6 u oba nosna kavuma. Tijekom postoperativnog praćenja, svakodnevno se sekret aspirirao, a kateteri se mobilizirali radi sprječavanja nastanka granulacija i stenoza. Dva tjedna nakon operativnoga zahvata, odstranjeni su kateteri, prvo iz jednog, a potom iz oba nosna kavuma. Dijete se ekstubira, nakon čega samostalno diše kroz nos, optimalne periferne oksigenacije. Zaključak: Pravovremenom prenatalnom dijagnostikom i osiguranjem dišnoga puta endotrahealnom intubacijom odmah po porodu, obostrana koštana atrezija hoana može se uspješno liječiti odgođenim operativnim zahvatom. Diodni laser je jedna od terapijskih mogućnosti pomoću koje se učinkovito uklanja mehanička barijera fiziološkom načinu disanja

Analysis of symptoms and clinical signs of laryngopharyngeal reflux depending on pepsia in saliva

In the last fifty years, an epidemic of reflux disease has occurred as a result of poor eating habits, stress, and activities of the food industry. Part of this disease is laryngopharyngeal reflux, a disease characterized by the return of gastric contents to the throat and surrounding organs, leading to hoarseness, coughing, difficulty in swallowing and breathing, and ultimately the development of benign and malignant changes in the larynx. This study is aimed to examine the symptoms and signs of laryngopharyngeal reflux in the study group before and after therapy and to compare the concentration of pepsin in saliva with the above. The prospective longitudinal cohort study included 50 subjects, divided into two groups. The first group consisted of 25 subjects with laryngopharyngeal reflux. The second group consisted of 25 healthy subjects without symptoms and signs of laryngopharyngeal reflux. Symptoms and signs before and after therapy were collected using RSI and RFS questionnaires. Pepsin in saliva was measured with Peptest before and after therapy. The most pronounced symptoms are hoarseness, postnasal drip, and a feeling of "a lump in the throat". The median RSI score after three months of therapy was reduced from 20 to 8. From the first group, 7 subjects had measurable levels of pepsin in saliva, and none after therapy. In the control group, no subjects were found to have pepsin in their saliva. Significant improvement was observed in clinical findings (subglottic edema, posterior commissure hypertrophy, vocal cord edema, dense endolaryngeal secretion) after three months of therapy in subjects with LPR. No association of pepsin with LPR symptoms was observed but there is a significant positive association between pepsin and the clinical finding of erythema/hyperemia. In most cases, we start therapy with medication. It is, therefore, important to emphasize that laryngopharyngeal reflux treatment must always begin with a change in diet, lifestyle, and stress regulation. Treatment must be individual and should include a multidisciplinary team with a nutritionist, psychologist, and psychiatrist

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

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

Povezanost indeksa tjelesne mase i patohistoloških značajki karcinoma štitnjače

Available studies report conflicting results on the association of body mass index (BMI) and pathohistological features of thyroid cancer. This study aimed to investigate the relationship between BMI and the pathohistological features of different thyroid cancer types. We analyzed the following data from 95 patients with thyroid cancer: age, gender, BMI, pathohistological characteristics of cancer (tumor size, multifocality, lymphovascular invasion, extrathyroidal invasion) and the presence of regional metastases. The BMI of all patients with thyroid cancer was 27.1 ± 4.2. Significantly more patients with obesity class I had cancer size less than 2 cm (p = 0.02). There is a significant association between BMI and extrathyroid invasion (p = 0.03; OR, 1.18), but not with lymphovascular invasion, tumor size, and multifocality. We can conclude that although obesity is a risk factor for the development of thyroid cancer, higher BMI is only partially associated with more aggressive pathohistological features of thyroid cancer.Dostupne studije pokazuju oprečne rezultate povezanosti indeksa tjelesne mase (ITM) s patohistološkim značajkama raka štitnjače. Cilj ove studije bio je istražiti odnos između ITM-a i patohistoloških značajki različitih tipova karcinoma štitnjače. Analizirali smo sljedeće podatke od 95 bolesnika s karcinomom štitnjače: dob, spol, ITM, patohistološke karakteristike karcinoma (veličina tumora, multifokalnost, limfovaskularna invazija, ekstratireoidna invazija) i prisutnost regionalnih metastaza. ITM svih bolesnika s karcinomom štitnjače bio je 27,1 ± 4,2. Značajno više pacijenata s klasom pretilosti I imalo je veličinu raka manju od 2 cm (p=0,02). Postoji značajna povezanost ITM-a i ekstratireoidne invazije (p=0.03; OR, 1,18), ali ne i s limfovaskularnom invazijom, veličinom tumora i multifokalnosti. Možemo zaključiti da iako je pretilost čimbenik rizika za razvoj raka štitnjače, viši ITM je samo djelomično povezan s agresivnijim patohistološkim značajkama raka štitnjače

Inverted papilloma: a twenty years retrospective study from one institution

We have been treating endoscopically different kinds of inverted papilloma including malignant inverted papilloma since 1995. This is a retrospective study which demonstrates our experience in the treatment of inverted papilloma. Inverted papilloma is defined as a benign, locally aggressive tumor with malignant transformation and frequent recurrence. The aim of the study is to investigate whether the malignancy starts developing at the beginning of disease or later, and whether we can consider deviated septum as a etiologic factor of inverted papilloma. We also wanted to show endoscopic endonasal surgery as a method of choice in the treatment of inverted papilloma. Data in the period from 1998 to 2017 were analyzed retrospectively. Out of a total number of 62 patients, three (4.8%) were diagnosed with inverted papilloma with squamous cell carcinoma in some part of the lesion and 59 (95.2%) were diagnosed like inverted papilloma. The patients diagnosed with inverted papilloma and with squamous cell carcinoma were significantly older than the patients diagnosed with IP (Mann-Whitney U test, p = 0.006). The most common localization of primary tumor was the maxillary sinus. The dominant symptom in patients with inverted papilloma was epistaxis in more than half of our patients, followed by nasal obstruction in more than one third of our patients. We compared our results with the results from literature. Our results show a low percentage of malignant transformation only in three cases (4.8%). The obtained result corresponds to previous studies, with values below the average obtained in other studies. Finally, the endoscopic endonasal approach is the contemporary gold standard in the treatment of inverted papilloma

Balloon dilatation of the Eustachian tube: domain of an otologist or rhinologist?

Background: Eustachian tube dysfunction is common in the general population, occurring in at least 1% of adults. Patients typically present with complaints of sensation of pressure or plugged ear, tinnitus, or hearing loss which can lead to an impaired quality of life. Eustachian tube balloon dilation is a novel surgical technique. The problem of treating Eustachian tube dysfunction with balloon dilatation is no clear consensus regarding patient selection and outcome assessment. Our case report aims to objectively measure the success of Eustachian tube balloon dilation by comparing pre and post-operative middle ear pressures using tympanometric testing. Case report: A 27-year-old patient reported a feeling of fullness in his right ear that lasted for a year. He also complained of occasional tinnitus in the same ear. He had not had frequent ear infections until then. Audiological processing determined a normal hearing threshold on both sides at the level of 10 dB, type C curve in the right ear, and the test of tube function by swallowing on the right side showed dysfunction. After the treatment, balloon dilatation of the tube was performed on the right transnasal approach under a pressure of 6 daPa, six months postoperatively, the patient no longer complained, and there was a regular test of Eustachian tube function on both sides. Conclusion: According to data from literature, balloon dilatation of the Eustachian tube showed success in 78% of patients. The transnasal approach to dilatation has proven to be a safe and effective method of treating chronic obstructive Eustachian tube dysfunction. A further consensus of patient selection and standardization of technique is required to optimize the effect of this therapy. The cooperation of otologists and rhinologists is needed in the diagnosis and treatment

Balloon dilatation of the Eustachian tube: domain of an otologist or rhinologist?

Background: Eustachian tube dysfunction is common in the general population, occurring in at least 1% of adults. Patients typically present with complaints of sensation of pressure or plugged ear, tinnitus, or hearing loss which can lead to an impaired quality of life. Eustachian tube balloon dilation is a novel surgical technique. The problem of treating Eustachian tube dysfunction with balloon dilatation is no clear consensus regarding patient selection and outcome assessment. Our case report aims to objectively measure the success of Eustachian tube balloon dilation by comparing pre and post-operative middle ear pressures using tympanometric testing. Case report: A 27-year-old patient reported a feeling of fullness in his right ear that lasted for a year. He also complained of occasional tinnitus in the same ear. He had not had frequent ear infections until then. Audiological processing determined a normal hearing threshold on both sides at the level of 10 dB, type C curve in the right ear, and the test of tube function by swallowing on the right side showed dysfunction. After the treatment, balloon dilatation of the tube was performed on the right transnasal approach under a pressure of 6 daPa, six months postoperatively, the patient no longer complained, and there was a regular test of Eustachian tube function on both sides. Conclusion: According to data from literature, balloon dilatation of the Eustachian tube showed success in 78% of patients. The transnasal approach to dilatation has proven to be a safe and effective method of treating chronic obstructive Eustachian tube dysfunction. A further consensus of patient selection and standardization of technique is required to optimize the effect of this therapy. The cooperation of otologists and rhinologists is needed in the diagnosis and treatment