Internal jugular vein thrombosis caused by invasive pharyngeal cancer: a case report and literature review

INTRODUCTION: Internal jugular vein (IJV) thrombosis is a potentially life-threating disease and can occur at any level. Variety of factors can induce thrombosis, but it is most often found following IJV catheterization, neck dissection, injuries, infectious disease, in ovarian hyperstimulation syndrome or in malignant neoplasms. Unlike thyroid cancer, in which thrombosis of the jugular vein have been relatively often described, thrombosis of the internal jugular vein in head and neck squamous cell cancer is extremely rare. OBJECTIVE: We report a unique case of a very advanced, locally invasive pharyngeal tumor causing thrombosis of the internal jugular vein. Literature review of the described topic was also conducted. MATERIAL AND METHODS: A crossreferenced PubMed and Scopus (EMBASE) search was performed and relevant data were extracted accordingly. The search was performed using the following key-words and Boolean operators: “head and neck cancer AND squamous cell cancer AND internal jugular vein thrombosis”. RESULTS: According to PubMed and Scopus search only two similar cases were found. The first patient had supraglottic SCC with N3 lymph node invading IJV. The second patient developed SCC of the thyroid gland with a large IJV thrombosis. Both patients were treated bimodally, but developed recurrences and died soon after the treatment. In our case, patient was treated with radical surgery. Radical dissection of the right side of the neck and selective dissection of the left side of neck levels II-IV were performed. Furthermore, total laryngectomy, subtotal pharyngectomy and total thyroidectomy en bloc were performed. Reconstruction was made with a free fasciocutaneous anterolateral thigh flap. Despite the patient\u27s poor general condition, IJV thrombosis, bulbus and sigmoid sinus thrombosis, and several comorbidities, he was considered for curative therapy and is still alive, in good general shape, 7 months after the surgery. DISCUSSION: The choice of treatment for this kind of patients is not standardized due to its rare occurrence. Even though IJV thrombosis carries a high chance of distant metastasis and local recurrence and consequently causing poor survival, the question arises what the best therapeutic option is. More documented cases are undoubtedly required to draw a more solid conclusio

Orbital cellulitis as a vfirst sign of ethmoid sinus osteoma in children - case report and short literature review

Introduction: Orbital cellulitis is a rare condition with very dangerous complication of acute sinus infection that could potentially lead to vision loss. It is the most common complication of acute sinusitis, especially in children. On the other hand, osteoma of paranasal sinuses in pediatric patients causing orbital cellulitis is a very rare phenomenon. Case report: A 13-year-old male child was presented to our Clinic with severe frontal headache, large swelling of the upper right eyelid, proptosis, chemosis and impaired vision of the affected eye. Fiberendoscopy showed purulent discharge from both nasal cavums and mucosal inflammation which caused the narrowing of the right ostiomeatal complex as well as sphenoetmoidal recess. Computer tomography of the paranasal sinuses revealed a subperiosteal abscess localized on the superolateral orbital wall with opacified right frontal sinus and huge ethmoid sinus osteoma measuring 2.5x2x1 cm. The tumour was removed endoscopically and great care was taken not to pierce the skull base and simultaneously remove all parts of the tumour. In addition, an outer incision of 1 cm of the upper eyelid was performed. The patient’s symptoms decreased postoperatively, and the patient was released from the Clinic with significant improvement on the sixth postoperative day. Discussion: We present an extremely rare case of ethmoidal osteoma which caused orbital cellulitis in a pediatric patient. Treating such patients is very sensitive and established algorithms do not exist. We examined the available literature on the aforementioned topic. According to Chandler’s classification of orbital cellulitis, the treating of grade III or subperiosteal abscess is still a controversy. However, in our patient’s case, the cause of cellulitis was large osteoma, so surgical intervention was inevitable. An endoscopic approach gives excellent results, but maximal care must be taken in order to avoid damaging the surrounding important structures, especially in pediatric patients who have narrow nasal cavities

NECK DISSECTION IN PATIENTS WITH LARYNGEAL SQAMOS CELL CARCINOMA

Skvamozni karcinom grkljana najčešći je maligni tumor grkljana. Brojni čimbenici utječu na pojavu bolesti ali najistaknutiji su pušenje i konzumiranje alkohola. U većini slučajeva javlja se u starijih muškaraca koji kroz dugi niz godina redovito puše i konzumiraju alkohol. Klinička slika veoma zavisi o primarnom sijelu tumora. U nekim regijama tumor se detektira rano zbog ranog javljanja simptoma dok u drugih regija, prvi znak može biti pojava čvorića na vratu. Kao i u drugih tumora glave i vrata, mjesto pojave limfogenih metastaza može se predvidjeti zbog poznatog puta širenja pojedinih regija. To se iskorištava radi preventivnog (elektivnog) ali i kurativnog liječenja. Uklanjanje limfnih čvorova vrata još je od davnina poznata operacija pod nazivom disekcija vrata. U prošlosti je to bila vrlo radikalna operacija s uklanjanjem svih limfnih regija vrata i nekih nelimfatičkih struktura. S vremenom, sakupljanjem različitih iskustva i znanja, te operacije postaju sve poštednije. Shvaćeno je da je moguće dobiti isti rezultat ali uz puno manje funkcionalnih i estetskih deformiteta. Tako se od uklanjanja svih limfnih regija vrata i nekih nelimfatičkih struktura (radikalna disekcija vrata) došlo do uklanjanja samo pojedinih regija i očuvanja nelimfatičkih struktura (selektivna disekcija vrata). U današnje vrijeme traže se nove metode kako bi se postigao optimalan opseg zahvata i pronašla adekvatna terapija.Squamous cell carcinoma of the larynx is the most often malignant tumor of the larynx. Numerous factors affect the occurrence of this disease but the most important ones are smoking and drinking alcohol. In most cases, it occurs in older men who smoke and drink alcohol on a daily basis for a long time. Clinical finding depends on the localization of the primary tumor. In some regions, the tumor is detected early due to early symptoms, while in the other regions, the first sign may be appearance of the nodule on the neck. As in the other head and neck tumors, the site of lymphatic metastases can be predicted due to the known route of spreading of certain regions. This is used for preventive (elective) but also for a curative treatment. Removal of the lymph nodes of the neck has long been known as an operation called neck dissection. In the past, it was a very radical operation with the removal of all lymphatic regions of the neck and some nonlymphatic structures. Over time, by gathering different experiences and knowledges, these operations become more and more spared. It is understood that it is possible to obtain the same result but with much less functional and aesthetic deformities. With time, radical neck dissection, in which all lymph node regions and some nonlymphatic structures were removed, was replaced with selective neck dissection, in which only certain regions were removed and nonlymphatic structures were preserved. Nowadays, new methods are being sought in order to achieve the optimal extent of the procedure and find adequate therapy

NECK DISSECTION IN PATIENTS WITH LARYNGEAL SQAMOS CELL CARCINOMA

Skvamozni karcinom grkljana najčešći je maligni tumor grkljana. Brojni čimbenici utječu na pojavu bolesti ali najistaknutiji su pušenje i konzumiranje alkohola. U većini slučajeva javlja se u starijih muškaraca koji kroz dugi niz godina redovito puše i konzumiraju alkohol. Klinička slika veoma zavisi o primarnom sijelu tumora. U nekim regijama tumor se detektira rano zbog ranog javljanja simptoma dok u drugih regija, prvi znak može biti pojava čvorića na vratu. Kao i u drugih tumora glave i vrata, mjesto pojave limfogenih metastaza može se predvidjeti zbog poznatog puta širenja pojedinih regija. To se iskorištava radi preventivnog (elektivnog) ali i kurativnog liječenja. Uklanjanje limfnih čvorova vrata još je od davnina poznata operacija pod nazivom disekcija vrata. U prošlosti je to bila vrlo radikalna operacija s uklanjanjem svih limfnih regija vrata i nekih nelimfatičkih struktura. S vremenom, sakupljanjem različitih iskustva i znanja, te operacije postaju sve poštednije. Shvaćeno je da je moguće dobiti isti rezultat ali uz puno manje funkcionalnih i estetskih deformiteta. Tako se od uklanjanja svih limfnih regija vrata i nekih nelimfatičkih struktura (radikalna disekcija vrata) došlo do uklanjanja samo pojedinih regija i očuvanja nelimfatičkih struktura (selektivna disekcija vrata). U današnje vrijeme traže se nove metode kako bi se postigao optimalan opseg zahvata i pronašla adekvatna terapija.Squamous cell carcinoma of the larynx is the most often malignant tumor of the larynx. Numerous factors affect the occurrence of this disease but the most important ones are smoking and drinking alcohol. In most cases, it occurs in older men who smoke and drink alcohol on a daily basis for a long time. Clinical finding depends on the localization of the primary tumor. In some regions, the tumor is detected early due to early symptoms, while in the other regions, the first sign may be appearance of the nodule on the neck. As in the other head and neck tumors, the site of lymphatic metastases can be predicted due to the known route of spreading of certain regions. This is used for preventive (elective) but also for a curative treatment. Removal of the lymph nodes of the neck has long been known as an operation called neck dissection. In the past, it was a very radical operation with the removal of all lymphatic regions of the neck and some nonlymphatic structures. Over time, by gathering different experiences and knowledges, these operations become more and more spared. It is understood that it is possible to obtain the same result but with much less functional and aesthetic deformities. With time, radical neck dissection, in which all lymph node regions and some nonlymphatic structures were removed, was replaced with selective neck dissection, in which only certain regions were removed and nonlymphatic structures were preserved. Nowadays, new methods are being sought in order to achieve the optimal extent of the procedure and find adequate therapy

Orbital cellulitis as a vfirst sign of ethmoid sinus osteoma in children - case report and short literature review

Introduction: Orbital cellulitis is a rare condition with very dangerous complication of acute sinus infection that could potentially lead to vision loss. It is the most common complication of acute sinusitis, especially in children. On the other hand, osteoma of paranasal sinuses in pediatric patients causing orbital cellulitis is a very rare phenomenon. Case report: A 13-year-old male child was presented to our Clinic with severe frontal headache, large swelling of the upper right eyelid, proptosis, chemosis and impaired vision of the affected eye. Fiberendoscopy showed purulent discharge from both nasal cavums and mucosal inflammation which caused the narrowing of the right ostiomeatal complex as well as sphenoetmoidal recess. Computer tomography of the paranasal sinuses revealed a subperiosteal abscess localized on the superolateral orbital wall with opacified right frontal sinus and huge ethmoid sinus osteoma measuring 2.5x2x1 cm. The tumour was removed endoscopically and great care was taken not to pierce the skull base and simultaneously remove all parts of the tumour. In addition, an outer incision of 1 cm of the upper eyelid was performed. The patient’s symptoms decreased postoperatively, and the patient was released from the Clinic with significant improvement on the sixth postoperative day. Discussion: We present an extremely rare case of ethmoidal osteoma which caused orbital cellulitis in a pediatric patient. Treating such patients is very sensitive and established algorithms do not exist. We examined the available literature on the aforementioned topic. According to Chandler’s classification of orbital cellulitis, the treating of grade III or subperiosteal abscess is still a controversy. However, in our patient’s case, the cause of cellulitis was large osteoma, so surgical intervention was inevitable. An endoscopic approach gives excellent results, but maximal care must be taken in order to avoid damaging the surrounding important structures, especially in pediatric patients who have narrow nasal cavities

Sekundarni primarni tumori nakon liječenja karcinoma grkljana

Cilj: Cilj studije je utvrditi pojavnost sekundarnih primarnih tumora kod bolesnika koji su liječeni zbog karcinoma grkljana, te analizirati njihovo preživljenje. Metode: Retrospektivno su analizirani podaci 248 bolesnika liječenih u Klinici za otorinolaringologiju i kirurgiju glave i vrata, KBC-a Rijeka zbog karcinoma grkljana. Rezultati: 63 bolesnika (25%) razvilo je sekundarni primarni zloćudni tumor. Od toga, 62 bolesnika bila su muškog, a jedna bolesnica ženskoga spola. Medijan godina u trenutku postavljanja dijagnoze iznosio je 69 godina. Podjednak je udio ranih i uznapredovalih karcinoma grkljana (51% naspram 49%). Nadalje, sekundarne primarne tumore smo, obzirom na sijelo, svrstali u tumore glave i vrata (17 bolesnika ili 27%) s medijanom vremena od postavljanja primarne dijagnoze do razvoja sekundarne neoplazme od 81 mjesec i u tumore ostalih sijela (46 bolesnika ili 73%) s medijanom vremena od 54 mjeseca. U podgrupi tumora ostalih sijela 14 je bolesnika (30%) razvilo karcinom pluća. Nije nađena statistički značajna razlika u preživljenju između bolesnika sa sekundarnim tumorima glave i vrata, te bolesnika sa sekundarnim tumorima ostalih sijela (p=0,1161), ali je utvrđeno da bolesnici sa sekundarnim primarnim tumorom glave i vrata žive dulje u odnosu na one bolesnike koji su razvili sekundarni primarni tumor pluća (p=0,002). Također, utvrđeno je da bolesnici kod kojih je došlo do recidiva bolesti, bilo na lokalnoj, regionalnoj ili udaljenoj razini, žive kraće u odnosu na bolesnike koji su razvili sekundarni primarni tumor (p<0,0001). Zaključak: Recidiv bolesti nakon liječenja karcinoma grkljana glavni je uzrok smrtnosti, ali svakako treba imati na umu i mogućnost razvoja sekundarnih primarnih tumora, posebice pluća. Primjereno praćenje takvih bolesnika i rana dijagnostika pravovaljan su pristup koji vodi uspješnijem liječenju i smanjenju smrtnosti od sekundarnih primarnih tumora nakon liječenja karcinoma grkljana

ANXIETY AND DEPRESSION AS COMORBIDITIES OF MULTIPLE SCLEROSIS

Multiple Sclerosis (MS), a chronic inflammatory neurodegenerative disease, is accompanied by a number of comorbidities. Among the psychiatric ones, depression and anxiety occupy a special place. It is estimated that the prevalence of anxiety in the MS population is 22.1% verus 13% in the general population; whereas the prevalence of anxiety levels, as determined by various questionnaires, reaches even 34.2%. Systematic literature reviews (SPL) show considerable data variations due to differences in study design, sample size, diagnostic criteria and extremely high heterogeneity (I2). Among the more conspicuous factors associated with anxiety disorder in MS are demographic factors (age and gender), nonsomatic depressive symptoms, higher levels of disability, immunotherapy treatments, MS type, and unemployment. Depression is the most common psychiatric commorbidity in MS and the lifetime risk of developing depression in MS patients is >50%. According to some research, the prevalence of depression in MS vary between 4.98% and 58.9%, with an average of 23.7% (I2=97.3%). Brain versus spinal cord lesions, as well as temporal lobe, fasciculus arcuatus, superior frontal and superior parietal lobe lesions in addition to the cerebral atrophy have been shown to be the anatomical predictors of depressive disorder in MS. Hyperactivity of the hypothalamic-pituitary-adrenal axis (HPA) and the consequent dexamethasone-insupressible hypercortisolemia, in addition to cytokine storm (IL-6, TNF--4) present the endocrine and inflammatory basis for development of depression. Fatigue, insomnia, cognitive dysfunction, spasticity, neurogenic bladder, pain, and sexual dysfunction have shown to be additional precipitating factors in development of anxiety and depression in MS patients

Smjernice za evaluaciju čvora na vratu

Novonastali uvećani čvor vrata je čest razlog posjete liječniku, a dijagnostika i liječenje ponekad uključuju specijaliste različitih specijalnosti. Anamneza i fizikalni pregled ključni su koraci u početku evaluacije i daljnjeg usmjeravanja bolesnika na odgovarajuće dijagnostičke ili terapijske postupke. Diferencijalna dijagnoza je vrlo široka, te dobno ovisna, pa je stoga bitno utvrditi radi li se o mogućem upalnom stanju, kongenitalnoj ili neoplastičnoj patologiji. U većini slučajeva dijagnostički postupak uključuje ultrazvuk s mogućom citološkom punkcijom tvorbe ili se čine druge slikovne pretrage poput CT-a ili MRI. U specifičnim slučajevima izvodi se biopsija tvorbe. Liječenje ovisi o uzroku