The Role of Tonsillectomy in the Prevention of Helicobacter Pylori Infection

The incidence of Helicobacter pylori infection varies globally and depends on the socioeconomic situation of a location. In the territory of Croatia, the incidence rate among the populace is 40-50% in persons with normal gastroscopic findings, whereas it is increased in persons with the pathohistological finding of the ulcus disease1. This study examines the potential preventive role of tonsillectomy with regard to H. pylori infection in later stages of life. The survey was conducted on a sample of 115 examinees (63 male, 52 female), aged between 19 and 86. The survey included examinees who underwent esophagogastroscopy at the Institute of Gastroenterology of the University Hospital Centre Osijek based on indication by a gastroenterology specialist. The survey has shown that of the total of 115 examinees, 28 of them had been tonsillectomised, and 87 had not been tonsillectomised. In the examinees who had not been subjected to tonsillectomy, positive H. pylori result was found in 63,2%, and 53,6% of those who had been tonsillectomised at a young age were positive to H.pylori. The results have shown that H. pylori infection was equally represented in all age groups, and the rate varies at 52.9 – 64.8%. Hence, the final conclusion was reached that tonsillectomy has no preventive role with regard to H.pylori infection

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

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

Funkcija unutarnjeg uha u bolesnika oboljelih od opstrukcijske apneje u bspavanju

Cilj: U ovom radu željeli smo ispitati postoji li pozitivan ili negativan odnos između funkcije unutarnjeg uha i opstrukcijske apneje tijekom spavanja. Metode: U ispitivanje je uključeno 35 bolesnika oboljelih od umjerene ili teške opstrukcijske apneje i 25 zdravih ispitanika koji čine kontrolnu skupinu. Svim ispitanicima učinjena je tonska audiometrija, timpanometrija, TEOAE (prolazno izazvana otoakustička emisija), DPOAE (otoakustička emisija koja je produkt distorzije) i slušni evocirani potencijali. Rezultati: Prag zračne vodljivosti na 1000, 4000 i 8000 Hz veći je u bolesnika s opstrukcijskom apnejom u spavanju u usporedbi s kontrolnom skupinom (p<0,05). Latencije I. i V. vala obaju uha u skupini OSA dulje su nego u kontrolnoj skupini, no i dalje u referentnim vrijednostima (1,60 +/- 0,45 vrs 1,43 +/-0,16 ms, p<0,001; 5,52 +/- 0,70 vrs 5,47 +/- 0,19 ms, p<0,001). Razlika između intervalnih latencija od I. do V. vala grupe OSA i kontrolne skupine statistički je značajna (4,17+/-0,36 vrs 4,03 +/- 4,03 +/- 0,16 ms, p<0,006). Rezultati analize SNR kod TEOAE pokazuju statistički značajnu razliku između ciljne grupe OSA i kontrolne skupine na 1.00 kHz, 1.42 kHz, 2.00 kHz, 2.83 kHz i 4.00 kHz (p<0,001). Rezultati analize SNR kod DPOAE pokazuju statistički značajnu razliku između bolesnika s opstrukcijskom apnejom u spavanju i kontrolne skupine na svim ispitivanim frekvencijama (p<0,027 za 500 Hz; p<0,001 za 1000 do 8000 Hz). Zaključak: Kod bolesnika oboljelih od OSA-e postoji oštećenje sluha u usporedbi s kontrolnom skupinom. Rezultati otoakustičke emisije pokazuju oštećenje receptorskih stanica pužnice

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

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

Assessment of Endothelial Dysfunction by Measuring Von Willebrand Factor and Exhaled Nitric Oxide in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a multisystemic disease, one of the leading causes of mortality and morbidity. The aim of this research is to assess the level of markers of endothelial dysfunction, vWf and the exhaled nitric oxide (NO) depending on the severity of COPD. The study included 100 subjects: 60 patients with COPD without adjoin- ing cardiovascular comorbidity, and 40 patients as the controls. The subjects underwent a fractional exhaled nitric oxide test (FeNO), spirometric testing, and diffusing capacity of the lung for carbon monoxide test (DLCO), samples were taken of their vein blood to analyze the level of vWf (using the vWf:RCO method), C-reactive protein (CRP), fibrinogen, choles- terol, triglycerides as well as the acid base status. COPD patients then filled COPD assessment test (CAT test) and the modified dyspnea scale (mMRC). The results showed that in patient group that higher levels of vWf are associated with lower values of exhaled NO, which means that higher levels of vWf are associated with lower values of exhaled NO. By comparing the ill subjects from four groups (A, B, C and D), a difference was established between the level of vWf [F (3.56 =0.24; p=0.869], while, although statistically not significant, the highest level of exhaled NO was found in group A and the lowest in group D. The rise in the value of vWf is followed by the rise of fibrinogen values, which is another marker of endothelial dysfunction. The results of this research have shown that a systemic inflammation and hypoxia in the early stages of COPD, when no significant changes in the absolute values of FEV1 are present, stipulate the existence of endo- thelial dysfunction together with the clinically relevant differences in the levels of vWf and exhaled NO

Angiosarcoma of the Hypopharynx: Case Report

Angiosarcomas are malignant neoplasias of rapid growth that emerge from endothelial cells. They are rarely found in the area of the head and neck and account less than 0.1% of all head and neck malignancies. In some cases it has been linked to trauma, radiation and angiectasia but the etiology mainly remains unknown. Here we report a case of angiosarcoma of pyriform sinus manifested by dysphagia and dysphonia. The patient underwent endoscopic hypopharyngeal excision followed by radiation therapy with a good result. Our patient remains tumor free after two years. The purpose of this article is to add another case of primary angiosarcoma of a rare site, the hypopharynx

Funkcija unutarnjeg uha u bolesnika oboljelih od opstrukcijske apneje u bspavanju

Cilj: U ovom radu željeli smo ispitati postoji li pozitivan ili negativan odnos između funkcije unutarnjeg uha i opstrukcijske apneje tijekom spavanja. Metode: U ispitivanje je uključeno 35 bolesnika oboljelih od umjerene ili teške opstrukcijske apneje i 25 zdravih ispitanika koji čine kontrolnu skupinu. Svim ispitanicima učinjena je tonska audiometrija, timpanometrija, TEOAE (prolazno izazvana otoakustička emisija), DPOAE (otoakustička emisija koja je produkt distorzije) i slušni evocirani potencijali. Rezultati: Prag zračne vodljivosti na 1000, 4000 i 8000 Hz veći je u bolesnika s opstrukcijskom apnejom u spavanju u usporedbi s kontrolnom skupinom (p<0,05). Latencije I. i V. vala obaju uha u skupini OSA dulje su nego u kontrolnoj skupini, no i dalje u referentnim vrijednostima (1,60 +/- 0,45 vrs 1,43 +/-0,16 ms, p<0,001; 5,52 +/- 0,70 vrs 5,47 +/- 0,19 ms, p<0,001). Razlika između intervalnih latencija od I. do V. vala grupe OSA i kontrolne skupine statistički je značajna (4,17+/-0,36 vrs 4,03 +/- 4,03 +/- 0,16 ms, p<0,006). Rezultati analize SNR kod TEOAE pokazuju statistički značajnu razliku između ciljne grupe OSA i kontrolne skupine na 1.00 kHz, 1.42 kHz, 2.00 kHz, 2.83 kHz i 4.00 kHz (p<0,001). Rezultati analize SNR kod DPOAE pokazuju statistički značajnu razliku između bolesnika s opstrukcijskom apnejom u spavanju i kontrolne skupine na svim ispitivanim frekvencijama (p<0,027 za 500 Hz; p<0,001 za 1000 do 8000 Hz). Zaključak: Kod bolesnika oboljelih od OSA-e postoji oštećenje sluha u usporedbi s kontrolnom skupinom. Rezultati otoakustičke emisije pokazuju oštećenje receptorskih stanica pužnice

RISK ASSESSMENT FOR SLEEP APNEA SYNDROME AND EXCESSIVE DAYTIME SLEEPINESS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Kronični i povremeni poremećaji spavanja problem su milijuna ljudi u cijelom svijetu. Loša kvaliteta spavanja oboljelih od KOPB-a nastaje kao posljedica smanjene saturacije kisikom, hiperkapnije, korištenja pomoćne respiratorne muskulature. Cilj ovog istraživanja je ispitati rizik za sindrom apneje u oboljelih od KOPB-a, te utvrditi povezanost s kardiovaskularnim komorbiditetom oboljelih. Istraživanje je uključilo 47 ispitanika oboljelih od KOPB-a koji su pregledani na Odjelu za pulmologiju Klinike za unutarnje bolesti KBC-a Osijek. Ispitanici su odgovarali na hrvatske verzije STOP upitnika i Epworthove ljestvice pospanosti. Prema STOP upitniku rizik za sindrom apneje u spavanju ima 35 (74,5 %) ispitanika. Rizični bolesnici su imali učestaliju pojavu komorbiditeta kao što su arterijska hipertenzija, šećerna bolest tipa II i gastroezofagealna refluksna bolest. Prekomjerna dnevna pospanost bila je izražena u 14,9 % oboljelih od KOPB-a, a prosječna dnevna pospanost iznosila je 4,76 boda. Za procjenu rizika od sindroma apneje u spavanju oboljelih od KOPB-a, STOP upitnik kao metoda probira ima svoje značenje, osobito kod oboljelih s kardiovaskularnim komorbiditetom, kako bi se izdvojili oni kojima je potrebno učiniti polisomnografiju.Aim: The objective of this study was to examine the risk of sleep apnea syndrome in patients with chronic obstructive pulmonary disease (COPD) and to determine correlation with the associated cardiovascular comorbidity in these patients. Chronic and occasional sleep disturbances represent a problem for millions of people worldwide. COPD is a multisystem disease and the leading cause of mortality and morbidity in the world. It is estimated that it will be the third cause of death in the world by 2020. Poor quality of sleep in patients with COPD occurs as a result of reduced oxygen saturation, hypercapnia, and the use of auxiliary respiratory muscles. Methods: The study included 47 patients with COPD, examined at the Department of Pulmonology, Clinical Department of Internal Medicine, Osijek University Hospital Center in 2011. The respondents answered questions from the Croatian version of the Snoring, Tired, Observed, Pressure (STOP) questionnaire, which examines the risk of sleep apnea syndrome, and the Epworth Sleepiness Scale, which examines excessive daytime sleepiness. The respondents also provided data related to the current smoking status, bronchodilation therapy they apply at home, the associated cardiovascular comorbidity related to coronary heart disease (previous myocardial infarction, angina pectoris), cerebrovascular incident, diabetes, asthma, gastroesophageal reflux disease (GERD) and anxiety-depressive disorder. Results: According to the STOP questionnaire, the risk of sleep apnea syndrome was recorded in 35 (74.5%) respondents. Patients at risk had a higher frequency of comorbidities such as hypertension, diabetes mellitus type 2 and GERD. Excessive daytime sleepiness was recorded in 14.9% of patients with COPD and the mean daytime sleepiness scored 4.76 points. In patients at a high risk according to the STOP questionnaire, the mean daytime sleepiness was 6.24 points versus 3.72 points in the group at a low risk. Snoring was present in 23 (49%), excessive tiredness in 27 (57%), and cessation of breathing during sleep in every other person in 4 cases (8.5% of patients). The t-test showed no significant differences in oxygen saturation, partial O2 and CO2 pressures between the groups of non-risk and high-risk patients according to the STOP questionnaire. Conclusion: For assessing the risk of sleep apnea syndrome in patients with COPD, the STOP questionnaire as a screening method has a significant role. Because of the high risk of sleep apnea syndrome in patients with COPD and considering the high level of associated cardiovascular comorbidity, it is necessary to perform polysomnography in patients at risk for timely detection and treatment of the syndrome, thus preventing its harmful consequences, with special reference to reduction of mortality in this population