TRAHEOTOMIJA I ULOGA VENTILACIJE NISKO POZITIVNIM TLAKOM ZA VRIJEME PREOKSIGENACIJE KOD BOLESNIKA S VELIKIM NEUROENDOKRINIM KARCINOMOM LARINKSA

Small cell neuroendocrine carcinoma of the larynx is a rare epithelial origin neuroendocrine carcinoma. Its endolaryngeal growth may lead to airway obstruction and consequently endanger patient life. Managing the airway in this case poses great challenge for the anesthesiologist. The aim of this case report is to present alternative airway management in case of the possible unsuccessful endotracheal intubation. Emergency tracheotomy in sedoanalgesia and local anesthesia is successfully performed in patient with large neuroendocrine carcinoma of the larynx. Midazolam and remifentanyl used for sedoanalgesia may lead to respiratory depression. Therefore, pressure support preoxygenation was performed in order to prevent hypoxia, which could occur during the period of apnea. In conclusion, this regimen of preoxygenation prior to tracheotomy in sedoanalgesia and local anesthesia could be an appropriate alternative to general anesthesia and endotracheal intubation, especially in case of large endoluminal tumor that almost completely obstructs the airway.Sitnostanični laringealni tumor je rijedak neuroendokrini tumor epitelnog podrijetla. Endoluminalni rast tumora može dovesti do opstrukcije dišnog puta te ugroziti život bolesnika. Uspostavljanje dišnog puta u ovakvom slučaju je velik izazov za anesteziologe. Cilj ovoga rada je prikaz alternativnog rješenja uspostavljanja dišnog puta kod bolesnika s velikim endoluminalnim tumorom larinksa u slučaju postojanja visokog rizika za bezuspješno izvođenje endotrahealne intubacije. Urgentna traheotomija u analgosedaciji i lokalnoj anesteziji uspješno je učinjena kod bolesnika s velikim neuroendokrinim karcinomom larinksa. Za analgosedaciju korišteni su midazolam i remifentanil koji mogu dovesti do respiratorne depresije. Kako bi se preveniralo hipoksiju koja može nastati tokom apneje bolesnik je adekvatno preoksigeniran uz pomoć pritiskom podržane ventilacije. Zaključak: Primjena analgosedacije i lokalne anestezije uz prethodnu preoksigenaciju potpomognutu inspiracijskim i endekspiracijskim pritiskom adekvatna je alternativa općoj anesteziji i endotrahealnoj intubaciji u slučaju izvođenja traheotomije, naročito kod bolesnika s velikim endoluminalnim tumorom

Mineral waters of Serbia and development of phototrophic microbial communities near points of emergence and on wellheads

Phototropic microorganisms in thermal mats had not attracted enough attention in Serbia in the past. The research presented in this paper is the first to address biofilms at selected occurrences of mineral water in Serbia (Bogatić, Metković and Belotić in the Mačva District as well as Radaljska Banja, Lukovska Banja and Vranjska Banja) (in Serbian, banja denotes a spa town). The study period is from 2014 to 2016. The temperatures of the studied occurrences are in the 30–93.9 °C range and the chemical composition corresponds to the HCO3 − – Na++K+ and SO4 2−, HCO3 − – Na++K+ types of mineral water. One of the objectives was to examine the condition of wellheads (incrustation, biofouling and corrosion), focusing on the presence of phototrophic microorganisms whose metabolites may lead to changes in mineral water quality, yield and chemistry. Analysis by light and scanning electron microscopy provides insight into the diversity of phototrophic microorganisms that populate biofilms near the points of emergence and on wellhead. The research reveals the presence of representatives of three groups of phototrophic microorganisms: Cyanobacteria, Chlorophyta and Bacillariophyta. Cyanobacteria were the most numerous, dominated by the order Oscillatoriales with ten recorded genera, of which Leptolynbgya and Phormidium feature the largest numbers of species. The order Chroococcales are the second most numerous, with seven recorded genera, of which Gloeocapsa and Synechocystisare the most noteworthy. The largest numbers of representative taxa were noted at Radaljska Banja and Vranjska Banja, where mineral waters originate from Encrustalithostratigraphic units of igneous origin, followed by mineral water occurrences in karst aquifers (Bogatić and Belotić) and an intergranular aquifer (Metković). The smallest number of identified phototrophic microorganisms is noted at Lukovska Banja, where the origin is associated with a fractured aquifer formed in sedimentary and metamorphic rocks, with occasional diabase interbeds. Although many representative taxa are found on only one of the studied localities, such as Synechococcus bigranulatus and Pseudanabaena thermalis, those of the genera Leptolyngbya, Phormidium and Cosmarium laeve, as well as genera of the phylum Bacillariophyta, occur at several sampling sites. Principal component analysis (PCA) was used to show the relationship between documented cyanobacterial and algal taxa and environmental parameters.  Key words: Serbia, mineral waters, phototrophic microorganisms, biofilm.  Mineralne vode v Srbiji in razvoj fototrofnih mikrobnih združb na mestih izvirov in na ustjih vrtin Fototrofni mikroorganizmi v oblogah termalnih izvirov v Srbiji v preteklosti niso bili deležni posebne pozornosti. V članku predstavljena raziskava je prva, ki obravnava biofilme na izbranih mestih izvirov mineralnih vod v Srbiji (Bogatić, Metković in Belotić v Mačvi ter Radaljska Banja, Lukovska Banja in Vranjska Banja) (v srbskem jeziku je banja izraz za toplice). Preučevanje je potekalo med letoma 2014 in 2016. Temperature obravnavanih voda se gibljejo med 30 in 93,9 °C, glede na kemijsko sestavo pa jih uvrščamo v HCO3 − – Na++ K+ in SO4 2−, HCO3 − – Na++K+ tipe mineralne vode. Eden od ciljev raziskave je bil proučevati razmere na ustjih vrtin (inkrustacija, obrast in korozija) in se še posebej posvetiti navzočnosti fototrofnih mikroorganizmov, katerih metaboliti lahko spremenijo kakovost, izdatnost in kemizem mineralnih vod. Z analizo slik s svetlobnim in vrstičnim elektronskim mikroskopom lahko podrobneje spoznamo raznolikost fototrofnih organizmov, ki sestavljajo biofilme na mestih izvirov in na ustjih vrtin. Raziskava je pokazala obstoj predstavnikov treh skupin fototrofnih mikroorganizmov: cianobakterij ter predstavnikov debel Chlorophyta in Bacillariophyta. Cianobakterije so bile najbolj številčne, prevladovali so osebki reda Oscillatoriales z desetimi ugotovljenimi rodovi, od katerih je bilo največje število vrst iz rodov Leptolynbgya in Phormidium. Red Chroococcales je bil s sedmimi zabeleženimi rodovi drugi najbolj številčen, prevladovala sta Gloeocapsa in Synechocystis. Največreprezentativnih taksonov je bilo v Radaljski Banji in Vranjski Banji, kjer mineralne vode izvirajo iz litostratigrafskih enot vulkanskega izvora, sledijo mineralne vode iz kraškega (Bogatić in Belotić) in medzrnskega vodonosnika (Metković). Najmanjfototrofnih organizmov je bilo v vzorcu iz Lukovske Banje, kjer vode izvirajo iz razpoklinskih vodonosnikov v sedimentnih in metamorfnih kamninah z vmesnimi lečami diabaza. Čeprav soštevilne reprezentativne taksone našli le na eni od proučevanih lokacij, kot na primer Synechococcus bigranulatus in Pseudanabaena thermalis, se tisti iz rodu Leptolyngbya, Phormidium in Cosmarium laeve in predstavniki več rodov, ki pripadajo deblu Bacillariophyta, pojavljajo na več vzorčnih mestih. Za ugotavljanje odvisnosti med taksoni cianobakterij in alg ter okoljskimi parametri so uporabili analizo glavnih komponent.Ključne besede: Srbija, mineralne vode, fototrofni mikroorganizmi, biofilm.

Mineral waters of Serbia and development of phototrophic microbial communities near points of emergence and on wellheads

Phototropic microorganisms in thermal mats had not attracted enough attention in Serbia in the past. The research presented in this paper is the first to address biofilms at selected occurrences of mineral water in Serbia (Bogatic, Metkovic and Belotic in the Macva District as well as Radaljska Banja, Lukovska Banja and Vranjska Banja) (in Serbian, banja denotes a spa town). The study period is from 2014 to 2016. The temperatures of the studied occurrences are in the 30-93.9 degrees C range and the chemical composition corresponds to the HCO3- -Na++ K+ and SO42-, HCO3--Na++ K+ types of mineral water. One of the objectives was to examine the condition of wellheads (incrustation, biofouling and corrosion), focusing on the presence of phototrophic microorganisms whose metabolites may lead to changes in mineral water quality, yield and chemistry. Analysis by light and scanning electron microscopy provides insight into the diversity of phototrophic microorganisms that populate biofilms near the points of emergence and on wellhead. The research reveals the presence of representatives of three groups of phototrophic microorganisms: Cyanobacteria, Chlorophyta and Bacillariophyta. Cyanobacteria were the most numerous, dominated by the order Oscillatoriales with ten recorded genera, of which Leptolynbgya and Phormidium feature the largest numbers of species. The order Chroococcales are the second most numerous, with seven recorded genera, of which Gloeocapsa and Synechocystisare the most noteworthy. The largest numbers of representative taxa were noted at Radaljska Banja and Vranjska Banja, where mineral waters originate from lithostratigraphic units of igneous origin, followed by mineral water occurrences in karst aquifers (Bogatic and Belotic) and an intergranular aquifer (Metkovic). The smallest number of identified phototrophic microorganisms is noted at Lukovska Banja, where the origin is associated with a fractured aquifer formed in sedimentary and metamorphic rocks, with occasional diabase interbeds. Although many representative taxa are found on only one of the studied localities, such as Synechococcus bigranulatus and Pseudanabaena thermalis, those of the genera Leptolyngbya, Phormidium and Cosmarium laeve, as well as genera of the phylum Bacillariophyta, occur at several sampling sites. Principal component analysis (PCA) was used to show the relationship between documented cyanobacterial and algal taxa and environmental parameters

Soil Moisture as One of the Limiting Factors in the Production of Medicinal Plants

On small production lots on which medicinal plants are grown, irrigation systems of a smaller capacity (“drip, drip” and “sprinkling” systems) are mainly used. The water for irrigation should be in keeping with the national and the potential European quality standards, and should be as “free” as possible of potential pollutants, such as feces, heavy metals, pesticides, and toxicologically hazardous matters. Therefore, in this chapter, several priority MAPs are selected according to their importance for this sector, and their needs are analyzed in drought and irrigation conditions. In this group of plants, the authors included the following: marshmallow (Althaea officinalis L.), peppermint (Mentha piperita L.), valerian (Valeriana officinalis L.), lovage (Levisticum officinale Koch), lemon balm (Melissa officinalis L.), ribwort plantain (Plantago lanceolata L.), marigold (Calendula officinalis L.), and basil (Ocimum basilicum L.)

Endoscopic repair of cerebrospinal fluid rhinorrhea

Abstract Introduction: Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. Objective: The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. Methods: This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. Results: Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula. Conclusion: Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate

Surgical approach and results of treating two subcategories pT2 glottic carcinoma of the larynx

Background: T2 glottic carcinoma is a nonhomogenous localization of laryngeal carcinoma with two subcategories. The aim of the study was to retrospectively analyze the results of surgically treated pT2 glottic carcinomas and to determine the importance of subcategories of glottic carcinomas in diagnostics, surgical treatment, and patients’ survival. Methods: During the period 1990-2000, 71/701 (10%) patients were diagnosed. with pT2 glottic carcinoma. All patients were treated with different surgical techniques. Results: Total laryngectomy was performed in 14/71 patients. Involvement of anterior commisure in local spreading of the cancer was found in 24/71 patients; total laryngectomy was performed in 13/24 and reconstructive surgery in 11/24. Selective resection of neck was done in 49 patients and metastases were found in 2 of these patients. Out of fifty-seven patients who had reconstructive laryngeal surgery local disease recurrence appeared in 8 patients. These 8 patients were treated with total laryngectomy. Overall 5-year survival was 90.1% with a slight difference between subcategories (89.1% subcategory I; 93.7% subcategory II) which was not statistically significant (p>0.05). Disease free 5-year survival was 83.6% with a difference between subcategories (81.1% subcategory I; 93.3% subcategory II) which was not statistically significant (p>0.05). Conclusion: Spreading of glottic carcinoma toward supraglottic and subglottic structures complicates exact preoperative evaluation of tumor size regardless to preoperative diagnostic procedures. Just owing to that, larger surgical resections performed bring more radicalness with less percentage of local recurrence and better effects on overall survival and disease free survival rate

Frequency and intensity of symptoms in patients with chronic rhinosinusitis

Introduction/Objective. Chronic rhinosinusitis is one of the most frequent chronic disorders which significantly influences the patients‘ quality of life. The objectivе of this paper was to examine which are the most frequent and intensive symptoms in patients with chronic rhinosinusitis, and also to determine whether there is a correlation between a subjective assessment of the disease as a whole and individual symptoms. Methods. The study encircled 90 patients with clinical diagnosis of chronic rhinosinusitis that was endoscopically proven and computer tomography of the nose and paranasal sinuses. Every possible symptom was recorded in every patient (nasal congestion, nasal discharge, facial pain/pressure, reduction or loss of smell, headache, fatigue, cough, halitosis and ear pain/fullness), the intensity of every possible symptom as well as the disorder as a whole. The patients assessed the intensity of their symptoms on the visual analogue scale. Results. Nose congestion is the most frequent symptom. It occured in 82 patients (91.1%), followed by nasal discharge in 81 patients (90%) and there was no difference in frequency of these two symptoms. Nasal discharge has been recorded as the most intensive symptom (x– = 5.4) and it is significantly more intensive in comparison to nasal congestion which was the second on the intesity list (x– = 4.1, p = 0.002). All other symptoms were significantly less frequently and less intensive. The average intensity value of the disease as a whole is the same as the average intensity value of the nasal discharge (x– = 5.4) while the average intensity values of all other symptoms are statistically significantly lower than the average intensity value of the disease as a whole; in all comparisons p < 0.001. Conclusion. Nasal congestion and nasal discharge are the most common symptoms in the patients with chronic rhinosinusitis. Nasal discharge is the most intensive symptom in patients with chronic rhinosinusitis while its intensity determines the sensation of the intesity of the disorder as a whole